Dolutegravir (S/GSK1349572), a once-daily, unboosted integrase inhibitor, was recently approved in the United States for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in ...combination with other antiretroviral agents. Dolutegravir, in combination with abacavir-lamivudine, may provide a simplified regimen.
We conducted a randomized, double-blind, phase 3 study involving adult participants who had not received previous therapy for HIV-1 infection and who had an HIV-1 RNA level of 1000 copies per milliliter or more. Participants were randomly assigned to dolutegravir at a dose of 50 mg plus abacavir-lamivudine once daily (DTG-ABC-3TC group) or combination therapy with efavirenz-tenofovir disoproxil fumarate (DF)-emtricitabine once daily (EFV-TDF-FTC group). The primary end point was the proportion of participants with an HIV-1 RNA level of less than 50 copies per milliliter at week 48. Secondary end points included the time to viral suppression, the change from baseline in CD4+ T-cell count, safety, and viral resistance.
A total of 833 participants received at least one dose of study drug. At week 48, the proportion of participants with an HIV-1 RNA level of less than 50 copies per milliliter was significantly higher in the DTG-ABC-3TC group than in the EFV-TDF-FTC group (88% vs. 81%, P=0.003), thus meeting the criterion for superiority. The DTG-ABC-3TC group had a shorter median time to viral suppression than did the EFV-TDF-FTC group (28 vs. 84 days, P<0.001), as well as greater increases in CD4+ T-cell count (267 vs. 208 per cubic millimeter, P<0.001). The proportion of participants who discontinued therapy owing to adverse events was lower in the DTG-ABC-3TC group than in the EFV-TDF-FTC group (2% vs. 10%); rash and neuropsychiatric events (including abnormal dreams, anxiety, dizziness, and somnolence) were significantly more common in the EFV-TDF-FTC group, whereas insomnia was reported more frequently in the DTG-ABC-3TC group. No participants in the DTG-ABC-3TC group had detectable antiviral resistance; one tenofovir DF-associated mutation and four efavirenz-associated mutations were detected in participants with virologic failure in the EFV-TDF-FTC group.
Dolutegravir plus abacavir-lamivudine had a better safety profile and was more effective through 48 weeks than the regimen with efavirenz-tenofovir DF-emtricitabine. (Funded by ViiV Healthcare; SINGLE ClinicalTrials.gov number, NCT01263015 .).
•Accumulative prediction of preload loss due to self-loosening in bolted joints.•Standardized experimental characterization of bolted joints.•Handle variable amplitudes caused by vibration and ...overload peaks.
This paper presents a new method to experimentally characterize the rotational self-loosening behavior of bolted joints. Furthermore, a method to calculate the preload loss due to certain relative displacements of the clamped parts was developed. The method obtains all required calculation parameters from the experimental tests performed and neither needs further experimental determination of friction coefficients nor numerical simulations to predict the preload loss. The method accumulates the preload loss of load cycles. Thereby, it can be used to estimate the time a machine can operate until a critical amount of preload is lost. Non-linear dependencies of the preload loss to the displacement amplitude and the remaining preload are considered. The calculation method also applies to load cases with variable load amplitudes. This is validated experimentally.
Las personas que padecen patologías de salud mental con frecuencia sufren estigma y exclusión por parte de la sociedad. El desconocimiento y el temor a ser discriminado evita el acercamiento de las ...personas a los servicios de salud, provocando latencias y abandono del tratamiento. La psicoeducación es una herramienta que busca que pacientes y familias conozcan la naturaleza de la enfermedad, promoviendo la autonomía, el empoderamiento y la reintegración social. El siguiente artículo recoge evidencia en torno a esta temática, discutiendo sobre la aplicabilidad de sus resultados, la importancia de replicar métodos y sistematizar experiencias.
Mental health illness are often related with social stigma. The unknowledge and the generalization of conducts of people with mental health illness, impacts the approach to social or medical services and sometimes quit the treatment. Psychoeducation as a tool in this area, persuits that patients and family know the nature of the illness, his ethiology, course, therapeutic approaches and outcomes. This article takes evidence sorround psychoeducation in mental health illness, discuss the appliance of the results and the importance of replying and systematization of experiences.
Resumen: Las personas que padecen patologías de salud mental con frecuencia sufren estigma y exclusión por parte de la sociedad. El desconocimiento y el temor a ser discriminado evita el acercamiento ...de las personas a los servicios de salud, provocando latencias y abandono del tratamiento. La psicoeducación es una herramienta que busca que pacientes y familias conozcan la naturaleza de la enfermedad, promoviendo la autonomía, el empoderamiento y la reintegración social. El siguiente artículo recoge evidencia en torno a esta temática, discutiendo sobre la aplicabilidad de sus resultados, la importancia de replicar métodos y sistematizar experiencias. Summary: Mental health illness are often related with social stigma. The unknowledge and the generalization of conducts of people with mental health illness, impacts the approach to social or medical services and sometimes quit the treatment. Psychoeducation as a tool in this area, persuits that patients and family know the nature of the illness, his ethiology, course, therapeutic approaches and outcomes. This article takes evidence sorround psychoeducation in mental health illness, discuss the appliance of the results and the importance of replying and systematization of experiences. Palabras clave: Psicoeducación, servicios de salud mental, educación del paciente, trabajo social psiquiátrico, Keywords: Psychoeducation, mental health services, patient education, psychiatric social work
In 1890 Robert Hart was elected Honorary Fellow of the Royal Statistical Society. Hart had sent copies of the statistical publications of the Maritime Customs Service regularly to the Society, but he ...himself was no statistician. He did publish one piece in the Journal of the Statistical Society of London, but this was no more than an extract of a conclusion Hart wrote to reports written by the Commissioners at China's Treaty Ports on local opium consumption. But Hart, as Inspector General of the Maritime Customs Service, bore general responsibility for its publications and involved himself deeply in its statistical projects. H. B. Morse, who would serve as Statistical Secretary, wrote: ‘while weak in the fiscal and economic field, he was a marvel in organisation and the direction of the work of others’. Within the Customs Service, it was the Statistical Secretary who had immediate responsibility for the statistical publications of the Customs. He was stationed in Shanghai, China's busiest port, rather than Beijing, where the Inspectorate had its offices close to the Zongli Yamen, the Qing agency overseeing China's relations with Western countries.
Abstract
Background
Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain ...Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:
1.
Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and
2.
Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps).
Methods
After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps.
Results
Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients).
Conclusions
The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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