Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information ...based on "expert opinion" and antimicrobial susceptibility testing supports certain antibiotic choices for the treatment of common infections, but less evidence-based literature is available to guide treatment decisions. Evidence in the literature supports the selection of amoxicillin as first-line antibiotic therapy for acute otitis media. Alternative drugs, such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole and cefuroxime axetil, can be used to treat resistant infections. Penicillin V remains the drug of choice for the treatment of pharyngitis caused by group A streptococci. Inexpensive narrow-spectrum drugs such as amoxicillin or trimethoprim-sulfamethoxazole are first-line therapy for sinusitis. Animal and human bites can be treated most effectively with amoxicillin-clavulanate. For most outpatient procedures, amoxicillin is the preferred agent for bacterial endocarditis prophylaxis. Beta-lactam antibiotics are usually not the first choice for empiric outpatient treatment of community-acquired pneumonia. Based on the literature, the role of beta-lactam antibiotics in the treatment of bronchitis, skin infections and urinary tract infections remains unclear.
Standard network meta‐analysis and indirect comparisons combine aggregate data from multiple studies on treatments of interest, assuming that any factors that interact with treatment effects (effect ...modifiers) are balanced across populations. Population adjustment methods such as multilevel network meta‐regression (ML‐NMR), matching‐adjusted indirect comparison (MAIC), and simulated treatment comparison (STC) relax this assumption using individual patient data from one or more studies, and are becoming increasingly prevalent in health technology appraisals and the applied literature. Motivated by an applied example and two recent reviews of applications, we undertook an extensive simulation study to assess the performance of these methods in a range of scenarios under various failures of assumptions. We investigated the impact of varying sample size, missing effect modifiers, strength of effect modification and validity of the shared effect modifier assumption, validity of extrapolation and varying between‐study overlap, and different covariate distributions and correlations. ML‐NMR and STC performed similarly, eliminating bias when the requisite assumptions were met. Serious concerns are raised for MAIC, which performed poorly in nearly all simulation scenarios and may even increase bias compared with standard indirect comparisons. All methods incur bias when an effect modifier is missing, highlighting the necessity of careful selection of potential effect modifiers prior to analysis. When all effect modifiers are included, ML‐NMR and STC are robust techniques for population adjustment. ML‐NMR offers additional advantages over MAIC and STC, including extending to larger treatment networks and producing estimates in any target population, making this an attractive choice in a variety of scenarios.
Students evaluate their domain-specific abilities by comparing their own achievement in a certain domain with the achievement of others (social comparison), with their own prior achievement (temporal ...comparison), and with their own achievement in other domains (dimensional comparison). This article is the first to analyze the simultaneous effects of social, temporal, and dimensional comparisons on students' academic self-concepts of various domains in experimental and field studies. In Study 1 (N = 120), students judged their ability self-concept after having received experimentally manipulated social, temporal, and dimensional comparison feedback. In Study 2 (N = 924), students had to rate their math and German self-concept and were asked to directly compare their achievement to social, temporal, and dimensional comparison standards. In the longitudinal Study 3a (N = 3,054) and 3b (N = 14,008), the three types of comparisons were modeled in an extended internal/external frame of reference model (Marsh, 1986) containing paths from math and verbal achievement level and achievement change to math and verbal self-concept. In all studies, social, temporal, and dimensional comparisons showed significant effects on self-concept. For each comparison process, downward comparisons with worse-off standards resulted in higher self-concepts, whereas upward comparisons with better-off standards resulted in lower self-concepts. These results are in accordance with the theories underlying social, temporal, and dimensional comparison processes and support their integration into a combined framework.
Educational Impact and Implications Statement
Academic self-concepts describe students' subjective beliefs concerning their strengths and weaknesses in different school subjects. A high self-concept is of major importance; for example, students tend to show better achievements in a certain subject if they have a high self-concept in the respective subject. This study shows that three comparison processes bear an influence on the formation of students' academic self-concepts: social comparisons, temporal comparisons, and dimensional comparisons. Students develop a higher academic self-concept if they judge their achievement superior in comparison with their classmates (social comparison), with their prior achievement (temporal comparison), and with their achievement in other subjects (dimensional comparison). Teachers can make use of these findings by stressing specific comparison processes to support their students in the development of positive academic self-concepts.
Pigmentocracies --the fruit of the multiyear Project on Ethnicity and Race in Latin America (PERLA)--is a richly revealing analysis of contemporary attitudes toward ethnicity and race in Brazil, ...Colombia, Mexico, and Peru, four of Latin America's most populous nations. Based on extensive, original sociological and anthropological data generated by PERLA, this landmark study analyzes ethnoracial classification, inequality, and discrimination, as well as public opinion about Afro-descended and indigenous social movements and policies that foster greater social inclusiveness, all set within an ethnoracial history of each country. A once-in-a-generation examination of contemporary ethnicity, this book promises to contribute in significant ways to policymaking and public opinion in Latin America. Edward Telles, PERLA's principal investigator, explains that profound historical and political forces, including multiculturalism, have helped to shape the formation of ethnic identities and the nature of social relations within and across nations. One of Pigmentocracies 's many important conclusions is that unequal social and economic status is at least as much a function of skin color as of ethnoracial identification. Investigators also found high rates of discrimination by color and ethnicity widely reported by both targets and witnesses. Still, substantial support across countries was found for multicultural-affirmative policies--a notable result given that in much of modern Latin America race and ethnicity have been downplayed or ignored as key factors despite their importance for earlier nation-building.
Individuals tend to compare themselves with those whose attributes and abilities are better (i.e., upward social comparison) or worse (i.e., downward social comparison) than their own to evaluate ...self. Based on social comparison theory, this study examined the influence of fitness comparison on fitness app users' beliefs about (self-efficacy), attitudes toward (motivation), and behaviors in (participation) physical activities (PA). For the research, fitness app users who use social media were recruited (N = 567) through a crowdsourcing internet marketplace. The results revealed that downward fitness comparison appeared to thwart fitness app users' self-efficacy in PA, whereas upward fitness comparison appeared to enhance self-efficacy in PA. As a consequence, people who engaged in upward fitness comparison had elevated motivation and participation in PA. In particular, self-efficacy was a crucial variable in improving people's motivation for PA. Those who want to improve their fitness activities should engage in comparing themselves with high performers. The given managerial implication is that fitness practitioners should encourage people to compare their fitness abilities with better performers or role models, and fitness app developers should design apps that permit users to have more opportunities for comparison with superior others.
•Upward fitness comparison appeared to enhance self-efficacy in PA.•Downward fitness comparison appeared to thwart self-efficacy in PA.•PA self-efficacy was a crucial variable in improving people's motivation for PA.•PA motivation had a positive direct effect on PA participation.
The device used to scale up and manufacture an immunotherapeutic agent is a highly relevant factor in ensuring the most optimal product in terms of the time it takes to produce a dose of the therapy, ...the risk encountered in processing, the final quality of that product, and the necessary inputs required for production, e.g. cells, reagents, and hands-on time (HoT). In this work, three types of devices for Tcell expansion were compared: a static culture perfusion membrane device (SCPM) device, a rocking bag device (RB), and two sizes of hollow-fiber perfusion bioreactor (HFB-Large and HFB-Small). The Tcell yield, time to dose, fold-expansion (FE) from the initial seed, number of open events (OE), and HoT required for each device were measured.
Tcells from three donors were selected from leukopaks and cryopreserved. Upon thaw, Tcells were activated as a pool in a T-flask overnight using a soluble activator. For three donors, 5×106 Tcells were seeded into the HFB-Small and 5×107 Tcells were seeded into the HFB-Large, the RB, and the SCPM. For Donors 2-3, an additional arm seeding 5×107 Tcells into the HFB-Small was also conducted. Both HFB devices and the SCPM were seeded directly, while Tcells for the RB were maintained in T-flasks until the manufacturer's minimum recommended seeding number of 1.5×108 was reached. Tcells were cultured according to each manufacturer's guidance and harvested when the total number of cells was ≥ 2×109, an estimated autologous dose of a Tcell product. Results from each platform were as follows. RB: 2.9×109 Tcells at 98% viability in 8.0 days with 234 min HoT, 6 OE, and a FE of 57.6; SCPM: 2.4×109 Tcells at 98% viability in 9.0 days with 22 min HoT, 4 OE, and a FE of 47.0; HFB-Large: 1.5×1010 Tcells at 98% viability in 4.9 days with 57 min HoT, 1 OE, and a FE of 303.6; HFB-Small bioreactor: 3.0x109 Tcells at 96% viability in 7.8 days with 57 min HoT, 1 OE, and a FE of 613.7. The arms seeding 5×107 Tcells into the HFB-Small yielded an average of 4.9× 109 Tcells at 94% viability in 6.5 days with 1 OE, and a FE of 98.5. When harvested cells were interrogated by flow cytometry, no notable difference was seen between Tcells harvested from all platforms in terms of the expression of TIM-3 and PD-1. The TSCM phenotype (CCR7+/CD45RA+) was displayed in 30% of cells harvested from the RB, 8% of cells from the SCPM, 16% of cells from the HFB-Large, 31% of the cells from the HFB-Small (5M), and 49% of cells from the HFB-Small (50M).
Aim
To conduct an adjusted indirect treatment comparison (aITC) of the efficacy of tirzepatide 5/10/15 mg versus semaglutide 2 mg in patients with type 2 diabetes.
Materials and Methods
The primary ...analysis was a Bucher aITC of the change from baseline at week 40 in HbA1c (%) and body weight (kg). Aggregate data from the SURPASS‐2 study that met the HbA1c inclusion criterion of the SUSTAIN FORTE study and from SUSTAIN FORTE metformin‐only treated patients were used for primary analysis.
Results
The SURPASS‐2 refined population comprised 238/245/240 and 240 participants for tirzepatide 5/10/15 mg and semaglutide 1 mg, respectively. The SUSTAIN FORTE metformin‐only population comprised 222 and 227 participants for semaglutide 1 and 2 mg, respectively. In this aITC, tirzepatide 10 and 15 mg significantly reduced HbA1c versus semaglutide 2 mg with an estimated treatment difference (ETD) of −0.36% (95% confidence interval CI −0.63, −0.09) and −0.4% (95% CI −0.67, −0.13), respectively. Tirzepatide 10 and 15 mg significantly reduced body weight versus semaglutide 2 mg with an ETD of −3.15 kg (95% CI −4.84, −1.46) and −5.15 kg (95% CI −6.85, −3.45), respectively. There were no significant differences between tirzepatide 5 mg and semaglutide 2 mg on change from baseline in HbA1c and body weight.
Conclusions
In this aITC, HbA1c and weight reductions were significantly greater for tirzepatide 10 and 15 mg versus semaglutide 2 mg and were similar for tirzepatide 5 mg versus semaglutide 2 mg. These findings provide comparative effectiveness insights in the absence of a head‐to‐head clinical trial.
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