896 resultados para Oreskes, Naomi
Resumo:
Objectives: To update the 2006 systematic review of the comparative benefits and harms of erythropoiesis-stimulating agent (ESA) strategies and non-ESA strategies to manage anemia in patients undergoing chemotherapy and/or radiation for malignancy (excluding myelodysplastic syndrome and acute leukemia), including the impact of alternative thresholds for initiating treatment and optimal duration of therapy. Data sources: Literature searches were updated in electronic databases (n=3), conference proceedings (n=3), and Food and Drug Administration transcripts. Multiple sources (n=13) were searched for potential gray literature. A primary source for current survival evidence was a recently published individual patient data meta-analysis. In that meta-analysis, patient data were obtained from investigators for studies enrolling more than 50 patients per arm. Because those data constitute the most currently available data for this update, as well as the source for on-study (active treatment) mortality data, we limited inclusion in the current report to studies enrolling more than 50 patients per arm to avoid potential differential endpoint ascertainment in smaller studies. Review methods: Title and abstract screening was performed by one or two (to resolve uncertainty) reviewers; potentially included publications were reviewed in full text. Two or three (to resolve disagreements) reviewers assessed trial quality. Results were independently verified and pooled for outcomes of interest. The balance of benefits and harms was examined in a decision model. Results: We evaluated evidence from 5 trials directly comparing darbepoetin with epoetin, 41 trials comparing epoetin with control, and 8 trials comparing darbepoetin with control; 5 trials evaluated early versus late (delay until Hb ≤9 to 11 g/dL) treatment. Trials varied according to duration, tumor types, cancer therapy, trial quality, iron supplementation, baseline hemoglobin, ESA dosing frequency (and therefore amount per dose), and dose escalation. ESAs decreased the risk of transfusion (pooled relative risk [RR], 0.58; 95% confidence interval [CI], 0.53 to 0.64; I2 = 51%; 38 trials) without evidence of meaningful difference between epoetin and darbepoetin. Thromboembolic event rates were higher in ESA-treated patients (pooled RR, 1.51; 95% CI, 1.30 to 1.74; I2 = 0%; 37 trials) without difference between epoetin and darbepoetin. In 14 trials reporting the Functional Assessment of Cancer Therapy (FACT)-Fatigue subscale, the most common patient-reported outcome, scores decreased by −0.6 in control arms (95% CI, −6.4 to 5.2; I2 = 0%) and increased by 2.1 in ESA arms (95% CI, −3.9 to 8.1; I2 = 0%). There were fewer thromboembolic and on-study mortality adverse events when ESA treatment was delayed until baseline Hb was less than 10 g/dL, in keeping with current treatment practice, but the difference in effect from early treatment was not significant, and the evidence was limited and insufficient for conclusions. No evidence informed optimal duration of therapy. Mortality was increased during the on-study period (pooled hazard ratio [HR], 1.17; 95% CI, 1.04 to 1.31; I2 = 0%; 37 trials). There was one additional death for every 59 treated patients when the control arm on-study mortality was 10 percent and one additional death for every 588 treated patients when the control-arm on-study mortality was 1 percent. A cohort decision model yielded a consistent result—greater loss of life-years when control arm on-study mortality was higher. There was no discernible increase in mortality with ESA use over the longest available followup (pooled HR, 1.04; 95% CI, 0.99 to 1.10; I2 = 38%; 44 trials), but many trials did not include an overall survival endpoint and potential time-dependent confounding was not considered. Conclusions: Results of this update were consistent with the 2006 review. ESAs reduced the need for transfusions and increased the risk of thromboembolism. FACT-Fatigue scores were better with ESA use but the magnitude was less than the minimal clinically important difference. An increase in mortality accompanied the use of ESAs. An important unanswered question is whether dosing practices and overall ESA exposure might influence harms.
Resumo:
Morphogenesis emerges from complex multiscale interactions between genetic and mechanical processes. To understand these processes, the evolution of cell shape, proliferation and gene expression must be quantified. This quantification is usually performed either in full 3D, which is computationally expensive and technically challenging, or on 2D planar projections, which introduces geometrical artifacts on highly curved organs. Here we present MorphoGraphX (www.MorphoGraphX.org), a software that bridges this gap by working directly with curved surface images extracted from 3D data. In addition to traditional 3D image analysis, we have developed algorithms to operate on curved surfaces, such as cell segmentation, lineage tracking and fluorescence signal quantification. The software’s modular design makes it easy to include existing libraries, or to implement new algorithms. Cell geometries extracted with MorphoGraphX can be exported and used as templates for simulation models, providing a powerful platform to investigate the interactions between shape, genes and growth.DOI: http://dx.doi.org/10.7554/eLife.05864.001Author keywordsResearch organism
Resumo:
Since the discovery of the JAK2 V617F mutation in the majority of the myeloproliferative neoplasms (MPN) of polycythemia vera, essential thrombocythemia and primary myelofibrosis ten years ago, further MPN-specific mutational events, notably in JAK2 exon 12, MPL exon 10 and CALR exon 9 have been identified. These discoveries have been rapidly incorporated into evolving molecular diagnostic algorithms. Whilst many of these mutations appear to have prognostic implications, establishing MPN diagnosis is of immediate clinical importance with selection, implementation and the continual evaluation of the appropriate laboratory methodology to achieve this diagnosis similarly vital. The advantages and limitations of these approaches in identifying and quantitating the common MPN-associated mutations are considered herein with particular regard to their clinical utility. The evolution of molecular diagnostic applications and platforms has occurred in parallel with the discovery of MPN-associated mutations, and it therefore appears likely that emerging technologies such as next-generation sequencing and digital PCR will in the future play an increasing role in the molecular diagnosis of MPN. Accepted for publication 30 April 2015 doi:10.1111/ejh.12578
Resumo:
Greetings Pacesetter Grads Feel Boost in Entry to Nursing Workforce UTHealth-UH Dual Bachelors Program for First-Time Students UTHealth School of Nursing – By the Numbers 2012 PARTNERS Spring Luncheon – honored “Generations of Nurses” – guest speaker Naomi Judd UT Health Services Expands Care for Patients When I Grow Up, – A UTHealth Nursing Student’s Story Donors Support Start of New Accelerated Family Nurse Practitioner Program Giuseppe Colasurdo, M.D. – Appointed Sixth President in U THealth’s 40-Year History Dean Starck Named to UT Academy of Health Science Education, Marcus Honored by Regents for Outstanding Teaching Students Select Two for 2012 McGovern Awards Endowed scholarships Former home of School of Nursing for 30 years disappears in dust cloud Ruppert Named 2012 FAAN
Resumo:
La actividad biológica de Lonchocarpus guaricensis Pittier fue evaluada utilizando dos dosis de Tecnona® en el control de larvas de Tuta absoluta (Meyrick), Valle de Azapa, Chile, mediante una pulverización sobre plantas de tomate cv. Naomi en macetas, ubicadas aleatoriamente en un invernáculo dentro de un vivero. Semanas previas a la pulverización, las macetas se infestaron artificialmente con adultos del fitófago para obtener larvas en los foliolos. Los tratamientos evaluados fueron los siguientes: T1 (0,21 g de IA de L. guaricensis·L-1), T2 (0,43 g de IA de L. guaricensis·L-1), T3 (control positivo a base de spinosad 0,048 g de IA·L-1) y T0 (control negativo a base de agua de pozo). De acuerdo con el porcentaje de mortalidad acumulada de larvas contabilizadas a las 24, 48, 120 horas y 9no día post aplicación, no hay diferencias estadísticas entre los tratamientos T0 y T1, a su vez, T2 alcanza una media de 53,05% de mortalidad, no diferenciándose de T3 que logra un 73,9%. Se concluye que la dosis experimental L. guaricensis de 0,43 g de IA∙ L-1 puede constituir una alternativa interesante de utilizar en el Manejo Integrado de Plagas del cultivo de tomate en el Valle de Azapa.
Resumo:
El documento presenta los resultados de la segunda evaluación del Programa Ciudadanía Porteña del Gobierno de la Ciudad de Buenos Aires. Los datos señalan el alto impacto del programa en la eliminación de la indigencia y disminución de la pobreza en magnitud e intensidad, el incremento en la asistencia escolar de niños y adolescentes y la reducción del trabajo infantil. De este modo, se garantiza el derecho de la población en situación de pobreza a un ingreso que le permite cubrir sus necesidades básicas y el derecho de niños, niñas y adolescentes a un desarrollo pleno, contribuyendo a la ruptura de los mecanismos de reproducción intergeneracional de la pobreza. Ello confirma la pertinencia de la estrategia de intervención para dar respuesta a cuestiones que históricamente han sido de difícil abordaje para las políticas y programas sociales en Argentina, tales como la inclusión, reinserción y/o permanencia en el sistema educativo de niños de corta edad, adolescentes y jóvenes, la reducción del trabajo infantil, la eliminación de la indigencia y la reducción de la pobreza
Resumo:
El documento presenta los resultados de la segunda evaluación del Programa Ciudadanía Porteña del Gobierno de la Ciudad de Buenos Aires. Los datos señalan el alto impacto del programa en la eliminación de la indigencia y disminución de la pobreza en magnitud e intensidad, el incremento en la asistencia escolar de niños y adolescentes y la reducción del trabajo infantil. De este modo, se garantiza el derecho de la población en situación de pobreza a un ingreso que le permite cubrir sus necesidades básicas y el derecho de niños, niñas y adolescentes a un desarrollo pleno, contribuyendo a la ruptura de los mecanismos de reproducción intergeneracional de la pobreza. Ello confirma la pertinencia de la estrategia de intervención para dar respuesta a cuestiones que históricamente han sido de difícil abordaje para las políticas y programas sociales en Argentina, tales como la inclusión, reinserción y/o permanencia en el sistema educativo de niños de corta edad, adolescentes y jóvenes, la reducción del trabajo infantil, la eliminación de la indigencia y la reducción de la pobreza
Resumo:
El documento presenta los resultados de la segunda evaluación del Programa Ciudadanía Porteña del Gobierno de la Ciudad de Buenos Aires. Los datos señalan el alto impacto del programa en la eliminación de la indigencia y disminución de la pobreza en magnitud e intensidad, el incremento en la asistencia escolar de niños y adolescentes y la reducción del trabajo infantil. De este modo, se garantiza el derecho de la población en situación de pobreza a un ingreso que le permite cubrir sus necesidades básicas y el derecho de niños, niñas y adolescentes a un desarrollo pleno, contribuyendo a la ruptura de los mecanismos de reproducción intergeneracional de la pobreza. Ello confirma la pertinencia de la estrategia de intervención para dar respuesta a cuestiones que históricamente han sido de difícil abordaje para las políticas y programas sociales en Argentina, tales como la inclusión, reinserción y/o permanencia en el sistema educativo de niños de corta edad, adolescentes y jóvenes, la reducción del trabajo infantil, la eliminación de la indigencia y la reducción de la pobreza
