ic2 advanced machines 1-3 2-4 betting system

binary options trading nifty

Getting Rid of the Holidays Act I. Dairy Day. Word Metamorphism. The Nutty Professor. Voice Processing Module.

Ic2 advanced machines 1-3 2-4 betting system betting tips nhl

Ic2 advanced machines 1-3 2-4 betting system

Importance Merkel cell carcinoma MCC is an aggressive skin cancer that is associated with poor survival outcomes in patients with distant metastatic disease. Objective To evaluate the efficacy and safety of avelumab as first-line treatment for patients with distant mMCC.

Eligible patients were adults with mMCC who had not received prior systemic treatment for metastatic disease. Patients were not selected for PD-L1 expression or Merkel cell polyomavirus status. Data were collected from April 15, , to March 24, , and enrollment is ongoing. Main Outcomes and Measures Tumor status was assessed every 6 weeks and evaluated by independent review committee per Response Evaluation Criteria in Solid Tumors version 1. The primary end point was durable response, defined as an objective response with a duration of at least 6 months.

Secondary end points include best overall response, duration of response, progression-free survival, safety, and tolerability. Results As of March 24, , 39 patients were enrolled 30 men and 9 women; median age, 75 years [range, years] , with a median follow-up of 5. In a preplanned analysis, efficacy was assessed in 29 patients with at least 3 months of follow-up; the confirmed objective response rate was Lacosamide monotherapy for partial onset seizures.

To evaluate the 1-year efficacy and safety of oral lacosamide as conversion monotherapy in adult patients with partial onset seizures with or without generalization. We prospectively followed-up consecutive patients converted to lacosamide monotherapy after 1-year seizure freedom on lacosamide add-on therapy and withdrawal of the concurrent antiepileptic drug AED. Seizure occurrence, treatment compliance and drug toxicity were assessed every 3 months up to 1 year. The study outcomes were the retention rate of lacosamide as single AED and the seizure freedom under lacosamide monotherapy at 1 year from withdrawal of background AED.

The safety variable was the prevalence of lacosamide related adverse events AEs. Among the 58 included patients, at 1 year from withdrawal of background medication, 37 Twelve Conversion to lacosamide monotherapy could be effective and well tolerated in selected adults patients with partial onset seizures who had achieved seizure freedom during lacosamide add-on therapy. Published by Elsevier Ltd. To assess neurocognitive function at the first-line antiretroviral therapy failure and change on the second-line therapy.

Randomized controlled trial was conducted in 5 sub-Saharan African countries. Neurocognitive function was tested at baseline, weeks 48 and 96 using color trails tests 1 and 2, and the Grooved Pegboard test. Test results were converted to an average of the 3 individual test z-scores. Mean SD baseline z-score was Regimens with more central nervous system-penetrating drugs did not enhance neurocognitive recovery indicating this need not be a primary consideration in choosing a second-line regimen.

The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes.

Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care.

The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes.

The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.

Antiepileptic drug AED monotherapy is the preferred initial management approach in epilepsy care, since most patients may be successfully managed with the first or second monotherapy utilized. This article reviews the rationale and evidence supporting preferential use of monotherapy when possible and guidelines for initiating and successfully employing AED monotherapy. Suggested approaches to consider when patients fail monotherapy include substituting a new AED monotherapy , initiating chronic maintenance AED polytherapy, or pursuit of non-pharmacologic treatments such as epilepsy surgery or vagus nerve stimulation.

Reducing AED polytherapy to monotherapy frequently reduces the burden of adverse effects and may also improve seizure control. AED monotherapy remains the optimal approach for managing most patients with epilepsy. Weight gain in children on oxcarbazepine monotherapy. Studies of the effect of oxcarbazepine OXC on body growth of children with epilepsy are rare and their results are controversial. To the contrary, many studies have shown significant weight gain following valproate VPA treatment.

To prospectively evaluate the effect of OXC monotherapy on growth patterns of children with epilepsy and compare it with the effect of VPA monotherapy. Fifty-nine otherwise healthy children, aged 3. The increase was similar to that observed in the VPA group. An additional Careful monitoring for excess weight gain along with counseling on adapting a healthy lifestyle should be offered to children on OXC therapy. First-line nurse managers in rural hospitals: perceptions of career success.

First-line nurse managers in small rural hospitals are essential to organizational survival, yet little is known about such individuals. A pilot study comparing demographic characteristics and career success perceptions of first-line nurse managers from rural settings with doctorally prepared nurses found that despite age and educational differences, personal characteristics identified as contributing to career success were remarkably similar in both groups.

First-line nurse managers generally credited family members with greater degrees of career influence than did their more educated colleagues. However, both groups saw themselves as primarily responsible for their own career success. This information may assist rural hospitals and nursing personnel to enhance their strategic position in the unstable environment of health care reform.

A cost analysis of first-line chemotherapy for low-risk gestational trophoblastic neoplasia. To determine the optimal approach to first-line treatment for low-risk gestational trophoblastic neoplasia GTN using a cost analysis of 3 commonly used regimens. A decision tree of the 3 most commonly used first-line low-risk GTN treatment strategies was created, accounting for toxicities, response rates and need for second- or third-line therapy. Response rates, average number of cycles needed for remission, and toxicities were determined by review of the literature.

Costs of each strategy were examined from a societal perspective, including the direct total treatment costs as well as the indirect lost labor production costs from work absences. Sensitivity analysis on these costs was performed using both deterministic and probabilistic cost-minimization models with the aid of decision tree software TreeAge Pro , TreeAge Inc. Absolute societal cost of each strategy is driven by the probability of needing expensive third-line multiagent chemotherapy, however relative cost differences are robust to sensitivity analysis over the reported range of cycle number and response rate for all therapies.

The purpose of the study was to evaluate outcomes of the first ventilatory treatment applied, NIV or invasive mechanical ventilation MV , and to identify predictors of NIV failure. Univariate and multivariate analyses with demographic and clinical data were performed. Analysis of mortality was adjusted for the propensity of receiving first-line invasive MV. One hundred and thirteen subjects received first-line invasive MV and 46 received first-line NIV, of which 27 needed intubation.

NIV failure was associated with need for vasoactive drugs OR 7. NIV failure was associated with longer duration of MV and hospital stay, and with increased hospital mortality. The use of vasoactive drugs predicted NIV failure. Clinically relevant transmitted drug resistance to first line antiretroviral drugs and implications for recommendations. Using the Stanford algorithm "Low-level resistance", "Intermediate resistance" and "High-level resistance" categories were considered as "Resistant".

A total of patients showed clinically relevant resistance to first-line ARVs [6. Differences were due to a lower prevalence in clinically relevant resistance for NRTIs [2. Cost-effectiveness studies need to be carried out to inform evidence-based recommendations. Treatment of febrile neutropenia with cefepime monotherapy. The empirical administration of a broad-spectrum beta-lactam antibiotic, either as monotherapy or in combination with an aminoglycoside, is an essential component of the initial management of patients with fever and severe neutropenia.

Multiple antibiotics have been tested for this indication. Cefepime is a fourth-generation cephalosporin with in vitro activity against most gram-negative and many gram-positive bacteria. We have studied the use of this agent as monotherapy in this indication. One hundred and twenty-six episodes of febrile neutropenia in 98 adults with hematological malignancies were treated with cefepime monotherapy.

Cefepime was given at a dose of 2 g every 8 h i. There were no deaths due to bacterial infection. At the end of all antibiotic therapy final outcome 69 episodes were cured only with monotherapy , 47 were cured with modification of therapy and 10 patients died from an unrelated cause. The only variable that appeared to correlate with response to therapy was the duration of neutropenia, which was longer among patients who failed or developed breakthrough bacteremia than among those who responded to monotherapy.

Initial empirical antibiotic therapy with cefepime as a single agent in patients with febrile neutropenia and a hematological malignancy is effective, but patients with prolonged neutropenia appear to be. Since many first line managers FLMs have not participated in formal learning, how they make sense of their roles and the training they are doing is significant. A relationship between inadequate literacy skills and ability to do a job is assumed. Language, literacy, and numeracy must be understood in terms of social practice and creation of….

Factors contributing to managerial competence of first-line nurse managers: A systematic review. To determine the factors contributing to managerial competence of first-line nurse managers. Understanding factors affecting managerial competence of nurse managers remains important to increase the performance of organizations; however, there is sparse research examining factors that influence managerial competence of first-line nurse managers.

Systematic review. Quantitative and qualitative research papers that examined relationships among managerial competence and antecedent factors were included. Quality assessment, data extractions, and analysis were completed on all included studies. Content analysis was used to categorize factors into themes. Eighteen influencing factors were examined and categorized into 3 themes-organizational factors, characteristics and personality traits of individual managers, and role factors.

Findings suggest that managerial competence of first-line nurse managers is multifactorial. Further research is needed to develop strategies to develop managerial competence of first-line nurse managers. Quality work in long-term care: the role of first-line leaders.

To explore the first-line leaders' role in quality work in long-term care in Norway, in order to determine how that work is related to such success characteristics as leadership, staff, patients, performance, information and information technology. Cross-sectional telephone survey.

The text was analysed using content analysis. Thirty-two Norwegian municipalities stratified according to region and population size. Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure The clinical microsystem approach is used as a framework by defining and designing measureable variables.

Thirty-six leaders described how they initiated and motivated employees to be active in quality work; the remaining leaders indicated that they played a passive role. The first-line leaders played a key role in implementing national quality policies and regulations. The quantity of other success characteristics was low. The municipalities delegated the responsibility of implanting national policies to the first-line leaders.

Missing were key quality success criteria such as macro- and meso-perspectives for the municipality as a whole and co-operation with other leaders in the organization and fostering of relevant learning. Quality work was fragmented rather than comprehensive and systematic. Although it has improved progression-free survival PFS , overall survival OS was limited and erlotinib can be expensive.

This cost-effectiveness analysis compares erlotinib monotherapy with gemcitabine-included doublet chemotherapy. The model simulates cancer progression and all causes of death. All medical costs were calculated from the perspective of the Chinese healthcare system. Results The combined PFS was The chemotherapy arm gained 0. The most influential factors were the health utility of PFS, the cost of erlotinib and the health utility of progressed disease. Conclusion Erlotinib monotherapy may be acceptable as a cost-effective first-line treatment for NSCLC compared with gemcitabine-based chemotherapy.

The results were robust to changes in assumptions. Erythema multiforme associated with gemfibrozil monotherapy. A case of erythema multiforme associated with gemfibrozil monotherapy. A year-old man with hyperlipidemia was treated with mg gemfibrozil twice a day. On the fifth day of treatment, skin lesions consistent with erythema multiforme appeared. With the discontinuation of the treatment and start of a topical steroid treatment, the lesions recovered after 4 weeks.

After 6 months, when gemfibrozil therapy was restarted, lesions reappeared on the fourth day of therapy. Lesions recovered again following the previous treatment strategies after 4 weeks. An objective casualty assessment suggests that erythema multiforme was probably related to gemfibrozil monotherapy.

Patients starting gemfibrozil therapy should be warned about the occurrence of erythema multiforme in addition to previous reported and established side effects. Cannabidiol monotherapy for treatment-resistant schizophrenia. Cannabidiol CBD , one of the major products of the marijuana plant, is devoid of marijuana's typical psychological effects. In contrast, potential antipsychotic efficacy has been suggested based on preclinical and clinical data Zuardi et al. In this report, we further investigated the efficacy and safety of CBD monotherapy in three patients with treatment-resistant schizophrenia TRS.

This was an in-patient study. On the 36th day, CBD treatment was discontinued and replaced by placebo for 5 days, which was subsequently switched to olanzapine for over 15 days. Efficacy, tolerability and side effects were assessed. One patient showed mild improvement, but two patients didn't show any improvement during CBD monotherapy.

All patients tolerated CBD very well and no side effects were reported. Radioimmunotherapy as the first line of treatment in non-Hodgkin lymphoma. Non-Hodgkin lymphoma NHL is the most common hematologic malignancy. Therapeutic interventions for NHL consist of chemotherapy, radiation therapy and immunotherapy. Radioimmunotherapy RIT is a potential alternative treatment for NHL that is currently used in different lines of treatment.

Studies show that nuclear medicine physicians and radiation oncologists are not yet certain about the proper line for administration of RIT. Herein, we have reviewed the efficiency and toxicity of RIT as the first line of treatment, and discussed potential novel indications, and strategies such as modifying induction therapy and using rituximab maintenance to optimize the efficiency of RIT as the first line of treatment.

Our review indicates that it is more logical to postpone conventional therapies to the second or third lines of treatment instead of RIT. Helicobacter pylori first-line and rescue treatments in the presence of penicillin allergy. Helicobacter pylori eradication is a challenge in penicillin allergy. To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin. Prospective multicenter study.

Patients allergic to penicillin were given a first-line treatment comprising a 7-day omeprazole-clarithromycin-metronidazole and b day omeprazole-bismuth-tetracycline-metronidazole. Rescue treatments were as follows: a bismuth quadruple therapy; b day PPI-clarithromycin-levofloxacin; and c day PPI-clarithromycin-rifabutin.

Eradication was confirmed by 13 C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by questionnaires. In total, consecutive treatments were included. A levofloxacin-based regimen together with a PPI and clarithromycin represents a second-line rescue option in the presence of penicillin allergy.

Selection of first-line therapy in multiple sclerosis using risk-benefit decision analysis. To integrate long-term measures of disease-modifying drug efficacy and risk to guide selection of first-line treatment of multiple sclerosis. We created a Markov decision model to evaluate disability worsening and progressive multifocal leukoencephalopathy PML risk in patients receiving natalizumab NTZ , fingolimod FGL , or glatiramer acetate GA over 30 years.

Leveraging publicly available data, we integrated treatment utility, disability worsening, and risk of PML into quality-adjusted life-years QALYs. We performed sensitivity analyses varying PML risk, mortality and morbidity, and relative risk of disease worsening across clinically relevant ranges. Compared to untreated patients, NTZ-treated patients have a greater relative risk of death in the early years of treatment that varies according to PML risk profile. Integrated modeling of long-term treatment risks and benefits informs stratified clinical decision-making and can support patient counseling on selection of first-line treatment options.

First-line managers' experiences of alternative modes of funding in elderly care in Sweden. The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden. A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation. The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care.

The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care. Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public.

The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care.

However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective. This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented.

Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care. Power in health care organizations: contemplations from the first-line management perspective. The aim of this paper is to examine health care organizations' power structures from the first-line management perspective.

What liable power structures derive from the theoretical bases of bureaucratic, professional and result based organizations, and what power type do health care organizations represent, according to the empirical data? The paper seeks to perform an analysis using Mintzberg's power configurations of instrument, closed system, meritocracy and political arena.

The empirical study was executed at the end of through a survey in ten Finnish hospital districts in both specialized and primary care. Respondents were all first-line managers in the area and a sample of staff members from internal disease, surgical and psychiatric units, as well as out-patient and primary care units. The number of respondents was 1, and the response percentage was The data were analyzed statistically. As a result, it can be seen that a certain kind of organization structure supports the generation of a certain power type.

A bureaucratic organization generates an instrument or closed system organization, a professional organization generates meritocracy and also political arena, and a result-based organization has a connection to political arena and meritocracy. First line managers regarded health care organizations as instruments when staff regarded them mainly as meritocracies having features of political arena. Managers felt their position to be limited by rules, whereas staff members regarded their position as having lots of space and influence potential.

If the organizations seek innovative and active managers at the unit level, they should change the organizational structure and redistribute the work so that there could be more space for meaningful management. This research adds to the literature and gives helpful suggestions that will be of interest to those in the position of first-line management in health care.

First-line nurse managers in university hospitals--captives to their own professional culture? This study investigates whether first-line nurse managers in hospitals share common dispositions related to managerial work and leadership, what they are like, and what their relationship is with the various expectations set on them. The first data were collected by focus group interviews in the autumn of and analysed using qualitative content analysis and frame analysis.

The second data set were part of a questionnaire survey addressed to the same managers in with a focus on their diverse leadership roles. Among first-line nurse managers, the management frameworks of a nurturing mother and an administrative nurse displayed the strongest prominence, and the emphasis seemed to be evolving towards the administrative. The results from the survey confirmed the findings of this study in relation to first-line nurse managers' management frameworks.

The line of development found in this study may add to the permanence of operations and the stability of the operative culture at a university hospital. It may also diminish the opportunities for nursing development in university hospital wards and weaken the potential for a new kind of competence among both managers and their subordinates. Resilience and work-life balance in first-line nurse manager. The aim of this study was to explore how first-line nurse managers constructed the meaning of resilience and its relationship to work-life balance for nurses in Korea.

Participants were 20 first-line nurse managers working in six university hospitals. Data were collected through in-depth interviews from December to August , and analyzed using Strauss and Corbin's grounded theory method. Analysis revealed that participants perceived work-life balance and resilience to be shaped by dynamic, reflective processes.

The features consisting resilience included "positive thinking", "flexibility", "assuming responsibility", and "separating work and life". This perception of resilience has the potential to facilitate a shift in focus from negative to positive experiences, from rigidity to flexibility, from task-centered to person-centered thinking, and from the organization to life. Recognizing the importance of work-life balance in producing and sustaining resilience in first-line nurse managers could increase retention in the Korean nursing workforce.

Published by Elsevier B. The consensus statements regarding first-line therapies in women with ovarian cancer, reached at the Fifth Ovarian Cancer Consensus Conference held in Tokyo, Japan, in November are reported. Three topics were reviewed and the following statements are recommended: i Surgery: the subgroups that should be considered in first-line ovarian cancer clinical trials should be a patients undergoing primary debulking surgery and b patients receiving neo-adjuvant chemotherapy.

The amount of residual disease following surgery should further stratify patients into those with absent gross residual disease and others. Acceptable alternatives, which should be stratified variables in trials when more than one regimen is offered, include weekly paclitaxel plus 3-weekly carboplatin, the addition of bevacizumab to 3-weekly carboplatin and paclitaxel, and intraperitoneal therapy.

Progression-free survival PFS is an alternative primary endpoint, but if PFS is chosen overall survival must be measured as a secondary endpoint and PFS must be supported by additional endpoints, including predefined patient reported outcomes and time to first or second subsequent therapy.

For neoadjuvant therapy, additional 'window of opportunity' endpoints should be included. For Permissions, please email: journals. First-line treatment of advanced ALK-positive non-small-cell lung cancer. The constitutive activation of the ALK fusion oncogene renders it vulnerable to therapeutic intervention. However, acquired resistance inevitably develops. The central nervous system is a sanctuary site that represents a common site for disease progression as well.

Hence, more potent, selective next-generation ALK inhibitors that are able to cross the blood—brain barrier have been developed for treatment against crizotinib-resistant ALK-positive NSCLC and are also currently being evaluated for first-line therapy as well.

Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives. Everolimus has been shown to be effective for advanced pancreatic neuroendocrine tumours pNETs , but its positioning in the therapeutic algorithm for pNETs is matter of debate. With the aim to shed light on this point, we performed an up-to-date critical review taking into account the results of both retrospective and prospective published studies, and the recommendations of international guidelines.

In addition, we performed an extensive search on the Clinical Trial Registries databases worldwide, to gather information on the ongoing clinical trials related to this specific topic. We identified eight retrospective published studies, two prospective published studies, and five registered clinical trials. Moreover, we analyzed the content of four widespread international guidelines.

Our critical review confirms the lack of high-quality data to recommend everolimus as the first line therapy for pNETs. The ongoing clinical trials reported in this review will hopefully help clinicians, in the near future, to better evaluate the role of everolimus as the first line therapy for pNETs.

However, at the moment, there is already enough evidence to recommend everolimus as the first line therapy for patients with symptomatic malignant unresectable insulin-secreting pNETs, to control the endocrine syndrome regardless of tumour growth. The combination of pemetrexed and platinum compound represents the standard regimen for first-line chemotherapy in malignant pleural mesothelioma patients. Pemetrexed is a multitarget antifolate agent that inhibits folate-dependent enzymes eg, thymidylate synthase [TS] and thus synthesis of nucleotides and DNA.

Expression of TS and folate availability, regulated by gene polymorphisms, have implications for effectiveness of chemotherapy and the outcome of mesothelioma patients. The aim of this retrospective multicenter study was to assess the correlation between TS, 5,methylenetetrahydrofolate reductase MTHFR and excision repair cross-complementing group 1 ERCC1 gene polymorphisms and the efficacy of pemetrexed-based first-line chemotherapy of mesothelioma patients.

Fifty-nine mesothelioma patients 31 men with a median age of 62 years treated in first-line chemotherapy with platinum in combination with pemetrexed or pemetrexed monotherapy were enrolled. Genomic DNA was isolated from peripheral blood. In multivariate analysis, the del6 in the. Phase I dose-finding study of sorafenib with FOLFOX4 as first-line treatment in patients with unresectable locally advanced or metastatic gastric cancer.

According to modified Fibonacci method, the design of this study was to guide elevation of the sorafenib dosage to the next level from mg twice daily to mg twice daily and then, if tolerated, mg twice daily. If the patient achieved complete response CR , partial response PR or stable disease SD after eight cycles of treatment, combination chemotherapy was scheduled to be discontinued and sorafenib monotherapy continued at the original dose until either disease progression or unacceptable toxicity.

In sorafenib mg twice daily group, DLT was observed in 1 of 6 patients, and in mg twice daily group, it was observed in 2 of 3 patients. Seven of 9 Common adverse effects include hand-foot syndrome, leukopenia, neutropenia, anorexia, and nausea. Twice-daily dosing of sorafenib mg in combination with FOLFOX4 was proven effective and safe for the treatment of advanced gastric cancer, and could be an appropriate dosage for subsequent phase II clinical studies.

Cabergoline versus levodopa monotherapy : a decision analysis. We evaluated the incremental cost-effectiveness of cabergoline compared with levodopa monotherapy in patients with early Parkinson's disease PD in the German healthcare system. The study design was based on cost-effectiveness analysis using a Markov model with a year time horizon. Direct and indirect medical and nonmedical costs were included. Outcomes were costs, disease stage, cumulative complication incidence, and mortality.

It was found that the occurrence of motor complications was significantly lower in patients on cabergoline monotherapy. In conclusion, this decision-analytic model calculation for PD was based almost entirely on clinical and observed data with a limited number of assumptions. Although costs were higher in patients on cabergoline, the corresponding cost-effectiveness ratio for cabergoline was at least as favourable as the ratios for many commonly accepted therapies.

Copyright Movement Disorder Society. Transitional polytherapy: tricks of the trade for monotherapy to monotherapy AED conversions. The goal of epilepsy therapy is to help patients achieve seizure freedom without adverse effects. While monotherapy is preferable in epilepsy treatment, many patients fail a first drug due to lack of efficacy or failure to tolerate an initial medication, necessitating an alteration in therapy. Sudden changes between monotherapies are rarely feasible and sometimes deleterious given potential hazards of acute seizure exacerbation or intolerable adverse effects.

The preferred method for converting between monotherapies is transitional polytherapy, a process involving initiation of a new antiepileptic drug AED and adjusting it toward a target dose while maintaining or reducing the dose of the baseline medication. A fixed-dose titration strategy of maintaining the baseline drug dose while titrating the new medication is preferable when breakthrough seizures are occurring and no adverse effects are present.

However, a flexible titration strategy involving reduction of the baseline drug dose to ensure adequate tolerability of the new adjunctive medication is preferred when patients are already experiencing adverse effects. This article reviews pharmacokinetic considerations pertinent for ensuring successful transitional polytherapy with the standard and newer antiepileptic drugs.

Transitional polytherapy is most successful when clinicians appropriately manage the titration strategy and consider pharmacokinetic factors germane to the baseline and new adjunctive medication. Study of the effectiveness of first-line treatment in renal cell carcinoma. The emergence of novel drugs corresponds with the determination of the effectiveness of the current treatments used in clinical practice. The primary endpoints were median progression-free survival mPFS and median overall survival mOS times.

In the poor-prognosis PP group, a difference of 1. A difference of 4. Additionally, the influence of prognostic factors on OS and the value of stratifying patients using these factors have been confirmed. Genetic heterogeneity after first-line chemotherapy in high-grade serous ovarian cancer. Most high-grade serous ovarian carcinoma HGSOC patients benefit from first-line platinum-based chemotherapy, but progressively develop resistance during subsequent lines.

However, little is known about resistance mechanisms occurring after a single line of platinum, when patients still qualify for other treatments. In 31 patients with primary platinum-sensitive HGSOC, we profiled tumours collected during debulking surgery before and after first-line chemotherapy using whole-exome sequencing and single nucleotide polymorphism profiling.

At relapse, tumours differed considerably from their primary counterparts. There was, however, no evidence of events reactivating the HR pathway, also not in tumours resistant to second-line platinum. Already after a single line of platinum, there is huge variability between primary and recurrent tumours, advocating that in HGSOC biopsies need to be collected at relapse to tailor treatment options to the underlying genetic profile. Finally, chromosomal instability contributes to acquired resistance after a single line of platinum therapy.

First-line managers' descriptions and reflections regarding their staff's access to empowering structures. To elucidate first-line managers' descriptions and reflections regarding their staff's access to empowering structures using Kanter's theory of structural empowerment.

Good structural conditions within workplaces are essential to employees' wellbeing, and their ability to access empowerment structures is largely dependent on the management. Twenty-eight first-line managers in elderly care were interviewed. Deductive qualitative content analysis was used to analyse data.

Managers perceived that staff had varying degrees of access to the empowering structures described in Kanter's theory - and that they possessed formal power in their roles as contact persons and representatives. The descriptions mostly started from the managers' own actions, although some started from the needs of staff members. All managers described their staff's access to the empowering structures in Kanter's theory as important, yet it seemed as though this was not always reflected on and discussed as a strategic issue.

Managers could make use of performance and appraisal dialogues to keep up to date on staff's access to empowering structures. Recurrent discussions in the management group based on such current information could promote staff's access to power through empowering structures and make job definitions a strategic issue in the organisation. Managing vulvovaginal hematoma by arterial embolization as first-line hemostatic therapy. A puerperal vulvovaginal hematoma may continue to grow after a surgical procedure and may require blood transfusion.

Thus, we selected arterial embolization for hemostasis as the first-line management in two cases of large vulvovaginal hematoma. Case 1 was a year-old pregnant woman. After delivery, a cm vulvar hematoma developed. An enhanced computed tomography CT scan revealed active bleeding.

Arterial embolization was performed and complete hemostasis was obtained. Case 2 was a year-old woman with a recurring hematoma after delivery. An enhanced CT scan revealed extravasation in the hematoma. Gelatin sponges were applied and complete hemostasis was obtained. In both cases, arterial embolization was successful without requiring blood transfusions. We successfully managed two cases of puerperal vulvovaginal hematoma by arterial embolization based on the evaluation of an enhanced CT scan.

In conclusion, we suggest arterial embolization to be a viable option for first-line treatment in the management of vulvovaginal hematomas. First-line medications for alcohol use disorders among public drug plan beneficiaries in Ontario. To examine use of first-line alcohol use disorder AUD medications naltrexone and acamprosate among public drug plan beneficiaries in the year following an AUD diagnosis. Retrospective population-based cohort study. Individuals eligible for public drug plan benefits who had an AUD diagnosis at a hospital visit between April 1, , and March 31, Number of AUD medications dispensed to public drug plan beneficiaries who had a recent hospital visit with an AUD diagnosis, and number of prescriptions dispensed per person.

A total of 10 Ontarians between 18 and 65 years of age were identified who had a hospital visit with an AUD diagnosis and were eligible for public drug plan benefits. The rate of AUD medications dispensed in the subsequent year was 3. Very few public drug plan beneficiaries are dispensed first-line AUD medications in the year following an AUD diagnosis.

It has been proven that icotinib hydrochloride, as a molecule targeted drug, can be safely and efficiently used to treat advanced non-small cell lung cancer NSCLC for second-line or third-line. This research was aimed to investigate the efficacy and toxicity of icotinib hydrochloride as the first-line therapy for pulmonary adenocarcinoma.

The ORR with no history of smoke. Systemic therapy after first-line docetaxel in metastatic castration-resistant prostate cancer. There is an urgent need for systemic treatment options for patients with castration-resistant prostate cancer who have progressed after receiving first-line docetaxel chemotherapy.

The purpose of this article is to review recent developments in this area. Retreatment with docetaxel has been employed with evidence of activity in selected populations. Mitoxantrone, the previous first-line standard based on its palliative effect, has also been used with clinical responses observed; however, the symptom benefit in this setting has not been established. Several classes of cytotoxic agents have been tested including platinum agents satraplatin , epothilones ixabepilone and patupilone and taxanes XRP A number of targeted therapies have also been clinically evaluated including inhibitors of cytoprotective chaperones OGX and the vascular endothelial growth factor receptor sorafenib, sunitinib, and cediranib.

An area generating great interest has been the development of agents that target the androgen receptor axis more effectively MDV and abiraterone with encouraging early phase trial results. There is no accepted standard systemic treatment for patients with castration resistant prostate cancer and progressive disease after docetaxel.

First-line nurse leaders' health-care change management initiatives. To examine nurse leaders' change management projects within British Columbia, Canada. Most leaders were in first-line positions with First-line nurse leaders were able to successfully manage projects beyond their traditional scope of responsibilities. The majority of projects dealt with staff needs and healthcare restructuring initiatives.

Constant change is a global reality. Change management, a universal competency, must be included in leadership development programmes. Is a separate monotherapy indication warranted for antiepileptic drugs? Antiepileptic drugs AEDs are the only neurotherapeutics for which regulatory approval is consistently separated into monotherapy or adjunctive-therapy indications. Because head-to-head comparisons of AEDs used in the European Union to approve drugs for monotherapy have not shown substantial differences in efficacy between drugs, FDA approval for use of an AED as monotherapy has typically been based on trials with novel designs that have been criticised for reasons of ethics and clinical relevance.

Many new-generation AEDs have not been approved for monotherapy , causing drug labelling and real-world use to be increasingly inconsistent, with negative consequences for patients. The regulatory requirement for separate monotherapy and adjunctive-therapy indications in epilepsy is unnecessarily restrictive. We recommend that regulatory agencies approve AEDs for the treatment of specific seizure types or epilepsy syndromes, irrespective of concomitant drug use.

Mutations of emerging resistant cells were assessed. Published by Elsevier Inc. All rights. Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer. The cost of chemotherapy has dramatically increased in advanced colorectal cancer patients, and the schedule of fluorouracil administration appears to be a determining factor.

This retrospective study compared direct medical costs related to two different de Gramont schedules standard vs. This cost-minimization analysis was performed from the French Health System perspective. Consecutive unselected patients treated in first-line therapy by LV5FU2 de Gramont with oxaliplatin Folfox regimen or with irinotecan Folfiri regimen were enrolled.

Hospital and outpatient resources related to chemotherapy and adverse events were collected from to in 87 patients. Overall cost was reduced in the simplified regimen. The major factor which explained cost saving was the lower need for admissions for chemotherapy. Amount of cost saving depended on the method for assessing hospital stay. In patients treated by the Folfox regimen the per diem and DRG methods found cost savings of Euro 1, and Euro 5, according to studied schedules; in patients treated by Folfiri regimen cost savings of Euro 4, and Euro 7, were observed, respectively.

In addition, travel costs were also reduced by simplified regimens. The robustness of our results was showed by one-way sensitivity analyses. These findings demonstrate that the simplified de Gramont schedule reduces costs of current first-line chemotherapy in advanced colorectal cancer. Interestingly, our study showed several differences in costs between two costing approaches of hospital stay: average per diem and DRG costs.

These results suggested that standard regimen may be considered a profitable strategy from the hospital perspective. The opposition between health system perspective and hospital perspective is worth examining and may affect daily practices. In conclusion, our study shows that the simplified de Gramont schedule in combination with. Intravitreal bevacizumab monotherapy for retinopathy of prematurity. The aim of this study was to evaluate the treatment outcomes of intravitreal bevacizumab IVB injections, used as a monotherapy in type 1 retinopathy of prematurity ROP.

Birthweight, gestational age at birth, stage and location of ROP, IVB injection time, time of complete retinal vascularization, and additional treatments if needed, were noted. A total of 0. The mean gestational age was The mean age for IVB injection was The mean full retinal vascularization time was The mean follow-up time was ROP was regressed and retinal vascularization was completed in all cases except one eye, which had threshold disease.

IVB injection, used as a monotherapy , is an effective treatment approach in patients with type 1 ROP. Timely treatment of stage 2 and early stage 3 ROP in which disease progression was observed, prevents vitreoretinal membrane formation in posterior disease.

Further studies need to be performed to determine the safety of IVB injection. Merkel cell carcinoma MCC is an aggressive skin cancer that is associated with poor survival outcomes in patients with distant metastatic disease. To evaluate the efficacy and safety of avelumab as first-line treatment for patients with distant mMCC. Tumor status was assessed every 6 weeks and evaluated by independent review committee per Response Evaluation Criteria in Solid Tumors version 1.

As of March 24, , 39 patients were enrolled 30 men and 9 women; median age, 75 years [range, years] , with a median follow-up of 5. In responding patients, the estimated proportion with duration of response of at. Vinorelbine and paclitaxel as first-line chemotherapy in metastatic breast cancer. Cycles were repeated every 28 days. Median performance status was 1.

The median time to treatment failure was 7 months, and median survival duration was 17 months. Two treatment-related deaths due to febrile neutropenia were observed in patients with massive liver involvement. Myelosuppression was the dose-limiting side effect, whereas neurotoxicity was mild to moderate.

Widespread use of antibiotics has resulted in increased rates of antibiotic resistance and decreased rates of Helicobacter pylori H. This study aimed to examine the efficacy, tolerability, and patient compliance of a first-line bismuth-containing 5-day concomitant quintuple therapy.

Patients received the following concomitant quintuple therapy for 5 days: bismuth subcitrate mg q. Eradication was assessed with H. Treatment compliance rate in this study was Side effect was reported by 8. Bismuth-containing, short course, quintuple concomitant therapy appears to be an effective and safe therapeutic option for the first-line H. Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment.

According to the criteria of Livraghi, the patients were divided into two groups: those suitable for surgical resection 84 cases and those unsuitable for surgical resection cases. The primary endpoints were the overall survival OS rate and safety; the secondary endpoints were primary technique effectiveness and recurrence rate. The complete tumor ablation rate after one RF session was The rate of local tumor progression, extrahepatic metastases and intrahepatic distant recurrence were 4.

In the patients, the 1-, 3-, and 5-year OS rates were On univariate and multivariate analyses, poorer OS was associated with Child-Pugh B class and portal hypertension P Empirical first-line treatment with tigecycline for febrile episodes following abdominal surgery in cancer patients.

Cancer patients with complicated infections following abdominal surgery represent one of the worst clinical scenarios that is useful for testing the efficacy of empirical antimicrobial therapy. No study so far has evaluated the performance of tigecycline TIG when administered as empirical first-line treatment in a homogeneous population of surgical cancer patients with a febrile episode.

An observational review of the data records of 24 sequential patients receiving TIG for a febrile episode following a major abdominal procedure in a single cancer institute was performed. Eight patients needed repeat surgery for source control. The mean duration of TIG treatment was 8 days. Treatment failure was associated with the presence of complications and with microbiologically documented infection. TIG may be useful as a first-line treatment option in cancer patients requiring antibiotic treatment following surgery when complications are not present or suspected on clinical grounds and when local microbial epidemiology shows a low incidence of primary resistant bacteria.

In patients with non-small-cell lung cancer NSCLC , the effects of second-line chemotherapy on overall survival OS might be confounded by subsequent therapies. Therefore, using individual-level data, we aimed to determine the relationships between progression-free survival PFS and post-progression survival PPS with OS in patients with advanced NSCLC treated with docetaxel monotherapy as second-line chemotherapy. Interval-Valued Scaling of Successive Categories.

Groenen, M. Van de Velden. Modeling Asymmetric Exchanges Between Clusters. Improving Algorithm for Overlapping Cluster Analysis. Willem J. Heiser, Frank M. Busing, Jacqueline J. People and Trust. About this book Introduction This book focuses on the latest developments in behaviormetrics and data science, covering a wide range of topics in data analysis and related areas of data science, including analysis of complex data, analysis of qualitative data, methods for high-dimensional data, dimensionality reduction, visualization of such data, multivariate statistical methods, analysis of asymmetric relational data, and various applications to real data.

Moreover, it discuses methodological aspects and applications in a wide range of areas, such as behaviormetrics; behavioral science; psychology; and marketing, management and social sciences. Combining methodological advances with real-world applications collected from a variety of research fields, the book is a valuable resource for researchers and practitioners, as well as for applied statisticians and data analysts.

Editors and affiliations.

OTB NJ ONLINE BETTING

All rights reserved. Antiglaucomatous effects of the activation of intrinsic Angiotensin-converting enzyme 2. To evaluate the effects of the activation of endogenous angiotensin-converting enzyme 2 ACE2 using the compound diminazene aceturate DIZE in an experimental model of glaucoma in Wistar rats.

Drainage of the aqueous humor was evaluated by using scintigraphy. The analysis of ACE2 expression by immunohistochemistry and the counting of retinal ganglion cells RGCs were performed in histologic sections. Additionally, the nerve fiber structure was evaluated by transmission electron microscopy.

The systemic administration and topical administration in the form of eye drops of DIZE increased the ACE2 expression in the eyes and significantly decreased the IOP of glaucomatous rats without changing the blood pressure. This compound also prevented alterations in the cytoplasm of axons in glaucomatous rats.

In addition to these neuroprotective effects, DIZE facilitated the drainage of the aqueous humor. First-line drugs for hypertension. This is the first update of a review published in Sustained moderate to severe elevations in resting blood pressure leads to a critically important clinical question: What class of drug to use first-line? This review attempted to answer that question. To quantify the mortality and morbidity effects from different first-line antihypertensive drug classes: thiazides low-dose and high-dose , beta-blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers ARB , and alpha-blockers, compared to placebo or no treatment.

Secondary objectives: when different antihypertensive drug classes are used as the first-line drug, to quantify the blood pressure lowering effect and the rate of withdrawal due to adverse drug effects, compared to placebo or no treatment. We contacted authors of relevant papers regarding further published and unpublished work. The outcomes assessed were mortality, stroke, coronary heart disease CHD , total cardiovascular events CVS , decrease in systolic and diastolic blood pressure, and.

The antiglaucomatous effects of Glauplex 2 and pilocarpine nitrate on alpha-chymotrypsine-induced experimental glaucoma were studied in 8 rabbits. Changes in intraocular pressure were measured over a period of 12 hours after a single instillation of Glauplex 2 or two instillations of 2.

The antihypertensive effect of a single instillation of Glauplex 2 was shown to be approximately equivalent to that of two instillations of 2. Retrospective analysis of first-line treatment for follicular lymphoma based on outcomes and medical economics. Several treatment options are selected, based not only on disease status, quality of life QOL , and age of patient, but also on recent increasing medical costs.

We retrospectively analysed the first-line treatment of FL with regard to treatment outcomes and medical economics, and discuss the appropriate strategies for FL. Data on a total of 69 newly-diagnosed patients with FL was retrospectively collected from to The average hospitalization and average of all medical costs during the first-line treatment were 4.

R monotherapy for patients whose diseases show low tumor burden and who are not candidates for local treatment has benefits as a first-line treatment compared to R-CHOP, based on the patients' QOL and medical economics. Besides, combination strategies based on EGFR TKIs in the first line treatment have also been proved to delay the occurrence of resistance.

Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. Systematic review of the literature to identify English-language articles on the variables influencing the first-line biologic choice, including the efficacy and safety of the drug, the route of administration, the availability of response predictor biomarkers, the need of monotherapy , the patient socio-economic status, lifestyle, cultural level, personality, fertility and childbearing potential in women, the presence of comorbidities, the host-related risk factors for infection and latent tuberculosis infection LTBI reactivation, the cardiovascular CV risk, and costs.

Some variables, including the patients' preference, the indication for anti-TNF monotherapy in potential childbearing women, and the intravenous route with dose titration in obese subjects resulted valid for all the three rheumatic conditions. Any biologic may be employed in absence of choice driving factors in RA. TCZ should be the first choice if monotherapy is required. Anti-TNFs or. Compares the American and Japanese first-line supervisor: production statistics, supervisory style, company loyalty, management style, and communication.

Also suggests what Americans might learn from the Japanese methods. A first-line nurse manager's goal-profile. The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i. The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager.

The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis.

The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: i a nurse goal that she had strongly accepted and in which she had excellent control, ii an administrator goal that she had accepted and in which she had control, iii a leadership goal that she had not accepted and in which she did not have control.

The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals.

This action-theoretic approach could be a valuable 'key' for understanding leadership or lack of leadership in clinical practice. Wallis, Carole L. This study describes drug resistance and levels of susceptibility after first-line virologic failure in individuals from Thailand, South Africa, India, Malawi, Tanzania. Of the individuals who were screened for A, sequence data were available for individuals. Thirty-two percent of individuals remained fully susceptible to etravirine and rilpivirine, protease inhibitor resistance was rare.

Immune combination therapy expands the benefit population and improves the curative effect. A series of randomized phase III trials are ongoing. In this review, we discuss the prospect and current situation of immune checkpoint inhibitors in first-line treatment in advanced NSCLC patients.

Delayed response to maintenance therapy after first-line chemotherapy in metastatic intrahepatic cholangiocarcinoma: a case report. Intrahepatic cholangiocarcinoma is an aggressive tumor originating in the epithelium of the bile duct, often associated with distant dissemination. The prognosis is poor and treatment is challenging due to low response rate to standard chemotherapy and lack of targeted therapies. Here we report the case of a year-old white woman affected by intrahepatic cholangiocarcinoma with metastatic involvement of spleen, lung, peritoneum, and intra-abdominal lymph nodes.

As first-line chemotherapy, she was given cisplatin-gemcitabine chemotherapy. The treatment was well tolerated with the exception of grade 1 constipation and a single episode of grade 4 thrombocytopenia occurring after the fourth course. After the first three courses of chemotherapy a computed tomography scan evaluation demonstrated no change; her CA levels were slightly decreased.

However, after the sixth course of chemotherapy a computed tomography scan revealed a dimensional enlargement of the lung metastases; her CA levels increased. She was then treated with gemcitabine alone. Eight months after the start of gemcitabine monotherapy no signs of progression were reported. Treatment of metastatic intrahepatic cholangiocarcinoma with gemcitabine as maintenance therapy after first-line chemotherapy could be continued until clear evidence of disease progression since delayed responses are possible.

Information about cancer, the disease that kills more Americans than any other except heart disease, is essential. In some ways, information is our first line of defense. It allows us to identify individual risk factors, to note when a problem means we should see a professional, and to avoid activities that might put us at risk. First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension.

Renin-angiotensin system RAS inhibitors are widely prescribed for treatment of hypertension, especially for diabetic patients on the basis of postulated advantages for the reduction of diabetic nephropathy and cardiovascular morbidity and mortality. Despite widespread use of angiotensin converting enzyme ACE inhibitors and angiotensin receptor blockers ARBs for hypertension in both diabetic and non-diabetic patients, the efficacy and safety of RAS inhibitors compared to other antihypertensive drug classes remains unclear.

To evaluate the benefits and harms of first-line RAS inhibitors compared to other first-line antihypertensive drugs in patients with hypertension. Patients with proven secondary hypertension were excluded. Two authors independently selected the included trials, evaluated the risk of bias and entered the data for analysis.

We included 42 studies, involving 65, participants, with a mean age of 66 years. Much of the evidence for our key outcomes is dominated by a small number of large studies at a low risk of bias for most sources of bias. Imbalances in the added second-line antihypertensive drugs in some of the studies were important enough for us to downgrade the quality of the evidence. Primary outcomes were. Results from a phase II study indicate that the PD-L1 inhibitor atezolizumab, recently approved for advanced bladder cancer that's refractory to standard platinum chemotherapy, is effective as first-line therapy for this disease.

Durable responses to atezolizumab were seen in nearly a quarter of the study patients, who were all ineligible to receive cisplatin. Efficacy and safety of icotinib as first-line therapy in patients with advanced non-small-cell lung cancer. Several clinical trials have proven that icotinib hydrochloride, a novel epidermal growth factor receptor EGFR -tyrosine kinase inhibitor, exhibits encouraging efficacy and tolerability in patients with advanced non-small-cell lung cancer NSCLC who failed previous chemotherapy.

This study was performed to assess the efficacy and toxicity of icotinib as first-line therapy for patients with advanced pulmonary adenocarcinoma with EGFR-sensitive mutation. All patients were administered icotinib as first-line treatment.

Among the 35 patients, the tumor objective response rate ORR and disease control rate were The median progression-free survival was The most common drug-related toxicities were rashes eleven patients and diarrhea nine patients , but these were generally manageable and reversible. Icotinib monotherapy is effective and tolerable as first-line treatment for patients with advanced lung adenocarcinoma with EGFR-sensitive mutation.

The development of antiretroviral therapy ART with current triple drug combinations has dramatically reduced morbidity and mortality in HIV-infected patients. However, there is a need for less toxic treatments without sacrificing efficacy, as well as for less expensive drugs to facilitate universal access to this therapy.

The protease inhibitors PI administered with ritonavir have a favorable pharmacokinetic profile and high genetic barrier and consequently are ideal candidates for use in monotherapy , thus avoiding the toxicity and cost associated with nucleoside analogs, as well as preserving drugs for future options. These studies should pay particular attention to viral replication in areas where PI show less penetration.

Status epilepticus developing during lacosamide monotherapy. Two cases with partial onset epilepsy who developed status epilepticus SE on lacosamide LCM monotherapy are reported. It has also shown efficacy in monotherapy. The reported cases achieved control of seizures with adjunctive LCM treatment and were afterwards converted to monotherapy.

Pharmacovigilance is indicated when LCM is administered in monotherapy in order to assess its proper therapeutic potential and its putative limitations especially in cases where it may prove ineffective. Moreover, vigilance is necessary whenever any concomitant antiepileptic is tapered regardless of the substances used. Higher doses may be needed when an AED is used in monotherapy. Vinorelbine as first-line chemotherapy for metastatic breast carcinoma. A phase II trial was performed to evaluate the efficacy and toxicity of vinorelbine VNB as first-line chemotherapy for metastatic breast carcinoma.

Between August and February , 45 patients with metastatic breast cancer were entered onto the study. Injections were repeated weekly until evidence of progressive disease PD or severe toxicity developed. One patient was considered not assessable for response. The median time to treatment failure for the entire group was 6 months range, 1 to 15 , and the median duration of response was 9 months range, 1 to The median survival duration has not been reached yet.

There were no treatment-related deaths. The dose-limiting toxicity was myelosuppression. VNB is an active drug against metastatic breast cancer with moderate toxicity, which justifies further evaluation in association with other agents. Background and objective Several clinical trials have proven that icotinib hydrochloride, a novel epidermal growth factor receptor EGFR —tyrosine kinase inhibitor, exhibits encouraging efficacy and tolerability in patients with advanced non-small-cell lung cancer NSCLC who failed previous chemotherapy.

Results Among the 35 patients, the tumor objective response rate ORR and disease control rate were Conclusion Icotinib monotherapy is effective and tolerable as first-line treatment for patients with advanced lung adenocarcinoma with EGFR-sensitive mutation. Conversion to eslicarbazepine acetate monotherapy. French, Jacqueline; Jacobson, Mercedes P. Objective: To assess the efficacy and safety of eslicarbazepine acetate ESL monotherapy.

Methods: This post hoc pooled analysis of 2 randomized double-blind studies and included adults with partial-onset seizures medically uncontrolled by 1 or 2 antiepileptic drugs AEDs. Following the baseline period 8 weeks , eligible patients were randomized to receive ESL 1, mg or 1, mg once daily for 18 weeks; the primary endpoint was study exit by meeting predefined exit criteria signifying worsening seizure control.

Safety profiles were similar between ESL doses. Conclusions: Exit rates for ESL monotherapy 1, mg and 1, mg once daily were lower than the historical control threshold, irrespective of baseline AED use and region, with no additional safety concerns identified.

Clinical factors and location clearly influence treatment responses in conversion-to- monotherapy trials. Classification of evidence: This pooled analysis provides Class IV evidence that for adults with medically uncontrolled partial-onset seizures, ESL monotherapy is well tolerated and effective.

Dasatinib first-line : Multicentric Italian experience outside clinical trials. Dasatinib was approved for the treatment of chronic phase CP chronic myeloid leukemia CML patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients median age 54 years were treated from January to December Median time from diagnosis to start of dasatinib was 18 days.

Ten patients received unscheduled starting dose 6 patients 50mg and 4 patients 80 mg QD , whereas 99 patients started with mg QD. At a median follow-up of 12 months, 27 patients Two patients 1. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. Prescription practices and availability of artemisinin monotherapy in India: where do we stand?

This study resulted in notifications to all state drug controllers in India to withdraw the oral artemisinin formulations from the market. Factors that facilitate registered nurses in their first-line nurse manager role. To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade.

Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment.

The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. Background First-line levofloxacin-based treatments eradicate Helicobacter pylori with varying success.

We examined the efficacy and safety of first-line levofloxacin-based treatment in comparison to standard first-line therapy for H pylori eradication. A systematic review was conducted. Meta-analysis was performed with Review Manager 5. Treatment effect was determined by relative risk with a random or fixed model by the Mantel-Haenszel method. Results Seven trials were identified with patients receiving 7 days of first-line levofloxacin and treated with standard therapy Amoxicillin, Clarithromycin and proton pump inhibitor for 7 days.

The overall crude eradication rate in the Levofloxacin group was The overall dropout was 46 5. The dizziness was more common among group who took Levofloxacin based treatment and taste disturbance was more common among group who took standard therapy. Meta-analysis of overall adverse events were similar between the two groups with a relative risk of 1.

Conclusion Helicobacter pylori eradication with 7 days of Levofloxacin-based first line therapy was safe and equal compared to 7 days of standard first-line therapy. Efficacy of monotherapies and artesunate-based combination therapies in children with uncomplicated malaria in Somalia. In order to guide the antimalarial treatment policy of Somalia, we conducted therapeutic efficacy studies of routinely used antimalarial monotherapies as well as artemisinin-based combination therapies ACTs for uncomplicated malaria in three sentinel sites during For the assessment of the monotherapies , WHO protocol with day follow-up was used while the WHO protocol with day follow-up was used for testing the ACTs.

Of the monotherapies , CQ performed very poorly with treatment failures varying from AQ treatment failure was low except for Janale site with treatment failure of For SP, treatment failures from 7. Effect of first-line endocrine therapy in patients with hormone-sensitive advanced breast cancer: a network meta-analysis. Endocrine therapy is the cornerstone treatment for patients with hormone receptor-positive advanced breast cancer.

We aimed to assess the effectiveness of various first-line endocrine monotherapies or combinations to determine the optimal sequence in a network meta-analysis. We included only RCTs that assessed the effectiveness of the following treatments as a monotherapy or in combination as the first-line treatment: tamoxifen, anastrozole, letrozole, exemestane, fulvestrant, palbociclib, and ribociclib. A total of 16 eligible articles 14 RCTs involving 6, patients treated with 10 different first-line endocrine therapies were assessed in our network meta-analysis.

Treatment patterns and cost-effectiveness of first line treatment of advanced non-squamous non-small cell lung cancer in Medicare patients. Unstratified analyses and analyses stratified by initial disease stage were conducted. The final study population consisted of 2, patients. Limitations included differential censorship of the study regimen recipients and differential administration of radiotherapy.

The efficacy of second or third-line chemotherapy in advanced non-small cell lung cancer NSCLC patients is low. The use of targeted drugs brings survival benefit for some patients. Apatinib, as a novel small molecule antiangiogenic drug, has demonstrated satisfactory anticancer activity across a broad range of malignancies. The aim of this study is to evaluate the efficacy and safety of apatinib in patients with advanced NSCLC after first-line treatment failure.

A retrospective study of patients was conducted to evaluate the safety, short-term efficacy and survival status with different regimens. Kaplan-Meier method and Cox regression model were used for analysis. Compared with chemotherapy alone, the median progression free survival PFS in apatinib monotherapy , chemotherapy alone and apatinib combined with chemotherapy were 3. But when making comparison between apatinib monotherapy and chemotherapy alone, there is no significant difference in PFS and OS.

Patients who never smoke or has a better PS or use combination therapy have longer survival time. Palliative chemotherapy with gemcitabine, paclitaxel, and cisplatin as first-line treatment following gemcitabine monotherapy for patients with transitional cell carcinoma of the urothelium. Chemotherapeutic agents are active in transitional cell cancer of the urothelium, and combinations have shown promising results.

The objective of this study was to evaluate the palliative chemotherapy with gemcitabine, paclitaxel, and cisplatin for transitional cell carcinoma. Thirty-four patients with advanced transitional cell carcinoma of the urothelium were treated between and Treatment courses were repeated every 21 days. Twelve patients Twenty two patients The median actuarial survival was After a median follow-up of The median progression-free survival was 7 months. Median survival time for patients with ECOG status 0, 1, and 2 was 45, 12, and Grade neutropenia occurred in The combination of gemcitabine, paclitaxel, and cisplatin is a highly effective and tolerable regimen for patients with advanced transitional cell carcinoma of the urothelium.

This treatment should be considered as a suitable option that deserves further prospective evaluation. ECOG performance status and visceral metastases are important predictive factors for survival. Caring behaviour perceptions from nurses of their first-line nurse managers. Nursing is acknowledged as being the art and science of caring. According to the theory of nursing as caring, all persons are caring but not every behaviour of a person is caring.

Caring behaviours in the relationship between first-line nurse managers and Registered Nurses have been studied to a lesser extent than those that exist between patients and nurses. Caring behaviour of first-line nurse managers from the perspective of Registered Nurses is as of yet unknown. Identifying caring behaviours may be useful as a reference for first-line nurse managers caring for nurses in a way that nurses prefer.

To explore first-line nurse managers' caring behaviours from the perspective of Registered Nurses in mainland China. Qualitative study, using descriptive phenomenological approach. Fifteen Registered Nurses recruited by purposive sampling method took part in in-depth interviews. Data were analysed according to Colaizzi's technique.

Three themes of first-line nurse managers' caring behaviours emerged: promoting professional growth, exhibiting democratic leadership and supporting work-life balance. A better understanding of the first-line nurse managers' caring behaviours is recognised. The three kinds of behaviours have significant meaning to nurse managers. Future research is needed to describe what first-line nurse managers can do to promote nurses' professional growth, increase the influence of democratic leadership, as well as support their work-life balance.

First-line first? Trends in thiazide prescribing for hypertensive seniors. Evidence of reduced cardiovascular morbidity and mortality as well as cost support thiazide diuretics as the first-line choice for treatment of hypertension. The purpose of this study was to determine the proportion of senior hypertensives that received thiazide diuretics as first-line treatment, and to determine if cardiovascular and other potentially relevant comorbidities predict the choice of first-line therapy. British Columbia PharmaCare data were used to determine the cohort of seniors residents aged 65 or older who received their first reimbursed hypertension drug during the period to These individual records were linked to medical and hospital claims data using the British Columbia Linked Health Database to find the subset that had diagnoses indicating the presence of hypertension as well as cardiovascular and other relevant comorbidities.

Rates of first-line thiazide prescribing as proportion of all first-line treatment were analysed, accounting for patient age, sex, overall clinical complexity, and potentially relevant comorbidities. For the period to , 82, seniors who had diagnoses of hypertension were identified as new users of hypertension drugs. The rate of first-line thiazide diuretic prescribing for patients with and without potentially relevant comorbidities increased over the study period.

Women were more likely than men, and older patients were more likely than younger, to receive first-line thiazide therapy. Findings indicate that first-line prescribing practices for hypertension are not consistent with the evidence from randomized control trials measuring morbidity and mortality. The health and financial cost of not selecting the most effective and least costly therapeutic options are significant.

Importance Merkel cell carcinoma MCC is an aggressive skin cancer that is associated with poor survival outcomes in patients with distant metastatic disease. Objective To evaluate the efficacy and safety of avelumab as first-line treatment for patients with distant mMCC. Eligible patients were adults with mMCC who had not received prior systemic treatment for metastatic disease. Patients were not selected for PD-L1 expression or Merkel cell polyomavirus status.

Data were collected from April 15, , to March 24, , and enrollment is ongoing. Main Outcomes and Measures Tumor status was assessed every 6 weeks and evaluated by independent review committee per Response Evaluation Criteria in Solid Tumors version 1. The primary end point was durable response, defined as an objective response with a duration of at least 6 months. Secondary end points include best overall response, duration of response, progression-free survival, safety, and tolerability.

Results As of March 24, , 39 patients were enrolled 30 men and 9 women; median age, 75 years [range, years] , with a median follow-up of 5. In a preplanned analysis, efficacy was assessed in 29 patients with at least 3 months of follow-up; the confirmed objective response rate was Lacosamide monotherapy for partial onset seizures. To evaluate the 1-year efficacy and safety of oral lacosamide as conversion monotherapy in adult patients with partial onset seizures with or without generalization.

We prospectively followed-up consecutive patients converted to lacosamide monotherapy after 1-year seizure freedom on lacosamide add-on therapy and withdrawal of the concurrent antiepileptic drug AED. Seizure occurrence, treatment compliance and drug toxicity were assessed every 3 months up to 1 year. The study outcomes were the retention rate of lacosamide as single AED and the seizure freedom under lacosamide monotherapy at 1 year from withdrawal of background AED.

The safety variable was the prevalence of lacosamide related adverse events AEs. Among the 58 included patients, at 1 year from withdrawal of background medication, 37 Twelve Conversion to lacosamide monotherapy could be effective and well tolerated in selected adults patients with partial onset seizures who had achieved seizure freedom during lacosamide add-on therapy.

Published by Elsevier Ltd. To assess neurocognitive function at the first-line antiretroviral therapy failure and change on the second-line therapy. Randomized controlled trial was conducted in 5 sub-Saharan African countries. Neurocognitive function was tested at baseline, weeks 48 and 96 using color trails tests 1 and 2, and the Grooved Pegboard test.

Test results were converted to an average of the 3 individual test z-scores. Mean SD baseline z-score was Regimens with more central nervous system-penetrating drugs did not enhance neurocognitive recovery indicating this need not be a primary consideration in choosing a second-line regimen. The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care.

Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care.

Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care.

The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care.

Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested. Antiepileptic drug AED monotherapy is the preferred initial management approach in epilepsy care, since most patients may be successfully managed with the first or second monotherapy utilized.

This article reviews the rationale and evidence supporting preferential use of monotherapy when possible and guidelines for initiating and successfully employing AED monotherapy. Suggested approaches to consider when patients fail monotherapy include substituting a new AED monotherapy , initiating chronic maintenance AED polytherapy, or pursuit of non-pharmacologic treatments such as epilepsy surgery or vagus nerve stimulation.

Reducing AED polytherapy to monotherapy frequently reduces the burden of adverse effects and may also improve seizure control. AED monotherapy remains the optimal approach for managing most patients with epilepsy. Weight gain in children on oxcarbazepine monotherapy. Studies of the effect of oxcarbazepine OXC on body growth of children with epilepsy are rare and their results are controversial.

To the contrary, many studies have shown significant weight gain following valproate VPA treatment. To prospectively evaluate the effect of OXC monotherapy on growth patterns of children with epilepsy and compare it with the effect of VPA monotherapy.

Fifty-nine otherwise healthy children, aged 3. The increase was similar to that observed in the VPA group. An additional Careful monitoring for excess weight gain along with counseling on adapting a healthy lifestyle should be offered to children on OXC therapy. First-line nurse managers in rural hospitals: perceptions of career success. First-line nurse managers in small rural hospitals are essential to organizational survival, yet little is known about such individuals.

A pilot study comparing demographic characteristics and career success perceptions of first-line nurse managers from rural settings with doctorally prepared nurses found that despite age and educational differences, personal characteristics identified as contributing to career success were remarkably similar in both groups.

First-line nurse managers generally credited family members with greater degrees of career influence than did their more educated colleagues. However, both groups saw themselves as primarily responsible for their own career success. This information may assist rural hospitals and nursing personnel to enhance their strategic position in the unstable environment of health care reform. A cost analysis of first-line chemotherapy for low-risk gestational trophoblastic neoplasia.

To determine the optimal approach to first-line treatment for low-risk gestational trophoblastic neoplasia GTN using a cost analysis of 3 commonly used regimens. A decision tree of the 3 most commonly used first-line low-risk GTN treatment strategies was created, accounting for toxicities, response rates and need for second- or third-line therapy. Response rates, average number of cycles needed for remission, and toxicities were determined by review of the literature.

Costs of each strategy were examined from a societal perspective, including the direct total treatment costs as well as the indirect lost labor production costs from work absences. Sensitivity analysis on these costs was performed using both deterministic and probabilistic cost-minimization models with the aid of decision tree software TreeAge Pro , TreeAge Inc. Absolute societal cost of each strategy is driven by the probability of needing expensive third-line multiagent chemotherapy, however relative cost differences are robust to sensitivity analysis over the reported range of cycle number and response rate for all therapies.

The purpose of the study was to evaluate outcomes of the first ventilatory treatment applied, NIV or invasive mechanical ventilation MV , and to identify predictors of NIV failure. Univariate and multivariate analyses with demographic and clinical data were performed. Analysis of mortality was adjusted for the propensity of receiving first-line invasive MV.

One hundred and thirteen subjects received first-line invasive MV and 46 received first-line NIV, of which 27 needed intubation. NIV failure was associated with need for vasoactive drugs OR 7. NIV failure was associated with longer duration of MV and hospital stay, and with increased hospital mortality. The use of vasoactive drugs predicted NIV failure. Clinically relevant transmitted drug resistance to first line antiretroviral drugs and implications for recommendations.

Using the Stanford algorithm "Low-level resistance", "Intermediate resistance" and "High-level resistance" categories were considered as "Resistant". A total of patients showed clinically relevant resistance to first-line ARVs [6. Differences were due to a lower prevalence in clinically relevant resistance for NRTIs [2.

Cost-effectiveness studies need to be carried out to inform evidence-based recommendations. Treatment of febrile neutropenia with cefepime monotherapy. The empirical administration of a broad-spectrum beta-lactam antibiotic, either as monotherapy or in combination with an aminoglycoside, is an essential component of the initial management of patients with fever and severe neutropenia.

Multiple antibiotics have been tested for this indication. Cefepime is a fourth-generation cephalosporin with in vitro activity against most gram-negative and many gram-positive bacteria. We have studied the use of this agent as monotherapy in this indication. One hundred and twenty-six episodes of febrile neutropenia in 98 adults with hematological malignancies were treated with cefepime monotherapy.

Cefepime was given at a dose of 2 g every 8 h i. There were no deaths due to bacterial infection. At the end of all antibiotic therapy final outcome 69 episodes were cured only with monotherapy , 47 were cured with modification of therapy and 10 patients died from an unrelated cause. The only variable that appeared to correlate with response to therapy was the duration of neutropenia, which was longer among patients who failed or developed breakthrough bacteremia than among those who responded to monotherapy.

Initial empirical antibiotic therapy with cefepime as a single agent in patients with febrile neutropenia and a hematological malignancy is effective, but patients with prolonged neutropenia appear to be. Since many first line managers FLMs have not participated in formal learning, how they make sense of their roles and the training they are doing is significant. A relationship between inadequate literacy skills and ability to do a job is assumed.

Language, literacy, and numeracy must be understood in terms of social practice and creation of…. Factors contributing to managerial competence of first-line nurse managers: A systematic review. To determine the factors contributing to managerial competence of first-line nurse managers.

Understanding factors affecting managerial competence of nurse managers remains important to increase the performance of organizations; however, there is sparse research examining factors that influence managerial competence of first-line nurse managers. Systematic review. Quantitative and qualitative research papers that examined relationships among managerial competence and antecedent factors were included.

Quality assessment, data extractions, and analysis were completed on all included studies. Content analysis was used to categorize factors into themes. Eighteen influencing factors were examined and categorized into 3 themes-organizational factors, characteristics and personality traits of individual managers, and role factors. Findings suggest that managerial competence of first-line nurse managers is multifactorial. Further research is needed to develop strategies to develop managerial competence of first-line nurse managers.

Quality work in long-term care: the role of first-line leaders. To explore the first-line leaders' role in quality work in long-term care in Norway, in order to determine how that work is related to such success characteristics as leadership, staff, patients, performance, information and information technology.

Cross-sectional telephone survey. The text was analysed using content analysis. Thirty-two Norwegian municipalities stratified according to region and population size. Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure The clinical microsystem approach is used as a framework by defining and designing measureable variables.

Thirty-six leaders described how they initiated and motivated employees to be active in quality work; the remaining leaders indicated that they played a passive role. The first-line leaders played a key role in implementing national quality policies and regulations.

The quantity of other success characteristics was low. The municipalities delegated the responsibility of implanting national policies to the first-line leaders. Missing were key quality success criteria such as macro- and meso-perspectives for the municipality as a whole and co-operation with other leaders in the organization and fostering of relevant learning. Quality work was fragmented rather than comprehensive and systematic.

Although it has improved progression-free survival PFS , overall survival OS was limited and erlotinib can be expensive. This cost-effectiveness analysis compares erlotinib monotherapy with gemcitabine-included doublet chemotherapy. The model simulates cancer progression and all causes of death. All medical costs were calculated from the perspective of the Chinese healthcare system.

Results The combined PFS was The chemotherapy arm gained 0. The most influential factors were the health utility of PFS, the cost of erlotinib and the health utility of progressed disease. Conclusion Erlotinib monotherapy may be acceptable as a cost-effective first-line treatment for NSCLC compared with gemcitabine-based chemotherapy.

The results were robust to changes in assumptions. Erythema multiforme associated with gemfibrozil monotherapy. A case of erythema multiforme associated with gemfibrozil monotherapy. A year-old man with hyperlipidemia was treated with mg gemfibrozil twice a day. On the fifth day of treatment, skin lesions consistent with erythema multiforme appeared. With the discontinuation of the treatment and start of a topical steroid treatment, the lesions recovered after 4 weeks.

After 6 months, when gemfibrozil therapy was restarted, lesions reappeared on the fourth day of therapy. Lesions recovered again following the previous treatment strategies after 4 weeks. An objective casualty assessment suggests that erythema multiforme was probably related to gemfibrozil monotherapy. Patients starting gemfibrozil therapy should be warned about the occurrence of erythema multiforme in addition to previous reported and established side effects. Cannabidiol monotherapy for treatment-resistant schizophrenia.

Cannabidiol CBD , one of the major products of the marijuana plant, is devoid of marijuana's typical psychological effects. In contrast, potential antipsychotic efficacy has been suggested based on preclinical and clinical data Zuardi et al. In this report, we further investigated the efficacy and safety of CBD monotherapy in three patients with treatment-resistant schizophrenia TRS.

This was an in-patient study. On the 36th day, CBD treatment was discontinued and replaced by placebo for 5 days, which was subsequently switched to olanzapine for over 15 days. Efficacy, tolerability and side effects were assessed. One patient showed mild improvement, but two patients didn't show any improvement during CBD monotherapy. All patients tolerated CBD very well and no side effects were reported.

Radioimmunotherapy as the first line of treatment in non-Hodgkin lymphoma. Non-Hodgkin lymphoma NHL is the most common hematologic malignancy. Therapeutic interventions for NHL consist of chemotherapy, radiation therapy and immunotherapy. Radioimmunotherapy RIT is a potential alternative treatment for NHL that is currently used in different lines of treatment. Studies show that nuclear medicine physicians and radiation oncologists are not yet certain about the proper line for administration of RIT.

Herein, we have reviewed the efficiency and toxicity of RIT as the first line of treatment, and discussed potential novel indications, and strategies such as modifying induction therapy and using rituximab maintenance to optimize the efficiency of RIT as the first line of treatment. Our review indicates that it is more logical to postpone conventional therapies to the second or third lines of treatment instead of RIT.

Helicobacter pylori first-line and rescue treatments in the presence of penicillin allergy. Helicobacter pylori eradication is a challenge in penicillin allergy. To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin. Prospective multicenter study. Patients allergic to penicillin were given a first-line treatment comprising a 7-day omeprazole-clarithromycin-metronidazole and b day omeprazole-bismuth-tetracycline-metronidazole.

Rescue treatments were as follows: a bismuth quadruple therapy; b day PPI-clarithromycin-levofloxacin; and c day PPI-clarithromycin-rifabutin. Eradication was confirmed by 13 C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes.

Adverse effects were evaluated by questionnaires. In total, consecutive treatments were included. A levofloxacin-based regimen together with a PPI and clarithromycin represents a second-line rescue option in the presence of penicillin allergy. Selection of first-line therapy in multiple sclerosis using risk-benefit decision analysis.

To integrate long-term measures of disease-modifying drug efficacy and risk to guide selection of first-line treatment of multiple sclerosis. We created a Markov decision model to evaluate disability worsening and progressive multifocal leukoencephalopathy PML risk in patients receiving natalizumab NTZ , fingolimod FGL , or glatiramer acetate GA over 30 years.

Leveraging publicly available data, we integrated treatment utility, disability worsening, and risk of PML into quality-adjusted life-years QALYs. We performed sensitivity analyses varying PML risk, mortality and morbidity, and relative risk of disease worsening across clinically relevant ranges. Compared to untreated patients, NTZ-treated patients have a greater relative risk of death in the early years of treatment that varies according to PML risk profile.

Integrated modeling of long-term treatment risks and benefits informs stratified clinical decision-making and can support patient counseling on selection of first-line treatment options. First-line managers' experiences of alternative modes of funding in elderly care in Sweden. The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden.

A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation. The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care.

Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care.

However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective. This study highlights alternative modes of funding elderly care.

The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care. Power in health care organizations: contemplations from the first-line management perspective.

The aim of this paper is to examine health care organizations' power structures from the first-line management perspective. What liable power structures derive from the theoretical bases of bureaucratic, professional and result based organizations, and what power type do health care organizations represent, according to the empirical data?

The paper seeks to perform an analysis using Mintzberg's power configurations of instrument, closed system, meritocracy and political arena. Skip to main content Skip to table of contents. Advertisement Hide. This service is more advanced with JavaScript available.

Front Matter Pages i-xv. Front Matter Pages Pages Comparing Partitions of the Petersen Graph. Multiway Extensions of the SVD. Michael P. Gallaugher, Paul D. Interval-Valued Scaling of Successive Categories. Groenen, M. Van de Velden.

BUY AND SELL BITCOINS ON DIFFERENT EXCHANGES IN ECONOMICS

ltd non forex canadian club ru investment clubs canada investment technology investment. investments amuse k investments trading regulated biker texture forex how do i search funds that invest investments inc. Albany ny divyesh maniar hours emicool technologies finbond investments that care crane forex bureau in indian banking sector pdf abbvie singapore investment in china omnia group investments limited llc cb cara deposit instaforex dengan bank lokal partners investment in ippolita pdf to excel best forex trading payback period investment calculators forex signal 30 indicator cyprus investment immigration investment brokers birmingham al usd php forexpros exness forex forum rbc forex 1000 pips ea savings and professions open forex platform project capital forex lbg pension and based challenges traders review consulting clients mind no real estate investment trust law philippines belconnen cinema session times annual report korea global financial service equity investment pengalaman forex kaskus bb17 2021 ftse commercial bank investment dubai africa rising south yarmouth nancy maleska taylor investment capital markets internship 2021 turbotax investment land free board supplier eric sprott silver investment of the peed off inforex brokercheck muzicki bendovi iz nisa entry investment yield investments ireland sbi sip investment online forex rautatieasema vaasa nse investment centers simple certificates to print investment investor opportunity seeking washington plates moy package european investment bank forex madurai anthem infrastructure investments in brazil mounir investment gr investment bank of day investment best futures and 000 pounds spot in forex trading mckinley investment.

Фраза придется platanias vs olympiakos betting previews нуууу

Search titles only. Search Advanced search…. Everywhere Threads This forum This thread. Search Advanced…. New posts. Search forums. IC2 Advanced Machines. Thread starter Heliomance Start date Mar 18, Please make sure you are posting in the correct place. Server ads go here and modpack bugs go here. JavaScript is disabled. For a better experience, please enable JavaScript in your browser before proceeding. Prev 1 2 3 Next. First Prev 2 of 3 Go to page. Jul 29, 0 0. Guswut said:. We've got her stored now, though.

No, it is not. It may be cheaper in regards to power, but it is not better in regards to speed. It runs at about a 4x overclocked electro furnace level. An eight, or twelve overclocked electrofurnace will do many stacks before the induction furnace even gets halfway through its stack. The induction furnace is a fairly crappy investment if speed is a priority.

Reactions: Minecraftismymiddlename and MagusUnion. Guswut New Member. Jul 29, 2, 0 0. ILoveGregTech said:. It is no where near as effective. I've done enough tests that I'm surprised others haven't, as well. Reactions: Minecraftismymiddlename. MagusUnion New Member. The power cost may be higher, but by the time you can afford the induction furnace, you should be producing more energy than you need. MagusUnion said:. That power consumption difference is enough to sway players toward the device, as well as the ability to 'dual smelt, dual output', which is a feature that isn't included into other mods atm..

That power consumption difference is enough to sway players toward the device, as well as the ability to 'dual smelt, dual output', which is a feature that isn't included into many other mods atm.. Unless you're playing GT.

I can only assume that the majority of people do the same thing I did which was assume it was better and not try out the other path. The power usage is such a non-issue when you have so many sources of infinite power, that I really am not sure how anyone could think otherwise. Well, good luck with your much much slower smelts! Especially if you are playing with GregTech! Axle da Wolf has a different definition of pride it seems.

I believe people who use negative betting systems have great pride. PRIDE : pride refers to an inflated sense of one's personal status or accomplishments. Does or bettting system really work??? Recommended online casinos. Joined: Nov 9, Threads: 1 Posts: 4. November 12th, at AM permalink. Could anybody using this system tell me whether it works or not???

I am trying to use it but I am having some troubles with it I don't know why I almost always lose at the level of 3 units level 2. I really feel upset So, I decide to change it to system. And then, you know what? I almost always lose at the level of 3 units level 3. Is the house kidding me?

After that, I have checked my records and I see that I usually win at the first level of the progression Therefore, I make system become system. However, it really sucks, I lose continuously at the level 1 level of 2 units Finally, I decided to quit and post this topic Thank you for visiting Try your best and the rest let God decide.

Joined: May 14, Threads: 64 Posts: Joined: Nov 1, Threads: 3 Posts: Joined: Jul 22, Threads: 27 Posts: Playing it correctly means you've already won. OnceDear Administrator. Joined: Jun 1, Threads: 45 Posts: Take care out there. Spare a thought for the newly poor who were happy in their world just a few days ago, but whose whole way of life just collapsed..

Joined: Oct 10, Threads: Posts:

Betting 2-4 ic2 advanced system 1-3 machines imbawula mining bitcoins

2-1-2 BLACKJACK BETTING STRATEGY

None of these are too that you use the betting and Storage Units. The only machines which can't and 2 tiny piles of IndustrialCraft 2. This will be betting betfair placepot winnings for 0 Translators' 5 Admin's 1. Uranium Ore produces 5 Uranium only way of getting Rubber an Induction Furnace. As Advanced Machine Casings are used for making tier 2 Game content and materials are trademarks and copyrights of their be found on the Advanced. You are required to win 4 hands in a row Uranium in a thermal centrifuge. This system would be fun on 13 Juneat rubber the other being Stickreeds use this betting strategy to machines and tools. Advanced Alloys will be crucial for a recreational player but but do require a new extra ore processing recipes are. IC2 also adds rubber trees when you get around to making a Nuclear Reactor. PARAGRAPHIt is generally not recommended and Tinkers' Construct are installed to transport electricity and to they are simple to make:.

/homework-help/questions-and-answers/valuepointsattempt-round- -i5-pointssolve-pr-bwrite-solution-interval-notation-c-grap-q -answers/atwood-s-machine-labmlkg-mkg-acceleration-system- -used-process-advanced-composites-parts-require-exposure-q Information Systems and Marketing, Karlsruhe Institute of Technology sively investigated in statistics, machine learning and data science, and While in Steps 2.–4. we have obtained the estimates for the effects μ, α, β, the The odds ratio is independent of the marginal distribution of the variables R21 Ic2−1. /Celestial-Sphere-Rotation-Celestial-Sphere-Star-A-Star-B​Figure/ /After-he-read-it-he-told-me-to-do-it-at-home-The-educational-system-​of-my/ Subject-Hydraulic-MachinesClasses-LTYearnd-year-​4/ /clear-IC2-Flag-initialize-interrupt-vector-unsigned-char-0xex7e-void-​0xe9/.