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The power grid has seen substantial growth in smaller-scale renewables, such as household, community, and commercial solar and battery systems. The high volume of interconnected distributed energy resources (DERs) has [...]

When Pooja Viswanathan, PhD, founded Braze Mobility in Toronto over three years ago, she wanted to apply her knowledge and passion for accessibility to a field where she could make [...]

Introduction: Several Testosterone Replacement Therapies exist for hypogonadism, but an in-depth analysis of these products reveals a high dosing frequency and a high drug loading, up to 120 mg for a potent drug like Testosterone. This may lead to patient non-compliance and toxicity problems if used improperly. Androderm®is the only 24-hour marketed transdermal patch. Testopel pellets are another extended-release product given subcutaneously every 3-6 months. But it requires surgical implantation and is associated with severe adverse effects. For this reason, the development of other extended- release testosterone products is needed. The study aims at using different excipients for the exploration of sustained-release patches. Methods: Reservoir formulations were prepared using Carbomer 941 and HPMC K100M as the sustained- release polymers plus CoTran™ 9702 and CoTran™ 9712 as the release membranes. The formulated patches were subjected to in vitrodissolution for 24 h. The amount of drug release at each time point was determined using the developed HPLC assay. FDA Similarity Factor, f2, t-test, and ANOVA were applied to all nine-point collected samples. Results: CoTran™ 9712 membrane was found to be a better candidate than CoTran™ 9702. The in vitrorelease profiles of the four formulations were compared (Carbomer vs.HPMC, and CoTran™ 9702 vs.CoTran™ 9712). Conclusion: CoTran™ 9702 releases testosterone significantly lower. Carbomer and CoTran™ 9712 were the best formulation among all with the highest drug release of 2.16 �± 0.36 mg.

The extent that universal social determinants of health (SDH) screening in clinical encounters, as recommended by the American Academy of Pediatrics, has been implemented in inpatient pediatric settings is unknown. We aimed to determine the national prevalence and predictors of standardized SDH screening in US level 2 to 4 neonatal care units (NICUs), describe characteristics of SDH screening programs, and ascertain beliefs of clinical leaders about this practice in the NICU setting.We randomly selected 100 hospitals with level 2 to 4 NICUs among each of 5 US regions (n = 500) and surveyed clinical leaders from January to November 2021 regarding standardized SDH screening. Responses were weighted for number of level 2 to 4 NICUs in each region and nonresponse.Overall response rate was 34% (28%–40% by region). Twenty-three percent of US level 2 to 4 NICUs reported standardized SDH screening. We found no associations of hospital characteristics, such as region, size, or safety-net status, with implementation of this practice. Existing programs conducted systematic screening early in the hospitalization (84%), primarily led by social workers (92%). We identified practice variation regarding the type of screening tool, but there was substantial overlap among domains incorporated in the screening. Reported barriers to implementation included perceived lack of resources, inadequate referrals, and lack of an inpatient screening tool.The prolonged neonatal hospitalization provides opportunities to systematically address SDH. Yet, only 23% of US level 2 to 4 NICUs have implemented this practice. To scale-up implementation, quality improvement may support adaptation of screening and referral processes to the NICU context.

EXECUTIVE SUMMARY * Laptops, flash drives, and other convenient devices may have significant unresolved risk exposures. Unless you encrypt or otherwise protect the data they contain, you're endangering your business [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.03.065 Byline: Antonio F. Corno, Edmund J. Ladusans, Marco Pozzi, Stephen Kerr Abbreviations: conv-PAB, conventional pulmonary artery banding; FW-PAB, FloWatch pulmonary artery banding; ICU, intensive care unit; PAB, pulmonary artery banding Abstract: We sought to compare the efficacy of conventional pulmonary artery banding with that of FloWatch pulmonary artery banding. Author Affiliation: Alder Hey Children Hospital, Liverpool, England. Article History: Received 9 February 2007; Revised 15 March 2007; Accepted 22 March 2007

The impact of activity-based costing and ISO standards on a business enterprise's total quality management is discussed.

Background: Per-oral cholangioscopy (POC) has evolved over the past decade from fiberoptic to digital and video imaging systems. Nowadays, only direct per-oral cholangioscopy (DPOC) and digital single-operator cholangioscopy (DS) are performed in daily practice. With better image resolution, POC is increasingly used as diagnostic tools in patients with suspected malignant biliary stricture (MBS). We aimed to evaluate the diagnostic yield of digital/video cholangioscopes for the diagnosis of MBS. Methods: A systematic search was performed in MEDLINE, Embase, and ISI Web of Knowledge databases until April 2020, to identify randomized controlled trials and prospective studies using digital or video POC. The meta-analysis of diagnostic accuracy study was performed to calculate summary estimates of the primary outcomes, including pooled sensitivity, and specificity of POC to diagnose MBS using bivariate random-effects models. Tissue histopathology was used as the reference standard for MBS diagnosis. For benign stricture, negative tissue histopathology and at least 6 months clinical follow-up were required. Results: Thirteen original articles with 876 patients were identified. The overall pooled sensitivity and specificity were 88 (95% CI 83–91) and 95 (95% CI 89–98), respectively. The area under the curve (AUROC) was 0.94 (95% CI 0.92–0.96). Subgroup analysis showed that cholangioscopic image impression provided significantly higher sensitivity (93% (95% CI 88–96) vs 82% (95% CI 76–87); p= 0.007), but lower specificity 86% (95% CI 75–92) vs 98 (95% CI 95–99); p< 0.001) than the tissue diagnosis from cholangioscopic-guided biopsy. In addition, biopsy obtained from DPOC had significantly higher sensitivity than that of DS (92% (95% CI 81–97) vs 79% (95% CI 72–84); p= 0.004). Diagnostic performance under image-enhanced endoscopy was not significantly better from white light endoscopy. Conclusions: Digital/video POC has very high diagnostic performance to diagnose MBS. While image diagnosis provides higher sensitivity than biopsy, its specificity drops as a trade-off.

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The use of pharmaceutical decision-support systems by the Australian general practitioners and their perceptions of the deficiencies and strengths of these systems are discussed. It was found that improved computer-user interface design could enhance the usefulness of pharmaceutical decision-support systems.

Digital signatures are a technology that allows two parties to validate the authenticity of electronically transmitted information and documents. When added to a document, a digital signature provides some assurance [...]

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ABSTRACTIntroductionDespite dramatic increases in new drugs and regimens, a combination of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) remains the backbone of many regimens to treat HIV.Area coveredThis article summarizes the pharmacokinetic characteristics of approved NRTIs that are currently in the international treatment and prevention guidelines.Expert opinionCompared to other NRTIs, tenofovir alafenamide fumarate (TAF) is more advantageous in terms of potency and safety. It is therefore a preferred choice in combination with emtricitabine (FTC) in most HIV treatment guidelines. The efficacy of the two-drug combination of NRTI/Integrase strand-transfer inhibitor, i.e. lamivudine/dolutegravir has been approved as an option for initial therapy. This regimen however has some limitations in patients with HBV coinfection. The two NRTI combinations tenofovir disproxil fumarate (TDF)/FTC and TAF/FTC have also been approved for pre-exposure prophylaxis (PrEP). Interestingly, a promising long-acting nucleoside reverse transcriptase translocation inhibitor, islatravir, formulated for implant was well tolerated and remained effective for up to a year, suggesting its potential as a single agent for PrEP. In the next decade, it remains to be seen whether NRTI-based regimens will remain the backbone of preferred ART regimens, or if the treatment will eventually move toward NRTI-sparing regimens to avoid long-term NRTI-toxicity.

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Of 56 children with perinatally acquired human immunodeficiency virus (HIV) who had been prescribed second-line protease inhibitor-based antiretroviral therapy and had ≥1 previous episode of viral failure (HIV RNA, ≥1000 copies/mL), 46% had ≥1, 34% had ≥2, and 23% had ≥3 consecutive episodes of viral failure during the 2 years of follow-up. Two of these children experienced a major protease inhibitor mutation.

Celecoxib, the first COX-2-selective non-steroidal anti-inflammatory drug (C2SN), and Rofecoxib, the second C2SN, were listed on the Pharmaceutical Benefits Scheme (PBS) in August 2000 and February 2001 respectively. The early adoption of C2SNs by Australian general practitioners has resulted in prescribing and drug use patterns that were not in accord with quality use of medicine (QUM) principles.

This study indicates that COX-2-specific inhibitors (CSI) are equivalent to non-steroidal anti-inflammatory drugs (NSAIDs) in terms of their effectiveness as anti-inflammatory agents. Both types of drugs can change a patient's symptoms, but they do not alter the course of the muscoskeletal disease. More information on the similarities and differences of CSIs and NSAIDs are discussed, with an emphasis on side effects.

Russia and Ontario are adopting similar labour codes. Surprised? Don't be. New anti-worker labour codes allow bosses to roll back working-class living standards and pad the already hefty profits of [...]

Background Loss to follow-up (LTFU) is a crucial indicator to evaluate the effectiveness of HIV care and treatment programmes. We assessed the LTFU rate and associated factors of Thai HIV-infected patients who enrolled in the National AIDS Program (NAP) for two periods: prior to (pre-ART) and after starting ART (ART-patients).Methods Thai HIV patients aged =15 years enrolled in NAP from 2008 to 2014. Vital status was ascertained by linkage with the National Death Registry. Competing risk models were used to calculate the adjusted sub-distribution hazards (aSHR) for LTFU for pre-ART and ART-patients, with death considered as a competing risk.Results A total of 157,026 patients registered in care and were included in analyses. The cumulative incidence of LTFU in pre-ART patients at 1 year was 10.2%, whereas in ART-patients it was 12.8%. Among pre-ART patients, younger age (<30 versus =45 years, aSHR 1.60, 95% CI 1.49, 1.72), less advanced HIV stage (aSHR 1.29, 95% CI 1.21, 1.37) and higher CD4+T-cell count (=350 versus <100, aSHR 6.31, 95% CI 5.74, 6.95) had a higher chance of LTFU. ART-patients with high baseline CD4+T-cell count (CD4 =350 versus CD4 <50, aSHR 2.06, 95% CI 1.97, 2.15) and non-advanced HIV stage had increased risk of LTFU.Conclusions Our findings provide new evidence of the LTFU rate in Thai HIV-infected patients in NAP. Emphasis needs to be placed on improving follow-up in all patients with higher CD4+T-cell counts. LTFU will be important to monitor as programmes move to commence ART regardless of CD4+T-cell count.

Background To investigate metabolic changes associated with second-line antiretroviral therapy (ART) following virological failure of first-line ART.Methods SECOND-LINE was an open-label randomized controlled trial. Participants were randomized 1:1 to receive ritonavir-boosted lopinavir (LPV/r) with 2–3 nucleoside/nucleotide reverse transcriptase inhibitors (N[t]RTI group) or raltegravir (RAL group). 210 participants had a dual energy X-ray absorptiometry (DXA)-scan at baseline, week 48 and 96. We categorized participants according to second-line ART backbone: thymidine analogue (ta-NRTI) + lamivudine/emtricitabine (3[F]TC; ta-NRTI group); tenofovir (TDF)+3(F)TC (TDF group); TDF+ta-NRTI ±3(F)TC (TDF+ta-NRTI group); RAL. Changes in fasted total cholesterol (TC), low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, TC/HDL-cholesterol ratio, triglycerides and glucose from baseline to week 96 were examined. We explored the association between metabolic and DXA-assessed soft-tissue changes. Linear regression methods were used.Results We analysed 454 participants. Participants in RAL group had greater TC increases, TC (adjusted mean difference [aMD]=0.65, 95% CI 0.33, 0.96), LDL-c (aMD=0.38, 95% CI 0.15, 0.61) and glucose (aMD=0.47, 95% CI -0.01, 0.92) compared to TDF group, and had greater increases in TC (aMD=0.65, 95% CI 0.28, 1.03), HDL-c (aMD=0.12, 95% CI 0.02, 0.23) and LDL-c (aMD=0.41, 95% CI 0.13, 0.69) compared to TDF+ta-NRTI group. TC/HDL ratio and triglycerides increased in all groups without significant differences between groups. A 1 kg increase in trunk fat mass was associated with an increase in TC.Conclusions We observed metabolic changes of limited clinical significance in the relatively young population enrolled in this study. However, the metabolic changes observed may have greater clinical significance in older people living with HIV or those with other concomitant cardiovascular risks.

To examine variation in safe sleep and breastfeeding practices among US non-Hispanic black (NHB) mothers according to birth country.

To assess how mothers' choice of e-mail or text messages (SMS) to receive safe sleep communications is associated with educational video viewing and responses to care practice queries.

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To determine predictors of maternal trust in doctors about advice on infant care practices.

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Background Access to combination antiretroviral therapy (cART) has decreased mortality in HIV-positive people. We aimed to estimate the expected additional years of life in HIV-positive Thai people after starting cART through the National AIDS Program (NAP), administered by the Thai National Health Security Office (NHSO).Methods The NHSO database collects characteristics of all Thai HIV-infected patients through the National AIDS Program, including linkage with the National Death Registry for vital status. This study included patients aged =15 years at cART initiation between 2008 and 2014. The abridged life table method was used to construct life tables stratified by sex and baseline CD4+T-cell count. Life expectancy was defined as the additional years of life from age at starting cART.Results 201,688 eligible patients were included in analyses, contributing 618,837 person-years of follow-up. Median CD4+T-cell count was 109 cells/mm3and median age 37 years. The overall life expectancy after cART initiation at age 20 was 25.4 (95% CI, 25.3, 25.6) years and 20.6 (95% CI, 20.5, 20.7) at age 35 years. Life expectancy at baseline CD4+T-cell count =350 cells/mm3was 51.9 (95% CI, 51.0, 52.9) years for age 20 years and 43.2 (95% CI, 42.4, 44.1) years for age 35 years, close to life expectancy in the general Thai population.Conclusions Increasing life expectancy with higher baseline CD4+T-cell counts supports the guideline recommendations to start cART irrespective of CD4+T-cell count. These results are beneficial to forecast the treatment cost and develop health policies for people living with HIV in Thailand and Asia.

Men who have sex with men (MSM) are at high risk of developing human papillomavirus (HPV)-related anal cancer. We compared HPV genotypes in anal tissues (Bx) and anal liquid-based cytology fluid (LBC) from HIV-positive and HIV-negative MSM.

Prevalence estimates of human immunodeficiency virus (HIV) infection in Asia are diverse, ranging from <0.1% to 1.1%. In Asia, approximately 4.7 million people are living with HIV and 310,000 are newly infected each year. The fastest growth of the epidemic throughout Asia is among men who have sex with men (MSM). Drug resistance varies from 4%-5% in an Asian cohort to 10% in an acutely infected MSM cohort in Bangkok. A rise (4%-14%) in the prevalence of syphilis is associated with the HIV epidemic in Asia. Tuberculosis is among the most common coinfections; however, HIV testing of tuberculosis patients is not routine. Coinfection with HBV, HCV, and triple coinfection varies from 8.7%-11%, 5%-18%, and 0.4%-3% respectively. Although the World Health Organization 2013 guidelines to start antiretroviral therapy (ART) early are implemented, most patients present late, with low CD4 counts, resulting in a high mortality during the first year of ART. While integrase inhibitor-based treatments are preferred first-line treatments in high income countries, efavirenz-based treatments remain preferred treatments in resource-limited countries. HIV-1 viral load testing is not available in most of these countries, making low-cost point-of-care testing accessibility an urgent priority. Effective ART coverage to prevent new HIV infections among children in Asia remains low. To provide life-long ART for children, better use of current first-line regimens and access to pediatric second-line formulations are important. To end AIDS in Asia by 2030, committed policy with innovative strategies to enhance “reach recruit, treat and retain” combined with effective prevention strategies are required.

Chemotherapy produces many side effects in children with cancer, including nausea and vomiting. Dehydration, chemical imbalances, bone fractures, esophageal tears, malnutrition, and refusal of continued therapy are all potential problems in patients with severe nausea and vomiting. Drugs used either alone or in combination with other drugs for controlling nausea and vomiting have different results and complications. The effectiveness of these drugs was compared in 26 children receiving chemotherapy. Two treatment regimes were used. Patients receiving metoclopramide, benzotropine, dexamethasone and lorazapam (MBDL) regimes had 89 percent less vomiting than use of chlorpromazine alone. Three fourths of the patients favored the MBDL regime. Use of the MBDL regime to prevent side effects of nausea and vomiting caused by chemotherapy drugs is considered a safe and preferable regime for children.

Thai patients with HIV have higher exposure to HIV protease inhibitors than do white people and dose reduction might be possible. We compared the efficacy of low-dose with standard-dose ritonavir-boosted atazanavir in virologically suppressed Thai patients with HIV.

Background The World Health Organization recommends HBV–HIV-coinfected individuals start antiretroviral therapy containing tenofovir. Here we describe first-line tenofovir use and treatment outcomes in coinfected patients in Asia.Methods HBV surface antigen positive patients enrolled in the TREAT Asia HIV Observational Database who started first-line antiretroviral therapy were included. Logistic regression adjusted for period of treatment initiation was used to determine factors associated with tenofovir use. Generalized estimating equations were used to evaluate factors associated with alanine transaminase levels and CD4+T-cell count on treatment.Results There were 548 eligible patients, of whom 149 (27.2%) started tenofovir. Patients treated in high/high-middle income countries (odds ratio 4.4 versus low/low-middle, 95% CI 2.6, 7.4; P<0.001) and those with elevated baseline alanine transaminase (odds ratio 4.2 versus normal, 95% CI 2.4, 7.2; P<0.001) were more likely to receive tenofovir. Hepatitis C antibody positive patients (odds ratio 0.4 versus negative, 95% CI 0.2, 0.8; P=0.008) were less likely. In those starting antiretroviral therapy with elevated alanine transaminase, mean reduction after tenofovir initiation was 11.2 IU/l (95% CI 0.9, 21.6; P=0.034) lower compared with those using a non-tenofovir-based regimen although this did not significantly increase the chance of alanine transaminase normalization. Tenofovir use was not associated with a superior CD4+T-cell response.Conclusions HBV–HIV-coinfected patients in Asia are most likely to receive tenofovir if they are treated in a high/high-middle income country, have elevated alanine transaminase levels and are hepatitis C antibody negative. Compared to other antiretroviral therapies, tenofovir-based regimens more effectively reduce liver inflammation in HBV–HIV-coinfection but do not result in superior CD4+T-cell recovery.

You achieved your goal [in getting the Journal 'unstuck']. The September issue [2009] was a joy to read. It was perhaps the first time in four years I have read [...]

Who was Marjorie Dashwood? I was left frustrated by what was not reported in the story (Large bequest leaves church with surplus for 2008, June 2009). What about her life [...]

Previous research has demonstrated that profits are a key requirement in private pharmaceutical development. We sought to examine the extent that pressure of financial incentives exerted by investors and the board of directors, including senior management financial rewards, have on regulatory decisions made by senior management. Our selected case study involved Aveo Pharmaceuticals Inc (Aveo). The specific question was to what extent the terms of financing, particularly the corporate governance goals which determined executive bonus compensation, may have dictated Aveo’s regulatory approach in the drug application process for tivozanib. These corporate governance goals emphasized quantitative over qualitative goals for the executive team. Aveo did not conduct the second arm of the randomized crossover trial, whose results could possibly have demonstrated a favorable clinical profile or a superior competitor’s product. Arguably, as a result of this decision, the participating research subjects were denied an opportunity for improvement, and progress in the study of renal cell cancer was curtailed.

Half a millennia of colonialism has made Canada an industry leader in the natural resources business. Today, Canadians are hewers of other people's wood, drawers of other people's water--and exploiters [...]

TRANQUILIZERS HAVE LONG KEPT SUBURbanites from cracking under the daily stress of consumer capitalism. Now American authorities are planning to use them to 'crack' down on pesky protestors. U.S. citizens' [...]

Understanding the extent to which early antiretroviral therapy (ART) can limit the establishment and persistence of the HIV reservoir is an important step to designing interventions aimed at achieving HIV cure. We measured the markers of HIV persistence and HIV-specific immunity in early treated children.

Men who have sex with men (MSM) are at elevated risk of having anal cancer. However, the prevalence and incidence among MSM of high-grade anal intraepithelial neoplasia (HGAIN), the putative precursor of anal cancer, is understudied, particularly in Asians.

We previously reported similar AIDS-free survival at 3 years in children who were >1 year old initiating antiretroviral therapy (ART) and randomized to early versus deferred ART in the Pediatric Randomized to Early versus Deferred Initiation in Cambodia and Thailand (PREDICT) study. We now report neurodevelopmental outcomes.