Search

Background: Increased training and competition demands of the in-season period may disturb athlete fatigue and recovery balance. The aim of this study was to describe the training load distribution applied in a competitive period and the training adaptations and fatigue/recovery status of elite water polo players. Hypothesis: Effective workload management during tapering (TAP) would restore player recovery and enhance performance. Study Design: Case series. Level of Evidence: Level 4. Methods: Training load, perceived recovery, maximal speed in 100- and 200-meter swim, heart rate (HR) during submaximal swimming (HRsubmax) and HR recovery (HRR) were assessed in 7 outfield water polo players a week before starting a normal training microcycle (NM), after NM, and after congested (CON) and TAP training blocks in the lead-up to the Final Eight of the European Champions League. Results: Training load was higher in NM compared with CON and TAP by 28.9 ± 2.6% and 42.8 ± 2.1% (P < 0.01, d = 11.54, and d = 13.45, respectively) and higher in CON than TAP by 19.4 ± 4.2% (P < 0.01, d = 3.78). Perceived recovery was lower in CON compared with NM and TAP (P < 0.01, d = 1.26 and d = 3.11, respectively) but not different between NM and TAP (P = 0.13, d = 0.62). Both 100- and 200-meter swim performance was improved in TAP compared with baseline (P < 0.01, d = 1.34 and d = 1.12, respectively). No differences were detected among other training blocks. HRsubmax and most HRR were similar among the training periods. Conclusion: Effective management of training load at TAP can restore recovery and improve swimming performance without affecting HR responses. Clinical Relevance: Despite lower workloads, CON training impairs perceived recovery without affecting performance; however, a short-term training load reduction after a CON fixture restores recovery and improves performance. [ABSTRACT FROM AUTHOR]

Objective: To examine the evidence and practice of antipsychotic dose reduction from the lens of biomedical ethics (specifically principlism) to support evidence-based practice and patient choice and self-determination. Methods: An overview of the evidence from randomized controlled trials of antipsychotic dose reduction versus maintenance is presented. This is followed by a theoretical examination of the four key biomedical ethical principles of autonomy, nonmaleficence, beneficence, and justice and how they apply in the case of antipsychotic dose reduction. Results: Existing clinical trial research is dominated by relapse as the primary outcome, with dose reduction associated with a higher risk of relapse than maintenance. Few studies have measured other patient-centered outcomes but have shown preliminary evidence for superior cognitive functioning, lower negative symptoms, and better functioning following dose reduction. Respect for autonomy is a cornerstone of psychiatric rehabilitation, and this includes the right of people to choose to reduce or discontinue antipsychotic medication. Reduced capacity for treatment decision making can be supported. Autonomy and appraisal of nonmaleficence and beneficence associated with dose reduction can be facilitated through shared or supported decision making. Clinicians should continue to strive for justice through the fair allocation of resources to support all people who request antipsychotic dose reduction. Conclusions and Implications for Practice: Clinicians have a responsibility to balance the four core ethical principles to the best of their ability when supporting a person in their recovery journey. Exploring, trialing, and supporting antipsychotic dose reduction may be part of this process if that is the patient's choice. Impact and Implications: Autonomy and justice are upheld when people are supported to reduce or cease antipsychotic medication if that is their choice. Clinicians can balance the principles of nonmaleficence and beneficence (i.e., minimize harm and promote a person's welfare) by staying up-to-date with and sharing the evidence openly with patients, promoting supported or shared decision making, advanced statements, slow hyperbolic tapering, and providing additional monitoring and psychosocial support. [ABSTRACT FROM AUTHOR]

Welch's method provides an estimator of the power spectral density that is statistically consistent. This is achieved by averaging over periodograms calculated from overlapping segments of a time series. For a finite-length time series, while the variance of the estimator decreases as the number of segments increases, the magnitude of the estimator's bias increases: a bias-variance trade-off ensues when setting the segment number. We address this issue by providing a novel method for debiasing Welch's method that maintains the computational complexity and asymptotic consistency, and leads to improved finite-sample performance. Theoretical results are given for fourth-order stationary processes with finite fourth-order moments and an absolutely convergent fourth-order cumulant function. The significant bias reduction is demonstrated with numerical simulation and an application to real-world data. Our estimator also permits irregular spacing over frequency and we demonstrate how this may be employed for signal compression and further variance reduction. The code accompanying this work is available in R and python. [ABSTRACT FROM AUTHOR]

Objective: Antipsychotics remain the first‐line treatment for people diagnosed with psychotic disorders despite adverse effects which lead many people to stop their medication. Many stop without the support of the prescriber, who may fear relapse. The objective of this study is to better understand the process of withdrawal from antipsychotics, from the perspective of people taking antipsychotics. Design: Online survey. Methods: An international online survey elicited quantitative responses about pre‐withdrawal planning (560) and qualitative responses about what was helpful and unhelpful when withdrawing from antipsychotics (443). Responses came from users of antipsychotics in 29 countries. Results: Forty‐seven per cent did not consult their psychiatrist before discontinuing. Only 40% made preparations, most commonly making a plan, gathering information and informing family. The most frequently reported helpful factors were focussing on the benefits of getting off the drugs (including ending adverse effects and feeling more alive), information about withdrawal symptoms and how to withdraw safely, withdrawing slowly, and support from psychologists, counsellors and psychotherapists. The most common unhelpful factor was the psychiatrist/doctor, largely because of their lack of knowledge, refusal to support the patient's wishes and the threat or use of coercion. Conclusions: Evidence‐based, respectful, collaborative responses to patients' concerns about adverse effects and desires to withdraw would probably reduce relapse rates and improve long‐term outcomes. It would definitely help end pervasive breaching of the principle of informed consent and human rights legislation. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Although long‐term opioid therapy (LTOT) for chronic pain has declined, it remains common in the U.S. Providers do not have clinical practice guidelines for vulnerable LTOT patients, in whom both LTOT continuation and tapering to discontinuation pose risks of harm and in whom opioid use disorder (OUD) is absent.To begin to meet the gap in guidelines, the study used a multiple case study approach. Five cases were constructed to systematically vary key elements of LTOT continuation and discontinuation harms among patients reporting LTOT's lack of efficacy (experience of pain and poor function). For each, treatment approaches were collected from 28 opioid safety experts identified through their participation in a national policy panel (19 were physicians) and analyzed using template analysis.For patients receiving LTOT with harms of continuation and discontinuation, experts recommended attempting a slow taper (even with a prior unsuccessful taper, possibly with adjuvant medications to manage withdrawal) and not maintaining opioid therapy. Experts considered switching to buprenorphine, especially if the patient had aberrant behaviors. They also considered adding non‐opioid pain therapies (especially re‐trying such therapies if they were unhelpful before) and engaging in shared decisionmaking, although with little consensus on specific approaches. Some experts would address co‐occurring conditions related to patient safety (alcohol use, mental health symptoms, opioid side effects). Few experts referenced assessing or addressing OUD or overdose risk. In quantitative data, 36% of experts agreed LTOT is beneficial, 36% agreed most LTOT patients should be discontinued, and 57% agreed patients experience harm from tapering and from discontinuation.Evidence is needed to build on and test these experts' recommendations to attempt tapering and add non‐opioid pain therapies for patients reporting harms of continued LTOT who may experience harms from tapering. Such evidence informs the development of clinical practice guidelines that provide comprehensive protocols to support the safety and functioning of this group of patients. [ABSTRACT FROM AUTHOR]

Background/objectives: Fostamatinib is a spleen tyrosine kinase (SYK) inhibitor approved for the treatment of adult patients with chronic immune thrombocytopenia (ITP). There is little information about dose tapering and sustained remission after discontinuation in ITP. In this retrospective multicenter study, we evaluated efficacy and safety of fostamatinib in adult patients with ITP before, during, and after tapering/discontinuation (T/D). Methods: T/D was performed on subjects who achieved complete platelet response (CR) with progressive, conditional dose reduction every four weeks. Results: Sixty-one patients were included from 14 reference centers between October 2021 and May 2023. In subjects that completed T/D (n = 9), the median time from treatment initiation to response was 21 days (IQR: 7.5–42), median time from treatment initiation to CR was 28 days (IQR: 28–42), median time from treatment initiation to the start of tapering was 116 days (IQR: 42–140), and duration of tapering was 112.5 days (IQR: 94.5–191). The median platelet count was 232 × 109/L (IQR: 152–345 × 109/L) at tapering and 190 × 109/L (IQR: 142.5–316.5 × 109/L) at discontinuation. With a median follow-up since discontinuation of 263 days (IQR: 247–313 days), only two patients have relapsed (at 63 and 73 days). Fostamatinib was restarted, achieving a new CR. Platelet counts higher than 100 × 109/L in week 12 were the only positive predictive factors for successful tapering and discontinuation. Conclusions: Sustained response in patient with ITP treated with fostamatinib could be developed. The prognostic factors and recommended scheme of tapering still have to be evaluated. [ABSTRACT FROM AUTHOR]

During adolescence, sleep is essential for physical and cognitive development. However, modern lifestyles often disrupt sleep patterns in young people, potentially impacting athletic performance. Swimming, with its demanding training schedules, presents unique challenges to sleep patterns and may influence performance. This study investigates the role of sleep in the performance of young swimmers during the tapering period. Nineteen athletes participated in this study, but only 15 completed it. The data were collected 21 days before the target competition, when the athletes were already engaged in training. Based on sonography, divided into good sleep group (GSG; n=8) and poor sleep group (PSG; n=7). Athletes used an actigraph daily (for 21 days, during tapering phase) to identify sleep quality and had their performance results obtained by the International Point Score (IPS). We observed that 46.67% of the athletes had poor sleep, with no difference between genders. We identified a significant difference (p=0.001; ES=1.52; 18.65%) between week 1 and week 3 of total sleep time (TST), without showing changes in sleep efficiency (SE). Sleep latency (SL) in both groups improved, with a reduction in the difference between the groups (9.73%), and wake after sleep onset (WASO) decreased (p=0.001; ES=-1.79; 20.91%). The increase in TST, maintenance of SE, reduction of WASO, and the difference in SL between the groups, associated with the equal performance of the groups obtained by IPS, suggest better sleep quality during the period, with tapering reducing any performance differences that PSG could have compared to GSG. [ABSTRACT FROM AUTHOR]

Abstract Background The optimal retreatment strategy with rituximab for rheumatoid arthritis (RA) remains a point of discussion. Depending on local guidelines, rituximab can either be administered at fixed intervals or when losing disease control, balancing therapeutic effectiveness with drug overexposure. However, treatment based on loss of disease control may significantly affect patients’ lives, provoking uncertainty and potentially leading to progressive joint damage. Moreover, as low-dose rituximab proved to be effective in treating RA while decreasing toxicity, drug exposure may be limited by tapering down rituximab doses guided by disease activity. Methods RITUXERA is a 104-week open-label multicentre randomised controlled superiority trial. In total, 134 patients with RA treated with rituximab will be 1:1 randomised when in need of retreatment (DAS28-CRP ≥ 3.2 with previous rituximab administration at least 24 weeks earlier) to either a treat-to-target-driven fixed dose retreatment strategy (usual care group) or fixed interval disease-activity guided dose optimisation strategy (experimental group). The usual care group will be retreated with fixed rituximab doses (1 × 1000 mg IV) in case of loss of disease control (DAS28-CRP ≥ 3.2). The experimental group will receive a 24-weekly rituximab treatment while tapering down the dose in a decreasing sequence if DAS28-CRP ≤ 3.2: 1 × 1000 mg IV (maximal dose), 1 × 500 mg IV, and 1 × 200 mg IV (minimal dose). If DAS28-CRP exceeds 3.2 at the six-monthly retreatment, patients will receive and remain on the previous effective dose. Study visits are planned every 12 weeks. Primary outcome is the comparison of longitudinal patient-reported disease impact over 104 weeks, measured with the Rheumatoid Arthritis Impact of Disease (RAID) instrument, analysed using a linear mixed model. Main secondary outcome is the comparison of longitudinal disease activity (DAS28-CRP) over 104 weeks. Discussion The RITUXERA trial aims to explore the optimal retreatment strategy with rituximab for RA in terms of long-term patient-reported disease impact, by proposing a fixed interval disease activity-guided dose optimisation strategy as compared to a treat-to-target fixed dose strategy. Trial registration CTIS 2023–506638-59–01 (registration date: 07 September 2023), ClinicalTrials.gov NCT06003283 (registration date: 17 August 2023).

Background: The optimal retreatment strategy with rituximab for rheumatoid arthritis (RA) remains a point of discussion. Depending on local guidelines, rituximab can either be administered at fixed intervals or when losing disease control, balancing therapeutic effectiveness with drug overexposure. However, treatment based on loss of disease control may significantly affect patients' lives, provoking uncertainty and potentially leading to progressive joint damage. Moreover, as low-dose rituximab proved to be effective in treating RA while decreasing toxicity, drug exposure may be limited by tapering down rituximab doses guided by disease activity. Methods: RITUXERA is a 104-week open-label multicentre randomised controlled superiority trial. In total, 134 patients with RA treated with rituximab will be 1:1 randomised when in need of retreatment (DAS28-CRP ≥ 3.2 with previous rituximab administration at least 24 weeks earlier) to either a treat-to-target-driven fixed dose retreatment strategy (usual care group) or fixed interval disease-activity guided dose optimisation strategy (experimental group). The usual care group will be retreated with fixed rituximab doses (1 × 1000 mg IV) in case of loss of disease control (DAS28-CRP ≥ 3.2). The experimental group will receive a 24-weekly rituximab treatment while tapering down the dose in a decreasing sequence if DAS28-CRP ≤ 3.2: 1 × 1000 mg IV (maximal dose), 1 × 500 mg IV, and 1 × 200 mg IV (minimal dose). If DAS28-CRP exceeds 3.2 at the six-monthly retreatment, patients will receive and remain on the previous effective dose. Study visits are planned every 12 weeks. Primary outcome is the comparison of longitudinal patient-reported disease impact over 104 weeks, measured with the Rheumatoid Arthritis Impact of Disease (RAID) instrument, analysed using a linear mixed model. Main secondary outcome is the comparison of longitudinal disease activity (DAS28-CRP) over 104 weeks. Discussion: The RITUXERA trial aims to explore the optimal retreatment strategy with rituximab for RA in terms of long-term patient-reported disease impact, by proposing a fixed interval disease activity-guided dose optimisation strategy as compared to a treat-to-target fixed dose strategy. Trial registration: CTIS 2023–506638-59–01 (registration date: 07 September 2023), ClinicalTrials.gov NCT06003283 (registration date: 17 August 2023). [ABSTRACT FROM AUTHOR]

Objective: Variation in training load is consistently demonstrated within weekly microcycles in soccer, yet less is known of load variations between the same weekday sessions across different microcycles. Our study aim was to examine between-microcycle variability in key measures of external training load. Methods: Thirty-seven professional soccer players participated in this observational study which took place across the clubs' initial 8-week in-season mesocycle of the 2022/23 season. During this mesocycle, each 1-week microcycle consisted of four distinct classifications of training session (Matchday (MD)-4, MD-3, MD-2, and MD-1, and one match (Saturday). External load data (total distance, high-intensity (>5.5 m.s) distance, high-intensity accelerations (>3 m/s2), and percentage (%) of maximal speed attained) were collected across 564 training sessions (MD-4 = 123, MD-3 = 148, MD-2 = 130, MD-1 = 163). Data were analysed with mixed linear modelling. Results: When compared to the first microcycle, substantial week-to-week variation was evident for each of the four training session classifications, ranging from 1244 m to 2248 m for total distance, 80 m to 197 m for high-intensity distance, 11 to 25 for high-intensity accelerations, and 10.2 percentage points to 15.4 percentage points for % maximal speed. Conclusion: Our data show that despite training sessions having a consistency of planned training stimulus across an 8-week mesocycle, external load varied between microcycles. Nevertheless, within-player variability on the same day relative to matchday indicated a more consistent stimulus for key training variables relevant to specific training days. [ABSTRACT FROM AUTHOR]

This study investigates the impact of Central Bank interventions on the pricing dynamics of select stock markets. The research utilizes the instrumental variables three-stage least square (3SLS) model approach. It analyses the effects of variations in the Federal Reserve's balance sheet size across three distinct intervention scenarios: the 2008–2013 Great Recession, the 2020–2021 COVID-19 pandemic periods, and an overarching analysis spanning these timelines. Our methodology includes estimations of the Seemingly Unrelated Regression Equations (SURE), and the results are robust under the two-step Generalized Method of Moments (GMM). Our findings indicate that changes in the size of the Fed's balance sheet correlate significantly with the pricing of principal U.S. equity market indices. This correlation reflects a time-dependent effect emanating from the Fed's balance sheet expansion, marking a growing divergence between the adaptability of pricing mechanisms in equity and debt markets. Notably, the Federal Reserve's interventions during the COVID-19 crisis are associated with an increase of approximately 0.0403 basis points per billion in treasury yields. This research makes a significant contribution to the understanding of financial asset pricing, particularly by elucidating the extent to which interventions in government debt securities engender price distortions in certain equity markets. [ABSTRACT FROM AUTHOR]

This paper analyzes the effects of central bank interventions via large-scale purchases of government debt securities on the pricing of stock market indices. This study examines the effects of changes in the size of the Federal Reserve's balance sheet in three intervention scenarios: during the 2008–2013 period, the 2020–2022 period, and in the years between by using the instrumental variables three-stage least squares (3SLS) method for a time series approach, and calculates the effects of these interventions on each index in a fund of funds setup using the panel data strategy. This study confirms that large-scale purchases of government debt securities in response to the Great Recession and COVID-19 crises influenced the pricing of equity markets via their effect on the pricing of treasury bonds, with different degrees of sensitivity of each index to the effects on yields. Although the findings apply to the U.S. market, the results indicate that the pricing of small capitalization indices such as the Russell 2000 are less sensitive to changes in treasury yields caused by central bank interventions than large capitalization indices such as the DJIA. This research contributes to the understanding of financial asset pricing, particularly by identifying price distortions within equity market portfolios. [ABSTRACT FROM AUTHOR]

Thrombopoietin receptor agonists (TPO-Ras; romiplostim/eltrombopag/avatrombopag) have demonstrated high efficacy rates (59–88%) and a good safety profile in clinical trials with adult patients with immune thrombocytopenia (ITP). Similar efficacy and safety results have been observed with romiplostim and eltrombopag in paediatric cohorts. Continuous treatment with TPO-RAs has shown durable responses with long-term use, up to 3 years. The effect of TPO-RAs was generally considered transient, as platelet counts tended to drop to baseline values after a short period of time (about 2 weeks), unless treatment was maintained. Several groups have reported successful discontinuation of TPO-RAs without the need for concomitant treatments. This is referred to as sustained remission off treatment (SROT). Both short- and medium-term treatment with TPO-RAs may reduce costs to our healthcare systems and, more importantly, may reduce the potential side effects that may be associated with continuous TPO-RA treatment. The issue of tapering and discontinuation of TPO-RAs in paediatric patients with ITP has received little attention to date. Given that paediatric ITP has much higher rates of spontaneous remission than ITP in adults, we consider that the possibility of SROT of TPO-RAs in paediatric patients with ITP is a neglected but very relevant issue in this subtype of the disease. [ABSTRACT FROM AUTHOR]

The article "Xylem conduit widening: globally convergent yet variable" explores the process of water transport in trees and the role of xylem conduits in facilitating this process. It highlights the global convergence of xylem widening, which helps reduce hydraulic resistance and allows for efficient water transport. However, the study also reveals significant variability in xylem widening rates among trees and years, suggesting that the theoretical optimum may not always be achieved. The text emphasizes the importance of considering factors such as conduit density and variations in sapwood area when predicting how biological traits scale with plant size. It also discusses the influence of environmental factors on xylem structure and the potential implications for plant adaptation and resilience. The document provides a list of references for further research on xylem anatomy, climate, and tree growth, offering valuable insights into the complex interactions between trees, climate, and their hydraulic system. [Extracted from the article]

Objectives: This article aims to evaluate the effect of the extended dosing interval on the efficacy and safety of ozoralizumab in patients with rheumatoid arthritis (RA). Methods: In a long-term extension study (HOSHIZORA trial) for patients who had completed a phase II/III study with methotrexate or a phase III study without methotrexate, the dosing interval of ozoralizumab was allowed to extend from every 4 weeks (Q4W) to every 8 weeks (Q8W), at the physician's discretion, for patients who had maintained a 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) <3.2 at the last two time points. The continuation rate, efficacy, and safety were examined in patients who had completed 24 weeks after the change in the dosing interval by the data cut-off point. Results: Of the 32 patients who maintained DAS28-ESR <3.2 and changed the interval from Q4W to Q8W, 28 (87.5%) remained on Q8W for 24 weeks. At Week 24, the percentages of patients who remained on Q8W and achieved DAS28-ESR <2.6 and <3.2 were 71.9% and 84.4%, respectively. No safety concerns were observed for 24 weeks in the Q8W group. Conclusions: In patients with RA and maintained DAS28-ESR <3.2 with ozoralizumab, efficacy was sustained and well tolerated after the dosing interval was extended from Q4W to Q8W. [ABSTRACT FROM AUTHOR]

The purpose: this study aimed to determine the effect of a two-week tapering period on physiological variables by reducing three different percentages of volume (30%, 50%, 70%) while maintaining high training intensity on young futsal players. Method: An experimental design was used. The research sample was chosen from players of the talent school in Nineveh Governorate for the year 2023-2024, totaling 18 players (6 players per group). A paired student's t-test was used to process the interaction effect between pre- and post-training, and an ANCOVA test was used to determine the differences between the three groups. Results: Tapering with a 50% reduction rate led to the development of all physiological variables of performance in the Bruce test (p<0.005), aerobic (p<0.025) and anaerobic work (p<0.018), VO2max (p<0.028), and blood Lactate (p<0.031). while tapering with a 30% reduction rate led to the development of aerobic work (p<0.33) and VO2max (p<0.044). Tapering with a 70% reduction rate led to the development of achievement in the Bruce test(p<0.01), anaerobic work (p<0.046), and LA (p<0.030). While there were no significant differences among the three groups in physiological variables of performance in the Bruce test (p<0.151), aerobic (p<0.085) and anaerobic work (p<0.343), VO2max (p<0.181), and LA (p<0.166). Conclusions: the tapering by 50%, showed a more balanced development in aerobic and anaerobic work, VO2max, and LA compared to to the tapering by 30% reduction, which developed only aerobic work and VO2max, and to the tapering 70% reduction, which developed anaerobic work and LA. [ABSTRACT FROM AUTHOR]

In this work, a single mode fiber (SMF) is spliced with a photonic crystal fiber (ESM-12) from both sides and tapered down to (92.1 µm) to create a surface plasmon resonance (SPR) based on Mach–Zehnder interferometer for the purpose of calculating the refractive indices of Carbonated liquids with different expiration dates. The (SMF-PCF-SMF) sensor is coated with gold film (Au) of 40 nm thickness on the stripped part of the spliced PCF to optimize the sensing performance of the fiber. The sensor has a sensitivity of (7.17) (µm/RIU), figure of merit is (19.14), signal-to-noise ratio of (0.536), and resolution of (1.3 × 10–4) (RIU). [ABSTRACT FROM AUTHOR]

The proposed fiber-optic device is an array of tapering cores in a common cladding. Possible applications of the device for radiation summation in multielement laser systems are discussed. The criterion is specified for the formation of the device parameters to obtain optically independent channels, which makes it possible to produce a narrow radiation beam in the far zone. Analytical expressions are derived for the radiation field in the far zone and the parameters of the device for obtaining a close-to-diffraction divergence. This device allows an unlimited increase in the number of emitters to increase the radiation power in a narrow beam. [ABSTRACT FROM AUTHOR]

Current recommendations for RA treatment determine the need to reduce the dose and duration of glucocorticoid(GC) use. This is due to the wide spectrum and high frequency (up to 100%) of serious adverse events (AE) during GC treatment. However, in real practice GCs in RA are used very often (in Russia, Western Europe and the USA they are used in about 50% of patients), and often in long-term courses. This is explained by the fact that the combination of disease-modifying antirheumatic drugs (DMARDs), including biologics (bDMARDs) and Janus kinase inhibitors (JAK), with GCs allows to achieve faster improvement of patients’ condition and therefore is very “convenient” for many patients and physicians.However, it is very difficult to ensure dose reduction and (especially!) complete discontinuation of GC administration afterwards. Clinical and observational studies show that 30–40% of patients manage to discontinue the use of GCs during treatment with bDMARDs and JAK. In addition, discontinuation of GCs may significantly increase the risk of RA flare, even with complex pathogenetic therapy.Nevertheless, prolonged use of GCs, including low doses (less than 7.5 mg/day of prednisolone) should be considered as an indicator of the severity of the disease course and inadequacy of the current therapy. Therefore, we should strive for personalization of RA therapy, selection of DMARDs based on the assessment of the disease phenotype and predictors of response to treatment with different drugs, achieving the main goal of therapy – remission/low disease activity and achievement of acceptable quality of life, without the use of GCs.

Abstract Background 80% of patients value information on treatment options as an important part of recovery, further patients with a history of psychotic episodes feel excluded from decision making about their antipsychotic treatment, and on top of that, mental health staff is prone to be reluctant to support shared decision making and medication tapering for patients with schizophrenia. This case series aims to demonstrate the tapering of antipsychotic medication and how guided tapering affects the patient’s feeling of autonomy and psychiatric rehabilitation. Case presentation We present six patients diagnosed with schizophrenia (International Classification of Mental and Behavioral Disorders– 10th Edition codes F20.0–5, F20.7–9) who underwent professionally guided tapering in our clinic. The clinic aims to guide the patients to identify the lowest possible dose of antipsychotic medication in a safe setting to minimise the risk of severe relapse. Two patients completely discontinued their antipsychotic medication, two suffered a relapse during tapering, one chose to stop the tapering at a low dose, and one patient with treatment resistant schizophrenia, which is still tapering down. Conclusions Reducing the antipsychotic dose increased emotional awareness in some patients (n = 4) helping them to develop better strategies to handle stress and increased feelings of recovery. Patients felt a greater sense of autonomy and empowerment during the tapering process, even when discontinuation was not possible. Increased awareness in patients and early intervention during relapse may prevent severe relapse. Impact and implications Some patients with schizophrenia might be over medicated, leading to unwanted side effects and the wish to reduce their medication. The patients in our study illustrate how guided tapering of antipsychotic medication done jointly with the patient can lead to improved emotional awareness and the development of effective symptom management strategies. This may in turn lead to a greater sense of empowerment and identity and give life more meaning, supporting the experience of personal recovery.

BACKGROUND: Depression drugs can be difficult to come off due to withdrawal symptoms. Gradual tapering with tapering support is needed to help patients withdraw safely. OBJECTIVE: To review the withdrawal success rates, using any intervention, and the effects on relapse/recurrence rates, symptom severity, quality of life, and withdrawal symptoms. METHODS: Systematic review based on PubMed and Embase searches (last search 4 October 2022) of randomised trials with one or more treatment arms aimed at helping patients withdraw from a depression drug, regardless of indication for treatment. We calculated the mean and median success rates and the risk difference of depressive relapse when discontinuing or continuing depression drugs. RESULTS: We included 13 studies (2085 participants). Three compared two withdrawal interventions and ten compared drug discontinuation vs. continuation. The success rates varied hugely between the trials (9% to 80%), with a weighted mean of 47% (95% confidence interval 38% to 57%) and a median of 50% (interquartile range 29% to 65%). A meta-regression showed that the length of taper was highly predictive for the risk of relapse (P = 0.00001). All the studies we reviewed confounded withdrawal symptoms with relapse; did not use hyperbolic tapering; withdrew the depression drug too fast; and stopped it entirely when receptor occupancy was still high. CONCLUSION: The true proportion of patients on depression drugs who can stop safely without relapse is likely considerably higher than the 50% we found. [ABSTRACT FROM AUTHOR]

Background: Midodrine has been used in the intensive care unit (ICU) setting to reduce the time to vasopressor discontinuation. The limited data supporting midodrine use have led to variability in the pattern of initiation and discontinuation of midodrine. Objectives: To compare the effectiveness and safety of 2 midodrine discontinuation regimens during weaning vasopressors in critically ill patients. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City. Included patients were adults admitted to ICU who received midodrine after being unable to be weaned from intravenous vasopressors for more than 24 hours. Patients were categorized into two subgroups depending on the pattern of midodrine discontinuation (tapered dosing regimen vs. nontapered regimen). The primary endpoint was the incidence of inotropes and vasopressors re-initiation after midodrine discontinuation. Results: The incidence of inotropes or vasopressors' re-initiation after discontinuation of midodrine was lower in the tapering group (15.4%) compared with the non-tapering group (40.7%) in the crude analysis as well as regression analysis (odd ratio [OR] = 0.15; 95% CI = 0.03, 0.73, P = 0.02). The time required for the antihypertensive medication(s) initiation after midodrine discontinuation was longer in patients who had dose tapering (beta coefficient (95% CI): 3.11 (0.95, 5.28), P = 0.005). Moreover, inotrope or vasopressor requirement was lower 24 hours post midodrine initiation. In contrast, the two groups had no statistically significant differences in 30-day mortality, in-hospital mortality, or ICU length of stay. Conclusion and Relevance: These real-life data showed that tapering midodrine dosage before discontinuation in critically ill patients during weaning from vasopressor aids in reducing the frequency of inotrope or vasopressor re-initiation. Application of such a strategy might be a reasonable approach among ICU patients unless contraindicated. [ABSTRACT FROM AUTHOR]

• ASMs with a very long half-life as co-medication do not affect LTM. • In the majority of cases there is no need for ASM withdrawal prior to LTM. • Baseline seizure frequency and FLE correlate with LTM seizure rates. • Seizure frequency and ASM reduction are associated with the first recorded seizure. • Enzyme inhibitor VPA is associated with longer time to first recorded seizure. To assess the impact of antiseizure medications (ASMs) with a very long half-life on long term video-EEG monitoring (LTM) in people with focal epilepsy (FE). In this retrospective cohort study, we searched our local database for people with FE who underwent ASM reduction during LTM at the University Hospital of 'La Fe', Valencia, from January 2013 to December 2019. Taking into account the half-life of the ASM, people with FE were divided into two groups: Group A contained individuals who were taking at least one ASM with a very long half-life at admission, and Group B consisted of those not taking very long half-life ASMs. Using multivariable analysis to control for important confounders, we compared the following outcomes between both groups: seizure rates per day, time to first seizure, and LTM duration. Three hundred seventy individuals were included in the study (154 in Group A and 216 in Group B). The median recorded seizure rates (1.3 seizures/day, range 0–15.3 vs.1.3 seizures/day, range 0–9.3, p-value=0.68), median time to the first seizure (24 h, range 2–119 vs. 24 h, range 2–100, p-value=0.92), and median LTM duration (4 days, range 2–5 vs. 4 days, range 2–5, p-value=0.94) were similar in both groups. Multivariable analysis did not reveal any significant differences in the three outcomes between the two groups (all p-values>0.05). ASMs with a very long half-life taken as co-medication do not significantly affect important LTM outcomes, including recorded seizure rates, time to the first seizure, or LTM duration. Therefore, in general, there is no need to discontinue ASMs with a very long half-life prior to LTM. [ABSTRACT FROM AUTHOR]

ObjectivesTapering biologic agents can be considered for patients with stable disease activity in rheumatoid arthritis (RA). However, the specific strategy for abatacept is uncertain. This study aimed to examine the impact of tapering abatacept on disease activity in RA patients and assess the potential influence of concomitant methotrexate (MTX) treatment.MethodsUsing data from the KOBIO registry, we included 505 1 year intervals from 176 patients with RA that initiated abatacept with concomitant MTX at baseline. The intervals were divided into two groups based on the dose quotient (DQ) of abatacept during each period (i.e., the tapering group (DQ

Introduction We report our initial experience with a novel ureteroplasty technique that combines the advantages of excisional tapering and folding. Methods and cases Following dissection of the megaureter, the distal ureteral end was transected at a point with an appropriate caliber to create a neo‐orifice, which was left intact. Only the proximally redundant part of the ureter was excised and closed over a 10F catheter, following which the ureter was anastomosed to the bladder with an indwelling ureteral stent. This procedure was performed in four pediatric patients. Case 1 involved a 6‐year‐old girl with continuous urinary incontinence due to ureteral ectopia in a duplex system. Cases 2 and 3 involved infants with refluxing megaureter. Case 4 involved a 9‐year‐old boy with a ureteral stone impacted in a megaureter. All four patients achieved successful outcomes without ureteral obstruction. Conclusion This ureteroplasty technique is a promising alternative in specific patients.

Abstract Background Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. Methods Design 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. Setting: primary care general practices in southeast Queensland, Australia. Population: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. Intervention: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. Outcome measures: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. Secondary outcomes: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. Sample size: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). Discussion The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. Trial registration ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Eosinophil-related diseases represent a group of pathologic conditions with highly heterogeneous clinical presentation and symptoms ranging from mild to critical. Both systemic and localized forms of disease are typically treated with glucocorticoids. The approval of novel biologic therapies targeting the interleukin-5 pathway can help reduce the use of systemic glucocorticoids (SGC) in eosinophilic diseases and reduce the risk of SGC-related adverse effects (AEs). In this article, a panel of experts from differentmedical specialties reviewed current evidence on the use of SGC in two systemic eosinophilic diseases: Eosinophilic Granulomatosis with PolyAngiitis (EGPA) and HyperEosinophilic Syndrome (HES); and in two single-organ (respiratory) eosinophilic diseases: Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) and Severe Asthma with Eosinophil Phenotype (SA-EP), and contrasted it with their experience in clinical practice. Using nominal group technique, they reached consensus on key aspects related to the dose and tapering of SGC as well as on the initiation of biologics as SGC-sparing agents. Early treatment with biologics could help prevent AEs associated with medium and long-term use of SGC. [ABSTRACT FROM AUTHOR]

Background: Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. Methods: Design: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. Setting: primary care general practices in southeast Queensland, Australia. Population: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. Intervention: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. Outcome measures: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. Secondary outcomes: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. Sample size: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). Discussion: The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. Trial registration: ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022. [ABSTRACT FROM AUTHOR]

Objectives: To determine how therapeutic strategies for giant cell arteritis (GCA), especially glucocorticoid (GC) management, evolved between 2014 and 2020. Patients and Methods: Consecutive GCA patients followed for at least 24 months in a single tertiary center were enrolled and separated into two groups: those diagnosed from 2014 to 2017 and those diagnosed from 2018 to 2020. GC doses (mg/kg/day) were analyzed at onset, at Month 3 (M3) and, if continued, at M6, M12, M18 and M24. Physicians' practices were also individually analyzed. Results: Among the 180 patients included, 96 (53%) were diagnosed in 2014–2017 and 84 (47%) in 2018–2020. All patients received GC at diagnosis without a difference in the initial dose between the two groups (p = 0.07). At M3, the daily dose was lower in patients treated after 2017 (p = 0.002). In patients who still received GC at M6 (p = 0.0008), M12 (p = 0.01) and M24 (p = 0.02), the daily GC dose was still lower in patients treated after 2017. The proportion of patients who definitively discontinued GC use before M18 (42% versus 21%, p = 0.003) was higher in those treated after 2017. The rates of immunosuppressant use were not different between the two time periods (31% versus 38%, p = 0.34), but tocilizumab replaced methotrexate. Significant differences were observed among practitioners regarding the GC doses at M6 (p = 0.04) and M12 (p = 0.04), the total GC duration (p = 0.02) and the ability to stop GC before M18 (p = 0.007). Conclusions: This real-life study showed a global change in GC management over time for GCA patients, with important variability among physicians' practices. [ABSTRACT FROM AUTHOR]

Nonlinear models are commonly used for analyzing real-life data such as in medicine, engineering, and economics. To make efficient inferences about model parameter estimations and statistical results in nonlinear regression, assumptions related to error term are needed to be satisfied. Ordinary least squares and some modified least squares methods fail to give efficient parameter estimates when there are the problems of autocorrelation and outlier together in nonlinear regression. In this study, a novel hybrid robust tapering approach called as robust modified two-stage least squares is proposed to overcome the problems for obtaining more efficient parameter estimates in nonlinear regression. Two numerical examples and a comprehensive Monte–Carlo simulation study are given in order to examine the performance of robust modified two-stage least squares. [ABSTRACT FROM AUTHOR]

Background: Patients with remitted psychosis face a dilemma between the wish to discontinue antipsychotics and the risk of relapse. We test if an operationalized guided-dose-reduction algorithm can help reach a lower effective dose without increased risks of relapse. Methods: A 2-year open-label randomized prospective comparative cohort trial from Aug 2017 to Sep 2022. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomized 2:1 into guided dose reduction group (GDR) v. maintenance treatment group (MT1), together with a group of naturalistic maintenance controls (MT2). We observed if the relapse rates would be different between 3 groups, to what extent the dose could be reduced, and if GDR patients could have improved functioning and quality of life. Results: A total of 96 patients, comprised 51, 24, and 21 patients in GDR, MT1, and MT2 groups, respectively. During follow-up, 14 patients (14.6%) relapsed, including 6, 4, and 4 from GDR, MT1, and MT2, statistically no difference between groups. In total, 74.5% of GDR patients could stay well under a lower dose, including 18 patients (35.3%) conducting 4 consecutive dose-tapering and staying well after reducing 58.5% of their baseline dose. The GDR group exhibited improved clinical outcomes and endorsed better quality of life. Conclusions: GDR is a feasible approach as the majority of patients had a chance to taper antipsychotics to certain extents. Still, 25.5% of GDR patients could not successfully decrease any dose, including 11.8% experienced relapse, a risk comparable to their maintenance counterparts. [ABSTRACT FROM AUTHOR]

Contemporary practices of long-term antipsychotic maintenance treatment for schizophrenia are being challenged, and clinicians must consider the possibilities of reducing long-term maintenance use. However, research indicates that people with schizophrenia receive little support from mental health staff to reduce antipsychotic medication. This article reports a study which aimed to investigate interdisciplinary mental health staff's accounts of tapering of antipsychotic medication and to explore different positions that mental health staff assign to themselves and others. Six focus groups were conducted with 39 mental health staff from outpatient clinics, inpatient units, forensic mental health units, and community mental health services. The data analysis combined analyses of the interactions during focus groups and the thematic content. Results were considered from a discourse analytic perspective considering the function and consequence of accounts applied by the mental health staff. The mental health staff accounted for their perspectives on tapering from the following three distinctive positions: 1) No, patients will eventually realize that they need the medication, 2) Yes, but tapering means running a big risk of relapse in symptoms, and 3) Yes, we need to welcome risks to support personal recovery. Our findings indicated that there was reluctance among interdisciplinary mental health staff to let service users make decisions and limited possibilities for people with schizophrenia to have their request for tapering of their antipsychotic medication met by mental health staff. [ABSTRACT FROM AUTHOR]

The undeniable benefits of enhanced sleep quality resulting from physical exercise have been well-established. However, analyzing the intricate relationship between recovery levels and sleep quality necessitates a thorough investigation. This exploration is essential to develop a comprehensive of how sleep influences recovery, particularly concerning training loads, in the context of young athletes. Physical recovery is a pivotal and rejuvenating aspect for athletes, highlighting the importance of examining its interplay with sleep. This study aimed to evaluate the impact of sleep quality on recovery during the tapering period among young swimmers. Based on a cross-sectional, descriptive, and quantitative approach, this research involved 15 swimming athletes affiliated with both the Pernambuco Aquatic Federation and the Brazilian Confederation of Aquatic Sports. The Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth Sleepiness Scale (ESS) sleepiness questionnaire were used to assess sleep behavior, and the Total Quality Recovery Scale was applied to verify levels of recovery (TQR). Data were collected 21 days before the target competition, body composition measurements were obtained and questionnaires were applied. Spearman's correlation showed a difference between total sleep time and sleep efficiency (r= -0.64) and a positive correlation between recovery from the second week to the third week (r= 0.0223). Females showed good sleep quality and recovery at week 1, while males did not show significant changes. The conclusion of the study was that the quality of sleep and its variables showed good quality in relation to recovery, described as reasonably recovered in week 2 closes to the competition. [ABSTRACT FROM AUTHOR]

This paper proposes a design method to reduce cogging torque and torque ripple in the concentrated winding of IPMSMs (Interior Permanent Magnet Synchronous Motors) used in motors for the semiconductor ETCH process. IPMSMs can utilize reluctance torque through the difference in inductance between the d axis and q axis, but they are at a disadvantage in terms of reducing cogging torque while tapering the rotor and stator to reduce torque ripple. In addition, the existing single tapering can push the permanent magnets into the rotor. If the rotor's permanent magnets are embedded, the magnetic reluctance will increase, and the overall performance of the motor will decrease. However, an optimum design method was derived in which the magnets do not move during rotor tapering. This geometric design is an optimum design method that reduces cogging torque and torque ripple. This paper compares and analyzes four models, the concentrated winding model, distributed winding model, conventional tapering model, and separated tapering model, using 2D and 3D finite element analysis (FEA). [ABSTRACT FROM AUTHOR]

Although different strategies have been implemented to manage recovery-fatigue status in athletes, there is still a lack of consensus on which recovery protocols have the greatest impact and effectiveness when implemented with basketball players, including both physiological and psychological recovery methods. Thus, the purpose of this systematic review is to: (a) determine which recovery methods attain the greatest benefit in restoring the process of attenuating fatigue and (b) provide sports practitioners with guidelines on how some of the most effective recovery strategies can be used to optimize athletes' recovery and ultimately enhance their performance. Using the PRISMA guidelines, a total of 3931 research reports were obtained through four database searches (i.e., PubMed, Scopus, Cochrane, and Web of Science), from which only 25 met the inclusion and exclusion criteria. The recovery protocols analyzed in this systematic review were: sleep, nutrition, hydration, ergogenic aids, cold-water immersion, compression garments, massage, acupuncture, tapering, mindfulness, and red-light irradiation. The results revealed that all recovery strategies are capable of attenuating fatigue and enhancing recovery in basketball players to a certain degree. However, an individualized approach should be promoted, where a combination of proactive recovery modalities appears to result in the most rapid rates of recovery and athletes' ability to maintain high-level performance. Recovery should be programmed as an integral component of training regimens. Also, cooperation and communication between coaches, players, and the rest of the team staff members are essential in minimizing the risk of non-functional overreaching or injury and optimizing basketball players' on-court performance. [ABSTRACT FROM AUTHOR]

BackgroundNarrative communication is often more persuasive for promoting health behaviour change than communication using facts and figures; the extent to which narrative persuasiveness is due to patients' identification with the storyteller vs engagement with the story is unclear.ObjectiveTo examine the relative impacts of patient engagement, age concordance and gender concordance on perceived persuasiveness of video-recorded narrative clips about opioid tapering.MethodsPatient raters watched and rated 48 brief video-recorded clips featuring 1 of 7 different storytellers describing their experiences with opioid tapering. The dependent variable was clips' perceived persuasiveness for encouraging patients to consider opioid tapering. Independent variables were rater engagement with the clip, rater-storyteller gender concordance and rater-storyteller age concordance (

Abstract Background Chronic use of hypnotic agents is prevalent in older adults, who as a result are at increased risk for certain adverse events, such as day-time drowsiness and falls. Multiple strategies to discontinue hypnotics have been tested in geriatric patients, but evidence remains scarce. Hence, we aimed to investigate a multicomponent intervention to reduce hypnotic drug use in geriatric inpatients. Methods A before-after study was performed on the acute geriatric wards of a teaching hospital. The before group (= control group) received usual care, while intervention patients (= intervention group) were exposed to a pharmacist-led deprescribing intervention, comprising education of health care personnel, access to standardized discontinuation regimens, patient education and support of transitional care. The primary outcome was hypnotic drug discontinuation at one month after discharge. Secondary outcomes among others were sleep quality and hypnotic use at one and two weeks after enrolment and at discharge. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) upon inclusion, two weeks after enrolment and one month after discharge. Determinants for the primary outcome were identified using regression analysis. Results A total of 173 patients were enrolled, with 70.5% of patients taking benzodiazepines. Average age was 85 years (interquartile range 81–88.5) and 28.3% were male. A higher discontinuation rate at one month after discharge was observed in favour of the intervention (37.7% vs. 21.9%, p = 0.02281). No difference in sleep quality was found between both groups (p = 0.719). The average sleep quality was 8.74 (95% confidence interval (CI): 7.98–9.49) and 8.57 (95% CI: 7.75–9.39) in the control and intervention groups respectively. Determinants for discontinuation at one month were: the intervention (odds ratio (OR) 2.36, 95% CI: 1.14–4.99), fall on admission (OR 2.05; 95% CI: 0.95–4.43), use of a z-drug (OR 0.54, 95% CI: 0.23–1.22), PSQI score on admission (OR 1.08, 95% CI: 0.97–1.19) and discontinuation prior to discharge (OR 4.71, 95% CI: 2.26–10.17). Conclusions A pharmacist-led intervention in geriatric inpatients was associated with a reduction of hypnotic drug use one month after discharge, without any loss in sleep quality. Trial registration ClinicalTrials.gov Identifier: NCT05521971 (retrospectively registered on 29th of August 2022).

Eosinophil-related diseases represent a group of pathologic conditions with highly heterogeneous clinical presentation and symptoms ranging from mild to critical. Both systemic and localized forms of disease are typically treated with glucocorticoids. The approval of novel biologic therapies targeting the interleukin-5 pathway can help reduce the use of systemic glucocorticoids (SGC) in eosinophilic diseases and reduce the risk of SGC-related adverse effects (AEs). In this article, a panel of experts from different medical specialties reviewed current evidence on the use of SGC in two systemic eosinophilic diseases: Eosinophilic Granulomatosis with PolyAngiitis (EGPA) and HyperEosinophilic Syndrome (HES); and in two single-organ (respiratory) eosinophilic diseases: Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) and Severe Asthma with Eosinophil Phenotype (SA-EP), and contrasted it with their experience in clinical practice. Using nominal group technique, they reached consensus on key aspects related to the dose and tapering of SGC as well as on the initiation of biologics as SGC-sparing agents. Early treatment with biologics could help prevent AEs associated with medium and long-term use of SGC.

This article discusses the importance of centering the patient in decisions about opioid tapering. The author reflects on the historical context of opioid prescribing, highlighting how drug manufacturers influenced medical education and the subsequent rise of the opioid overdose epidemic. The article emphasizes the need for clinicians to consider the competing risks of opioid continuation versus tapering and to involve patients in decision-making. It also addresses the challenges of patient-provider relationships and provides guidance on how to approach conversations about tapering. The article concludes by emphasizing the individualized nature of these decisions and the importance of aligning them with the patient's values and preferences. [Extracted from the article]

Objective We examined patient and providers' perspectives on tapering biologic or targeted synthetic disease modifying antirheumatic drugs (bDMARD or tsDMARD) in well-controlled RA to determine which factors influence their long-term treatment decisions. Methods A standardized phone survey was administered to patients with well-controlled RA based on electronic health record review. Providers were also surveyed. Univariate and multivariable regression analysis was performed with odds ratios (OR) and 95% CI. Results Sixty-two patients and 11 providers completed the survey. In total, 39 (63%) patients would consider a bDMARD/tsDMARD taper. Patients were more likely to consider a taper if they thought their RA was well-controlled (OR 8.02, 95% CI 2.15–29.99, P  = 0.002) and of shorter duration (OR 0.94, 95% CI 0.89–0.99, P  = 0.02). Patients were less likely to consider a taper if older (OR 0.95, 95% CI 0.91–1.0, P  = 0.05), if they were being treated with conventional synthetic DMARDs (OR 0.25, 95% CI 0.07–0.86, P  = 0.0275) or daily glucocorticoids (OR 0.08, 95% CI 0.02–0.44, P  = 0.0033). Patients' and providers' top concerns about long-term bDMARD/tsDMARD use were malignancy and infection. Their concerns about tapering were worsening pain, flare and loss of function. Patients were more likely to consider a bDMARD/tsDMARD taper than providers (63% vs 36%). Conclusion Patients who have had well-controlled RA are more likely to consider tapering bDMARD/tsDMARD when not being treated with csDMARDs or glucocorticoids. Patients and providers shared similar concerns regarding long-term use and tapering of bDMARD/tsDMARD, but patients were more likely to consider a taper. [ABSTRACT FROM AUTHOR]

Disponibles depuis le début des années 1950, les glucocorticoïdes (GC) font aujourd'hui partie intégrante de la prise en charge de la polyarthrite rhumatoïde (PR). Leur rapidité d'action les rend particulièrement intéressants pour le traitement des poussées ou comme agents relais dans la PR débutante. L'efficacité des GC dans la PR a été établie, à la fois pour contrôler l'activité de la maladie et pour retarder la progression des dégradations articulaires. Parallèlement à ces bénéfices, les GC ont également des effets indésirables bien identifiés. Il est généralement déconseillé d'utiliser les GC sur de longues périodes, surtout à forte dose, et les directives récentes pour la prise en charge de la PR préconisent de ne pas recourir à ces agents, ou suggèrent de ne les utiliser qu'à titre de thérapie relais. Les perceptions relatives aux effets néfastes des GC, essentiellement fondées sur des études observationnelles, demeurent. Les corticothérapies prolongées à faible dose restent très prévalentes dans la pratique clinique, et des données récentes semblent indiquer que cette stratégie présente un rapport bénéfice–risque plutôt favorable, même chez les patients âgés. Ainsi, l'objectif de parvenir à équilibrer les bénéfices et les risques du traitement de la PR par des GC est toujours quelque peu controversé. Cette revue narrative met en avant la place, historique et actuelle, des GC dans la prise en charge de la PR, et résume les éléments récents étayant leurs effets bénéfiques et néfastes. De plus, des stratégies pratiques pour l'utilisation et la diminution des GC dans la PR sont proposées. Glucocorticoids have been available since the early 1950s and have since become an integral part of the management of rheumatoid arthritis (RA). Due to their rapid effect, glucocorticoids have an appealing profile for treating flares or as ''bridging'' agents in early RA. The efficacy of glucocorticoids to treat RA has been well established, both to control disease activity and to delay the progression of joint damage. However, despite their benefits, glucocorticoids have equally well-known adverse effects. It is generally accepted that long-term use of glucocorticoids, particularly at higher doses, is not advisable, and recent guidelines for the management of RA therefore either recommend against the use of glucocorticoids or suggest using them only as bridging therapy. Perceptions on the harmful effects of glucocorticoids remain, mainly based on observational studies. Prolonged glucocorticoid therapy at low doses is still highly prevalent in clinical practice, but recent data suggested a rather favourable risk-benefit balance for this strategy, even in senior patients. Balancing the benefits and risks of treating RA with glucocorticoids thus remains a somewhat controversial topic. Therefore, this narrative review outlines the historical and current position of glucocorticoids in the management of RA, while summarising recent evidence on their beneficial and detrimental effects. Furthermore, practical strategies for the current use and tapering of glucocorticoids in RA were formulated. [ABSTRACT FROM AUTHOR]

Background: The importance of tapering is increasingly recognised when discontinuing antidepressant medication. However, no previous studies have examined the reporting of antidepressant tapering methods in published studies. Aim: The aim of this study was to assess the completeness of reporting of antidepressant tapering methods in a published systematic review using the Template for Intervention Description and Replication (TIDieR) checklist. Method: A secondary analysis was conducted of studies included in a Cochrane systematic review that examined the effectiveness of approaches for discontinuing long-term antidepressant use. The completeness of reporting of antidepressant tapering methods in included studies was independently assessed by two researchers using the 12 items from the TIDieR checklist. Results: Twenty-two studies were included in the analysis. None of the study reports described all checklists items. No study clearly reported what materials had been provided (item 3) or whether tailoring had occurred (item 9). With the exception of providing a name for the intervention or study procedures (item 1), only a minority of studies clearly reported on any of the remaining checklist items. Conclusion: The findings highlight a lack of detailed reporting of antidepressant tapering methods in published trials to date. This needs to be addressed as poor reporting could hinder replication and adaptation of existing interventions, as well as the potential for successful translation of effective tapering interventions into clinical practice. [ABSTRACT FROM AUTHOR]

Stem profile modeling is crucial in the forestry sector, particularly for commercially valuable species like teak (Tectona grandis Linn F.), whose value depends on its stem dimensions, heartwood proportion, and age. We proposed a nonlinear mixed-effect model to describe the evolution of the stem and heartwood profiles of clonal teak trees with ages between 4 and 12 years in the Brazilian Amazon. Tapering models were used to estimate the bark, bark-free, and heartwood diameters. Dummy variables were included in each tapering model to estimate each type of diameter and enable compatibility. We used mixed models with age as a random effect in order to improve the accuracy. The Demaerschalk model provided the most accurate and compatible estimates for all three types of stem diameter. Also, age as a random effect significantly improved the model's accuracy by 7.2%. We observed a progressive increase in the heartwood proportion (14% to 34%) with advancing age, while the proportions of bark (23% to 20%) and sapwood (63% to 45%) showed inverse behavior. The growth rate of the heartwood differed from that of the bark volume, emphasizing the importance of considering the age of heartwood maximization when determining the cutting cycle of the species. [ABSTRACT FROM AUTHOR]