By B. Kafa. Point Park University. 2018.
Typical situations for the standby mode include transportation and non-intellectual activities purchase 25mg viagra with visa. Transportation: • in your car • on public transport Bernd Sebastian Kamps Full Power versus Standby | 27 Non-intellectual activity: • shopping • jogging • cooking • beach time • in the bathtub • during a siesta • before you fall asleep 2 Ear Memory has two powerful features for standby learning: The Repeat Mode and the Continuous Repeat Mode purchase viagra 50mg mastercard. If you click the second of the three buttons that sit on top 2 the AB button, Ear Memory starts repeating every snippet three times (Figure 5. This mode is particularly useful for the rehearsal of audio files you studied a few hours earlier. By the time you commute to work, you will have heard every snippet 10 to 20 times. Adjust the repeat mode to your needs by long-clicking the button and selecting the number of repeats from 1 to 7. As soon as you become familiar with the audio files, try the continuous repeat mode (Figure 5. Activate both the first and the second button that sit on top of the AB button. However, 2 at the end of the file, Ear Memory goes on to the next audio file. I use the continuous repeat mode primarily during grocery shopping, cooking, siesta and pre-sleep time. Bernd Sebastian Kamps Full Power versus Standby | 29 Figure 5. When you listen to a native speaker, you’ll hear three or more words per second. If there is only one key word you don’t know, the sentence will remain opaque and unintelligible forever. All you see are the backlights of the ‘sentence-train’, without time for a second guess and nobody giving you additional clues. On the contrary, when you read your first articles in your new language you can stop the train at any time and linger on single words until you control, guess or remember their meaning (one second, five seconds, 10 seconds – at your speed). Furthermore, after studying the text a few times, you’ll also dispose of some subtle clues to understanding, for example the number of letters in a word, the position on the page, the vicinity of other words, etc. The consequence: while an approximate knowledge of words is sufficient for reading, it is not sufficient for listening. You’ll soon experience by yourself that perfect comprehension of speech requires more than just a few sessions. Don’t be surprised if you need to listen to a sentence 20, 50 or even 100 times – today, tomorrow, next week – until you can distinguish every single word! This is perfectly normal for anyone who wants to get the best results quickly. Bernd Sebastian Kamps Full Power versus Standby | 31 * * * That’s it! You have • a suitable language manual with audio files and, ideally, a translation and word lists 2 • Ear Memory You know how to • cut an audio files into snippets • browse saved snippets with the arrow buttons ‘1►’ and ‘1◄’ • use Full Power mode and Standby mode • activate the repeat mode and the continuous repeat mode Important Please note that you need to “cut” an audio into snippets only once because all snippets are automatically saved. For all following sessions, stop using the AB button; instead, use only the middle- sized arrow buttons ‘1►’ and ‘1◄’. If you want to do AB exercises without saving the 2 snippets, go first into Ear Memory’s simple mode by long-clicking the folder button. Before going on to your next stop – the preliminary and final exams – remember your final target: understanding every single word and guess the correct spelling without reading the text, with eyes closed. Depending on your sustainable daily Power Listening, decrypting a one-hour audio will take you two to four months. Preliminary Exams Remember the ‘island uplift’ image. Like tectonic uplift, understanding a new language is a slow process: first a word, then a couple of words and half sentences; finally, complete sentences and then a whole text!
Diabetes Page 38 of 99 Final Report Drug Effectiveness Review Project Table10 viagra 75 mg fast delivery. Characteristics of exenatideactive-controlledtrials inadults with type2 diabetes a Age(years)(SD) a Sam ple % M ale a Baseline size(N ) % W hite a a Author order viagra 50 mg on-line,year F ollow- % Hispanic A1c (%)(SD) a Country up Diabetes duration W eight(kg) Com bination a 2 a Q uality (weeks) (years) BM I (kg/m ) Intervention therapy 54. Abbreviations:BID,twicedaily;M E T,m etform in;N R ,notreported;SD,standarddeviation;SU ,sulfonylurea. Diabetes Page 39 of 99 Final Report Drug Effectiveness Review Project Efficacy and effectiveness 27 Heine and colleagues compared once-daily glargine to exenatide twice daily over 26 weeks of follow-up in a noninferiority study, with both groups receiving metformin and a sulfonylurea. Fasting plasma glucose decreased in both treatment groups, with a greater reduction with insulin glargine (change in the insulin glargine group - 51. Weight increased in the insulin glargine group throughout the trial, with progressive reduction in the exenatide group (weight change -2. A per protocol analysis of 455 of 549 original trial patients revealed no significant differences between the two treatments for measures of symptoms, quality of life, vitality, and treatment satisfaction. These similar outcomes occurred despite an additional injection daily and gastrointestinal adverse events with exenatide. Change in A1c at 16 weeks was identical in the two treatment arms (-1. Both exenatide and insulin glargine reduced A1c by a similar amount in patients with baseline A1c ≥ 30 9% (approximate change -1. The change in A1c was similar between groups (change with exenatide -1. Exenatide patients lost weight while insulin-treated patients gained weight (between-group difference -5. Fasting serum glucose decreased in both groups (insulin aspart -1. In this small (N=51), exploratory RCT, exenatide 5 and then 10 mcg twice daily was substituted for insulin, while oral agents were continued. A1c did not change significantly in either group (P>0. Exenatide patients noted a decrease in weight (mean weight change -4. This study was rated fair-poor quality because of its high and differential withdrawal rate and lack of reporting methods for randomization and allocation. Adverse effects Total withdrawals in the exenatide group ranged from 12. Withdrawals due to adverse events for the exenatide group ranged from 8% to 15% and were less than 1% in the comparison groups. Nausea and vomiting were the most frequent adverse events among exenatide-treated subjects, and rates of these symptoms were significantly higher in the exenatide group than in 27, 30 26,28 groups using insulin glargine or other insulin routines, with rates of nausea ranging from 33% to 57% in the exenatide groups compared with <1 to 9% with the comparison group receiving insulin. Overall hypoglycemia rates were similar between groups treated with insulin and with 27, 28, 30 exenatide. Hypoglycemia was particularly common when exenatide (39%) or insulin Diabetes Page 40 of 99 Final Report Drug Effectiveness Review Project 26 (38%) was combined with sulfonylurea and/or metformin; 79% of hypoglycemia cases were 30 associated with sulfonylurea. In a study comparing exenatide and titrated insulin glargine, the overall rate of hypoglycemia with exenatide (14. In subgroup analysis of this study, however, the rate of hypoglycemia in patients who received metformin and exenatide was 2. Placebo-controlled trials 31-34 We identified 4 large, multicenter, fair-quality placebo-controlled trials of exenatide as combination therapy (Table 11, Evidence Tables 1-3). Subjects were similar in age (mean 53 to 57 years) and sex (52 to 60% male) with some variation in race and ethnicity. Diabetes Page 41 of 99 Final Report Drug Effectiveness Review Project Table11. Characteristics of exenatideplacebo-controlledtrials inadults with type 2diabetes a Age(years)(SD) a Sam ple % M ale a Baseline size(N ) % W hite a a Author,year F ollow- % Hispanic A1c (%)(SD) a Country up Durationof diabetes W eight(kg) Com bination a 2 a Q uality (weeks) (years) BM I (kg/m ) Intervention therapy 55(10-11) M ax im um SU (but Buse,2004 57-63 8. Abbreviations:BID,twicedaily;M E T,m etform in;SU ,sulfonylurea;TZD,thiaz olidinedione. Diabetes Page 42 of 99 Final Report Drug Effectiveness Review Project Efficacy and effectiveness Three very similar studies with overlapping authors compared exenatide to placebo, with both 31-33 33 treatment groups taking oral hypoglycemic agents. Kendall and colleagues randomized patients to exenatide 5 mcg or 10 mcg or placebo twice daily over 30 weeks. Patients continued their pre-study metformin and a sulfonylurea.
Such a scoring system is also adaptable as study treatment progression) was improved by 6% with CMT versus goals and end points change cheap 25mg viagra amex. A high positive predictive value (PPV) chemotherapy alone purchase 100 mg viagra with visa, whereas OS rates were identical at 95%. To address these needs, the Deauville Improvement in acute disease control (eg, PFS) is well documented 5PS was developed to serve as a categorical reading scheme that has in early-stage HL patients who receive CMT versus chemotherapy different positivity thresholds to adjust for the intended treatment alone; however, this has not translated to an improvement in OS. Therefore, the preferred Collectively, initial reports of interim FDG-PET/CT for early-stage treatment of HL patients with early-stage disease continues to be HL demonstrated a consistently high NPV and a low to moderate strongly debated in part because of the overarching goal of PPV in relation to treatment outcome. The high incidence of long-term OS with preserved quality of life. Thus, the most attractive application of a PET- ered. The functional imaging modality, FDG-PET/CT, has been response–adapted strategy in early-stage HL is likely de-escalation examined as a tool to direct when treatment should be deintensiﬁed of therapy (eg, omission of consolidative radiation therapy) for or escalated based on interim results. Interim PET/CT in early-stage HL Observational and prospective studies without treatment Phase 2 clinical trials using response-adapted strategies modiﬁcation in early-stage HL FDG-PET/CT may provide prognostic information at the individual There have been only a handful of phase 2 clinical studies completed patient level, allowing early in vivo evaluation of chemotherapy using a response-adapted strategy with interim FDG-PET/CT for sensitivity. It should be highlighted that most initial observational early-stage HL. Le Roux et al reported results in patients with early- studies reporting on the potential value of interim FDG-PET/CT as a and advanced-stage HL patients undergoing treatment with a response- response predictor included mixed proﬁles of HL patients with 28 9 adapted strategy after 4 cycles of ABVD (ie, PET-4; Table 1). Furthermore, there is comparatively much I/II nonbulky patients (n 26), PET-4 patients without progressive less data regarding the predictive value of interim PET in early- disease on CT or patients with CR on CT regardless of FDG-PET/CT stage HL versus advanced-stage HL, especially in favorable early- 12,14,15,18,22,38 ﬁndings received only IFRT. In the observational study by Gallamini and advanced-stage disease (n 44), those with negative PET-4 received 4 Hutchings that ignited an intense interest into response-adapted more cycles of ABVD. The remaining 28 patients with positive PET-4 therapy in HL, only a minority of patients had early-stage disease and no CR on CT underwent autologous stem cell transplantation. The and most of these patients had adverse risk factors (ie, unfavorable/ 12 NPV and PPV with PET-4 for 2-year PFS were 95% and 16%, intermediate early-stage HL). The low PPV reﬂects the likely negative impact that therapeutic intensiﬁcation had on the predictive value of In a retrospective analysis of 85 HL patients who had interim interim FDG-PET/CT results. FDG-PET/CT after 2-3 cycles of ABVD, the predictive power of FDG-PET/CT was much less robust for early-stage versus advanced- 39 Dann et al reported preliminary results from an ongoing phase 2 stage HL patients (Figure 2A,B). Interim FDG-PET/CT was study examining response-adapted therapy that included early-stage prognostic for 2-year PFS among the 57 early-stage HL patients 40 HL (Table 1), whereas other phase 2 prospective studies have (P. Interestingly, Ann Arbor stage retained CALGB-led early-stage response-adapted studies await long-term strong prognostic signiﬁcance on multivariate analysis with interim follow-up and completion of patient accrual (Table 1). Among patients with early-stage disease, with bulky disease. Completed phase 3 clinical trials using response-adapted Other investigators have reported similar PFS differences for strategies in early-stage HL interim FDG-PET/CT and FDG-PET/CT groups (P. The European Organisation for This study was limited by its retrospective design and variable Research and Treatment of Cancer (EORTC)-led H10F and H10U FDG-PET/CT timing (intervals of PET 2-4), although the results studies randomized patients with favorable and unfavorable early-stage have since been corroborated. In a prospective study of 88 patients with early-stage nonbulky the experimental arms of H10F and H10U had treatment intensiﬁed to HL treated with a nonstandard chemotherapy regimen of AVG BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, (doxorubicin, vinblastine, gemcitabine), 2-year PFS rates were 88% vincristine, procarbazine, prednisone)-escalated and INRT. With rela- and 54% for FDG-PET-2 and FDG-PET-2 groups, respectively tively early follow-up, preplanned interim analyses were performed for (P. At that point, 1 event had Hematology 2014 137 Figure 2. Shown is the PFS according to the result of interim FDG-PET/CT (status-post 2-3 ABVD cycles) of 57 early-stage (A) and 28 advanced-stage (B) HL patients. Treatment was continued regardless of FDG-PET/CT result. Incl indicates including; MRU, minimal residual uptake. In the H10U study, approximately 260 patients had continued to the original number of planned study patients, it was been randomized to each study arm with a PET-2 rate of 75%; 7 unlikely that equivalence would be shown between the control and events had occurred in the INRT arm versus 16 in the PET-based experimental arms. Therefore, the data safety and monitoring (no INRT) arm. Despite the low absolute number of events, committee amended the study adding INRT to all treatment arms. In statistical analyses in both H10F and H10U showed that the null addition, patient enrollment was increased in the PET arms to hypotheses of inferiority of the experimental PET-based treatment improve statistical power for the planned objectives.
One trial reported fewer 103 generic viagra 50 mg on line, 105 nocturnal awakenings in both children and adults treated with BUD/FM MART buy 50mg viagra with visa. The single study reporting hospitalizations and emergency visits found no difference between groups in the 98, 99 full population analysis but a small but significant decrease in hospitalizations / emergency 100 visits favoring BUD/FM MART among those age 16 and older. The trial reporting missed work found a numerical difference favoring BUD/FM MART, but the statistical significance was 98-100 not reported. None of the trials reported any outcomes favoring the BUD/FM for maintenance and SABA for relief. BUD/FM MART compared with FP/SM for maintenance and SABA for relief 98-100, 104 106 We found two good- and one fair-quality RCTs comparing these treatments. All three trials reported asthma symptoms, exacerbations, and rescue medicine use (Evidence Tables A 98-100, and B). Two trials reported nocturnal awakenings and hospitalizations or emergency visits. The results are mixed but show a trend favoring BUD/FM MART for some outcomes. All three trials reported no difference in symptoms or nocturnal awakenings, but statistically significantly lower exacerbation rates in those treated with BUD/FM MART. Outcomes related to rescue medications use were mixed. One trial reported no difference in rescue medicine use or 104 rescue-free days; one reported no difference in rescue medicine use but a greater percentage of rescue-free days for those treated with FP/SM plus SABA for relief (56% compared with 59. The trials reporting quality of life, and hospitalizations or emergency visits found no difference between treatment groups. The single trial reporting missed work found the lowest mean number of sick days in the FP/SM arm (2. If randomized to FP/SM, Controller medications for asthma 70 of 369 Final Update 1 Report Drug Effectiveness Review Project subjects were stepping down in their level of control and did not have the possibility to adjust the dose for 4 weeks. The BUD/FM MART group could increase their dose with as needed BUD/FM. This initial possible under-treatment may have biased the study in favor of the BUD/FM MART group. Controller medications for asthma 71 of 369 Final Update 1 Report Drug Effectiveness Review Project Table 13. Characteristics of head-to-head studies comparing BUD/FM for maintenance and relief (MART) with ICS/LABA for maintenance and Short-Acting Beta-Agonist (SABA) for relief Study design Country N Population Comparison Quality a Study Duration Setting (total daily ex-mouthpiece dose in mcg) Equipotent rating BUD/FM MART compared with BUD/FM for maintenance and SABA for relief or compared with FP/SM for maintenance and SABA for relief Bisgaard et al. Multinational (17) BUD/FM MART (640/18 + as-needed) DPI (overall No (medium Fair 104 RCT 2007 mean daily BUD dose including rescue use 792) BUD vs. FP) ICS+LABA, moderate persistent FP/SM (1000/100 + terbutaline 0. Characteristics of head-to-head studies comparing BUD/FM for maintenance and relief (MART) with ICS/LABA for maintenance and Short-Acting Beta-Agonist (SABA) for relief Study design Country N Population Comparison Quality a Study Duration Setting (total daily ex-mouthpiece dose in mcg) Equipotent rating 98 Kuna et al. Multinational (16) BUD/FM MART (640/18 + as-needed) DPI med Yes Good RCT (overall mean daily BUD dose including rescue use 2135 Age ≥12, not controlled, taking ICS ~ 650) at entry,smoking status NR vs. FP/SM (500/100 + as-needed SABA) DPI med + 12 months Multicenter (246) salbutamol as needed DPI or pMDI Abbreviations: BUD = budesonide; BUD/FM budesonide and formoterol administered in a single inhaler; DB = double-blind; DPI = dry powder inhaler; FD= fixed dose; FM = formoterol; FP = fluticasone propionate; FP/SM = fluticasone and salmeterol administered in a single inhaler; ICS = inhaled corticosteroids; LABAs = long-acting beta-2 agonists; MART = maintenance and reliever therapy; OL = open-label; pMDI= pressurized metered dose inhaler; RCT= randomized controlled trial; SABA = short-acting beta agonist; SM = salmeterol a Equipotency in BUD/FM + as-needed arms was determined by overall mean daily dose of ICS b 105 This publication describes the pediatric subset of the population in the O’Byrne et al. Thus it is not a separate trial and is not included in meta-analyses, to avoid double counting subjects Controller medications for asthma 73 of 369 Final Update 1 Report Drug Effectiveness Review Project F. Tiotropium Summary of findings Tiotropium is not approved for the treatment of asthma. It is approved for the treatment of chronic obstructive pulmonary disease (COPD). We found no studies of tiotropium meeting our inclusion criteria. Inhaled Corticosteroids (ICSs) compared with Leukotriene modifiers (LMs) Summary of findings 107-109 110-134 We found three systematic reviews with meta-analyses and 22 RCTs (Tables 14 and 15). Fourteen of the RCTs were in adolescents and adults ≥12 years of age and 8 (9 articles) 124-130, 132, 133 were in children < 12.
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