22,263 research outputs found
Validity testing of patient objections to acceptance of tamper-resistant opioid formulations
No full textCharles E Argoff,1 Steven P Stanos,2 Matthew S Wieman31Department of Neurology, Albany Medical College Neurology Group, Albany, NY, USA; 2Rehabilitation Institute of Chicago, Center for Pain Management, Northwestern University Medical School, Feinberg School of Medicine, Chicago, IL, USA; 3Department of Medical Sciences, Endo Pharmaceuticals Inc, Chadds Ford, PA, USABackground: Tamper-resistant formulations (TRFs) of oral opioid drugs are intended to prevent certain types of abuse (eg, intranasal, intravenous). Patients raising objections to receiving a TRF may have valid concerns or may be seeking a formulation that can be more easily misused.Methods: US clinicians experienced in pain management met in October 2011 to discuss common patient objections to being switched from a non-TRF opioid to a TRF of the same opioid. Retail pharmacy, health insurance, and scientific data were used to assess the potential validity of these patient objections.Results: Clinical experience switching patients from a non-TRF to a TRF opioid was limited to oxycodone controlled release (CR), as it was the only TRF available at that time; knowledge of other TRFs was limited to the scientific literature. Common objections from patients included “costs more,” “not covered by insurance,” “can't feel it working,” and “causes adverse events.” Objective retail pharmacy and insurance coverage information for oxycodone CR was accessible and indicated that patient objections were based on cost and coverage varied by insurer. Unpublished trial results (ClinicalTrials.gov) revealed that TRF oxycodone CR has a slower initial release than the non-TRF formulation, which may reduce positive subjective effects. The complaint “I can't feel it working” may reflect lessened positive subjective effects rather than reduced analgesic efficacy. Most tolerability complaints lacked objective support.Conclusion: The general process used to assess the validity of patient objections to TRF oxycodone CR may be applied to other TRFs once they become available. Publication of clinical data on TRFs would help clinicians to appropriately weigh patient concerns.Keywords: opioid analgesics, chronic pain, substance abuse, tamper-resistant formulation
CE Challenges: Work to Do
No full textCE has been used for more than two decades now. Despite many successes and advantages, there are still many challenges to be addressed. These challenges are both technical and organisational. In the paper we will address the current challenges of CE. Many challenges are related to the exchange of data and knowledge and to the systems that make data and knowledge exchange possible. Although much progress has been made in enabling extensive data and knowledge exchange and use, much remains to be wished. For example, there are still barriers to data exchange. Technically, these barriers may consist of different formats, differences in infrastructures and systems, and different semantics. There are also organisational and political barriers. For example, investment in information system may heavily impact upstream suppliers, while revenues of better information exchange may predominantly be gained by downstream actors. Without sharing costs and revenues, chain-wide information exchange will not be easily realised. Another barrier is the possible lack of willingness to share information, because of potential misuse of knowledge and loss of power. The paper is organised as follows. First we will describe the current manifestation of CE as described in a recent book. Second, we will list current trends in CE. Third, we will present some Critical Success Factors (CSFs) that are considered relevant for implementing and adapting CE practices. Last, we indicate some research and practical questions to be addressed, especially for areas that have a high potential and actual impact. </p
Improvement in pain severity category in clinical trials of pregabalin
No full textBruce Parsons,1 Charles E Argoff,2 Andrew Clair,1 Birol Emir1 1Pfizer, New York, NY, USA; 2Albany Medical Center, Albany, NY, USA Background: Pregabalin is approved by the US Food and Drug Administration for the treatment of fibromyalgia (FM), diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), and neuropathic pain due to spinal cord injury (SCI). Approval was based on clinical trial data demonstrating statistically significant differences in pain scores versus placebo. However, statistically significant pain relief may not always equate to clinically meaningful pain relief. To further characterize the clinical benefit of pregabalin, this analysis examined shifts in pain severity categories in patients with FM, DPN/PHN (pooled in this analysis), and SCI treated with pregabalin.Methods: Data were pooled from 23 placebo-controlled trials in patients with FM (1,623 treated with pregabalin, 937 placebo), DPN/PHN (2,867 pregabalin, 1,532 placebo), or SCI (181 pregabalin, 175 placebo). Pain scores were assessed on an 11-point numeric rating scale and categorized as mild (0 to <4), moderate (4 to <7), or severe (7 to 10). Only patients with mean score ≥4 at baseline were randomized to treatment. The percentage of patients shifting pain category from baseline to endpoint for pregabalin and placebo was analyzed using a modified ridit transformation with the Cochran–Mantel–Haenszel procedure.Results: A higher proportion of patients shifted to a less severe pain category at endpoint with pregabalin compared with placebo. With flexible-dose pregabalin, the percentage of patients improving from: severe to mild (pregabalin versus placebo) was 15.8 versus 13.4 in FM patients, 36.0 versus 16.6 in DPN/PHN patients, 14.3 versus 7.7 in SCI patients; severe to moderate was 28.7 versus 28.2 in FM patients, 32.5 versus 28.2 in DPN/PHN patients, 35.7 versus 28.2 in SCI patients; and moderate to mild was 38.3 versus 26.4 in FM patients, 59.5 versus 41.4 in DPN/PHN patients, 38.6 versus 27.2 in SCI patients.Conclusion: Compared with placebo, pregabalin is more often associated with clinically meaningful improvements in pain category in patients with FM, DPN, PHN, or SCI. Keywords: fibromyalgia, diabetic peripheral neuropathy, postherpetic neuralgia, neuropathic pain, pooled analysi
Predicting the Collapse of Pain Medicine Using the Economic Recession of 2008 as a Comparator: Lessons Remain Unlearned
No full textSayed E Wahezi,1 Corey W Hunter,2 Farshad M Ahadian,3 Charles E Argoff,4 Michael E Schatman5,6 1Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, Bronx, NY, USA; 2Ainsworth Institute of Pain Management, New York, NY, USA; 3Department of Anesthesiology, Center for Pain and Palliative Medicine, University of California, San Diego Medical Center, San Diego, CA, USA; 4Department of Neurology, Albany Medical Center, Albany, NY, USA; 5Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 6Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Sayed E Wahezi, Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8th Floor, Bronx, NY, 10461, USA, Tel +1 718-920-7246, Fax +1 929-263-3950, Email [email protected]: The last decade has seen a boom in pain medicine, basic science and interventional pain management. Concomitantly, there is a need to educate trainees, young attendings, and seasoned attendings on these innovations. There has been a growth in the number of societies that represent pain medicine physicians, each with its own philosophy and guiding principles. The variety of thought within pain management, within the various groups that practice this field, and amongst the societies which protect those missions inherently creates divergence and isolation within these different communities. There is the enormous opportunity for our field to grow, but we need the voices of all different specialties and sub-specialties which practice pain medicine to collectively design the future of our emerging field. The explosion of revolutionary percutaneous surgeries, medications, psychotherapy, and research and development in our field has outpaced the ability of payers to fully embrace them. There is an increased number of pain practitioners using novel therapies, postgraduate training programs do not adequately train users in these techniques thereby creating a potential for sub-optimal outcomes. In part, this is a reason why payers for many of our more novel treatments have decreased patient access or eliminated remuneration for some of them. We believe that society-based collaborative regulation of education, research, and treatment guidelines is needed to improve visibility for payers and end users who provide these treatments. Furthermore, postgraduate chronic pain fellowship education has been deemed by many to be insufficient to educate on all of the necessary requirements needed for the independent practice of pain medicine, especially the consummation of newer technologies. Here, we draw comparison with this tenuous stage in pain management history with the last United States recession to remind us of how poor institutional regulation and neglect for long-term growth hampers a community.Keywords: fellowship, training, futur
Synthesis optimization and charge carrier transfer mechanism in LiLuSiO<sub>4</sub>:Ce, Tm storage phosphor
No full textLiLuSiO4:Ce and LiLuSiO4:Ce, Tm show very efficient charge carrier storage properties upon beta irradiation after samples have received treatment in vacuum. They outperform the commercial storage phosphor BaFBr(I):Eu2+ in many aspects. The influence of the synthesis conditions, Ce and Tm concentration, nonstoichiometry and codoping with Ca, Hf, Al and Ge are reported. Based on the results of the synthesis optimization, thermoluminescence (TL) emission and TL excitation spectra a mechanism of charge carrier transfer, storage, and recombination during irradiation and thermal or optical readout is proposed.Accepted Author ManuscriptRST/Fundamental Aspects of Materials and EnergyRST/Luminescence Material
Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients
No full textCharles E Argoff1, F Michael Gloth2 1Albany Medical College and Comprehensive Pain Center, Albany Medical Center, Albany, NY, USA; 2Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Osteoarthritis is common in patients &ge;65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG) and diclofenac sodium 1.5% in 45.5% dimethylsulfoxide solution (D-DMSO), are approved in the US for the treatment of osteoarthritis pain. Topical NSAIDs have shown efficacy and safety in knee (DSG, D-DMSO) and hand (DSG) osteoarthritis. Analyses of data from randomized controlled trials of DSG in hand and knee osteoarthritis demonstrate significant improvement of pain and function in both younger patients (&lt;65 years) and older patients (&ge;65 years) and suggest good safety and tolerability. However, long-term safety data in older patients are limited. Topical NSAIDs can ease medication administration and help address barriers to pain management in older patients, such as taking multiple medications and inability to swallow, and are a valuable option for long-term care providers. Keywords: nonsteroidal anti-inflammatory drugs, long-term care, nursing homes, chronic pain, topical analgesic
The impact of P(NDI2OD-T2) crystalline domains on the open-circuit voltage of bilayer all-polymer solar cells with an inverted configuration
No full textWe fabricated P(NDI2OD-T2)/PTB7 bilayer all-polymer solar cells with an inverted configuration, where the annealing temperature was systematically varied. The current density-voltage behavior was investigated and the structural properties of the P(NDI2OD-T2) layers were characterized. Absorption spectroscopy, surface morphology, and crystallite analysis showed that increasing phase segregation of P(NDI2OD-T2) films occurred as the annealing temperature increased. We found that, as the P(NDI2OD-T2) stacking improved, with larger domains, the open-circuit voltage decreased and the saturation dark current density increased. This work provides a guide for the processing of P(NDI2OD-T2) layers to maximize the power conversion efficiency of all-polymer solar cells. (C) 2015 Author(s).open1186sciescopu
Data and code for: Variational Graph Author Topic Modeling
No full textThis is the tensorflow implementation of KDD-2022 paper "Variational Graph Author Topic Modeling" by Delvin Ce Zhang and Hady W. Lauw.
VGATM is a Graph Neural Network model that extracts interpretable topics for documents with authors and venues. Topics of documents then fulfill document classification, citation prediction, etc.
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Updated analytical solutions of continuity equation for electron beams precipitation – I. Pure collisional and pure ohmic energy losses
No full textWe present updated analytical solutions of continuity equations for power-law beam electrons precipitating in (a) purely collisional losses and (b) purely ohmic losses. The solutions of continuity equation (CE) normalized on electron density presented in Dobranskis & Zharkova are found by method of characteristics eliminating a mistake in the density characteristic pointed out by Emslie et al. The corrected electron beam differential densities (DD) for collisions are shown to have energy spectra with the index of −(γ + 1)/2, coinciding with the one derived from the inverse problem solution by Brown, while being lower by 1/2 than the index of −γ/2 obtained from CE for electron flux. This leads to a decrease of the index of mean electron spectra from −(γ − 2.5) (CE for flux) to −(γ − 2.0) (CE for electron density). The similar method is applied to CE for electrons precipitating in electric field induced by the beam itself. For the first time, the electron energy spectra are calculated for both constant and variable electric fields by using CE for electron density. We derive electron DD for precipitating electrons (moving towards the photosphere, μ = +1) and ‘returning’ electrons (moving towards the corona, μ = −1). The indices of DD energy spectra are reduced from −γ − 1 (CE for flux) to −γ (CE for electron density). While the index of mean electron spectra is increased by 0.5, from −γ + 0.5 (CE for flux) to −γ + 1(CE for electron density). Hard X-ray intensities are also calculated for relativistic cross-section for the updated differential spectra revealing closer resemblance to numerical Fokker–Planck (FP) solutions
Introduction and Author Biographical Notes
No full textThe Introductory Notes include The Cutting EDge\u27s mission statement, editorial board, founder\u27s note, and author\u27s biographies
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