10 research outputs found
sj-docx-6-tab-10.1177_1759720X211002682 – Supplemental material for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textSupplemental material, sj-docx-6-tab-10.1177_1759720X211002682 for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis by Alberto Migliore, Giuseppe Pompilio, Davide Integlia, Joe Zhuo and Evo Alemao in Therapeutic Advances in Musculoskeletal Disease</p
sj-docx-2-tab-10.1177_1759720X211002682 – Supplemental material for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textSupplemental material, sj-docx-2-tab-10.1177_1759720X211002682 for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis by Alberto Migliore, Giuseppe Pompilio, Davide Integlia, Joe Zhuo and Evo Alemao in Therapeutic Advances in Musculoskeletal Disease</p
sj-docx-5-tab-10.1177_1759720X211002682 – Supplemental material for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textSupplemental material, sj-docx-5-tab-10.1177_1759720X211002682 for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis by Alberto Migliore, Giuseppe Pompilio, Davide Integlia, Joe Zhuo and Evo Alemao in Therapeutic Advances in Musculoskeletal Disease</p
sj-docx-1-tab-10.1177_1759720X211002682 – Supplemental material for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textSupplemental material, sj-docx-1-tab-10.1177_1759720X211002682 for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis by Alberto Migliore, Giuseppe Pompilio, Davide Integlia, Joe Zhuo and Evo Alemao in Therapeutic Advances in Musculoskeletal Disease</p
sj-docx-4-tab-10.1177_1759720X211002682 – Supplemental material for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textSupplemental material, sj-docx-4-tab-10.1177_1759720X211002682 for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis by Alberto Migliore, Giuseppe Pompilio, Davide Integlia, Joe Zhuo and Evo Alemao in Therapeutic Advances in Musculoskeletal Disease</p
sj-docx-3-tab-10.1177_1759720X211002682 – Supplemental material for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textSupplemental material, sj-docx-3-tab-10.1177_1759720X211002682 for Cycling of tumor necrosis factor inhibitors versus switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis by Alberto Migliore, Giuseppe Pompilio, Davide Integlia, Joe Zhuo and Evo Alemao in Therapeutic Advances in Musculoskeletal Disease</p
Dispersion of silicon based micro-and nano-photonic structures and its device applications
No full textSignificant dispersion can occur in silicon micro- and nano-photonic structures, such as photonic crystals and microresonators. These dispersions may cause the phase shift and group velocity of light to be highly wavelength dependent along a fixed propagation path, or cause the propagation direction of light to be highly sensitive to the wavelength. These two types of effects are called longitudinal dispersion and angular dispersion, respectively. The slow-light effect is due to the longitudinal dispersion, and the angular dispersion is associated with the superprism effect in photonic crystals. Though, longitudinal dispersion has a less apparent influence on the superprism effect, as revealed through a more in-depth analysis. A synergistic theoretical framework of the dispersions is developed to enable a common examination of the longitudinal and angular dispersion in photonic crystal structures. These dispersive effects can lead to undesirable consequences, such as large losses and/or narrow bandwidths. For the slow-light effect, a basic proof will be shown for the scaling of random scattering losses due to fabrication imperfections in a photonic crystal waveguide. For the superprism effect, a fundamental limit, the bandwidth-sensitivity product, will be presented that governs the maximum angular sensitivities and the achievable bandwidth. This product is the counterpart of the bandwidth-delay product for the slow-light effect. A parallel-coupled dual racetrack silicon resonator structure is proposed and analyzed for arbitrary quadrature signal generation. The over-coupled, critically-coupled, and under-coupled scenarios are systematically studied. Simulations indicate that only the over-coupled structures can generate arbitrary quadrature signals. The effects of potential asymmetries in the coupling constants and quality factors of the two racetrack resonators are systematically studied. It is shown that these asymmetry effects can be compensated by small phase shifts in the two racetracks. The design, fabrication and characterization of silicon waveguides, resonator and periodic structures, including the parallel-coupled dual racetrack structure, will also be presented. The results have shown successful coupling of resonators. With the high dispersion of silicon micro- and nano-photonic structures, light can be modulated, switched, and steered with higher efficiency and lower power consumption. Thus this study may contribute to saving energy in photonic devices.Ph.D.Includes bibliographical referencesIncludes vitaby Ryan Anthony Integli
Cycling of tumor necrosis factor inhibitors switching to different mechanism of action therapy in rheumatoid arthritis patients with inadequate response to tumor necrosis factor inhibitors: a Bayesian network meta-analysis
No full textIntroduction: For patients with rheumatoid arthritis (RA) with an inadequate response to tumor necrosis factor inhibitors (TNFi), main options include cycling onto a different TNFi or switching to a biologic/targeted synthetic disease-modifying antirheumatic drug with a different mechanism of action (MOA). This network meta-analysis (NMA) assessed comparative clinical efficacy of cycling versus switching. Methods: We conducted a literature search in MEDLINE, Embase, and Cochrane Library. Outcomes included proportion of patients with 20%, 50%, or 70% response to American College of Rheumatology criteria (ACR20/ACR50/ACR70 response), Disease Activity Score in 28 joints (DAS28) score below 2.6 or between 2.6 and 3.2, mean change in DAS28 score, mean reduction in and proportion of patients achieving a clinically meaningful reduction (⩾0.22) in Health Assessment Questionnaire score, number of serious adverse events (AEs), and withdrawals for any reason/due to AEs/lack of treatment efficacy. To account for the wide range of study populations and designs, we developed three models to conduct the NMA: fixed-effect, random-effects, and hierarchical Bayesian. PROSPERO ID: CRD42019122993. Results: We identified nine randomized controlled trials and 16 observational studies. The fixed-effect model suggested a 0.99 probability that switch was the better strategy for increasing odds of a clinically meaningful improvement in ACR50 [odds ratio (OR): 1.35 (95% credible interval (CI): 0.96–1.81)]. The fixed-effect model also suggested that switch was associated with lower rates of withdrawal for any reasons [OR: 0.53 (95% CI: 0.40–0.68)]. The random-effects and hierarchical Bayesian models suggested additional uncertainty as they considered more variability than the fixed-effect model. Discussion: Results suggest that switching to a drug with a different MOA is more effective and associated with lower rates of withdrawal than cycling to a different TNFi after failure of first-line TNFi. Further trials that directly compare cycling with switching are warranted to better assess comparative efficacy. Plain language summary Assessment of the effectiveness of different drug treatment strategies in patients with rheumatoid arthritis: an analysis of the published literature Rheumatoid arthritis (RA) is a chronic disease in which inflammation affects joints along with the entire body; this may cause significant pain, joint damage, physical disability, a decreased quality of life, and an increased risk of death. Tumor necrosis factor inhibitors (TNFis) are a common choice as first-line drugs to treat RA. Although they are effective in many patients, therapy with a TNFi is not successful within the first year of treatment in approximately one-third of patients due to either a lack of efficacy or safety issues. When TNFi therapy is unsuccessful, the options are to “cycle” to another TNFi or to “switch” to another drug with a different mechanism of action (MOA). Further studies are needed to help doctors decide the best treatment strategy for their patients when treatment with an initial TNFi fails. This study analyzed 25 published studies in which patients were either “cycled” to another TNFi or “switched” to a drug with a different MOA after unsuccessful treatment with an initial TNFi. The results showed that “switching” to a drug with a different MOA was a better treatment strategy than “cycling” to another TNFi; “switching” increased the chance of clinically meaningful improvement in disease status and lowered the chance of having to stop treatment for any reason
L’incerta evoluzione del regionalismo sanitario in Italia
No full textMuovendo dal riparto di competenze in materia di “tutela della salute” prima e dopo la riforma del Titolo V della Costituzione, il contributo esamina le principali esperienze sovranazionali (in particolare, comunitarie) di federalismo sanitario e le modalità attraverso le quali i diversi Paesi hanno inteso coniugare il principio del decentramento con l’esigenza di garantire alla popolazione assistita uniformità di trattamento nel godimento delle prestazioni. Guardando poi all’ordinamento interno, ci si domanda quanto le diverse Regioni siano riuscite a sfruttare le opportunità di differenziazione loro concesse dalla riforma costituzionale sul piano dell’offerta dei servizi sanitari, nonché quali siano – e se siano oggi determinabili – gli effetti del federalismo fiscale sulla gestione delle risorse destinate alla sanità.Taking as its starting point the division of competences before and after the reform of Title V of the Italian Constitution, the essay surveys the main supranational experiences in health care federalism (particularly, in the European Union) and how different countries have tried to combine the principle of decentralisation and the guarantee of treatment uniformity for assisted citizens in the enjoyment of services. Turning to the Italian system, the essay investigates to which extent the Regions used the opportunities opened by the constitutional reform to adopt different models in providing health services, and which are – if they are currently determinable – the effects of fiscal federalism on the management of health care resources
