EFFICACY, SAFETY, AND TOLERABILITY OF MIRABEGRON IN PATIENTS AGED ≥65 YR WITH OVERACTIVE BLADDER WET: A PHASE IV, DOUBLE-BLIND, RANDOMISED, PLACEBOCONTROLLED STUDY (PILLAR)

Pozadina: Većina bolesnika s prekomjerno aktivnim mokraćnim mjehurom (PAMM) starija je od 65 godina. Dosad nije bilo prospektivnih ispitivanja kojima bi se ocijenila djelotvornost liječenja agonistom β3-adrenoreceptora mirabegronom u ovoj specifi čnoj dobnoj skupini. Cilj: Ispitivanje faze IV u kojem se uspoređuju mirabegron u fl eksibilnoj dozi i placebo u starijih bolesnika s PAMM om i urgentnom inkontinencijom. Dizajn, uvjeti i sudionici: Bolesnici iz lokalne zajednice koji imaju ≥ 65 godina i PAMM u trajanju od ≥ 3 mjeseca. Intervencija: Nakon 2 tjednog uvodnog razdoblja tijekom kojeg se primjenjivao placebo bolesnici s jednom ili više epizoda inkontinencije, tri ili više epizoda urgencije i prosječno osam ili više mokrenja tijekom 24 h bili su randomizirani u omjeru 1:1 za dvostruko zaslijepljenu primjenu 25 mg mirabegrona ili odgovarajuće formulacije placeba na dan tijekom 12 tjedana. Nakon 4. ili 8. tjedna doza se prema odluci bolesnika i ispitivača mogla povećati na 50 mg mirabegrona/odgovarajuće formulacije placeba na dan. Mjere ishoda i statistička analiza: Primarne mjere ishoda: promjena srednjeg broja mokrenja tijekom 24 h i srednjeg broja epizoda inkontinencije tijekom 24 h od početka ispitivanja do završetka liječenja. Sekundarne mjere ishoda: promjena srednjeg izmokrenog volumena nakon mokrenja, srednjeg broja epizoda urgencije tijekom 24 h i srednjeg broja epizoda urgentne inkontinencije tijekom 24 h od početka ispitivanja do završetka liječenja. Za ocjenu srednjeg broja mokrenja tijekom 24 h, srednjeg izmokrenog volumena nakon mokrenju i srednjeg broja epizoda urgencije tijekom 24 h koristila se analiza kovarijance (ANCOVA). Za ocjenu srednjeg broja epizoda inkontinencije tijekom 24 h i srednjeg broja epizoda urgentne inkontinencije tijekom 24 h koristila se stratifi cirana rang ANCOVA. Rezultati i ograničenja: Uz mirabegron su opažena statistički značajna poboljšanja u odnosu na placebo s obzirom na promjenu srednjeg broja mokrenja tijekom 24 h, srednjeg broja epizoda inkontinencije tijekom 24 h, srednjeg izmokrenog volumena nakon mokrenja, srednjeg broja epizoda urgencije tijekom 24 h i srednjeg broja epizoda urgentne inkontinencije tijekom 24 h od početka ispitivanja do završetka liječenja. Sigurnost i podnošljivost odgovarale su poznatom sigurnosnom profi lu mirabegrona. Zaključci: Potvrđene su djelotvornost, sigurnost i podnošljivost mirabegrona tijekom 12 tjedana u bolesnika s PAMM om i inkontinencijom u dobi od ≥ 65 godina. Sažetak za bolesnike: Ispitivali smo učinak mirabegrona u usporedbi s placebom u osoba u dobi od 65 ili više godina s prekomjerno aktivnim mokraćnim mjehurom i inkontinencijom. Mirabegron je ublažio simptome prekomjerno aktivnog mokraćnog mjehura u usporedbi s placebom. Opažene nuspojave bile su slične poznatim nuspojavama mirabegrona.Background: The majority of patients with overactive bladder (OAB) are aged >65 yr. There has been no prospectively designed study assessing treatment effi cacy with the b3-adrenoreceptor agonist, mirabegron, specifi cally in this age group. Objective: A phase IV study comparing fl exibly dosed mirabegron versus placebo in elderly patients with OAB and urgency incontinence. Design, setting, and participants: Community-dwelling patients aged ≥65 yr with OAB for ≥3 mo. Intervention: Following a 2-wk placebo run in, patients with one or more incontinence episodes, three or more urgency episodes, and an average of eight or more micturitions/ 24 h were randomised 1:1 to double-blind 25 mg/d mirabegron or matched placebo, for 12 wk. After week 4 or 8, the dose could be increased to 50 mg/d mirabegron/matched placebo based on patient and investigator discretion. Outcome measurements and statistical analysis: Coprimary endpoints: change from baseline to end of treatment (EOT) in the mean numbers of micturitions/24 h and incontinence episodes/24 h. Secondary endpoints: change from baseline to EOT in the mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Analysis of covariance (ANCOVA) was used for the mean number of micturitions/24 h, mean volume voided/micturition, and mean number of urgency episodes/24 h. Stratifi ed rank ANCOVA was used for the mean numbers of incontinence episodes/24 h and urgency incontinence episodes/24 h. Results and limitations: Statistically signifi cant improvements were observed for mirabegron versus placebo in change from baseline to EOT in the mean number of micturitions/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Safety and tolerability were consistent with the known mirabegron safety profi le. Conclusions: Mirabegron effi cacy, safety, and tolerability over 12 wk were confi rmed in patients aged ≥65 yr with OAB and incontinence

Coadministration of a 9-Valent Human Papillomavirus Vaccine With Meningococcal and Tdap Vaccines

BACKGROUND: This study in 11- to 15-year-old boys and girls compared the immunogenicity and safety of GARDASIL 9 (9-valent human papillomavirus [9vHPV] vaccine) administered either concomitantly or nonconcomitantly with 2 vaccines routinely administered in this age group (Menactra [MCV4; Neisseria meningitidis serotypes A/C/Y/W-135] or Adacel [Tdap; diphtheria/tetanus/acellular pertussis]). METHODS: Participants received 9vHPV vaccine at day 1 and months 2 and 6; the concomitant group (n = 621) received MCV4/Tdap concomitantly with 9vHPV vaccine at day 1; the nonconcomitant group (n = 620) received MCV4/Tdap at month 1. Antibodies to HPV-, MCV4-, and Tdap-relevant antigens were determined. Injection-site and systemic adverse events (AEs) were monitored for 15 days after any vaccination; serious AEs were monitored throughout the study. RESULTS: The geometric mean titers for all HPV types in 9vHPV vaccine 4 weeks after dose 3, proportion of subjects with a fourfold rise or greater in titers for 4 N meningitidis serotypes 4 weeks after injection with MCV4, proportion of subjects with antibody titers to diphtheria and tetanus ≥0.1 IU/mL, and geometric mean titers for pertussis antigens 4 weeks after injection with Tdap were all noninferior in the concomitant group compared with the nonconcomitant group. Injection-site swelling occurred more frequently in the concomitant group. There were no vaccine-related serious AEs. CONCLUSIONS: Concomitant administration of 9vHPV vaccine with MCV4/Tdap was generally well tolerated and did not interfere with the antibody response to any of these vaccines. This strategy would minimize the number of visits required to deliver each vaccine individually

Three-Year Follow-up of 2-Dose Versus 3-Dose HPV Vaccine

BACKGROUND AND OBJECTIVES: Human papillomavirus (HPV) antibody responses to the 9-valent abstract human papillomavirus (9vHPV) vaccine among girls and boys (aged 9–14 years) receiving 2- dose regimens (months 0, 6 or 0, 12) were noninferior to a 3-dose regimen (months 0, 2, 6) in young women (aged 16–26 years) 4 weeks after last vaccination in an international, randomized, open-label trial (NCT01984697). We assessed response durability through month 36. METHODS: Girls received 2 (months 0 and 6 [0, 6]: n = 301; months 0 and 12 [0, 12]: n = 151) or 3 doses (months 0,2, and 6 [0, 2, 6]: n = 301); boys received 2 doses ([0, 6]: n = 301; [0, 12]: n = 150); and young women received 3 doses ([0, 2, 6]: n = 314) of 9vHPV vaccine. Anti-HPV geometric mean titers (GMTs) were assessed by competitive Luminex immunoassay (cLIA) and immunoglobulin G-Luminex immunoassay (IgG-LIA) through month 36. RESULTS: Anti-HPV GMTs were highest 1 month after the last 9vHPV vaccine regimen dose, decreased sharply during the subsequent 12 months, and then decreased more slowly. GMTs 2 to 2.5 years after the last regimen dose in girls and boys given 2 doses were generally similar to or greater than GMTs in young women given 3 doses. Across HPV types, most boys and girls who received 2 doses (cLIA: 81%–100%; IgG-LIA: 91%–100%) and young women who received 3 doses (cLIA: 78%–98%; IgG-LIA: 91%–100%) remained seropositive 2 to 2.5 years after the last regimen dose. CONCLUSIONS: Antibody responses persisted through 2 to 2.5 years after the last dose of a 2-dose 9vHPV vaccine regimen in girls and boys. In girls and boys, antibody responses generated by 2 doses administered 6 to 12 months apart may be sufficient to induce high-level protective efficacy through at least 2 years after the second dose.Medicin

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite

Creative destruction in science

Drawing on the concept of a gale of creative destruction in a capitalistic economy, we argue that initiatives to assess the robustness of findings in the organizational literature should aim to simultaneously test competing ideas operating in the same theoretical space. In other words, replication efforts should seek not just to support or question the original findings, but also to replace them with revised, stronger theories with greater explanatory power. Achieving this will typically require adding new measures, conditions, and subject populations to research designs, in order to carry out conceptual tests of multiple theories in addition to directly replicating the original findings. To illustrate the value of the creative destruction approach for theory pruning in organizational scholarship, we describe recent replication initiatives re-examining culture and work morality, working parents\u2019 reasoning about day care options, and gender discrimination in hiring decisions. Significance statement It is becoming increasingly clear that many, if not most, published research findings across scientific fields are not readily replicable when the same method is repeated. Although extremely valuable, failed replications risk leaving a theoretical void\u2014 reducing confidence the original theoretical prediction is true, but not replacing it with positive evidence in favor of an alternative theory. We introduce the creative destruction approach to replication, which combines theory pruning methods from the field of management with emerging best practices from the open science movement, with the aim of making replications as generative as possible. In effect, we advocate for a Replication 2.0 movement in which the goal shifts from checking on the reliability of past findings to actively engaging in competitive theory testing and theory building. Scientific transparency statement The materials, code, and data for this article are posted publicly on the Open Science Framework, with links provided in the article

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016