Combination leflunomide and methotrexate (MTX) therapy for patients with active rheumatoid arthritis failing MTX monotherapy: open-label extension of a randomized, double-blind, placebo controlled trial

P e r s o n a l n o n -c o m m e r c i a l u s e o n l y . T h e J o u r n a l o f R h e u m a t o l o g y . C o p y r i g h t © 2 0 0 4 . A l l r i g h t s r e s e r v e d Conclusion. Response to therapy was maintained to 48 weeks of treatment in patients who continued to receive LEF and MTX during the extension. Importantly, ACR20 response rates after 24 weeks of LEF therapy were similar between patients switched from PLA to LEF without loading dose, and those who received a loading does of LEF (100 mg/day × 2 days) at randomization. Fewer adverse events were reported in patients switched to LEF without a loading dose. (J Rheumatol 2004;31:1521-31

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Variability of atmospheric density in the middle atmosphere /

An analysis of the time and space variability of density in the middle atmosphere has been developed in this report, affording a means to determine density changes that occur over distances out to 200 nmi and time periods of 1 to 72 hr. Spatial variations - The rms differences between densities at locations 50, 100, and 200 nmi apart are provided in Tables 4, 8 and 11 for low- and middle- latitude stations at altitudes from 20 through 60 km. These rms values are estimates of the day-to-day variability around the mean density gradients given in Table 5 for low latitudes and Tables 9 and 12 for middle latitudes. Time variations - The rms variability of density for time periods from 1 to 12 hr in tropical regions is given in Table 13 for altitudes up to 60 km. Estimates were derived using autocorrelation theory and an analysis of the diurnal variation of density, which is the dominant periodic cycle at low latitudes. Analyses of available density observations at several midlatitude locations for altitudes between 30 and 60 km provide reasonable estimates of the magnitude (and changes with season and latitude) of the variability of density with time for periods up to 72 hr. Variations of density at these latitudes are relatively small during summer and do not increase significantly with time. Rms variations remain between 1-1/2 and 4 percent for all periods up to 72 hr.Research supported by the Air Force Geophysics Laboratory, Air Force Systems Command, United States Air Force, Hanscom AFB, Massachusetts.Meteorology Division Project 6670."17 March 1983."Includes bibliographical references (page 24).An analysis of the time and space variability of density in the middle atmosphere has been developed in this report, affording a means to determine density changes that occur over distances out to 200 nmi and time periods of 1 to 72 hr. Spatial variations - The rms differences between densities at locations 50, 100, and 200 nmi apart are provided in Tables 4, 8 and 11 for low- and middle- latitude stations at altitudes from 20 through 60 km. These rms values are estimates of the day-to-day variability around the mean density gradients given in Table 5 for low latitudes and Tables 9 and 12 for middle latitudes. Time variations - The rms variability of density for time periods from 1 to 12 hr in tropical regions is given in Table 13 for altitudes up to 60 km. Estimates were derived using autocorrelation theory and an analysis of the diurnal variation of density, which is the dominant periodic cycle at low latitudes. Analyses of available density observations at several midlatitude locations for altitudes between 30 and 60 km provide reasonable estimates of the magnitude (and changes with season and latitude) of the variability of density with time for periods up to 72 hr. Variations of density at these latitudes are relatively small during summer and do not increase significantly with time. Rms variations remain between 1-1/2 and 4 percent for all periods up to 72 hr.Mode of access: Internet

A comparison between observed and deduced mean monthly winds from 700 mb to 200 mb /

Differences between mean monthly winds obtained from actual observations and geostrophic wind derived from mean monthly altitudes of constant-pressure surfaces are examined for January and July at four levels between 10,000 and 40,000 ft. Differences in speed for both east-west and north-south components are significantly and unexpectedly large. These results demonstrate the advantage of using observed winds rather than deduced values to provide climatic winds at altitudes betweet 10,000 and 40,000 ft. Modification of the existing system to include winds from actual observations wherever and whenever possible is recommended. (Author)."Aeronomy Laboratory Project 8624."ADA021897 (from http://www.dtic.mil).""22 January 1976."Includes bibliographical references."Differences between mean monthly winds obtained from actual observations and geostrophic wind derived from mean monthly altitudes of constant-pressure surfaces are examined for January and July at four levels between 10,000 and 40,000 ft. Differences in speed for both east-west and north-south components are significantly and unexpectedly large. These results demonstrate the advantage of using observed winds rather than deduced values to provide climatic winds at altitudes betweet 10,000 and 40,000 ft. Modification of the existing system to include winds from actual observations wherever and whenever possible is recommended. (Author).Mode of access: Internet

How dry is the sky? : a Decade later and the SST /

Water vapor that would be added to the stratosphere by a potential fleet of SSTs is related to the most accepted humidity balance in the stratosphere based on general circulation considerations, and to moisture introduced into the stratosphere by vaporization from convective clouds. A mean residence time of 25 months for water vapor was calculated from general circulation values. On the assumption that other water vapor reaching the stratosphere was an equal time of residence, a fleet of SSTs would increase humidity by 0.5 ppm or 25 percent of the generally accepted 2 ppm equilibrium value. Vaporization of only 1 percent of the convective cloud mass, calculated herein to enter the stratosphere, would increase its mixing ratio by 1 ppm. (Author).Research supported by the Air Force Cambridge Research Laboratories, Air Force Systems Command, United States Air Force, L.G. Hanscom Field, Bedford, Massachusetts.Aeronomy Laboratory Project 8624.Errata slip inserted: D 301.45/9:240/ERRATA.AD0748797 (from http://www.dtic.mil)."27 April 1972."Includes bibliographical references (pages 19-20).Water vapor that would be added to the stratosphere by a potential fleet of SSTs is related to the most accepted humidity balance in the stratosphere based on general circulation considerations, and to moisture introduced into the stratosphere by vaporization from convective clouds. A mean residence time of 25 months for water vapor was calculated from general circulation values. On the assumption that other water vapor reaching the stratosphere was an equal time of residence, a fleet of SSTs would increase humidity by 0.5 ppm or 25 percent of the generally accepted 2 ppm equilibrium value. Vaporization of only 1 percent of the convective cloud mass, calculated herein to enter the stratosphere, would increase its mixing ratio by 1 ppm. (Author).Mode of access: Internet

Kwajalein reference atmospheres, 1979 /

Updates and expands two earlier reports, J.E. Salah (1967)--Kwajalein standard atmosphere, and IRIG (1974) Kwajalein Missile Range, Kwajalein, Marshall Islands, reference atmosphere, Part 1."24 September 1979."Includes bibliographical references.Mode of access: Internet