Effectiveness and safety of betrixaban extended prophylaxis for venous thromboembolism compared with standard-duration prophylaxis intervention in acute medically ill patients : a systematic literature review and network meta-analysis

Aims: To determine the clinical effectiveness and safety of venous thromboembolism (VTE) prophylaxis using US- and Europe-approved anticoagulants relative to extended-duration VTE prophylaxis with betrixaban. Low molecular weight heparins (LMWHs), unfractionated heparin (UFH), fondaparinux sodium and placebo were each compared to betrixaban, as standard-duration VTE prophylaxis for hospitalized, non-surgical patients with acute medical illness at risk of VTE. Materials and methods: A systematic literature review was conducted up to June 2019 to identify randomized controlled trials (RCTs) of VTE prophylaxis in hospitalized, non-surgical patients with acute medical illness at risk of VTE. Studies that reported the occurrence of VTE events (including death) and, where possible, major bleeding, from treatment initiation to 20–50 days thereafter were retrieved and extracted. A Bayesian fixed effect network meta-analysis was used to estimate efficacy and safety of betrixaban compared with standard-duration VTE prophylaxis. Results: Seven RCTs were analyzed which compared betrixaban, LMWHs, UFH, fondaparinux sodium, or placebo. There were significantly higher odds (median odds [95% credible interval]) of VTE with LMWHs (1.38 [1.12–1.70]), UFH (1.60 [1.05–2.46]), and placebo (2.37 [1.55–3.66]) compared with betrixaban. There were significantly higher odds of VTE-related death with placebo (7.76 [2.14–34.40]) compared with betrixaban. No significant differences were observed for the odds of major bleeding with all comparators, VTE-related death with any active standard-duration VTE prophylaxis, or of VTE with fondaparinux sodium, compared with betrixaban. Limitations and conclusions: In this indirect comparison, betrixaban was shown to be an effective regimen with relative benefits compared with LMWHs and UFH. This indicates that betrixaban could reduce the burden of VTE in at-risk hospitalized patients with acute medical illness who need extended prophylaxis, though without direct comparative evidence, stronger conclusions cannot be drawn

Cost-effectiveness of cenobamate for focal seizures in people with drug-resistant epilepsy

OBJECTIVES: To estimate the cost-effectiveness of add-on cenobamate in the UK when used to treat drug-resistant focal seizures in adults who are not adequately controlled with at least two prior antiseizure medication, including at least one used adjunctively. METHODS: We estimated the cost per quality-adjusted life-year (QALY) for cenobamate compared to brivaracetam, eslicarbazepine, lacosamide and perampanel in the UK National Health Service over a lifetime time horizon. We used a Markov cohort structure to determine response to treatment, using pooled data from three long-term studies of cenobamate. A network meta-analysis informed the likelihood of response to therapy with brivaracetam, eslicarbazepine, lacosamide and perampanel relative to cenobamate. Once individuals discontinued treatment, they transitioned to subsequent treatment health states, including other antiseizure medicines, surgery, and vagus nerve stimulation. Costs included treatment, administration, routine monitoring, event management and adverse events. Published evidence and expert opinion informed the likelihood of response to subsequent treatments, associated adverse events, and costs. Utility data was based on short-form, six dimensions utility. Discounting was applied at 3.5% per annum as per National Institute for Health and Care Excellence guidance. Uncertainty was explored through deterministic and probabilistic sensitivity analyses. RESULTS: In the base case, cenobamate led to cost savings of £51,967 (compared to brivaracetam), £21,080 (compared to eslicarbazepine), £33,619 (compared to lacosamide), and £28,296 (compared to perampanel) and increased QALYs of 1.047 (compared to brivaracetam), 0.598 (compared to eslicarbazepine), 0.776 (compared to lacosamide), and 0.703 (compared to perampanel) per individual over a lifetime time horizon. Cenobamate also dominated the four drugs across most sensitivity analyses. Differences were due to reduced seizure frequency with cenobamate relative to comparators. SIGNIFICANCE: Cenobamate improved QALYs and was less costly than brivaracetam, eslicarbazepine, lacosamide and perampanel. Therefore, cenobamate may be considered as a cost-effective adjunctive antiseizure medication for people with drug-resistant focal seizures

Asher Lev at the Israel Museum: Stereotyping art and craft

Jesper Svartvik and Jakob Wirén (Eds.), Religious stereotyping and interreligious relations. New York: Palgrave Macmillan, 2013, reproduced with permission of Palgrave Macmillan. This extract is taken from the author's original manuscript and has not been edited. The definitive, published version of record is available here: http://www.palgrave.com/page/detail/religious-stereotyping-and-interreligious-relations-jesper-svartvik/?K=9781137344601 and http://www.palgraveconnect.com/pc/doifinder/10.1057/978113734267

Bullets over ballots: Islamist groups, the state and electoral violence in Egypt and Morocco

This article is concerned with state-sponsored electoral violence in liberalized autocracies. The first section of the paper identifies a number of variables that can help explain the decision calculus of authoritarian incumbents to deploy force against strong electoral challengers. The second section then examines these propositions with reference to Egypt and Morocco. Drawing on recent parliamentary elections in both countries the article questions why, despite facing the challenge of political Islam, the two regimes differed so markedly in their willingness to manipulate the polls by recourse to violence. Whilst the Egyptian authorities decided to abrogate all pretence of peaceful elections in favour of violent repression against the Muslim Brotherhood candidates and sympathizers, no such tactics were deployed by the ruling elite in Morocco. We suggest that three principal factors influenced the regimes' response to this electoral challenge: (1) the centrality of the elected institution to authoritarian survival; (2) the availability of alternative electioneering tools; and (3) the anticipated response of the international community. The article concludes by suggesting that in order to understand better when and how states deploy violence in elections, we need to focus on a more complex set of factors rather than simply on the electoral potency of key opposition challengers or the authoritarian nature of the state

Neither participation nor revolution: the strategy of the Moroccan Jamiat al-Adl wal-Ihsan

Scholars and students of Islamist movements are divided over the issue of Islamists' commitment to democracy and a number of studies have attempted to discover the true nature of Islamist parties. This paper rejects this approach and argues that the behaviour of Islamist parties can be better understood through an analysis of the constraints and opportunities that their surrounding environment provides. Specifically, the paper aims at explaining the choice of the Moroccan Jamiat al-Adl wal-Ihsan neither to participate in institutional politics nor to undertake violent actions to transform the regime. This is done through an examination of its relations with the other political actors. The paper argues that Jamiat al-Adl wal-Ihsan's behaviour is as much the product of rational thinking as it is of ideology and provides evidence to support this claim. Such findings are important not only in the Moroccan context, but contribute to a growing literature claiming that Islamist movements should be treated as rational political actors operating under 'environmental' constraints and opportunities

Оценка надежности высоконадежных систем с учетом ЗИП

Предложены приближенные верхние и нижние оценки коэффициента готовности высоконадежной восстанавливаемой системы со структурной избыточностью. Полученные расчетные соотношения могут использоваться для оценки надежности высоконадежных систем с учетом различных стратегий пополнения ЗИП

The Migration State in the Global South: Nationalizing, Developmental and Neoliberal Models of Migration Management

How do states in the Global South manage cross-border migration? This article identifies Hollifield’s “migration state” as a useful tool for comparative analysis yet notes that in its current version the concept is limited, given its focus on economic immigration in advanced liberal democracies. We suggest a framework for extending the “migration state” concept by introducing a typology of nationalizing, developmental, and neoliberal migration management regimes. The article explains each type and provides illustrative examples drawn from a range of case studies. To conclude, it discusses the implications of this analysis for comparative migration research, including the additional light it sheds on the migration management policies of states in the Global North