Treatment of immune thrombocytopenic purpura: focus on eltrombopag

Immune thrombocytopenic purpura (ITP) is a relatively common autoimmune disorder in which antibodies are produced to circulating platelets. Symptoms can be mild, but for most patients the risk of severe bleeding is unacceptable and treatment is required. Glucocorticoids followed by splenectomy had been the mainstays of therapy. High dose intravenous immunoglobulin and anti-RhD therapy are available for patients with severe illness, but produce only temporary benefit. Rituximab may provide more durable responses, danazol may be underutilized, and immunosuppressants and cytotoxic agents are less often required. Recently the pathophysiology of ITP has been more clearly elucidated, particularly the importance of decreased production of platelets in most patients and the very blunted rise that occurs in serum thrombopoietin (TPO). The isolation of TPO and better understanding of its role in thrombopoiesis has led to the development of new highly effective treatments. TPO analogs had some successes in treating highly refractory ITP patients but were taken out of development due to TPO-antibody induction. Two second-generation TPO-mimetics, romiplostim and the orally available eltrombopag, have recently been licensed in some territories for the treatment of ITP. Approval of eltrombopag was based on results from Phase II and III placebo-controlled clinical trials and a long-term extension study. About 80% of patients achieve significant increases in platelet count (11% of placebo patients), with reduced bleeding and reduced use of concomitant medications; responses are often durable with no tachyphylaxis. The side effects of eltrombopag are generally mild and not worse than placebo, although there are concerns about hepatic dysfunction, and the potentials for thromboses, marrow reticulin fibrosis, rebound thrombocytopenia and cataracts. This is an important new option for highly refractory patients, and its niche in earlier treatment (and for other thrombocytopenic disorders) is yet to be defined

Agricultural to urban water transfers in Colorado: an assessment of the issues and options

December 1993.This publication is a product of the Natural Resources Law Center, a research and public education center at the University of Colorado School of Law.With constrains on the additional development of water supplies and in the face of growing urban demands for water cites have increasingly been turning to the water transfer process as a means of expanding their supplies. Urban encroachment onto formerly irrigated croplands long has caused the use of irrigation water to change to urban use. To make the transfers economically warranted the size of the transfers tends to be large. This transfer of large quantities of water from often rural areas with little alternative economic opportunity is prompting many western states to revisit their water transfer laws. This report examines approaches taken in the western states to both better facilitate the water transfer process and better address so-called third party effects. The report focuses initially on water transfer law and procedure in Colorado and notes that Colorado emphasizes a single kind of transaction--one in which there is a permanent purchase of a water right and a consequent total cessation of the associated activity. The report then provides a detailed evaluation of a variety of approaches used in other western states involving (1) conditioning water transfers, (2) requiring reduced water use, (3) providing incentives to conserve, and (4) facilitating short-term transfers. Finally recommendations are made for changes in Colorado law and procedure providing incentives to save water, establishing water banks, and addressing third party effects.Financed in part by the U.S. Dept. of the Interior, Geological Survey, through the Colorado Water Resources Research Institute

Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems.

BackgroundGiven the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice.MethodsSemi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions.ResultsOf those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network.ConclusionAlthough the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies.Trial registrationNCT00880126

Immunizations for Oklahoma cow-calf herds

The Oklahoma Cooperative Extension Service periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

Controlling Water Use: The Unfinished Business of Water Quality Protection

This digital resource contains only an abstract, cover image and table of contents information from the published book. Print copy of book is available in the University of Colorado’s Wise Law Library: http://lawpac.colorado.edu/record=b136188~S0https://scholar.law.colorado.edu/books_reports_studies/1138/thumbnail.jp

Controlling Water Use: The Unfinished Business of Water Quality Protection

This digital resource contains only an abstract, cover image and table of contents information from the published book. Print copy of book is available in the University of Colorado’s Wise Law Library: http://lawpac.colorado.edu/record=b136188~S0https://scholar.law.colorado.edu/books_reports_studies/1138/thumbnail.jp