Does dupilumab decrease the amount of asthma exacerbations in patients suffering from asthma compared to placebo?

OBJECTIVE: The objective of this systematic EBM review is to determine “Does dupilumab decrease the amount of asthma exacerbations in patients suffering from asthma compared to placebo?” STUDY DESIGN: A review of three randomized, placebo-controlled trials (RCTs) that were peer reviewed and published in English after 2009. DATA SOURCE: All articles were published in peer reviewed journals and were researched using PubMed. Studies were selected based on their ability to answer the question posed in the objective, and if the researched outcomes were patient oriented. OUTCOMES: Assessed outcomes were either the occurrence or rate of asthma exacerbations during the studies. The specifics of a defined exacerbation were similar, but minimally different between each randomized controlled trial. Exacerbations according to the authors are as follows: Wenzel (2013): “\u3e1 systemic glucocorticoid burst, in patient hospitalization, or an emergency department visit for worsening asthma” Wenzel (2016): “deterioration of asthma that required the use of systemic corticosteroids for at least 3 days, or hospital admission or emergency department visit because of asthma treated with systemic corticosteroids” Rabe: “events leading to hospitalization, and ED visit, or treatment of \u3e3days with systemic glucocorticoids at \u3e2 times the current” RESULTS: All three studies found that Dupilumab had a large treatment effect on patients with asthma and decreased exacerbations. Wenzel et al. (2013) found a NNT of three, with an odds ratio (OR) of 0.08 (95% CI, 0.02 to 0.28, p\u3c0.001) in favor of intervention decreasing risk for exacerbation. Wenzel et al. (2016) had a NNT of seven, with a risk reduction percentage of 70.5% (95% CI, 45.4-84.1%, pvalue=0.0001) with Dupilumab intervention. And Rabe et al. found an RR of 0.407 (95% CI, 0.263 to 0.630) meaning there is less than half the risk of an exacerbation with intervention. CONCLUSIONS: The results of these three studies showed that Dupilumab does decrease the amount of asthma exacerbations compared to placebo in patients suffering from asthma. However, further research with more patients needs to be conducted with more consistent treatment protocols to understand optimal dosing

A Unified Framework for the Study of Anti-Windup Designs

We present a unified framework for the study of linear time-invariant (LTI) systems subject to control input nonlinearities. The framework is based on the following two-step design paradigm: "Design the linear controller ignoring control input nonlinearities and then add anti-windup bumpless transfer (AWBT) compensation to minimize the adverse eflects of any control input nonlinearities on closed loop performance". The resulting AWBT compensation is applicable to multivariable controllers of arbitrary structure and order. All known LTI anti-windup and/or bumpless transfer compensation schemes are shown to be special cases of this framework. It is shown how this framework can handle standard issues such as the analysis of stability and performance with or without uncertainties in the plant model. The actual analysis of stability and performance, and robustness issues are problems in their own right and hence not detailed here. The main result is the unification of existing schemes for AWBT compensation under a general framework

Curvature in causal BD-type inflationary cosmology

We study a closed model of the universe filled with viscous fluid and quintessence matter components in a Brans-Dicke type cosmological model. The dynamical equations imply that the universe may look like an accelerated flat Friedmann-Robertson-Walker universe at low redshift. We consider here dissipative processes which follow a causal thermodynamics. The theory is applied to viscous fluid inflation, where accepted values for the total entropy in the observable universe is obtained.Comment: 11 pages, revtex 4. For a festschrift honoring Alberto Garcia. To be publishen in Gen. Rel. Gra

Humans\u27 Bonding with their Companion Dogs: Cardiovascular Benefits during and after Stress

This study examined whether having one\u27s companion dog present during and after stress posed similar cardiovascular benefits as having a close friend present, even when the relationship quality for both the companion dog and friend was highly positive. Positive aspects of relationship quality for participants\u27 dog and friend were not associated with one another, suggesting that these relationships exist independently. Additionally, compared to participants with a close friend present, those with their dog present had lower heart rate and diastolic blood pressure (p\u27s \u3c .05) while undergoing the stressors, and tended to have lower heart rate and systolic blood pressure (p\u27s \u3c .09) when recovering from stressors. This study indicates that even when relationship quality is similarly high for companion dogs and friends, dogs may be associated with greater reductions in owners\u27 cardiovascular reactivity to stress, particularly if there is a potential for evaluation apprehension in the human friendships. These findings support the value of the human- companion animal relationship in promoting human welfare

Development of a testing protocol for oil solidifier effectiveness evaluation

Chemical countermeasures for oil spill remediation have to be evaluated and approved by the U.S. Environmental Protection Agency before they may be used to remove or control oil discharges. Solidifiers are chemical agents that change oil from a liquid to a solid by immobilizing the oil and bonding the liquid into a solid carpet-like mass with minimal volume increase. Currently, they are listed as Miscellaneous Oil Spill Control Agent in the National Contingency Plan and there is no protocol for evaluating their effectiveness. An investigation was conducted to test the oil removal efficiency of solidifiers using three newly developed testing protocols. The protocols were qualitatively and quantitatively evaluated to determine if they can satisfactorily differentiate effective and mediocre products while still accounting for experimental error. The repeatability of the three protocols was 15.9, 5.1, and 2.7 %. The protocol with the best performance involved measuring the amount of free oil remaining in the water after the solidified product was removed using an ultraviolet–visible spectrophotometer and it was adopted to study the effect of solidifier-to-oil mass ratio, mixing energy, salinity, and beaker size (i.e., area affected by the spill) on solidifier efficiency. Analysis of Variances were performed on the data collected and results indicated that the beaker size increased spreading, which reduced removal efficiency. Mixing speed appears to impart a ceiling effect with no additional benefit provided by the highest level over the middle level. Salinity was found to be mostly an insignificant factor on performance

An accelerated closed universe

We study a model in which a closed universe with dust and quintessence matter components may look like an accelerated flat Friedmann-Robertson-Walker (FRW) universe at low redshifts. Several quantities relevant to the model are expressed in terms of observed density parameters, $\Omega_M$ and $\Omega_{\Lambda}$, and of the associated density parameter $\Omega_Q$ related to the quintessence scalar field $Q$.Comment: 11 pages. For a festschrift honoring Alberto Garcia. To appear in Gen. Rel. Gra