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Machine Design Sharma Agarwal Pdf 11
In contrast to most of the other performance measures, which tend to reward process measures such as reaching blood pressure goals, the Million Hearts program emphasizes patient-centered outcomes. The Million Hearts program includes a concurrent cluster RCT designed to evaluate 4 different strategies for improving control of high BP among Medicare beneficiaries with hypertension, including 1) a usual care control strategy, 2) a collaborative care strategy with provider education and counseling, 3) a provider-only strategy with education and guideline reinforcement and periodic provider performance review, and 4) a patient-only strategy with education and guideline reinforcement. The proportion of Medicare beneficiaries with high BP reaching their blood pressure control goal at 1 year was 61.1% in the usual care group, 67.7% in the collaborative care group, 60.1% in the provider-only group, and 56.4% in the patient-only group. The control rate for high BP was greatest among those who were prescribed antihypertensive drugs and lowest among those who did not.
Clinical trials with dementia assessment have evaluated all-cause dementia but not Alzheimers disease specifically. However, all of these trials have methodological issues, such as low power, insufficient follow-up length, and inadequately designed dementia assessment batteries. Further, improved standardized cognitive and functional assessment tools are needed to help identify the characteristics of drug responses.
For a given target of therapeutic interest, cancer genomic studies will often be designed to identify the single most important driver gene. This strategy may lead to the discovery of a few recurrently mutated genes, but the sample size is usually too small to infer evolutionary relationships and subclones. It is unclear whether these results reflect the mutational profile of the tumor and its evolution, or are simply due to statistical noise. Given our observation of recurrent, strongly differing driver gene mutations in T-ALL and B-ALL, it is clear that this approach to identifying key genes will frequently misclassify the progenitor cell of interest and miss true driver genes that contribute only to part of the tumor, which may go undetected even when the whole tumor is sequenced. It is also often the case that these mutations are likely passenger mutations that did not help the tumor to colonize the body and are, therefore, unlikely to have been selected for. The challenge is to identify these early, often weakly selected, driver mutations within a chaotic mutational landscape. This goal of precision medicine relies on phylogenetic inference to identify the progenitor of an individual cancer and the subclones that contributed to it. The mutational profile of cancer cells can be evaluated by a high-depth analysis of spatially localized cancer cells or by mutational profiling of spatially distant cells ( solid tumor phylogeny ). Both approaches may potentially require a sufficient number of spatially-distinct cells.
The main advantages of this approach are that it can be used before and after a PTCA to successfully dilate the stenosis and bypass the lesion. Stents can also provide a mechanical means of vessel support and lumen enlargement. The main disadvantages of this approach are the incidence of stent thrombosis and delayed lesion re-occlusion because of late restenosis. Stent designs have changed to a self-expanding variety of materials, metallic or polymeric and a variety of design patterns, which optimizes their morphological attributes. The technology of endovascular stents is now directed more toward the application of long, tapered, self-expanding stents. The stents should be flexible, should be fabricated of biocompatible materials, should be durable and their acute use should be atraumatic.
Agarwal et al. [ 130 ] have developed a drug targeting mechanism which is based on the conjugation of calcium alginate beads with carboxymethylcellulose (CMC) loaded 5-fluoroacyl (5-FU) and is targeted to the colon. The beads with lower CMC proportions presented greater swelling and muco-adhesiveness in the simulated colonic environment. With existence of colonic enzymes there was a 90% release of 5-FU encapsulated in the beads. Hansen et al. [ 131 ] investigated four cellulose derivatives, including, meteylcellulose, hydroxypropyl methylcellulose, sodium carboxymethylcellulose and cationic hydroxyethyl cellulose for application in drug release into the nasal mucosa. The association of these cellulose derivatives with an additional excipient, was also evaluated. The drug model employed in this process was acyclovir. The viability of the polymers as excipients for nasal release applications was also scrutinized for its ciliary beat frequency (CBF) and its infusion through the tissue system of the nostril cavity. An increase in thermally induced viscosity was observed when the cellulose derivatives were mixed with polymer graft copolymer. Further an increased permeation of acyclovir into the nasal mucosa was detected when it was combined with cationic hydroxyethylcellulose. None of the cellulose derivatives caused negative effects on tissues and cells of the nasal mucosa, as assessed by CBF.
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