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- Alffenaar, J. W. C., et al.
(författare)
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Clinical standards for the dosing and management of TB drugs
- 2022
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Ingår i: The International Journal of Tuberculosis and Lung Disease. - Paris, France : International Union Against Tuberculosis and Lung Disease. - 1027-3719 .- 1815-7920. ; 26:6, s. 483-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Optimal drug dosing is important to ensure adequate response to treatment, prevent development of drug resistance and reduce drug toxicity. The aim of these clinical standards is to provide guidance on 'best practice' for dosing and management of TB drugs.Methods: A panel of 57 global experts in the fields of microbiology, pharmacology and TB care were identified; 51 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all participants.Results: Six clinical standards were defined: Standard 1, defining the most appropriate initial dose for TB treatment; Standard 2, identifying patients who may be at risk of sub-optimal drug exposure; Standard 3, identifying patients at risk of developing drug-related toxicity and how best to manage this risk; Standard 4, identifying patients who can benefit from therapeutic drug monitoring (TDM); Standard 5, highlighting education and counselling that should be provided to people initiating TB treatment; and Standard 6, providing essential education for healthcare professionals. In addition, consensus research priorities were identified.Conclusion: This is the first consensus-based Clinical Standards for the dosing and management of TB drugs to guide clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment to improve patient care.
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- Singh, K. P., et al.
(författare)
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Clinical standards for the management of adverse effects during treatment for TB
- 2023
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Ingår i: The International Journal of Tuberculosis and Lung Disease. - : International Union Against Tuberculosis and Lung Disease. - 1027-3719 .- 1815-7920. ; 27:7, s. 506-519
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Adverse effects (AE) to TB treatment cause morbidity, mortality and treatment interruption. The aim of these clinical standards is to encourage best practise for the diagnosis and management of AE.METHODS: 65/81 invited experts participated in a Delphi process using a 5-point Likert scale to score draft standards.RESULTS: We identified eight clinical standards. Each person commencing treatment for TB should: Standard 1, be counselled regarding AE before and during treatment; Standard 2, be evaluated for factors that might increase AE risk with regular review to actively identify and manage these; Standard 3, when AE occur, carefully assessed and possible allergic or hypersensitiv-ity reactions considered; Standard 4, receive appropriate care to minimise morbidity and mortality associated with AE; Standard 5, be restarted on TB drugs after a serious AE according to a standardised protocol that includes active drug safety monitoring. In addition: Standard 6, healthcare workers should be trained on AE including how to counsel people undertaking TB treatment, as well as active AE monitoring and management; Standard 7, there should be active AE monitoring and reporting for all new TB drugs and regimens; and Standard 8, knowledge gaps identified from active AE monitoring should be systematically addressed through clinical research.CONCLUSION: These standards provide a person -centred, consensus-based approach to minimise the impact of AE TB treatment.
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- Dahl-Jensen, D., et al.
(författare)
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Eemian interglacial reconstructed from a Greenland folded ice core
- 2013
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 493:7433, s. 489-494
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Tidskriftsartikel (refereegranskat)abstract
- Efforts to extract a Greenland ice core with a complete record of the Eemian interglacial (130,000 to 115,000 years ago) have until now been unsuccessful. The response of the Greenland ice sheet to the warmer-than-present climate of the Eemian has thus remained unclear. Here we present the new North Greenland Eemian Ice Drilling ('NEEM') ice core and show only a modest ice-sheet response to the strong warming in the early Eemian. We reconstructed the Eemian record from folded ice using globally homogeneous parameters known from dated Greenland and Antarctic ice-core records. On the basis of water stable isotopes, NEEM surface temperatures after the onset of the Eemian (126,000 years ago) peaked at 8 +/- 4 degrees Celsius above the mean of the past millennium, followed by a gradual cooling that was probably driven by the decreasing summer insolation. Between 128,000 and 122,000 years ago, the thickness of the northwest Greenland ice sheet decreased by 400 +/- 250 metres, reaching surface elevations 122,000 years ago of 130 +/- 300 metres lower than the present. Extensive surface melt occurred at the NEEM site during the Eemian, a phenomenon witnessed when melt layers formed again at NEEM during the exceptional heat of July 2012. With additional warming, surface melt might become more common in the future.
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- Wolff, E. W., et al.
(författare)
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Changes in environment over the last 800,000 years from chemical analysis of the EPICA Dome C ice core
- 2010
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Ingår i: Quaternary Science Reviews. - : Elsevier BV. - 0277-3791 .- 1873-457X. ; 29:1-2, s. 285-295
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Tidskriftsartikel (refereegranskat)abstract
- The EPICA ice core from Dome C extends 3259 m in depth, and encompasses 800 ka of datable and sequential ice. Numerous chemical species have been measured along the length of the cores. Here we concentrate on interpreting the main low-resolution patterns of major ions. We extend the published record for non-sea-salt calcium, sea-salt sodium and non-sea-salt sulfate flux to 800 ka. The non-sea-salt calcium record confirms that terrestrial dust originating from South America closely mirrored Antarctic climate, both at orbital and millennial timescales. A major cause of the main trends is most likely climate in southern South America, which could be sensitive to subtle changes in atmospheric circulation. Sea-salt sodium also follows temperature, but With a threshold at low temperature. We re-examine the use of sodium as a sea ice proxy, concluding that it is probably reflecting extent, with high salt concentrations reflecting larger ice extents. With this interpretation, the sodium flux record indicates low ice extent operating as an amplifier in warm interglacials. Non-sea-salt sulfate flux is almost constant along the core, confirming the lack of change in marine productivity (for sulfur-producing organisms) in the areas of the Southern Ocean contributing to the flux at Dome C. For the first time we also present long records of reversible species such as nitrate and chloride, and show that the pattern of post-depositional losses described for shallower ice is maintained in older ice. It appears possible to use these concentrations to constrain snow accumulation rates in interglacial ice at this site, and the results suggest a possible correction to accumulation rates in one early interglacial. Taken together the chemistry records offer a number of constraints on the way the Earth system combined to give the major climate fluctuations of the late Quaternary period.
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| 10. |
- Huang, X., et al.
(författare)
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The Extinction Properties of and Distance to the Highly Reddened Type IA Supernova 2012cu
- 2017
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Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 836:2
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Tidskriftsartikel (refereegranskat)abstract
- Correcting Type Ia Supernova brightnesses for extinction by dust has proven to be a vexing problem. Here we study the dust foreground to the highly reddened SN 2012cu, which is projected onto a dust lane in the galaxy NGC 4772. The analysis is based on multi-epoch, spectrophotometric observations spanning from 3300-9200 A degrees, obtained by the Nearby Supernova Factory. Phase-matched comparison of the spectroscopically twinned SN 2012cu and SN 2011fe across 10 epochs results in the best-fit color excess of (E(B-V), RMS) = (1.00, 0.03) and total-to-selective extinction ratio of (RV, RMS) = (2.95, 0.08) toward SN 2012cu within its host galaxy. We further identify several diffuse interstellar bands and compare the 5780 angstrom band with the dust- to-band ratio for the Milky Way (MW). Overall, we find the foreground dust-extinction properties for SN 2012cu to be consistent with those of the MW. Furthermore, we find no evidence for significant time variation in any of these extinction tracers. We also compare the dust extinction curve models of Cardelli et al., O'Donnell,. and Fitzpatrick, and find the predictions of Fitzpatrick fit SN 2012cu the best. Finally, the distance to NGC4772, the host of SN 2012cu, at a redshift of z = 0.0035, often assigned to the Virgo Southern Extension, is determined to be 16.6 +/- 1.1 Mpc. We compare this result with distance measurements in the literature.
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