Advantages Of US Research Articles

Comparative effectiveness of dupilumab and omalizumab on asthma exacerbations and systemic corticosteroid prescriptions: Real-world US ADVANTAGE study

In the United States, dupilumab is approved for moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma, and omalizumab is approved for managing moderate-to-severe allergic asthma uncontrolled by inhaled corticosteroids. However, limited comparative effectiveness data exist for these biologics due to differing patient characteristics and treatment histories. This study assessed the real-world effectiveness of dupilumab and omalizumab for asthma in patients in the United States. In this retrospective observational study, TriNetX Dataworks electronic medical record data were used to identify patients with asthma age ≥12 years who initiated (index) dupilumab or omalizumab between November 2018 and September 2020 and who had at least 12 months of pre- and post-index clinical information. Inverse probability of treatment weighting was applied to balance potential confounding in treatment groups. Asthma exacerbation rates and systemic corticosteroid (SCS) prescriptions were compared using a doubly robust negative binomial regression model, adjusting for baseline exacerbation/SCS rates and patient characteristics with ≥10% standardized differences after inverse probability of treatment weighting. All inclusion and exclusion criteria were met by 2138 dupilumab patients and 1313 omalizumab patients. After weighting, the majority of baseline characteristics were balanced (standard difference <10%) between the 2 groups. Dupilumab was associated with a 44% lower asthma exacerbation rate (P< .0001) versus omalizumab. Additionally, dupilumab treatment significantly (P< .05) reduced SCS prescriptions by 28% during the follow-up period compared with omalizumab treatment. The US ADVANTAGE real-world study demonstrated a significant reduction in severe asthma exacerbations and SCS prescriptions for patients prescribed dupilumab compared with patients prescribed omalizumab during 12 months of follow-up.

Real-world effectiveness of dupilumab in patients with asthma: Findings from the US ADVANTAGE study

BackgroundDupilumab is approved as an add-on maintenance therapy for patients (≥6 years) with moderate-to-severe asthma. Better understanding of real-world effectiveness is needed. ObjectiveTo characterize the real-world effectiveness of dupilumab in asthma management. MethodsThis retrospective study included patients (≥12 years of age) diagnosed with asthma, initiating dupilumab between November 2018 and September 2020. The study used a US electronic medical record database (TriNetX Dataworks, Cambridge, Massachusetts). Asthma exacerbation rates before and after the initiation of dupilumab were analyzed using generalized estimating equations models with Poisson probabilistic link to estimate incidence rate ratios (IRRs). Sensitivity analyses were conducted based on previous exacerbation data, eosinophil levels, history of atopic dermatitis or chronic rhinosinusitis with nasal polyps, previous use of biologics, and presence of SARS-CoV-2 (COVID-19). ResultsA total of 2400 patients initiating dupilumab met all study criteria. After initiation of dupilumab, risk of asthma exacerbation was reduced by 44% (IRR, 0.56; 95% CI, 0.47-0.57; P = <0.0001) and systemic corticosteroid prescriptions by 48% (IRR, 0.52; 95% CI, 0.48, 0.56; P = <0.0001) compared with those before initiation of dupilumab. Adjustment for COVID-19 showed a greater reduction in asthma exacerbations (IRR, 0.50; 95% CI, 0.45-0.55; P = <0.0001). ConclusionCurrent real-world efficacy evidence indicates that dupilumab reduces asthma exacerbations and total systemic corticosteroid prescriptions in clinical practice. The effectiveness of dupilumab was observed independent of exacerbation history, eosinophil levels, or COVID-19 impact.

REAL-WORLD EFFECTIVENESS OF DUPILUMAB IN ASTHMA: FINDINGS FROM THE US ADVANTAGE STUDY

<h3>Introduction</h3> Real-world evidence on patients with moderate-to-severe asthma treated with dupilumab is limited. Patients included in clinical trials may differ from the ones seen on a clinical office setting. The objective of our study was to characterize real-world effectiveness of dupilumab in US, as an add-on treatment in patients with moderate to severe asthma. <h3>Methods</h3> We retrospectively included patients (≥12 years of age) diagnosed with asthma, initiating dupilumab (index) between November 2018 to September 2020, with 12 months pre- and post-index information. The study employed a pre-post self-control design (TriNetX Dataworks, USA). Asthma exacerbation rates before vs. after dupilumab initiation were analyzed using Generalized Estimating Equations models with Poisson probabilistic link to estimate incidence rate ratios (IRRs). Sensitivity analyses on asthma exacerbations adjusted for COVID-19 confounding effects were performed using natural cubic splines to allow for time-varying effect estimates during pre- and post-pandemic time periods. <h3>Results</h3> A total of 2400 patients initiating dupilumab met all study criteria and 75.3% were biologic naïve. Dupilumab reduced risk of asthma exacerbations by 38% (IRR: 0.62 [95% confidence interval: 0.58-0.65], P=<.0001). Significant reductions in asthma exacerbations were observed in patients with at least 1 or 2, pre-index, asthma exacerbations, by eosinophil count categories, and when adjusted for impact of COVID-19 (Table-1) <h3>Conclusion</h3> The US ADVANTAGE study demonstrated real-world effectiveness of dupilumab in reducing asthma exacerbation among patients 12 years and older in US clinical practice. These findings are generally consistent with data from previous pivotal clinical trials with dupilumab.

US for Traumatic Nerve Injury, Entrapment Neuropathy, and Imaging-guided Perineural Injection.

US is commonly performed to help diagnose traumatic peripheral nerve injury and entrapment neuropathy, particularly with superficial nerves, where higher spatial resolution provides an advantage over MRI. Other advantages of US include dynamic evaluation, easy contralateral comparison, fewer implant contraindications, less artifact from ferromagnetic debris, and facile needle guidance for perineural injections. The authors review peripheral nerve US for traumatic peripheral nerve injury with an emphasis on injury grading and entrapment neuropathy and describe best-practice techniques for US-guided perineural injections while highlighting specific techniques and indications. Online supplemental material is available for this article. ©RSNA, 2022.

Use of non-contrast MR in diagnosing secondary lymphedema of the upper extremities (reply to a letter to the Editor)

We appreciate the opportunity to reply to the letter regarding the use of US as alternative to MRI as a diagnostic method for lymphedema diagnosis and tracking. The authors point out several advantages of US over MRI in the assessment of dermal thickening and subcutaneous edema: lower expense, easier access, and the virtual lack of contraindications to US. We completely agree that US is an indispensable tool for the evaluation of upper and lower extremity lymphedema. In addition to conventional US exams, ultra-high-frequency ultrasound (UHFUS), operating up to 70 MHz, has demonstrated a role in visualization of lymphatic channels. 1. Hayashi A. Giacalone G. Yamamoto T. Belva F. Visconti G. Hayashi N. Handa M. Yoshimatsu H. Salgarello M. Ultra high-frequency ultrasonographic imaging with 70 MHz scanner for visualization of the lymphatic vessels. Plast Reconstr Surg Glob Open. 2019; 7e2086https://doi.org/10.1097/GOX.0000000000002086 Google Scholar At our lymphedema clinic, we regularly use UHFUS to select sites for lympho-venous bypass.

Musculoskeletal imaging in neonates: use of ultrasound.

High-resolution US is a practical, cost-effective modality to evaluate the musculoskeletal system in neonates. US can be performed portably in the neonatal intensive care unit so that the critically ill infant can be evaluated with minimal distress. Sonography is noninvasive and does not require sedation; typical questions that might require the use of MRI or CT in older children can be rapidly resolved with US. Dynamic imaging can be used in real time to stress joints and see how articular structures relate. Given the advantages of US within the neonatal population, it has been widely used to evaluate for neonatal fractures, congenital joint abnormalities, limb deficiencies as well as muscular and soft-tissue abnormalities.

Trump and the End of an Era? The Liberal International Order in Perspective

ABSTRACT The liberal international economic and political order which the United States created from the ashes of World War II and has since led is in trouble. To United States President Donald Trump, the order which provided the framework under which sovereign states agreed to follow a rules-based system of economic and political cooperation and shared multilateral governance, has not only allowed other nations (in particular, China) to take advantage of US ‘magnanimity’, but also weakened the United States economically, while asymmetric alliances compromised its military advantages. Given the sustained assault this cosmopolitan order is facing, many fear that it may not survive if Trump is re-elected in November 2020. Indeed, if the United States response to the COVID-19 pandemic is any guide, an ‘America First’ agenda, especially a hard-line approach to China, will shape US policy if Trump wins a second term.

A Sino-US comparative analysis of the hi-tech entrepreneurial model

This paper adds a government subsidy variable to expand the WWY (Wang, C., Wang, N., Yang, J., 2012) model, which is a three-stage entrepreneurial dynamic partial equilibrium model and a useful theoretical tool to analyze entrepreneurial realities after government intervention factors are considered. We analyze the productivity shock and market portfolio risk, endogenous entry and exit, investment, consumption, enterprise value and so on, using 15 parameters and 21 variables. The paper explains the present hi-tech entrepreneurial competitive advantage of US, even Chinese government provides lump sum financial subsidy. Although subsidies lower the initial entrepreneurial condition, significantly increase the number of startups, but would not improve entrepreneurial quality such as the investment and the growth of the hi-tech entrepreneurial wealth. The ongoing market deepening reforms such as IPO reform and venture capital cooperation will finally improve model parameters of China and weaken US’s advantage. Another conclusion is that debt-based entrepreneurship should not be encouraged. The conclusions will have some important policy significance.

Ultrasound in the diagnosis and management of giant cell arteritis.

US has become an important diagnostic tool for musculoskeletal diseases. Because of its wide availability in rheumatology practice, US has also been applied in other rheumatic diseases such as GCA. In acute GCA, US displays a non-compressible, hypoechoic, most commonly concentric arterial wall thickening. Temporal and axillary arteries should be examined in patients with suspected GCA and PMR. Additionally, almost all other large arteries, with the exception of the thoracic aorta, can be easily delineated by US. Many studies and several meta-analyses have been conducted to evaluate the diagnostic performance of US. US is more sensitive than temporal artery biopsy (TAB) because TAB evaluates only a limited anatomical region in a systemic disease. Most US studies arrive at specificities between 90 and 100% compared with the final clinical diagnosis. Reliability for reading US images and videos is excellent and comparable to reliability for reading TAB specimens. The advantage of US over other imaging techniques in GCA is its availability, safety and tolerability and its high resolution of 0.1 mm. Rheumatology departments are increasingly establishing fast-track clinics. Physicians can refer patients with suspected GCA within 24 h. Patients receive clinical and US examination by experienced specialists, establishing a clear diagnosis either before TAB or without the need for TAB. The introduction of fast-track clinics has led to a significant reduction of permanent vision loss. Furthermore, a process that primarily includes US is significantly more cost-effective than TAB.

The Growth Effects of R&amp;D Spending in the EU: A Meta-Analysis

AbstractIn this paper we conduct a meta-analysis to examine the link between R&amp;D spending and economic growth in the EU and other regions. The results suggest that the growth-enhancing effect of R&amp;D in the EU15 countries does not differ from that in other countries in general, but it is less significant than that for other industrialized countries. A closer inspection of the data reveals that the weak results for the EU15 stem from comparisons with the US – the US has been able to generate a stronger growth response from its R&amp;D spending. Possible explanations for the US advantage include higher private sector investment in R&amp;D and stronger public-private sector linkages than in the EU. Hence, to reduce the “innovation gap” vis-à-vis the US, it may not be enough for the EU to raise the share of R&amp;D expenditures in GDP: continuous improvements in the European innovation system will also be needed, with focus on areas like private sector R&amp;D and public-private sector linkages.

Improving the fertilizer use efficiency and profitability of small farms by intercropping with transgenic Bt cotton

Bt transgenic hybrid cotton productivity and profitability could not be sustained after 2007 in India which necessitated to investigate into the nutrient needs of transgenic Bt hybrid cotton and their intercropping systems. Seven Bt transgenic hybrid cotton intercropping systems with four fertilizer management practices and two plant spacings were evaluated in split plot design during 2010-12 in Vertisols at Central institute for Cotton Research, Nagpur, India. Present recommendation of Pigeon pea refugea as stripcropping (2:8) with transgenic Bt hybrid cotton reduced seed cotton yield by 69%, therefore, not accepted by 82% farmers. Tagetus sp. or Dolichus lab lab were advocated as better refugea with economic advantage of US $ 600 ha-1 with C: B ratio of 1:2.8. However, a net a profitability of US $768 and 662 ha-1 with a C:B ratio of 1:3.7 and 1:3 were achieved in intercropping with roselle or soybean compared to US $ 348 C:B ratio of 1:2.5 only with transgenic Bt hybrid cotton alone. This study also breaks the myth of 30% extra fertilizer dose for transgenic Bt hybrid cotton, which requires 90:20:37 N:P:K kgha-1 only and soybean intercropping requires additional 14:13:0 N:P:K kg ha-1. Any deficiencies arising can be economically corrected with two prophylactic foliar sprays of NMgB after square initiation. NPK uptake, nutrient and fertilizer use efficiencies were significantly improved in transgenic Bt hybrid cotton and intercropping with soybean and roselle (except PUE). Hand weeding cost was minimum in soybean and maximum in roselle with Pendimethalin PPI rotated with Pyrithiobac Na EPE. Key words: Transgenic Bt hybrid cotton, fertilizer use efficiency, intercropping, small farms, soybean.

Midgut clockwise whirlpool – : A case report and review of Gray scale and Color Doppler ultrasonographic findings

Midgut volvulus is a cause of acute abdomen in neonates and infants. Learning to recognize the US ?ndings of midgut volvulus is imperative, and it should always be considered in the differential diagnosis of abdominal pain in the pediatric population. For the neonate with the classic appearance of a whirlpool sign, additional imaging investigation is often unnecessary, and the surgeon should be alerted to plan for emergency surgery. Until now, the diagnosis of this condition has relied on upper gastrointestinal barium studies. We describe a case of midgut volvulus diagnosed on ultrasound after observing the whirlpool sign. This sign corresponds to a clockwise wrapping of the superior mesenteric vein and the mesentery around the superior mesenteric artery. Using ultrasound as an investigation modality when suspecting midgut volvulus in neonates and infants is also emphasized. Also, the advantages of US for this age group are apparent, since it can be performed at the bedside in intensive care units and lacks the adverse effects of ionizing radiation.

American engagement and the pathways to Arab–Israeli peace

This close empirical study of decades of US efforts to bring peace between Arab states and Israel helps reflect on Arild Underdal and Oran R. Young’s leadership typologies. Distinguishing between coercive leadership based on the incentives and sanctions that robust capabilities make possible and instrumental leadership focused more on talking, skilled mediation, and policy innovation is useful. However, this US mediation demonstrates that the two are not wholly distinct as previously suggested. The narrative of US efforts from Richard M Nixon to William J Clinton, including 22 cases of US involvement in Arab–Israeli mediation, suggests successful US mediation has been based on four factors. US involvement has led to breakthroughs when the US administration was highly engaged and kept at the problem after an initial diplomatic setback; benefitted from an exogenous event; managed that event to the US advantage; and dealt with strong Arab and Israeli partners.

Reply to Dr. B. Karmazyn regarding ‘Duodenum between the aorta and the SMA does not exclude malrotation’

Sir, In response to Dr. Karmazyn’s letter [1], we would like to clarify the following: We disagree with the statement that the study evaluated patients with suspected malrotation, since this was not the case. The population, as stated in the materials and methods segment of the text, included asymptomatic patients explored for recurring respiratory symptoms [2]. Moreover, in all cases, US demonstrated the absence of whirlpool and the parallel position of the mesenteric vessels, excluding (unexpected) midgut volvulus. We agree with the title of Dr. Karmazyn’s letter, given that “the presence of the duodenum between the SMA and the aorta does not exclude malrotation,” complicated by midgut volvulus. If the duodenum twists around the axis of the mesenteric vessels, as it does in midgut volvulus, this clockwise rotation can position a portion of it behind the mesenteric vessels, as shown in Figs. 3 and 4 in his letter [1]. However, in these cases, the authors did not show parallel orientation of the superior mesenteric vessels. The embryology of intestinal rotation demonstrates the importance of the relationship between the duodenum and the mesenteric vessels. Upper gastrointestinal fluoroscopy defines the normal duodenal position in relation to bone structures. The advantage of US therefore resides in its ability to visualize the direct relationship between the mesenteric vessels and the duodenum and to identify those situations in particular in which the duodenum is not located in the aorto-mesenteric angle. In conclusion, retromesenteric D3 excludes uncomplicated malrotation, and parallel orientation of the mesenteric vessels excludes midgut volvulus. Only cross-sectional imaging as a whole and US in particular can achieve both objectives in the same setting and in the same study, not UGI.

Ultrasound of the paediatric chest

US is increasingly used to study the lung parenchyma, pleural cavity, mediastinum and chest wall, both prenatally and postnatally. Foetal lungs are routinely inspected in the standard cardiac four-chamber view. Owing to their fluid content, the foetal lungs are seen as homogeneous structures of medium echogenicity; the echogenicity increases slightly throughout gestation. Using colour or power Doppler, the examiner can assess lung vascularisation without intravenous contrast, a major advantage of US in clinical practice. Routine use of prenatal US has led to higher detection rates for congenital lung malformations (bronchopulmonary foregut malformations). These are readily identified on US since they are more echogenic than the surrounding lung and produce a mass effect on neighbouring structures, particularly the heart. The malformations tend to be focal and unilateral; hence, a bilateral increase in lung size and echogenicity would rather suggest laryngeal or tracheal atresia. The observation of significant lung enlargement due to accumulated bronchial secretions in foetuses with tracheal atresia inspired prenatal treatment of severe pulmonary hypoplasia secondary to diaphragmatic hernia. This treatment stimulates lung development by artificial tracheal obstruction achieved via endoscopic insertion of an intratracheal balloon. The degree of pulmonary hypoplasia can be determined by calculating the lung-to-heart ratio (LHR) using US, or by calculating the relative foetal lung volume (RFLV) using magnetic resonance planimetry. It is extremely difficult to identify the ipsilateral lung remnant (“ipsilateral cap”) by US, and therefore it is excluded from the LHR calculation. This limitation of US can sometimes be overcome using power Doppler to follow the pulmonary artery and thereby identify the lung cap. Unlike the foetal lung, the postnatal lung appears as echogenic lines with a comet-tail configuration produced by air in the alveoli. The most common condition studied by US in clinical practice is lung consolidation. One characteristic US sign of lung consolidation is the sonobronchogram produced by air-filled bronchi within consolidated lung (Fig. 1). The consolidated lung is vascularised by pulmonary vessels, easily identified by their quadriphasic waveform on pulsed Doppler. US can be used to study several pleural conditions, particularly fluid collections. Classically, when pleural fluid was suspected on plain film, lateral decubitus films were taken to confirm the finding. In our opinion, US should be used instead of decubitus films for this purpose since the fluid can be seen directly, fluid volume calculated and the nature of the fluid characterised to determine the severity of the condition. Thereby, further radiation exposure is avoided. US is the best radiological technique for characterising the nature of pleural collections, which are classified according to their sonographic appearance into two types: simple and complex. Simple effusions are completely anechoic and usually correspond to transudates. Complex effusions or exudates present one or more of these US features: echogenic debris, fibrin strands, septa and a honeycomb appearance. In children, infections are the most common cause of complex effusions (parapneumonic effusions, empyema). Characterisation of pleural collections Disclaimer Dr. Enriquez has no financial interests, investigational or off-label uses to disclose.

September 11 and the Middle East Failure of US ‘Soft Power’: Globalisation contra Americanisation in the ‘New’ US Century

September 11 has shed doubt over the United States’ ‘soft power’: the country’s cultural-ideological appeal. In the context of globalisation it was supposed that the US government did not need to exert any effort to broadcast the country’s values and appeal. Globalisation skews the ideological-informational playing field to US advantage: globalisation is Americanisation. In reality globalisation actually reduces the US grip on global information flows and image-making. Moreover, the US response to September 11 created even more problems in this regard, thanks to US neglect of the problems of poverty and underdevelopment that helped create the terrorist backlash. The US government has also continued to neglect cultural diplomacy, believing it can win a war against an aspect of globalisation -transnational terror -and re-impose a world split into zones of peace and zones of turmoil.

Sonography of the hand and wrist

In the recent years US has gained wide diffusion as a useful imaging tool in the evaluation of musculoskeletal disorders. Recognized advantages of US over the other imaging modalities are low costs, non-invasiveness, possibility to perform a dynamic examination and readiness. Unfortunately, US has a long learning curve and allows good results only when performed by well-trained and experienced examiners. Specifically, utilization of the recent small transducers allows to perform dynamic examination of the hand during flexion-extension movements of the fingers, while their high frequency (till 15 MHz) have increased the possibility to evaluate small anatomic structures of the hand and wrist as well as to detect subtle pathologic changes. The purpose of this article is to present first the normal basic anatomy and US appearance. Then the main pathological conditions including joint and tendon disorders, foreign bodies and other traumatic lesions, entrapment neuropathies and expansible lesions will be presented.

The National Origin of the Ownership Advantages of Firms

This study is designed to examine the extent to which home countries affect the nature of the ownership advantages of firms and subsequently their competitive position in the international market. The empirical analysis is based on a comparison of the ownership advantages of US, UK and French advertising agencies and examination of their possible origin in specific characteristics of the home countries. The findings suggest that the impact of home countries is essential, but it provides only partial explanation for the nature of the ownership advantages which advertising agencies develop. Some of these advantages re related to the attributes of individual advertising agencies and they vary in line with their unique characteristics rather than in response to the characteristics of their home countries.

The 1986 tax reform act: potential effects on domestic and foreign investors

Examines the way in which the 1986 Tax Reform Act affected the status of US real estate as a tax shelter. Demonstrates that because tax benefits previously were an important component of total returns from income producing real estate, its immediate effect is to reduce after‐tax returns from real estate. Argues that if market values fall and rents rise, however, after‐tax returns from income producing real estate should be sufficient to attract individual US investors. Adds that the 1986 Tax Act should attract more US pension funds and foreign investors to US investment real estate given that the buying advantage of US investors has been reduced.

Ultrasonic imaging

In the thirty years since US imaging became technically feasible, rapid progress is very recent and has occurred in the fields of obstetrics, cancer diagnostics and heart diagnostics. The advantages of US compared with X-ray methods are discussed and the two computerised methods of producing pulse-echo images by transducer scanning are described. Photographic records are presented illustrating a pregnancy, a liver tumour and a human heart exhibiting mitral stenosis.