To test the program’s effectiveness, Zarling compared a group of 515 men who completed ACTV classes to a group of 1,921 who completed the old curriculum. In the 12 months after they took the classes, the ACTV participants had about half the rate of new domestic violence arrests: 3.6 percent vs. 7 percent and they were about a third less likely to commit any new offense..
About 10 15 years ago, one of these guys discovered an incredibly striking variation of a rare plant at a remote location in the mountains of Madagascar. It was definitely a candidate for its own species, with beautiful, striking, pitch black trunks, and vivid white and red stems. There only seemed to be about 6 adult specimens in the area, and it was being threatened by an encroaching commercial agriculture development..
I have a philosophy about management/leadership I been sticking to. I make sure I always working the hardest of my dept, as that inspires the lab techs to work harder and not get lazy by following my example. Also I am never “above” doing menial tasks that I could just delegate to others.
The reasons for this vary, including cultural differences and the country’s attitude toward different business threats like the ePrivacy Regulation. Germany’s stance on data privacy is singular in Europe due to its time under Stasi rule. Consequently, data transparency in media and advertising is highly valued and incorporated earlier into business practices than in other countries.
Cover with another piece of muslin. Like a sandwich, put over the chest. Check chest in 5 minutes for any signs of allergic reaction. Could the same benefits be translated to those without established CVD (the majority of the patient population we see in clinical practice)? CANVAS PROGRAM was supposed to answer this vital question in addition to assessing CV outcomes in those with established CVD.What was the clinical impact of CANVAS PROGRAM?The only end points in which canagliflozin came out with flying colours were MACE hospitalisation due to heart failure.MACE benefits in only those with established CVD (mimicking EMPA REG trial).No reduction in all cause mortality.No reduction in CV deaths.Significant increase in rates of fractures lower limb amputations.To summarise treating patients with canagliflozin results in:23 fewer MACE (? clinical implication: in the absence of any superiority of the individual end points), 16 fewer hospitalisation due to heart failure, at the cost of 15 more amputations per 1000 patients treated for 5 years (1).Where does that leave us with?In a desperate bid to save the molecule there is an effort to generalise the amputation risk aspect.There is no escaping the fact that the amputation fracture related issue was haunting canagliflozin well before the CANVAS PROGRAM was published (indicated by the black box warnings).What was brought out in the forefront was an EMEA observation of imbalances in the amputation rates in females in the EMPA REG trial (4). Although the EMEA statements were contradictory, they wanted to scrutinise the entire empagliflozin dapagliflozin data before painting this entire class of molecules with the same brush.In July 19th 2017, the entire empagliflozin databank from phase 2 3 EMPA REG were analysed and there was no signal of either increased amputation nor fracture risk (5).Similarly the entire dapagliflozin polled phase 2 3 data did not indicate any adverse signals related to amputation fracture (6).So where do we stand as of now?Empagliflozin remains the gold standard therapy for all type 2 diabetes patients with established CVD with a very reassuring safety profile.Dapagliflozin has also documented its CV safety in polled phase 2 3 trials. Further clarifications will be available after publication oF DECLARE TIMI 58 results.Canagliflozin has MACE benefits but not any CV or all cause mortality benefits and at the cost of increased serious adverse effects.A recent news post from a reputed newspaper quoted a medical regulatory body and suggested that the physicians practicing as “Diabetologist” should be brought under the scanner.