Academic literature on the topic 'AHRI 340/360'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the lists of relevant articles, books, theses, conference reports, and other scholarly sources on the topic 'AHRI 340/360.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Journal articles on the topic "AHRI 340/360"
1
Putri, Wakhidati Nurrohmah, and Muhammad Aji Nugroho. "Strategi Pengembangan Profesionalisme Tenaga Pendidik di Madrasah." MUDARRISA: Jurnal Kajian Pendidikan Islam 8, no. 2 (December 13, 2016): 313. http://dx.doi.org/10.18326/mdr.v8i2.313-340.
Full textAbstract:
Penelitian ini bertujuan untuk mengetahui strategi pengembangan profesionalisme tenaga pendidik di madrasah, penelitian ini adalah penelitan diskriptif kualitatif yang mencoba mengeksplorasi makna profesionalisme pendidik sebagai langkah mengembangkan mutu madrasah dengan menyesuaikan tujuan pendidikan. Dalam penelitian ini melihat guru sebagai kunci atau figur sentral dalam penyelenggaraan pendidikan atau peningkatan mutu pendidikan madrasah, yang memiliki posisi yang sangat strategis bagi seluruh upaya reformasi pendidikan yang berorientasi pada pencapaian kualitas murid dan persekolahan. Hal ini disebabkan, pada era globalisasi yang makin masif dan ekstensif ini, tanpa didukung oleh sumber daya manusia (SDM) yang berkualitas, suatu Negara akan tertinggal jauh. Tolak ukur pengembangan Sumber Daya Manusia menjadi prioritas yang sangat urgen dalam pembentukan kepribadian bagi setiap Negara. Dalam menghadapi persaingan sosial, ekonomi, tekhnologi, dan kemanusiaan, semakin bereskalasi secara massif, Maka persyaratan kemampuan yang diperlukan orang untuk melakukan pekerjaan semakin meningkat, dimulai dari pengetahuan, ketrampilan, dan sikap. Dari sinilah, tuntutan akan perlunya profesionalisme dalam bekerja bagi seorang tenaga pendidik sangat dibutuhkan untuk memacu keberhasilan peserta didiknya. Betapapun baiknya kurikulum yang dirancang para ahli dengan ketersediaan peralatan dan biaya yang cukup sesuai dengan pendidikan, namun pada akhirnya keberhasilan pendidikan secara professional terletak ditangan guru. This study aims to determine the development strategy of the professionalism of educators at the school, this research is descriptive qualitative research that tries to explore the meaning of professionalism of teachers as a step to develop the quality of Islamic education by adjusting educational purposes. In this study, the teacher is a key or central figure in education or improving the quality of Islamic education, which has a very strategic position for all reforms oriented educational attainment of pupils and the quality of schooling. This is because, in the era of globalization, is more massive and this extensive, unsupported by human resources quality, A State would be left far behind. The measurement of the development of human resources is a priority that is extremely vital in the formation of personality to any State. In the face of social, economics, technology competition, and humanity, increasingly escalated massively, then the requirements of the capabilities required to do the work increased, starting from the knowledge, skills, and attitudes. So "professionalism in the works" for the educators is needed to spur the success of learners. Although well-designed curriculum was made by experts with complete facilities, the success of professional education lies in the
2
Oktavia, Selvi Nanda, Ardyanto Tanjung, and Listyo Yudha Irawan. "Atmospheric learning: Pengembangan digital mind maps berbantuan mind mapping software untuk siswa Geografi SMA." Jurnal Integrasi dan Harmoni Inovatif Ilmu-Ilmu Sosial 1, no. 3 (May 20, 2021): 300–310. http://dx.doi.org/10.17977/um063v1i3p300-310.
Full textAbstract:
Learning media is a tool for students to make learning easier. Mind map digital is a learning media in the form of mind maps with the help applications of mindset mind manager presentation. The main objective of developing mind maps is to produce digital-based products for class X students on material atmospheric. This media can be a reference for the latest material, examples and learning resources around the atmosphere to provide students with an easy understanding of the lesson. The mind map digital developed has been tested internally by media experts and material experts. The final results are in the form of a digital mind map product design that has been revised based on suggestions and recommendations from each validator. This research and development use the modified ADDIE’s model only in the ADD section with research procedures namely goal formulation, media design, media validation. The research subjects were 28 students of class X IPS 4 in SMA 2 Batu. The research data used included the results of the media feasibility questionnaire, while the techniques data analysis used descriptive analysis to process the trial data. The results showed that digital mind maps were feasible to be used in the learning process with each gaining scores from material experts 98 percent and media experts 79 percent. Then the assessment or product response from students as research subjects get a value of 80.02 percent.
Media pembelajaran merupakan alat bantu untuk peserta didik agar memberikan kemudahan dalam belajar. Mind map digital adalah media pembelajaran dalam bentuk peta pikiran dengan berbantuan aplikasi presentasi mindjet mindmanager. Tujuan utama pengembangan mind map adalah menghasilkan produk berbasis digital untuk peserta didik kelas X pada materi atmosfer. Media ini dapat menjadi rujukan materi, contoh, dan sumber belajar terbaru seputar atmosfer untuk memberikan peserta didik kemudahan dalam memahami pelajaran. Mind map digital yang dikembangkan telah di uji internal oleh ahli media dan ahli materi. Hasil akhir berupa rancangan desain produk mind map digital yang telah direvisi berdasarkan saran dan rekomendasi dari masing-masing validator. Penelitian dan pengembangan ini menggunakan model ADDIE yang dimodifikasi hanya pada bagian ADD dengan prosedur penelitian yaitu perumusan tujuan, desain media, validasi media. Subjek penelitian adalah 28 peserta didik kelas X IPS 4 SMA 2 Batu. Data penelitian yang digunakan meliputi hasil angket kelayakan media, sedangkan teknik analisis data menggunakan analisis deskriptif untuk mengolah data hasil uji coba. Hasil penelitian menunjukkan bahwa mind map digital layak digunakan dalam proses pembelajaran dengan masing-masing memperoleh nilai dari ahli materi 98 persen dan ahli media 79 persen. Kemudian penilaian atau tanggapan produk dari peserta didik selaku subjek penelitian mendapatkan nilai 80,02 persen.
3
Gilli, Marita. "Une vision allemande du 18 Brumaire." Annales historiques de la Révolution française, no. 318 (December 1, 1999): 747–54. http://dx.doi.org/10.4000/ahrf.300.
Full text
4
Sukrillah, Siti. "Tafsir Pendidikan Tauhid Keluarga dalam Qs. al-Baqarah 132-133." MUDARRISA: Journal of Islamic Education 6, no. 2 (December 31, 2015): 277. http://dx.doi.org/10.18326/mdr.v6i2.277-300.
Full textAbstract:
Fokus penelitian yang akan dikaji adalah: 1. Bagaimana biografi Ibnu Katsir. 2. Bagaimana konsep pendidikan Tauhid dalam Islam menurut al Qur’an Surat al Baqarah ayat 132-133. 3. Bagaimana konsep pendidikan tauhid dalam keluarga menurut Ibnu Katsir. 4. Relevansi konsep pendidikan tauhid dalam keluarga menurut Tafsir Ibnu Katsir di kehidupan sekarang. Penelitian ini merupakan penelitian kepustakaan (library research), sedangkan dalam pengumpulan datanya menggunakan metode dokumetasi (documentation research method),analisis data yang digunakan dalam skripsi ini adalah analisis isi (content analysis). Hasil penelitian menyimpulkan bahwa: 1. Ibnu Katsir adalah seorang ahli tafsir dan sejarah ternama. Ia juga seorang ahli fiqih dan ahli hadis. Ibnu Katsir lahir pada tahun 700 H/1300 M di timur Bashri yang masuk wilayah Damaskus dan wafat pada tahun 774 H di Damaskus. Salah satu karya ilmiah Ibnu Katsir yang akan dibahas dalam skripsi ini adalah kitab Tafsîr al Qurân al ‘Azîmyang termasyhur dengan sebutan Tafsir Ibnu Katsirpada Qur’an Surat al Baqarah ayat 132-133. 2. Konsep pendidikan tauhid dalam Islam menurut al Qur’an Surat al Baqarah ayat 132-133 merupakan proses membimbing manusia untuk tetap teguh kepercayaannya bahwa Allah Maha Esa dan hanya tunduk kepada-Nya sampai akhir hayat. 3. Sedangkan konsep pendidikan tauhid dalam keluarga menurut Ibnu Katsir dalam Qur’an Surat al Baqarah ayat 132-133 adalah, upaya membina manusia dalam menyerahkan diri secara mutlak kepada Allah SWT sepanjang hayatnya dalam keluarga secara berkesinambungan sampai keturunannya di masa depan kelak meskipun berbeda cara atau metode dalam pelaksanaannya. 4. Adapun relevansi pendidikan tauhid dalam keluarga dimasa sekarang adalah bahwa pendidikan tauhid di masa sekarang ini harus berusaha lebih keras lagi untuk terus memperhatikan dengan membuat metode yang variatif agar anak didik dapat mengikuti dengan nyaman dan tidak terbebani akan aturan-aturan yang harus dilaluinya untuk mencapai tujuan dari pendidikan tauhid ini. This research focus on: 1) the biography of Ibn Kathir 2) the educational concept of Tawheed in Islam according to the Quran Surah al-Baqarah verse 132-133 3) the concept of monotheism education in the family according to Ibn Kathir 4) The relevance of the educational concept of monotheism in the family according to Ibn Kathir’s interpretation in the present. It is a library research, which uses documentation to collect the data, and content analysis to analyze it. The study concluded that 1) Ibn Kathir (700 H-774 H) is an interpreter, renowned history, expert jurists and scholars of hadith. One of his scientific works is the book of Tafseer al Quran al 'Azîm, Qur'an Surah al-Baqarah verse 132-133. 2) The educational concept of monotheism is the process of guiding people to remain belief in Allah Almighty and subject only to Him until the end 3) While the concept of monotheism education in the family is an effort to develop human who rely on his self to God during his entire life in the family on an ongoing basis until the later offspring in the future despite the different ways in its implementation. 4) Monotheism in the present education must strive harder to continue to pay attention in making varied methods so that students can follow comfortably with the rules that must be gone through to reach the purpose of tawheed education. Kata Kunci: Konsep Pendidikan Tauhid, Keluarga, Ibnu Katsir
5
Xia, J., X. Zhu, T. Haarmann-Stemmann, J. Wang, and J. Krutmann. "330 The Aryl Hydrocarbon Receptor (AHR) regulates vitamin A metabolism in keratinocytes." Journal of Investigative Dermatology 139, no. 5 (May 2019): S57. http://dx.doi.org/10.1016/j.jid.2019.03.406.
Full text
6
Defranceschi, Jean. "Antoine-Marie Graziani, Pascal Paoli, Père de la patrie corse, Paris, Tallandier, coll. Figures de proue, 2002, 340 p." Annales historiques de la Révolution française, no. 330 (December 1, 2002): 177–81. http://dx.doi.org/10.4000/ahrf.3843.
Full text
7
Foxwell, M. H., L. L. Whitman, and J. M. Yanni. "330 AHR-5333, A new antiallergy compound. II. Inhibition of mediator release/responses in vitro." Journal of Allergy and Clinical Immunology 81, no. 1 (January 1988): 250. http://dx.doi.org/10.1016/0091-6749(88)90564-7.
Full text
8
Karras, Ruth Mazo. ":Gender in the Early Medieval World: East and West, 300–900." American Historical Review 110, no. 5 (December 2005): 1576–77. http://dx.doi.org/10.1086/ahr.110.5.1576.
Full text
9
Díaz, Pablo C. "Damián Fernández. Aristocrats and Statehood in Western Iberia, 300–600 C.E." American Historical Review 124, no. 4 (October 1, 2019): 1500–1501. http://dx.doi.org/10.1093/ahr/rhz885.
Full text
10
Adiyanta, F. C. Susila. "Sinkronisasi Kewenangan Regulasi Pemerintah Kabupaten/Kota sebagai Model Implementasi Kebijakan Ekonomi Nasional yang Mendukung Iklim Investasi di Daerah." Administrative Law and Governance Journal 2, no. 2 (June 2, 2019): 282–300. http://dx.doi.org/10.14710/alj.v2i2.282-300.
Full textAbstract:
Abstract This study aims to Synchronize the Authority of Regency / City Government Regulations as a Model of the Implementation of National Economic Policies that Support the Investment Climate in the Region. By using a statute approach and empirical approach, this research is carried out to identify regulatory authorities and solutions to problems in regional regulations that are not conducive to national policies on investment in the region. The results of the study obtained conclusions: a) the characteristics and problems of regional regulations in supporting the implementation of investment policies in regions categorized into general and specific characteristics. General characteristics include legal products that have juridical problems, substance, and legal principles, while special characteristics are problems related to supporting legal products that can affect the business climate and competitiveness of investment, spatial planning, and regional institutions; b) Measures for governance of regional regulations to support the implementation of national economic policies that are conducive to investment for investment require planning, design, and preparation of comprehensive regional regulations by synchronizing the content of regional regulations involving all elements in the region, namely: executive institutions , legislative, business actors, and the community. Some recommendations from the results of this study are: a) local governments need to increase institutional capacity, innovation, and public services; b) the existence of experts who can be a reference in the design and preparation of regional regulations that are conducive to the investment climate and business competitiveness; c) in the preparation and design of regional regulations it is necessary to further increase access to public participation. Keywords: National Economic Policy, Regional Regulations, Investment Abstrak Penelitian ini bertujuan untuk Sinkronisasi Kewenangan Regulasi Pemerintah Kabupaten/Kota sebagai Model Implementasi Kebijakan Ekonomi Nasionalyang Mendukung Iklim Investasi di Daerah. Dengan menggunakan pendekatan perundang-undangan (statute approach) dan empiris (empirical approach), penelitian ini dilakukan untuk mengidentifikasi kewenangan regulasi dan model solusi permasalahan peraturan daerah yang tidak kondusif bagi kebijakan nasional tentang investasi di daerah. Hasil kajian diperoleh kesimpulan : a) karakteristik dan kebermasalahan peraturan daerah dalam mendukung implementasi kebijakan investasi di daerah kategorikan ke dalam karakteristik umum dan khusus. Karakteristik umum meliputi produk-produk hukum yang mempunyai kebermasalahan yuridis, substansi, dan prinsip-prinsip hukum, sedangkan karakteristik khusus adalah kebermasalahan yang berkaitan dengan produk-produk hukum pendukung yang dapat mempengaruhi iklim usaha dan daya saing investasi, tata ruang, dan kelembagaan daerah; b) Langkah-langkah solutif tata kelola peraturan daerah untuk mendukung implementasi kebijakan ekonomi nasional yang kondusif bagi investasi bagi investasi memeerlukan perencanaan, perancangan, dan penyusunan peraturan derah yang komprehensif dengan sinkronisasi materi muatan peraturan daerah yang melibatkan semua elemen di daerah, yaitu: lembaga eksekutif, legislatif, pelaku usaha, dan masyarakat. Beberapa rekomendasi dari hasil penelitian ini adalah : a) pemerintah daerah perlu meningkatkan kapasitas kelembagaan, inovasi, dan pelayanan publik; b) adanya tenaga ahli yang dapat menjadi rujukan dalam perancangan dan penyusunan peraturan daerah yang kondusif bagi iklim investasi dan daya saing usaha; c) dalam penyusunan dan perancangan peraturan derah perlu lebih meningkatkan akses partisipasi publik. Kata kunci: Kebijakan Ekonomi Nasional, Peraturan Daerah, Investasi
Dissertations / Theses on the topic "AHRI 340/360"
1
Schenk, Franz. "An Active Domain Node Architecture for the Semantic Web." Doctoral thesis, 2008. http://hdl.handle.net/11858/00-1735-0000-0006-B3B7-3.
Full text
2
Lanwert, Dirk. "Funktions- / Strukturorientierte Pflanzenmodellierung in E-Learning-Szenarien." Doctoral thesis, 2007. http://hdl.handle.net/11858/00-1735-0000-0006-B10B-A.
Full textBooks on the topic "AHRI 340/360"
1
Ku Hassan, Ku Halim. Himpunan sajak: ABATA. UUM Press, 2018. http://dx.doi.org/10.32890/9789672064992.
Full textAbstract:
Sumpah tujuh keturunan bukan sumpah biasa-biasa. Usai padang jarak padang terkukur tersemat di dada zaman, tamatlah jua sumpah seorang pejuang budaya dan sejarah di bumi Langkawi yang terpendam di dasar hati puluhan tahun. Pejuang tidak pernah berundur. Sekalipun bercerai nyawa dari badan, berdikit-dikit beliau terus berpencak secara terus agar seni budaya dan sejarah Mahsuri tidak hilang begitu sahaja.Gelanggangnya adalah masyarakat. Kuda-kuda ditegapkan selama ini bagi menangkis musuh. Musuhnya adalah masa dan peradaban. Namun, Abata tetap dijunjung dan diletakkan pada singgahsana termahal. Ku Halim Ku Hassan bukan manusia biasa-biasa. Sajak-sajaknya umpama keris berlok tujuh yang dilangir dengan limau dari 99 pulau.Ku Halim Ku Hassan dilahirkan pada 11 Oktober 1947 di Kampung Raja, Padang Mat Sirat Langkawi. Pesara kerajaan ini telah mula terlibat dengan bidang seni sejak awal persekolahan serta amat meminati pengkajian sejarah. Pernah menjadi seorang pendidik pada sekitar 1966 dan bertugas sebagai anggota tentera dalam Rejimen Semboyan pada tahun 1968 hingga 1975. Semangat patriotik dan kecintaan terhadap bangsa dan negara begitu kuat dalam dirinya.Beliau mula menghasilkan karya kreatif dalam bentuk puisi tradisional (syair dan pantun) serta puisi moden (sajak) sejak 30 tahun lalu. Puisi beliau sering menjadi perhatian beberapa orang ahli politik tempatan khususnya dalam Parlimen Langkawi kerana elemen nasionalisme yang diterapkan dalam setiap nukilannya. Beliau pernah menerima beberapa pingat kebesaran antaranya Ahli Mangku Negara (AMN), Ahli Mahkota Kedah (AMK), Bintang Khidmat Masyarakat (BKM) dan Pingat Jasa Kebaktian (PJK). Penulis juga telah dilantik sebagai fasilitator seni budaya oleh Pusat Latihan Kemahiran Negara (PLKN) Langkawi serta sering diundang memberikan pengkisahan tentang sejarah Langkawi, Mahsuri, serta Beras Terbakar yang terletak dalam kawasan rumah beliau.Kini beliau aktif bergiat dalam seni kreatif di Langkawi dan merupakan antara individu yang merestui penubuhan Persatuan Gabungan Penulis dan Penggiat Seni Budaya Langkawi (PGSBL) sebagai entiti memartabatkan seni sastera dan budaya di Langkawi.
Book chapters on the topic "AHRI 340/360"
1
Cerrito, Patricia, and John Cerrito. "Comparisons of Patient Severity Indices." In Advances in Medical Technologies and Clinical Practice, 249–86. IGI Global, 2010. http://dx.doi.org/10.4018/978-1-61520-905-7.ch012.
Full textAbstract:
In this section, we will briefly discuss two methods of ranking patient severity. The first method we consider is the AHRQ comorbidities, which is a collection of 30 patient conditions that are used to define an index consisting of the number of comorbidites that a patient has been diagnosed with. In this chapter, we will also discuss the Charlson Index and compare it to the AHRQ comorbidities. Another measure we will define in this chapter uses the patient diagnoses that have the highest mortality rates. As we find, many of these diagnoses are related to serious and resistant infections that are generally not included in other indices, which tend to focus on chronic patient conditions. We will show that the severity of a patient’s condition can be highly variable, depending upon the severity index that is used.
2
Armstrong, Tyler D., Usa Suwannasual, Conner L. Kennedy, Akshaykumar Thasma, Leah J. Schneider, Danielle Phillippi, and Amie K. Lund. "Exposure to Traffic-Generated Pollutants Exacerbates the Expression of Factors Associated with the Pathophysiology of Alzheimer’s Disease in Aged C57BL/6 Wild-Type Mice." In Advances in Alzheimer’s Disease. IOS Press, 2021. http://dx.doi.org/10.3233/aiad210017.
Full textAbstract:
Background: Multiple studies report a strong correlation between traffic-generated air pollution-exposure and detrimental outcomes in the central nervous system (CNS), including Alzheimer’s disease (AD). Incidence of AD is rapidly increasing and, worldwide, many live in regions where pollutants exceed regulatory standards. Thus, it is imperative to identify environmental pollutants that contribute to AD, and the mechanisms involved. Objective: We investigated the effects of mixed gasoline and diesel engine emissions (MVE) on the expression of factors involved in progression of AD in the hippocampus and cerebrum in a young versus aged mouse model. Methods: Young (2 months old) and aged (18 months old) male C57BL/6 mice were exposed to either MVE (300 μg/m3 PM) or filtered air (FA) for 6 h/d, 7 d/wk, for 50 d. Immunofluorescence and RT-qPCR were used to quantify oxidative stress (8-OHdG) and expression of amyloid-β protein precursor (AβPP), β secretase (BACE1), amyloid-β (Aβ), aryl hydrocarbon receptor (AhR), cytochrome P450 (CYP) 1B1, angiotensin-converting enzyme (ACE1), and angiotensin II type 1 (AT1) receptor in the cerebrum and hippocampus, in addition to cerebral microvascular tight junction (TJ) protein expression. Results: We observed age-related increases in oxidative stress, AhR, CYP1B1, Aβ, BACE1, and AT1 receptor in the CA1 region of the hippocampus, and elevation of cerebral AβPP, AhR, and CYP1B1 mRNA, associated with decreased cerebral microvascular TJ protein claudin-5. MVE-exposure resulted in further promotion of oxidative stress, and significant increases in AhR, CYP1B1, BACE1, ACE1, and Aβ, compared to the young and aged FA-exposed mice. Conclusion: Such findings suggest that MVE-exposure exacerbates the expression of factors in the CNS associated with AD pathogenesis in aged populations.
Conference papers on the topic "AHRI 340/360"
1
Mendoza-Choquemamani, Jorch, Brayan Espinoza-Garcia, Juan Carlos Cutipa-Luque, and Pablo R. Yanyachi. "Comparison and Evaluation Between a Low-cost IMU and INS VN-300 in AHRS mode." In 2021 IEEE International Conference on Aerospace and Signal Processing (INCAS). IEEE, 2021. http://dx.doi.org/10.1109/incas53599.2021.9666920.
Full text
2
Campesato, Luis F., Sadna Budhu, Mathieu Gigoux, Jeremy Tchaicha, Stephane Pourpe, Cailian Liu, Dmitriy Zamarin, et al. "Abstract PR05: Blockade of AHR activation by IDO/TDO-derived kynurenine restricts cancer immune suppression." In Abstracts: AACR Special Conference on Tumor Immunology and Immunotherapy; November 27-30, 2018; Miami Beach, FL. American Association for Cancer Research, 2020. http://dx.doi.org/10.1158/2326-6074.tumimm18-pr05.
Full text
3
Ohoka, Nobumichi, Genichiro Tsuji, Takuji Shoda, Takuma Fujisato, Masaaki Kurihara, Yosuke Demizu, and Mikihiko Naito. "Abstract C125: Development of small molecule chimeras that recruit aryl-hydrocarbon receptor (AhR) E3 ligase to induce degradation of target proteins." In Abstracts: AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; October 26-30, 2019; Boston, MA. American Association for Cancer Research, 2019. http://dx.doi.org/10.1158/1535-7163.targ-19-c125.
Full textReports on the topic "AHRI 340/360"
1
O’Neil, Maya E., Tamara P. Cheney, Yun Yu, Erica L. Hart, Rebecca S. Holmes, Ian Blazina, Stephanie P. Veazie, et al. Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder: 2022 Update of the PTSD Repository Evidence Base. Agency for Healthcare Research and Quality (AHRQ), October 2022. http://dx.doi.org/10.23970/ahrqepcptsd2022.
Full textAbstract:
Objectives. Identify and abstract data from randomized controlled trials (RCTs) examining treatment for posttraumatic stress disorder (PTSD) and comorbid PTSD/substance use disorder to update the previous Agency for Healthcare Research and Quality (AHRQ) report and National Center for PTSD (NCPTSD) PTSD Trials Standardized Data Repository (PTSD-Repository). Data sources. We searched PTSDpubs, Ovid® MEDLINE®, Cochrane CENTRAL, PsycINFO®, Embase®, CINAHL®, and Scopus® for eligible RCTs published from June 1, 2018, to January 26, 2022. Review methods. In consultation with AHRQ and NCPTSD, we updated the evidence tables for the PTSD-Repository by including evidence published after publication of the last update and expanding abstraction of results to include calculated standardized effect sizes. The primary publication for each RCT was abstracted; data and citations from secondary publications (i.e., companion papers) appear in the same record. We assessed risk of bias (RoB) for all newly included studies using the Revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials. For studies already in the PTSD-Repository, we will add calculated standardized effect sizes and update RoB using the new RoB 2 tool over the next several annual updates. Results. We added 48 new RCTs examining treatments for PTSD, for a total of 437 included studies published from 1988 to July 30, 2021. Among the 48 newly added RCTs, psychotherapy interventions were the most commonly employed (50%), followed by complementary and integrative health (17%). Approximately half of studies were conducted in the United States (46%), and enrolled community participants (52%) and participants with a mix of trauma types (48%). Studies typically had sample sizes ranging from 25 to 99 participants (69%). RoB was rated as high for 52 percent of studies, 31 percent were rated as low RoB, and the remaining studies were rated as having some concerns (15%). Conclusions. This report updates the previous AHRQ report to include 48 recently published RCTs, for a total of 437 studies. This update adds comprehensive data, standardized effect sizes for PTSD outcomes, and RoB assessment for the newly included RCTs. As with the previous AHRQ update, this report will inform updates to the PTSD-Repository, a comprehensive database of PTSD trials.
2
Viswanathan, Meera, Jennifer Cook Middleton, Alison Stuebe, Nancy Berkman, Alison N. Goulding, Skyler McLaurin-Jiang, Andrea B. Dotson, et al. Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions. Agency for Healthcare Research and Quality (AHRQ), April 2021. http://dx.doi.org/10.23970/ahrqepccer236.
Full textAbstract:
Background. Untreated maternal mental health disorders can have devastating sequelae for the mother and child. For women who are currently or planning to become pregnant or are breastfeeding, a critical question is whether the benefits of treating psychiatric illness with pharmacologic interventions outweigh the harms for mother and child. Methods. We conducted a systematic review to assess the benefits and harms of pharmacologic interventions compared with placebo, no treatment, or other pharmacologic interventions for pregnant and postpartum women with mental health disorders. We searched four databases and other sources for evidence available from inception through June 5, 2020 and surveilled the literature through March 2, 2021; dually screened the results; and analyzed eligible studies. We included studies of pregnant, postpartum, or reproductive-age women with a new or preexisting diagnosis of a mental health disorder treated with pharmacotherapy; we excluded psychotherapy. Eligible comparators included women with the disorder but no pharmacotherapy or women who discontinued the pharmacotherapy before pregnancy. Results. A total of 164 studies (168 articles) met eligibility criteria. Brexanolone for depression onset in the third trimester or in the postpartum period probably improves depressive symptoms at 30 days (least square mean difference in the Hamilton Rating Scale for Depression, -2.6; p=0.02; N=209) when compared with placebo. Sertraline for postpartum depression may improve response (calculated relative risk [RR], 2.24; 95% confidence interval [CI], 0.95 to 5.24; N=36), remission (calculated RR, 2.51; 95% CI, 0.94 to 6.70; N=36), and depressive symptoms (p-values ranging from 0.01 to 0.05) when compared with placebo. Discontinuing use of mood stabilizers during pregnancy may increase recurrence (adjusted hazard ratio [AHR], 2.2; 95% CI, 1.2 to 4.2; N=89) and reduce time to recurrence of mood disorders (2 vs. 28 weeks, AHR, 12.1; 95% CI, 1.6 to 91; N=26) for bipolar disorder when compared with continued use. Brexanolone for depression onset in the third trimester or in the postpartum period may increase the risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo (5% vs. 0%). More than 95 percent of studies reporting on harms were observational in design and unable to fully account for confounding. These studies suggested some associations between benzodiazepine exposure before conception and ectopic pregnancy; between specific antidepressants during pregnancy and adverse maternal outcomes such as postpartum hemorrhage, preeclampsia, and spontaneous abortion, and child outcomes such as respiratory issues, low Apgar scores, persistent pulmonary hypertension of the newborn, depression in children, and autism spectrum disorder; between quetiapine or olanzapine and gestational diabetes; and between benzodiazepine and neonatal intensive care admissions. Causality cannot be inferred from these studies. We found insufficient evidence on benefits and harms from comparative effectiveness studies, with one exception: one study suggested a higher risk of overall congenital anomalies (adjusted RR [ARR], 1.85; 95% CI, 1.23 to 2.78; N=2,608) and cardiac anomalies (ARR, 2.25; 95% CI, 1.17 to 4.34; N=2,608) for lithium compared with lamotrigine during first- trimester exposure. Conclusions. Few studies have been conducted in pregnant and postpartum women on the benefits of pharmacotherapy; many studies report on harms but are of low quality. The limited evidence available is consistent with some benefit, and some studies suggested increased adverse events. However, because these studies could not rule out underlying disease severity as the cause of the association, the causal link between the exposure and adverse events is unclear. Patients and clinicians need to make an informed, collaborative decision on treatment choices.