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Background and Objectives for the Systematic Review
This report will serve as an update to the 2006 report Comparative Effectiveness and Safety of Analgesics for Osteoarthritis.1
Osteoarthritis is a chronic condition involving degeneration of cartilage within the joints. It is the most common form of arthritis and is associated with pain, substantial disability, and reduced quality of life.2 About 6 percent of U.S. adults aged 30 years or older have symptomatic osteoarthritis of the knee, and 3 percent have symptomatic osteoarthritis of the hip.3 Osteoarthritis increases with age: the incidence and prevalence increase two- to tenfold from age 30 to 65 and continue to increase after age 65.4 The total costs for arthritis, including osteoarthritis, may be greater than 2 percent of the gross domestic product,3 with more than half of these costs related to work loss.5
Common oral medications for osteoarthritis include nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen. Patients with osteoarthritis also use over-the-counter supplements not regulated by the FDA as pharmaceuticals, including glucosamine and chondroitin, as well as topical agents. Opioid medications are also used for selected patients with refractory, chronic pain but are not recommended for first-line treatment of osteoarthritis and therefore will not be included in this review. Each class of medication or supplement is associated with a unique balance of risks and benefits. In addition, efficacy and safety may vary for individual drugs within a class. Nonpharmacologic interventions (such as physical therapy, weight reduction, and exercise) also help improve pain and functional status in patients with osteoarthritis.
A challenge in treating osteoarthritis is deciding which medications will provide the greatest symptom relief with the fewest serious adverse effects. NSAIDs decrease pain, inflammation and fever by blocking cyclo-oxygenase (COX) enzymes. Understanding of the pharmacology of NSAIDs continues to evolve, but it is now thought that most NSAIDs block three different COX isoenzymes, known as COX-1, COX-2, and COX-3. COX-1 protects the lining of the stomach from acid. COX-2 is found in joints and muscles and mediates effects on pain and inflammation; COX-3 is found in the brain cortex. In patients with arthritis,6 low back pain,7 minor injuries, and soft tissue rheumatism, NSAIDs reduce pain, when compared with placebo, by blocking COX-2. However, NSAIDs that also block the COX-1 enzyme (also called "nonselective NSAIDs") can cause gastrointestinal bleeding. In the United States, there are an estimated 16,500 annual deaths due to NSAID-induced gastrointestinal complications,8 a higher death rate than that for cervical cancer or malignant melanoma. Theoretically, NSAIDs that block only the COX-2 enzyme (also called "coxibs," "COX-2 selective NSAIDs," or "selective NSAIDs") should be safer with regard to gastrointestinal bleeding, but they also appear to be associated with increased rates of serious cardiovascular and other adverse effects. Less is known about COX-3, which is found in the cerebral cortex and cardiac tissue and appears to be involved in centrally mediated pain.9
This report will update the available evidence comparing the benefits and harms of analgesics in the treatment of osteoarthritis since publication of the original report in 2006.1 The main conclusions of the original report were:
- Acetaminophen relieves mild pain but is inferior to NSAIDs for reducing moderate or severe pain. Acetaminophen has fewer systemic side effects than NSAIDs.
- All non-aspirin NSAIDs work equally well for pain reduction
- NSAIDs increase the risk of GI bleeding. The risk increases with higher doses and with age. People older than 75 have the highest risk.
- Celecoxib, high dose ibuprofen, and high dose diclofenac increase the risk of myocardial infarction. Naproxen does not increase the risk of myocardial infarction.
- Capsaicin cream relieves chronic osteoarthritic pain, but about half of the people using it will experience local burning sensations. The burning diminishes over time.
- Over the counter topical creams containing salicylates do not reduce osteoarthritic pain.
Since the completion of the original report, three topical NSAIDs have received FDA approval for treating osteoarthritis. There have also been newly published studies of several drugs included in the original report. These newly approved drugs as well as the new publications make an update of the CER necessary at this time.
For this report, we have defined certain terms as follows:
- Selective NSAIDs, or COX-2 selective NSAIDs—drugs in the "coxib" class (celecoxib)
- Partially selective NSAIDs—other drugs shown to have partial in vitro COX-2 selectivity (etodolac, nabumetone, meloxicam)
- Aspirin—differs from other NSAIDs, because it irreversibly inhibits platelet aggregation; salicylic acid derivatives (aspirin and salsalate) are considered a separate subgroup
- All other NSAIDs—nonaspirin, nonselective NSAIDs, or simply nonselective NSAIDs
The Key Questions
The purpose of this comparative effectiveness review (CER) is to update the previous report that assessed the comparative efficacy and safety of non-opioid oral medications (selective and non-selective non-aspirin NSAIDs, aspirin, salsalate, and acetaminophen), over-the-counter supplements (chondroitin and glucosamine), and topical agents (NSAIDs and rubefacients, including capsaicin) for osteoarthritis.
The following key questions will be the focus of our report:
Question 1
- What are the comparative benefits and harms of treating osteoarthritis with oral medications or supplements?
- How do these benefits and harms change with dosage and duration of treatment?
- What is the evidence that standard dosing as labeled or alternative dosage strategies, such as intermittent dosing and drug holidays, affect the benefits and harms of oral medication use?
The only benefits considered here are improvements in osteoarthritis symptoms. Evidence of harms associated with the use of nonsteroidal antiinflammatory drugs (NSAIDs) includes studies of these drugs for treating osteoarthritis or rheumatoid arthritis and for cancer prevention.
Question 2
Do the comparative benefits and harms of oral treatments for osteoarthritis vary for certain demographic and clinical subgroups of patients?
- Demographic subgroups: age, sex, and race
- Coexisting diseases: cardiovascular conditions, such as hypertension, edema, ischemic heart disease, heart failure; peptic ulcer disease; history of previous gastrointestinal bleeding (any cause); renal disease; hepatic disease; diabetes; obesity
- Concomitant medication use: anti-thrombotics, corticosteroids, antihypertensives, selective serotonin reuptake inhibitors (SSRI)
Question 3
What are the comparative effects of co-prescribing H2 receptor antagonists, misoprostol, or proton pump inhibitors (PPIs) on the gastrointestinal harms associated with NSAID use?
Question 4
What are the comparative benefits and harms of treating osteoarthritis with oral medications as compared with topical preparations, or of different topical medications compared with one another?
For the update of this comparative effectiveness review, updates have been made to clarify the Key Questions, but these changes do not alter the meaning of each Key Question. Additional coexisting diseases and concomitant medications were included.
Review Scope for Key Questions:
- Population(s):
Adults with osteoarthritis. Note that selection of candidates for therapy is outside the scope of this review. The population included in this review will be the population identified from the existing evidence.
- Interventions:
Drug (any trade name) | Labeled indications | Dosing | Dose adjustments for special populations |
Oral drugs (trade names provided only for drugs under patent) | |||
acetaminophen | Fever; pain | Pain: 650-1000 mg up to 4 g/day | Pediatric patients (Peds): 10-15 mg/kg/dose up to 5 doses/day |
aspirin | Arthritis; cerebrovascular accident; transient ischemia; coronary artery bypass graft; disorder of joint of spine; fever; juvenile rheumatoid arthritis; myocardial infarction; prophylaxis; osteoarthritis; pain; percutaneous coronary intervention; pleurisy; systemic lupus erythematosus; rheumatoid arthritis; stable angina, chronic; unstable angina | Osteoarthritis (OA) and rheumatoid arthritis (RA): 3g/day divided into 4 to 6 doses | Peds: 40-130 mg/kg/day, depending upon condition |
celecoxib (Celebrex®) | Ankylosing spondylitis; familial adenomatous polyposis; syndrome osteoarthritis; pain; primary dysmenorrhea; rheumatoid arthritis; juvenile rheumatoid arthritis | OA: 200 mg/day; RA: 200-400 mg/day | Renal impairment: reduce dose by 50%; elderly patients weighing < 50 kg: initiate at lowest dose |
diclofenac | Ankylosing spondylitis; extraction of cataract; inflammatory disorder of eye; light intolerance; pain in eye; refractive keratoplasty; osteoarthritis; pain; rheumatoid arthritis | OA: delayed release, 100-150 mg/day in 2 to 3 doses; extended release, 100-200 mg/day; RA: delayed release, 100-200 mg/day in 3 to 4 doses; extended release, 75-225 mg/day | Renal impairment: initiate with lowest recommended dose, then monitor closely |
diflunisal | Osteoarthritis; pain, mild to moderate; rheumatoid arthritis | OA and RA: 500-1000 mg/day in 2 equally divided doses; maximum dose, 1500 mg/day | Renal impairment and elderly: initiate with lowest dose possible, then monitor closely |
etodolac | Juvenile rheumatoid arthritis; osteoarthritis; pain, acute; rheumatoid arthritis | OA and RA initial treatment: immediate release, 300 mg 2-3x/day or 400-500 mg 2x/day;
OA and RA maintenance: immediate release, 600-1000 mg/day 2-4x/day with a maximum dose of 1200 mg/day; extended release, 400-1000 mg/day |
Juvenile Rheumatoid Arthritis (JRA) weighing 20 to 30 kg: extended release, 400 mg 1x/day; JRA weighing 31 to 45 kg: extended release, 600 mg 1x/day; JRA weighing 46 to 60 kg: extended release, 800 mg 1x/day; JRA, extended release, weighing >60 kg: extended release,1000 mg 1x/day |
fenoprofen | Migraine; osteoarthritis; pain, mild to moderate; rheumatoid arthritis | OA and RA: 300- 600 mg, 3 to 4x/day; maximum daily dose, 3200 mg | Elderly: smaller dose recommended, 300 mg 3x/day; renal impairment: no dose adjustment necessary |
flurbiprofen | Constricted pupil, intraoperative prophylaxis; osteoarthritis; rheumatoid arthritis | OA and RA: 200-300 mg/day in 2 to 4 divided doses; maximum dose, 300 mg/day | Renal impairment, liver disease, and geriatric patients: initiate with lowest recommended dose, then monitor closely |
ibuprofen | Fever; juvenile rheumatoid arthritis; osteoarthritis; pain, minor; pain, mild to moderate; primary dysmenorrhea; rheumatoid arthritis | OA and RA: 1200-3200 mg/day in 3 to 4 divided doses | Renal impairment: initiate with lowest recommended dose, then monitor closely |
indomethacin | Ankylosing spondylitis; bursitis of shoulder–pain, acute; gouty arthritis, acute; osteoarthritis; tendonitis of shoulder—pain, acute; patent ductus arteriosus; rheumatoid arthritis | OA and RA: immediate release, 25-50 mg 2 to 3x/day or a maximum dose of 100 mg 2x/day; sustained release product, 75 mg 1 to 2x/day | Severe renal impairment (creatinine clearance [CrCL] < 15 mL/min), liver disease (Child-Pugh Class III), elderly, and peds: initiate with lowest recommended dose, then monitor closely |
ketoprofen | Fever; osteoarthritis; pain, minor; pain, mild to moderate; rheumatoid arthritis | OA and RA: immediate release, 150-300 mg/day in 3 to 4 divided doses; extended release, 100-200 mg 1x/day | Mild renal impairment (CrCL > 25 mL/min): maximum, 150 mg/day; moderate renal impairment (CrCL < 25 mL/min): maximum, 100 mg/day; geriatric (>75 years): initiate with doses of 75-150 mg/day; liver disease and serum albumin < 3.5 g/dL: maximum initial dose, 100 mg/day |
ketorolac | Extraction of cataract—inflammatory disorder of eye; light intolerance—pain in eye—refractive keratoplasty; pain, acute—moderate to severe; seasonal allergic conjunctivitis | Pain, acute—moderate to severe (<65 years of age): initiate with 20 mg, followed by 10 mg, every 4 to 6 hours; maximum, 40 mg/day | Peds: lowest effective dose for shortest possible duration; >65 years of age or weight <50 kg or renal impairment: 10 mg every 4 to 6 hours as needed; maximum, 40 mg/day |
meclofenamate sodium | Dysmenorrhea; menorrhagia; osteoarthritis; pain; rheumatoid arthritis | OA and RA: 200–400 mg/day in 3 to 4 equally divided doses; maximum, 400 mg/day | Elderly and renal impairment: lowest effective dose for shortest possible duration |
mefenamic acid | Dysmenorrhea; pain | Pain (children >14 years and adults): initiate with 500 mg, followed by 250 mg every 6 hours; use beyond 1 week is not recommended | Renal impairment: do not use; peds: use not studied |
meloxicam | Juvenile rheumatoid arthritis, polyarticular–pauciarticular juvenile rheumatoid arthritis; osteoarthritis; rheumatoid arthritis | OA and RA: 7.5 mg 1x/day; maximum, 15 mg 1x/day | Elderly, renal impairment, liver disease (Child-Pugh Class III): initiate with lowest recommended dose, then monitor closely |
nabumetone | Osteoarthritis; rheumatoid arthritis | OA and RA: initial treatment, 1000 mg/day in a single dose; maintenance, 1000-2000 mg 1x/day or in 2 equally divided doses | Renal impairment and liver disease: monitor closely and reduce dose if necessary |
naproxen | Ankylosing spondylitis; bursitis; fever; gout, acute; juvenile rheumatoid arthritis; osteoarthritis; pain; pain, minor; primary dysmenorrhea; rheumatoid arthritis; tendinitis | OA and RA: 250-500 mg 2x/day, maximum, 1500 mg/day ≤ 6 months; over-the-counter, ≤ 10 days | JRA: 10 mg/kg/day in 2 equally divided doses; renal impairment and liver disease: monitor closely and reduce dose if necessary |
oxaprozin | Juvenile rheumatoid arthritis; osteoarthritis; rheumatoid arthritis | OA and RA: 1200 mg 1x/day; maximum, 1800 mg/day or 26 mg/kg/day | JRA, 22 to 31 kg: 600 mg 1x/ day; JRA, 32 to 54 kg: 900 mg 1x/day; JRA, >55 kg: 1200 mg 1x/day; renal impairment or weight <50 kg: initiate with 600 mg 1x/day, then monitor closely |
piroxicam | Osteoarthritis; rheumatoid arthritis | OA and RA: 20 mg/day 1x/day or 2 equally divided doses | Renal impairment or liver disease: monitor closely and reduce dose if necessary |
salsalate | Inflammatory disorder of musculoskeletal system, rheumatic; osteoarthritis; rheumatoid arthritis | OA and RA: 3000 mg/day in 2 to 3 equally divided doses | Elderly: lower doses may be required; peds: safety and efficacy not established |
sulindac | Bursitis of shoulder—pain, acute; gouty arthritis, acute; osteoarthritis; tendonitis of shoulder—pain, acute; rheumatoid arthritis | OA and RA: 150 mg 2x/day; maximum 400 mg/day | Renal impairment and liver disease: monitor closely and reduce dose if necessary |
tolmetin | Juvenile rheumatoid arthritis; osteoarthritis; rheumatoid arthritis | OA and RA: initial treatment, 400 mg 3x/day for 1 to 2 weeks; maintenance, 200-600 mg 3x/day; maximum, 1800 mg/day | Renal impairment: initiate with lowest recommended dose, then monitor closely and reduce dose if necessary; juvenile rheumatoid arthritis, ≥2 years, initial treatment: 20 mg/kg/day divided into 3 to 4 doses; juvenile rheumatoid arthritis, ≥2 years, maintenance: 15-30 mg/kg/day divided into 3 to 4 doses |
Topical drugs (trade names provided only for drugs under patent) | |||
diclofenac epolamine (Flector®; one patch equals 180 mg in an aqueous base) | Acute pain from minor strains, sprains, and contusions | 1 patch to most painful area 2x/day | Patients with fluid retention or heart failure: use with caution |
diclofenac sodium (Voltaren®; 1% gel) | Osteoarthritis of joints amenable to topical treatment, such as knees and hands | Maximum, 32 g/day, over all affected joints; maximum, 16 g/day, to any single joint of lower extremities; maximum, 8 g/day to any single joint of upper extremities | Patients with fluid retention or heart failure: use with caution |
diclofenac sodium (Pennsaid®) | Osteoarthritis of knee | 40 drops on each painful knee, 4x/day | Patients with fluid retention or heart failure: use with caution |
capsaicin | Arthritis; diabetic neuropathy; postherpetic neuralgia | Arthritis: apply thin film 3 to 5x/day | Peds (>2 years): apply thin film 3 to 4x/day |
Glucosamine and chondroitin are widely used and available over-the-counter as supplements in the United States. No pharmaceutical grade formulation is approved by the FDA. Accordingly, this report will focus on studies of nonpharmaceutical grade preparations available in the United States. Studies of pharmaceutical-grade glucosamine and chondroitin will also be included, however; they will be analyzed separately, because almost all trials have been conducted on such products and they may provide some information about efficacy.
- Comparators will include placebo or other drugs included in this CER.
- Primary outcomes for benefits are improvements in osteoarthritis symptoms.
- Adverse events will be evaluated from studies of the drugs used for osteoarthritis, rheumatoid arthritis, or cancer treatment.
- Cardiovascular: stroke, MI, CHF, hypertension and angina
- GI: perforations, symptomatic gastroduodenal ulcers and upper GI bleeding (PUBs), obstructions, dyspepsia
- Renal toxicity
- Hepatotoxicity
- Other outcomes of interest: Quality of Life, Sudden death
- No minimum threshold will be established for duration of intervention. However, study duration will be considered in the assessment of the quality and applicability of the study.
- Primary care and specialty settings will be included.
Analytic Framework
Figure 1: This figure depicts the key questions within the context of the PICOTS described in the previous section. In general, the figure illustrates how the non-opiod oral medications, over-the-counter supplements, and topical agents may result in outcomes such as improvements in osteoarthritis symptoms. Also, adverse events may occur at any point after the treatment is received.
A. Criteria for Inclusion/Exclusion of Studies in the Review
Systematic reviews and controlled trials pertinent to the key questions will be included. We will retrieve any blinded or open, parallel or crossover randomized controlled trial that compared one included drug to another, or placebo. We will also include cohort and case-control studies with at least 1,000 cases or participants that evaluated serious gastrointestinal and cardiovascular endpoints that were inadequately addressed by randomized controlled trials.
For all studies that meet the criteria above, we will use PICOTS (Population, Intervention, Comparators, Outcomes, Timing and Setting) to evaluate inclusion in the CER Update. We will include studies that evaluate the safety, efficacy or effectiveness of the previously mentioned medications in adults with osteoarthritis. We will also include studies that report safety in patients with rheumatoid arthritis or were taking the drug for cancer or Alzheimer's prevention. Outcomes will include improvements in osteoarthritis symptoms, cardiovascular and gastrointestinal adverse events, renal, and hepatic toxicity, quality of life, and sudden death. There is no minimum threshold for duration of intervention. Studies will be included if they were conducted in primary care or specialty settings.
We will review English language abstracts for non- English studies that otherwise appear to meet eligibility criteria. Non- English studies that appear to meet eligibility criteria will be cited with a brief summary. If a need to include foreign language literature in our analysis arises, we will discuss it with the AHRQ Task Order Officer and the Technical Expert Panel.
If grey literature is identified during the preliminary search for evidence, it will be included as appropriate.
Publications from 2005 to the present will be searched. This date range was selected to provide an overlap with the publication date range used in the original CER.
B. Searching for the Evidence: Literature Search Strategies for Identification of Relevant Studies to Answer the Key Questions.
We will replicate the comprehensive search of the scientific literature conducted for the original CER, with an updated date range of 2005- present to identify relevant studies addressing the key questions.
Results from previously conducted meta-analyses and systematic reviews on these topics will be sought and used where appropriate and updated when necessary. To identify systematic reviews, in addition to MEDLINE, we will search the Cochrane Database of Systematic Reviews and the websites of the Canadian Coordinating Office for Health Technology Assessment (CCOHTA), Bandolier, and the NHA Health Technology Assessment Programme.
To identify articles relevant to each key question, we will search the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Ovid ®MEDLINE. We will use relatively broad searches, combining terms for drug names with terms for relevant research designs, limiting to those studies that focused on osteoarthritis and rheumatoid arthritis. Other sources may include reference lists of review articles and unpublished materials from the US Food and Drug Administration (FDA). Pharmaceutical manufacturers will be invited to submit scientific information packets, including citations if applicable. All citations from these sources will be imported into an electronic database (EndNote®) and considered for inclusion.
After finalizing our searches, we will systematically review abstracts against our pre-established inclusion/exclusion criteria to determine potential eligibility for inclusion in the evidence synthesis.
Full text literature will be reviewed and key data from each eligible study will be extracted and entered into an electronic database. A file of excluded studies with reasons for exclusion will be maintained.
Our research team will use appropriate procedures to reduce bias and enhance consistency in our study selection process. These procedures include using dual reviewers to review abstracts and full-text articles for inclusion and exclusion for each key question. We will use full text review and a consensus process to resolve conflicting assignments.
Searches will be updated while the report is posted for public comment and peer review to capture any new publications. Literature identified during the update search will go through the same process of dual review as all other literature considered for inclusion in the report. If any pertinent new literature is identified for inclusion in the report, it will be incorporated prior to the final submission of the report.
C. Data Abstraction and Data Management
Once studies have been selected for inclusion based on the key questions and PICOTS, the following data will be extracted and used to assess applicability and quality of the study: study design; population and clinical characteristics (including sex, age, ethnicity, diagnosis, comorbidities, concomitant medications, GI bleeding risk, cardiovascular risk); interventions (dose and duration); method of outcome ascertainment if available, and results for each outcome, focusing on efficacy and safety; setting (primary care or referral); the number of patients randomized relative to the number of patients enrolled, and how similar those patients were to the target population; whether a run in period was used; and the funding source. We will record intention-to-treat results if available.
D. Assessment of Methodological Quality of Individual Studies
We will assess the methodological quality of systematic reviews, randomized trials, and observational studies based on predefined criteria. These criteria are based on the Assessment of Multiple Systematic Reviews (AMSTAR) tool (systematic reviews),10 methods proposed by Downs and Black (observational studies),11 and methods developed by the US Preventive Services Task Force.12 Individual studies will receive quality ratings of "good," "fair," or "poor." Studies could receive one rating for assessment of efficacy and a different rating for assessment of harms. Studies that meet all criteria will be rated good quality and studies that have a serious or "fatal" flaw in one or more categories will be rated poor quality; the remainder will be rated fair quality. As the "fair quality" category is broad, studies with this rating vary in their strengths and weaknesses: the results of some fair-quality studies are likely to be valid, while others are only probably valid. A "poor quality" trial is unlikely to be valid—the results are at least as likely to reflect flaws in the study design as the true difference between the compared drugs.
We will rate the methodological quality of each controlled trial based on the methods used for randomization, allocation concealment, and blinding; the similarity of compared groups at baseline; maintenance of comparable groups; adequate reporting of dropouts, attrition, crossover, adherence, and contamination; loss to followup; the use of intention-to-treat analysis; and ascertainment of outcomes.12
Systematic reviews will be rated based on pre-defined criteria assessing whether they had a clear statement of the questions(s), reported inclusion criteria, used an adequate search strategy, assessed validity, performed dual data abstraction, reported adequate detail of included studies, assessed for publication bias, and used appropriate methods to synthesize the evidence.10 We will include systematic reviews and meta-analyses that included unpublished data inaccessible to the public, but because the results of such analyses are not verifiable, we will considered this a methodological shortcoming.
For assessing the quality of cohort studies, we will evaluate whether the study authors used nonbiased selection methods to create an inception cohort; whether rates of loss to follow-up were reported and acceptable; whether they used accurate methods for ascertaining exposures, potential confounders, and outcomes; and whether they performed appropriate statistical analyses of potential confounders.11 For assessing the quality of case-control studies, we will evaluate whether similar inclusion and exclusion criteria were applied to select cases and controls, whether they used accurate methods to identify cases, whether they used accurate methods for ascertaining exposures and potential confounders, and whether they performed appropriate statistical analyses of potential confounders.11
The applicability of trials and other studies will be assessed based on whether the publication adequately described the study population, how similar patients were to the target population in whom the intervention will be applied, whether differences in outcomes were clinically (as well as statistically) significant, and whether the treatment received by the control group was reasonably representative of standard practice. We will also record the funding source and role of the sponsor.
E. Data Synthesis
We will construct evidence tables showing study characteristics, quality ratings, and results for all included studies. We expect to conduct data synthesis similar to the analyses conducted for the original CER.
In the original CER, we performed two quantitative analyses. An important limitation of observational studies of NSAIDs was that none simultaneously assessed the risk for serious cardiac and GI events. We therefore re-analyzed data from a set of observational studies that reported rates of three different serious adverse events in the same population. We assumed that the adverse events occurred independently and that the logarithm of the rate ratios was distributed normally. After estimating the effect (number of events prevented or caused) for each of the three adverse events, we estimated the net effects on all three serious adverse events using Monte Carlo simulation.
We also pooled clinical success rates and withdrawal due to adverse events from head-to-head trials of topical versus oral NSAIDs using a random effects model (Dersimonian-Laird method, using RevMan® statistical software). We performed standard chi-square tests for heterogeneity. Because only four trials were available for pooling, we did not attempt meta-regression analyses to evaluate potential sources of heterogeneity.
F. Grading the Evidence for Each Key Question
We will assess the overall strength of evidence for a body of literature about a particular key question in accordance with the Grading the Strength of a Body of Evidence when Comparing Medical Interventions chapter of the AHRQ Effective Health Care Program Methods Guide.13 We will examine the type, number and quality of studies; the risk of bias; the consistency of results within and between study designs; the directness of the evidence linking the intervention and health outcomes; the precision of the estimate of effect; strength of association (magnitude of effect); and the possibility for publication bias.
We will rate the strength of evidence for each key question using the four categories recommended by Owens, et al.13: (1) "high" grade indicates high confidence that the evidence reflects the true effect and that further research is very unlikely to change our confidence in the estimate of effect; (2) "moderate" grade indicates moderate confidence that the evidence reflects the true effect and further research may change our confidence in the estimate of effect and may change the estimate; (3) "low" grade indicates low confidence that the evidence reflects the true effect and further research is likely to change the confidence in the estimate of effect and is likely to change the estimate; (4) "insufficient" grade indicates evidence either is unavailable or does not permit a conclusion. For example, Consistent results from good-quality studies across a broad range of populations suggest a high degree of certainty that the results of the studies were true (that is, the entire body of evidence would be considered "high-quality.") For a body of fair-quality studies, consistent results may indicate that similar biases are operating in all the studies, or results that are likely to be valid. Unvalidated assessment techniques or heterogeneous reporting methods for important outcomes may weaken the overall body of evidence for that particular outcome or make it difficult to accurately estimate the true magnitude of benefit or harm.
- Chou R, Helfand M, Peterson K, Dana T, Roberts C. Comparative effectiveness and safety of analgesics for osteoarthritis. Comparative Effectiveness Review No.6 (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-02-0024.). Rockville, MD: Agency for Healthcare Research and Quality; 2006. Accessed 01/12/2010.
- Towheed TE, Maxwell L, Anastassiades TP, et al. Impact of musculoskeletal disorders in Canada. Annals of the Royal College of Physicians and Surgeons of Canada. 1998;31(5):229-232.
- Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: New insights. Part 1: The disease and its risk factors. Ann Intern Med. 2000;133:635-646.
- Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis & Rheumatism. 1995;38:1134-1141.
- Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis & Rheumatism. 1998;41(8):1343-1355.
- Gotzsche PC. Musculoskeletal disorders. Non-steroidal anti-inflammatory drugs.[update in Clin Evid. 2004 Jun;(11):1551-9; PMID: 15652070][update of Clin Evid. 2002 Dec;(8):1203-11; PMID: 12603936]. Clinical Evidence. Vol 2003:1292-1300.
- van Tulder MW, Scholten R, Koes BW, Deyo RA. Non-steroidal anti-inflammatory drugs for low-back pain. Cochrane Database of Systematic Reviews. 2005(3).
- Tarone RE, Blot WJ, McLaughlin JK. Nonselective nonaspirin nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding: relative and absolute risk estimates from recent epidemiologic studies. Am J Therapeutics. Previous Report, 2004;11:17-25.
- Chandrasekharan NV, Dai H, Roos KLT, et al. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression.[see comment]. Proc Natl Acad Sci U S A. Oct 15 2002;99(21):13926-13931.
- Shea B, J. , Hamel C, Wells G, A. , et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Journal of Clinical Epidemiology. Vol 62. Elsevier; 2009:1013-1020.
- Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. Jun 1998;52(6):377-384.
- Harris RP, Helfand M, Woolf SH, et al. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. Apr 2001;20(3 Suppl):21-35.
- Owens DK, Lohr KN, Atkins D, et al. AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions--agency for healthcare research and quality and the effective health-care program. J Clin Epidemiol. May;63(5):513-523.
Definition of Terms
For this report, we have defined the terms as follows:
- Selective NSAIDs, or COX-2 selective NSAIDs—drugs in the "coxib" class (celecoxib)
- Partially selective NSAIDs—other drugs shown to have partial in vitro COX-2 selectivity (etodolac, nabumetone, meloxicam)
- Aspirin—differs from other NSAIDs, because it irreversibly inhibits platelet aggregation; salicylic acid derivatives (aspirin and salsalate) are considered a separate subgroup
- All other NSAIDs—nonaspirin, nonselective NSAIDs, or simply nonselective NSAIDs
Summary of Protocol Amendments
In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale.
NOTE: The following protocol elements are standard procedures for all protocols.
- Review of Key Questions
For Comparative Effectiveness reviews (CERs) the key questions were posted for public comment and finalized after review of the comments. For other systematic reviews, key questions submitted by partners are reviewed and refined as needed by the EPC and the Technical Expert Panel (TEP) to assure that the questions are specific and explicit about what information is being reviewed. - Technical Expert Panel (TEP)
A TEP panel is selected to provide broad expertise and perspectives specific to the topic under development. Divergent and conflicted opinions are common and perceived as health scientific discourse that results in a thoughtful, relevant systematic review. Therefore study questions, design and/or methodological approaches do not necessarily represent the views of individual technical and content experts. The TEP provides information to the EPC to identify literature search strategies, review the draft report and recommend approaches to specific issues as requested by the EPC. The TEP does not do analysis of any kind nor contribute to the writing of the report. - Peer Review
Approximately five experts in the field will be asked to peer review the draft report and provide comments. The peer reviewer may represent stakeholder groups such as professional or advocacy organizations with knowledge of the topic. On some specific reports such as reports requested by the Office of Medical Applications of Research, National Institutes of Health there may be other rules that apply regarding participation in the peer review process. Peer review comments on the preliminary draft of the report are considered by the EPC in preparation of the final draft of the report. The synthesis of the scientific literature presented in the final report does not necessarily represent the views of individual reviewers. The dispositions of the peer review comments are documented and will, for CERs and Technical briefs, be published three months after the publication of the Evidence report.
It is our policy not to release the names of the Peer reviewers or TEP panel members until the report is published so that they can maintain their objectivity during the review process.


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Oil Up on Economic Data Despite EU Contagion Worry
Oil prices rose Tuesday on supportive data that pointed to continued economic growth in the fourth quarter, sending U.S. crude to a 16-week peak and offsetting concerns that the euro zone debt crisis will keep spreading.
Trading was choppy and Brent's December crude contract and U.S. December crude options expired, contributing to oil's price volatility, brokers and analysts said.
U.S. retail sales rose and wholesale prices fell in October and a gauge of New York state manufacturing showed growth in November, bolstering hopes for a stronger fourth-quarter economy.
Data showing the German and French economies managed to expand in the third quarter added support.
``The U.S. data helped, especially the retail sales, the Germany and France growth wasn't so bad and the expiration of December Brent and U.S. crude options will add to the volatility even as everyone worries about Europe's debt problems,'' said Gene McGillian, analyst at Tradition Energy in Stamford, Connecticut.
Oil's strength came despite a stronger dollar index, measuring the greenback against a basket of currencies. A stronger dollar can pressure dollar-denominated commodities.
The euro fell against the dollar and hit a five-week low against the yen.
Evidence of contagion came as Italian government bond yields again topped 7 percent, a financing level seen as unsustainable.
U.S. stocks were higher, but also in choppy trading, led by gains in technology shares after concern about Europe had seemed to offset the cheery economic data.
Expiring ICE Brent December crude rose 50 cents to settle at $112.39 a barrel. The day's $111.62 low neared Brent's $111.43 100-day moving average and the $113.14 intraday peak was just above the 200-day moving average of $113.09.
Brent January crude settled at $112.18, up 90 cents.
U.S. December crude rose $1.23 to settle at $99.37 a barrel, the highest close since July 26, after hitting a high at $99.84.
U.S. crude again neared 70 on the relative strength index on 14-day moving basis, a level that indicates it has been overbought and could be due for a correction lower.
Brent's premium to U.S. crude narrowed to $12.57 a barrel intraday, the lowest since hitting $12.44 on June 27 as the spread continued its retreat from the $19.91 intraday peak reached on Nov. 8.
ICE Brent experienced one of the quietest expiries of its front contract in months, reflecting a better supplied prompt oil market in Europe as Libyan and West African crude oil flowed into the region, traders said.
After being unable to reach consensus on a production targets at its June meeting, OPEC is scheduled to meet again Dec. 14.
Iran's OPEC Governor Mohammad Ali Khatibi told Reuters that it was pressure from officials of consumer countries to increase production that led to the lack of consensus at the June meeting.
U.S. crude oil and refined products stockpiles were expected to have fallen last week, a survey of Reuters analysts showed.
Crude stocks were expected to be down 1.2 million barrels and distillate inventories were expected to be down 2.1 million barrels.
Gasoline stocks were estimated to be down 700,000 barrels.
U.S. retail gasoline demand remained sharply lower versus the year-ago period last week as pump prices stayed well above the 2010 period, MasterCard said in a weekly report.
Investors awaited fresh snapshots of U.S. oil inventories, starting with a report from the American Petroleum Institute on Tuesday at 4:30 p.m. EST (2130 GMT). The U.S. Energy Information Administration's report is due on Wednesday at 10:30 a.m. EST.

subset: commoncrawl


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If you're curious about "School Days," the Linda Cunningham artwork that was banned from an Emerald Art Center show for its commentary on gun violence, head to New Zone Gallery, where's its now on display. Our Slant column from the 1-9 issue made an open plea calling for another gallery to display the work. Kudos to New Zone Gallery, home of the Salon de Refusés, for embracing thought-provoking art.
The local case of censorship is also getting national attention.
The National Coalition Against Censorship (NCAC) — "an alliance of over 50 national non-profit organizations united in defense of free expression" — blogged about the censorship incident here. Today, Jan. 16, the NCAC Arts Advocacy Project sent a letter to the Emerald Art Center board. The NCAC writes:
"We urge you to revise your exhibition policies toassure that the Emerald Art Center does not become a repressive censor, trampling the artistic freedom of its own members. Such a revision would assure the continuing viability and prosperity of the EAC as a place of artistic excellence thatwould attract new members, rather than lose current ones.
'School Days' brings awareness to the continuing threat of gun violence in schools, a message that the Center's coordinator agreed was 'important' and that most people considered 'powerful.' According to press reports, however, the Board found the piece 'too controversial' and 'inappropriate' for the members' show.
Art that engages in issues that we all care about inevitably elicits emotional response: sometimes it elates, at other times it disturbs, but it always provokes though: this is what art is supposed to do. By labeling such art as inappropriate andcensoring it, the Emerald Art Center is doing a disservice to all Association members and is also jeopardizing its position as a relevant cultural institution."
The letter was signed by over 10 local artists including Rogene Manas and Jud Turner, who cancled an upcoming show at the EAC because of the censorship.
You can read the entire NCAC letter here.


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Girls Basketball: Sachem East ends Waves' season
Riverhead was under no misconception. The seventh-seeded Blue Waves knew they were facing a tall order, trying to upset No. 2 Sachem East in Wednesday's Suffolk County Class AA girls basketball quarterfinal.
Even so, perhaps Riverhead couldn't have imagined its challenge being as difficult as it was.
The most telling numbers of the game might have been these: With its reserves in the game, Sachem East put up a measly 2 points in the fourth quarter — and still won by 25!
A 25-10 third-quarter blast sent Sachem East on the way to a 63-38 trouncing of the visiting Blue Waves and its seventh straight county final four. The Flaming Arrows (16-1), who also ousted Riverhead from the playoffs in 2010, will play Bellport or Walt Whitman in a county semifinal on Saturday at St. Joseph's College in Patchogue.
"I expected a better fight, honestly, I did," said Riverhead coach Dave Spinella.
But Sachem East, the League I champion, brought too much for Riverhead to handle. Two juniors, Katie Doherty and Kathleen Everson, spearheaded the offense for the Flaming Arrows. Doherty led all scorers with 21 points to go with 6 assists while Everson put up 16 points and 10 rebounds. Emily Carmel chipped in 11 points with the aid of three 3-pointers, and Sammy Drake grabbed 10 rebounds to go with 8 points.
Doherty scored her first 6 points within the opening 3 minutes 22 seconds as Sachem East, like a basketball tsunami, flew out to a 10-0 lead. Riverhead (12-8) committed 8 of its 19 turnovers in the first quarter, which ended with Sachem East holding a 17-11 lead.
Then, Sachem East distanced itself further from Riverhead in the second quarter. While Riverhead struggled with 1-for-9 shooting from the field in the quarter, Sachem East closed out the first half on a 14-2 run for a 37-15 halftime cushion.
Another 14-2 run by Sachem East in the third quarter made the score 53-20. The rest of the game was little more than a formality.
"They execute so well," Spinella said. "They're big and they can move, and they can all shoot. It just makes it a tough situation. We didn't play very well, but that's a tribute to their defense. Our youth kind of got exposed."
Asked what the decisive factor in the game was, Doherty replied: "I think it was really our energy. We came out really hard. Everybody was going for loose balls and rebounds, and I think that motivated us to win."
Second-chance scoring opportunities didn't hurt, either. Sachem East hustled for 16 offensive rebounds. The Flaming Arrows outrebounded the visitors, 43-32.
"In spots of the game, they played as well as we can play," Sachem East coach Matt Brisson told reporters.
Asked if he was surprised by how well his team performed, Brisson answered, "They never surprise me."
The game marked the end of the Shanice Allen era for Riverhead. With the senior's five-year varsity career concluding, a poignant scene developed late in the game. After sinking a pair of free throws for her 13th and 14 points of the contest, Riverhead's all-time leading scorer with over 1,400 points, was pulled from the game. When Allen, who is headed for Pace University, arrived near the bench, she received a hug from Spinella, and then more hugs from teammates.
Brisson had some words for Allen after the game while the teams exchanged handshakes. "I said, 'What a legacy you leave behind,' " Brisson said. "She should be so proud of herself for what she accomplished in her time over there."
Sachem East is looking to accomplish a lot with a team that has the talent to win a second county crown in three years.
Brisson was the head coach of Sachem for two years before the school split into two schools, Sachem East and Sachem North. He could just as easily be the Sachem North coach now, but he chose Sachem East.
"Every now and then I think to myself, 'Which way should I have gone?' " Brisson said. "My momma raised no fool. I came the right way."
Brisson credited his players for the team's success. "Katie Doherty walks into the gym and Kathleen Everson walks into the gym, and all of a sudden I'm a pretty good coach," he said.
What are Sachem East's expectations?
"We want to win," Doherty said. "We want to win as much as we can, and we're going to go for it."
Riverhead, which had lost 10 players from the team that reached the New York State final four last year, couldn't feel too bad about its season.
In addition to Allen, Riverhead will lose Denise Brunskill, Naysha Trent and Jocelin Zaneski to graduation. The bulk of the team will be back next season, though, including two freshmen starters, Dezarae Brown and Sam Dunn. One can envision enhanced roles for Kim Ligon, Destiny McElroy and Kyra Braunskill.
"We lost 10 kids from last year, and we were one game from the [county] final four, so what can you say?" Spinella said. "This whole year has been a tremendous success. Our youth got so much extra time, extra games and so much more experience. Extra games and extra practices, all of that adds up in the long run."


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Undergraduate Bulletin
Spring 2024
GEO: Geosciences
GEO 101: Environmental Geology
Fundamental earth science concepts are used to assess the impact of increasing global population and development on earth's natural resources and also to examine how natural processes affect human activities. Topics include water usage and pollution, soil pollution and erosion, radioactive and solid waste disposal, landslides, stream flooding, coastal erosion, environmental consequences of energy and mineral resource utilization, acid rain, global climate change, and the environment effects on human health. Aspects of environmental geology that are particularly applicable to Long Island and metropolitan New York are emphasized.
3 credits
GEO 102: The Earth
A summary of the processes that have shaped the earth and the other terrestrial planets as inferred from study of their surface materials, structural features, and interiors. Topics include the earth in the solar system; earth materials and rock-forming processes; surface processes and their bearing on human activities; crustal deformation and global tectonics; the earth's interior; and the geological features, compositions, and evolution of the terrestrial planets. Not for credit in addition to GEO 122.
3 credits
GEO 103: The Earth Through Time
The history of the earth from its formation 4.5 billion years ago to the present. Major issues to be addressed include formation and early history of the earth and moon; evolution of continents, oceans, and atmosphere within the framework of plate tectonics; origin of life; and evidence of past climates.
3 credits
GEO 104: Ripples across the World: Global Effects of Natural Disasters
Earthquakes and tsunamis create widespread devastation. Volcanic eruptions bury cities under ash and cause closures of distant airports. Heavy rains cause landslides and flooding. How do these disasters happen? What are the secondary global effects on societal infrastructure, on public health, on international trade? How do societal differences cause varied local responses and affect the global impact? This course focuses on evaluating the global effects of several recent geological disasters. Scientific and popular news sources are used to explore the underlying natural phenomena and the nature and global distribution of the effects from geologic, economic, and public health perspectives.
Prerequisite: High school chemistry and biology
SBC: GLO3 credits
GEO 105: Energy Resources for the 21st Century
Today we are faced with the challenge of driving the economies of modern civilization with new energy resources. This course looks at the current energy sources to assess their long term sustainability. In particular, this course examines fossil fuels, from the geologic processes that create them through their utilization. This course evaluates the impact on the global environment and the finiteness of each resource. Nuclear, geothermal, solar, wind, hydro, tidal, and other energy sources will be evaluated. This course projects forward to anticipate needs and evaluate future resources for time scales of 10, 20, 50, and 100 years. It identifies the technical advances that are required to meet the future energy needs. The emphasis of the course is to provide a vision of the current global energy setting. It develops tools that enable critical thinking on issues that interface society and science. Homework assignments will use the internet for accessing relevant information and spread sheets (such as Excel) and Google Earth to evaluate this information.
3 credits
GEO 106: Planetary Geology
Geology and geological history of the terrestrial planets, planetary satellites and minor bodies of the solar system are evaluated. Whenever possible, emphasis will be placed on geological results from the most recent planetary missions. Among the main topics to be considered are meteorites and the origin of terrestrial planets, the internal structure of terrestrial planets, planetary volcanism, planetary stratigraphy, surface processes such as meteorite impacts, wind and weathering, minor bodies of the solar system and the origin of the solar system. Not for credit in addition to AST 105 or AST 205.
Advisory Prerequisite: High School Earth Science
3 credits
GEO 107: Natural Hazards
An introduction to the concepts, techniques, and scientific methods used in the earth sciences. The natural hazards posed by earthquakes and volcanic eruptions are used as a focus. These phenomena are examined in the context of the theory of plate tectonics to determine their cause, destructive potential, and the possibility of predicting and controlling their occurrence. Elementary probability methods are introduced in the treatment of approaches to prediction. Societal responses to forecasts are also considered.
3 credits
GEO 112: Physical Geology Laboratory
Rock and mineral identification, introduction to topographic and geologic maps. Not for credit in addition to GEO 122.
Pre- or Corequisite: GEO 102
1 credit
GEO 113: Historical Geology Laboratory
An introduction to basic techniques used for interpreting geological history. Topics include interpretation of topographic and geological maps and cross sections, introduction to fossils, and basic stratigraphic techniques. One three-hour laboratory per week.
Pre- or Corequisite: GEO 103
1 credit
GEO 115: Making the Invisible Visible: Polarized light microscopy
Light interacts with crystals and through this interaction reveals information on the composition of the crystals and their internal atomic arrangement. This course provides a hands-on exploration of the construction of the polarized light microscope, its use in investigating the behavior of polarized visible light passing through crystals, and how the observed behavior can be used to identify natural and synthetic crystalline materials. The scientific material covered is of particular relevance to students interested in chemistry, physics, materials science, and planetary and geological science. Two 80-min lectures and one three-hour laboratory per week for a 4-week period.
Prerequisite: AP Chemistry with a score of 4 or 5 or CHE 131 or equivalent
SBC: TECH1 credit
GEO 121: Principles of Geology
Course offered in conjunction with Sayville High School. Equivalent to GEO 122; GEO 122 may not be completed for credit after successful completion of GEO 121.
4 credits
GEO 122: Physical Geology
The nature of the earth and of the processes that shape it: the earth's external and internal energy; minerals and rocks; external processes and the evolution of the landscape; internal processes and the structure of the earth; the earth compared with other planets; sources of materials and energy. Laboratory includes study of minerals and rocks; landforms as shown on topographical maps and aerial photographs; geologic structures inferred from maps and block diagrams; problem sets. Two lectures and one three-hour laboratory and recitation per week. Not for credit in addition to GEO 102.
Advisory Prerequisite: high school chemistry and high school physics
4 credits
GEO 287: Introductory Research in Geology
Independent research, under the supervision of a faculty member, at a level appropriate to lower-division students. May be repeated once.
Prerequisites: U1 or U2 standing; one GEO course; permission of instructor and departmental research coordinator
SBC: ESI0-3 credits, S/U grading
GEO 303: Sedimentary Geology and Geochronology (with emphasis on the Turkana Basin)
Field course that applies fundamental geological concepts to the sediments and rock units in the Turkana Basin, Kenya, to provide a foundation for the chronology and context for recorded events in human evolution. Emphasis is given to sedimentation, stratigraphy, volcanism, and tectonics, as they apply to local geology, including training in field methods. Modern terrestrial processes and landscape evolution are examined using features present in the Turkana Basin. Consideration is also given to broader geologic events spanning the Oligocene to the present. Geologic concepts are linked to modern and ancient environments, archaeology, and paleoanthropology in northern Kenya.
Prerequisite: permission of the instructor/Study Abroad office
3 credits
GEO 304: Energy, Mineral Resources, and the Environment
A survey of the origin, distribution, and importance to modern civilization of the fuels and minerals won from the earth. Geology of mineral resources and problems of finding, extracting, and supplying fossil fuels, metallic ores, water, and non-metallic commodities to industry and community as well as the ultimate limits of their abundances. Environmental concerns related to the exploitation of mineral resources with review of legislation and other steps being taken to minimize environmental damage.
Prerequisite: one D.E.C. E or SNW course
3 credits
GEO 305: Field Geology
Geological field studies on and near the Stony Brook campus. Labs emphasize mapping techniques and field studies of glacial and environmental geology, and include geophysical and hydrological analyses and mapping. Course consists of two three-hour sessions per week, divided between lecture and outdoor labs.
Prerequisites: GEO 122 OR GEO 102 and GEO 112
SBC: EXP+3 credits
GEO 306: Mineralogy
Topics include basic crystallography, crystal chemistry, and identification of the important rock-forming and ore minerals. Included are the fundamentals of optical crystallography: indices of refraction, isotropic, uniaxial, and biaxial minerals; optical indicatrix theory and interference figures. Three hours of lecture per week. The laboratory component, GEO 366, must be taken concurrently; a common grade for both courses will be assigned.
Prerequisites: GEO 122 OR GEO 102 and GEO 112; CHE 131 or CHE 129
Corequisite: GEO 366
3 credits
GEO 307: Global Environmental Change
An analysis of the physical, chemical, and biological processes in the atmosphere, hydrosphere, lithosphere, and biosphere that are susceptible to change either from natural or anthropogenic causes. In addition to focusing on the processes, this course will examine the spatial/temporal scales of environmental changes, their consequences to systems including our economic, political, and social systems, and will consider our responsibility and capability in managing systems in a sustainable way. This course is offered as both ENV 304 and GEO 307.
Prerequisite: one of the following courses: SUS 111 (formerly SBC 111), SUS 113 (formerly SBC 113), ENS 101, GEO 101, GEO 102, GEO 122, ENV 115, CHE 131
3 credits
GEO 309: Structural Geology
Principles of structural geology, including classification, criteria for recognition, and mechanics of formation of crustal structural features. Elementary concepts of rock mechanics. Discussion of important tectonic features of the continents and oceans. Three hours of lecture per week. A two-day weekend field trip visits "classic" structural localities in the East. The laboratory component, GEO 369, must be taken concurrently; a common grade for both courses will be assigned.
Prerequisites: GEO 122, or GEO 102 and 112; one semester of calculus; PHY 131/133 or 141 and 133 or PHY 125 and 126 and 133
Corequisite: GEO 369
3 credits
GEO 310: Introduction to Geophysics
An introduction to theoretical and applied geophysics. Topics in global geophysics include seisomology, gravity, geomagnetics and heat flow, with applications to the structure and dynamics of the earth's interior. Students conduct computer-based analysis of geophysical data, some of which they collect using techniques of geophysical exploration and environmental geology. Three hours of lecture per week, plus group field experiments and analysis.
Prerequisite: GEO 122, or GEO 102 and 112 Pre- or corequisites: MAT 127 or MAT 132 or MAT 142 or MAT 171 or AMS 161; PHY 133; PHY 132 or PHY 127 or PHY 142
3 credits
GEO 311: Geoscience and Global Concerns
An exploration of how technologically-based problems facing the United States and the world are related to the basic scientific principles that explain the properties of the lithosphere, hydrosphere, and atmosphere. The set of issues include such geoscience-based topics as global warming, fossil fuel resources, nuclear waste disposal, and earthquake prediction and preparedness.
Prerequisite: Any 3 or 4 credit 100-level GEO course
3 credits
GEO 313: Understanding Water Resources for the 21st Century
A survey of the world's water resources and the fundamental processes and concepts that govern their distribution and resupply. Topics to be covered include processes in the hydrologic cycle, water resource supply and demand, water quality, and societal aspects relating to drinking water, and industrial and agricultural water usage. Consideration is given to global water shortages, projected impacts of climate change, water-based conflict, water resource management, and conservation practices. Detail will be devoted to pollution sources, water quality standards, drinking water treatment, and government regulation. Local water issues will also be addressed.
Prerequisite: one D.E.C. E or SNW course
3 credits
GEO 315: Groundwater Hydrology
Physical and chemical principles of geohydrology. Concepts of groundwater geology. Introduction to quantitative models of regional fluid flow and groundwater contamination. Groundwater and geologic processes, with examples from tectonics, petroleum geology, geothermics, and economic mineralization.
Prerequisites: GEO 102 or GEO 122; MAT 127 or MAT 132 or MAT 142 or MAT 171 or AMS 161
3 credits
GEO 316: Geochemistry of Surficial Processes
Chemical principles used in the study of surface and near-surface water, rocks, and soils. Application of equilibrium concepts and reaction rates to reactions involving gases, fluids, and minerals in nature. Consideration of soil properties and processes.
Prerequisites: GEO 122, or 102 and 112; CHE 132 or 142
4 credits
GEO 318: Engineering Geology and Coastal Processes
Fundamental concepts of soil, sediment, and rock mechanics and the physics of surficial processes. Application is made to problems of geotechnical and coastal engineering. Topics include consolidation, loose boundary hydraulics, slope stability, underground excavations and beach and tidal inlet stability, and channel sedimentation. This course is offered as both GEO 318 and MAR 318.
Prerequisites: GEO 122 or GEO 102 and 112; MAT 127 or 132 or 142 or 171 or AMS 161
SBC: STEM+3 credits
GEO 320: Glacial Geology
History of glaciation on earth; formation and dynamics of glaciers and ice sheets; processes of glacial erosion and deposition; and the nature of glacial sediments and landforms particularly relating to the development of Long Island.
Prerequisite: GEO 102 or 122
3 credits
GEO 330: The Geology of Mars
Overview of Mars as a planetary system. Evolution of the planet and its atmosphere through time. Detailed discussion of processes that have shaped the martian surface, including erosion, sedimentation, volcanism, impact cratering, physical and chemical weathering. Comparison of geologic processes on Mars and Earth. Discussion of past and future spacecraft missions to Mars.
Prerequisite: GEO 102 or GEO 122 or GEO 106
SBC: ESI3 credits
GEO 347: Remote Sensing
An introduction to the fundamental principles of remote sensing, with emphasis on geological and environmental applications. Discussion of the physical basis for remote sensing techniques. Survey of commonly used sensors and image analysis methods in earth sciences. Participants gain practical experience in geologic and environmental analysis using satellite imagery.
Prerequisite: GEO 102 or GEO 106 or GEO 122 or permission of the instructor
3 credits
GEO 366: Mineralogy Laboratory
Three hours of laboratory per week that corresponds to the content of GEO 306. Laboratory exercises involve work with crystallographic models, mineral samples, refraction oils and the polarizing light microscope. This course has an associated fee. Please see www.stonybrook.edu/coursefees for more information.
Corequisite: GEO 306
SBC: TECH1 credit
GEO 369: Structural Geology Laboratory
Three hours of laboratory per week that corresponds to the content of GEO 309. Laboratory exercises cover map interpretation and algebraic and graphical solutions of structural problems. This course has an associated fee. Please see www.stonybrook.edu/coursefees for more information.
Corequisite: GEO 309
1 credit
GEO 403: Sedimentation and Stratigraphy
The history and practice of defining units of layered rocks and interpreting their spatial relationships. Topics include the basis for the geologic time scale, lithostratigraphic versus chronostratigraphic units, biostratigraphy, magnetostratigraphy, facies patterns and Walther's Law, subsurface stratigraphy, and the application of stratigraphy to geological problems. The laboratory component, GEO 463, must be taken concurrently; a common grade for both courses will be assigned.
Prerequisite: GEO 103; GEO 113; C or better in GEO 306 and GEO 366
Corequisite: GEO 463
3 credits
GEO 404: Geomorphology
An introduction to the study of landforms and the processes that produce and modify them. This active learning class meets for two, three-hour periods each week consisting of recitations, discussions, and exercises. A significant portion of the exercises will relate to Long Island geomorphology. Computers will be used extensively in class.
Prerequisite: GEO 102/112 or GEO 122; and any 300 or 400 level GEO or MAR course
SBC: STEM+3 credits
GEO 405: Field Camp
A field course that may be taken at any one of several approved university field stations.
Prerequisite: student must receive permission from both field-site personnel and the Undergraduate Program Director
1-6 credits
GEO 407: Igneous and Metamorphic Petrology
Topics focus on the processes that govern the formation and distribution of igneous and metamorphic rocks and their link to the Earth's mantle, crust, and tectonic regimes. Emphasis will be placed on integrating assessment of the chemical control on compositional diversity through phase diagrams with the study of natural rock suites through hand sample and thin section analysis. Three hours of lecture per week. The laboratory component, GEO 467, must be taken concurrently; a common grade for both courses will be assigned.
Prerequisites: MAT 125 or MAT 131 or AMS 151; C or better in GEO 306 and GEO 366
Corequisite: GEO 467
SBC: STEM+3 credits
GEO 444: Experiential Learning
This course is designed for students who engage in a substantial, structured experiential learning activity in conjunction with another class. Experiential learning occurs when knowledge acquired through formal learning and past experience are applied to a "real-world" setting or problem to create new knowledge through a process of reflection, critical analysis, feedback and synthesis. Beyond-the-classroom experiences that support experiential learning may include: service learning, mentored research, field work, or an internship.
Prerequisite: WRT 102 or equivalent; permission of the instructor and approval of the EXP+ contract (http://sb.cc.stonybrook.edu/bulletin/current/policiesandregulations/degree_requirements/EXPplus.php)
SBC: EXP+0 credit, S/U grading
GEO 447: Senior Tutorial in Geology
Independent readings in advanced topics. May be repeated once.
Prerequisites: Permission of instructor and chairperson
1-3 credits
GEO 448: Geosciences Colloquium
Every semester, the Department of Geosciences hosts a colloquium series. The series features weekly lectures covering a wide variety of geosciences research topics. The purpose of this course is to expose upper division geoscience students to current research being performed at Stony Brook University and elsewhere. May be repeated up to a limit of 3 credits.
Prerequisite: U3 or U4 status as a GEO or ESS major; Permission of Instructor
1 credit
GEO 463: Sedimentation and Stratigraphy Laboratory
Three hours of laboratory per week that corresponds to the content of GEO 403. The course emphasizes practical techniques in stratigraphy. This course has an associated fee. Please see www.stonybrook.edu/coursefees for more information.
Corequisite: GEO 403
1 credit
GEO 467: Igneous and Metamorphic Petrology Laboratory
Three hours of laboratory per week that corresponds to the content of GEO 407. This course has an associated fee. Please see www.stonybrook.edu/coursefees for more information.
Corequisite: GEO 407
SBC: STEM+1 credit
GEO 475: Undergraduate Teaching Practicum I
Work with a faculty member as an assistant in one of the faculty member's regularly scheduled classes. The student is required to attend all the classes, do all the regularly assigned work, and meet with the faculty member at regularly scheduled times to discuss the intellectual and pedagogical matters relating to the course.
Prerequisite: U4 standing; previous preparation in subject field; interview; permission of instructor
SBC: EXP+3 credits, S/U grading
GEO 476: Undergraduate Teaching Practicum II
Work with a faculty member as an assistant in one of the faculty member's regularly scheduled classes. Students assume greater responsibility in such areas as leading discussions and analyzing results of tests that have already been graded. Students mya not serve as teaching assistants in the same course twice.
Prerequisite: GEO 475; previous preparation in subject field; interview; permission of instructor and department
SBC: EXP+3 credits, S/U grading
GEO 487: Senior Research in Geology
Under the supervision of a faculty member, a major in the department may conduct research for academic credit.
Prerequisites: Permission of instructor and chairperson
SBC: ESI, EXP+0-6 credits
GEO 488: Internship
Participation in local, state, or national private enterprises, public agencies, or nonprofit institutions. May be repeated to a limit of 6 credits.
Prerequisites: Permission of instructor and department
SBC: EXP+0-6 credits, S/U grading
GEO 496: Research and Synthesize Scientific Literature in Geoscience
An introduction to writing a scientific literature review in the field of geosciences. Students will gain experience using scientific journal article databases, selecting relevant research articles from the peer-reviewed literature, and summarizing information effectively in written form. This course is to be taken in conjunction with any 300- or 400-level GEO course. Successful completion of this course satisfies the SBC categories WRTD and ESI.
Prerequisite: permission of instructor and GEO 102 or GEO 122
Corequisite: one 300- or 400-level GEO course
SBC: ESI, WRTD1 credit, S/U grading
GEO 497: Research Communication in Geoscience
An introduction to ethics in scientific research and research communication in Geoscience. Topics from the NIH Ethics training course will be discussed with a focus on the student's current and future research and the ethical aspects of scientific communication. Discussions of clarity in scientific communication as a means of effecting ethical dissemination of scientific results will involve exposure to best practices in oral and written presentation. Students will give oral presentations of their written work (based on the co-requisite course GEO 496) and be involved in peer assessment of presentations. Successful completion of this course satisfies the SBC categories CER and SPK.
Prerequisite: GEO 102 and GEO 112; or GEO 122; and declared major in GEO or ESS
SBC: CER, SPK1 credit, S/U grading


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Building an ecosystem of open source connectors
Over the last few months, we have released a lot of connectors for Microsoft PowerApps and Microsoft Flow taking the number of connectors available to over 250. These connectors drive growth and adoption of the platform by enabling our customers to get started quickly building their apps and flows. It is also worth noting that all these connectors are built by partners – both internal partners within Microsoft and external partners. We have a process to certify these connectors.
Very often though, we get requests and feedback from our customers and community around features and gaps in many of these connectors. These could be as simple as the connector not providing a certain field/property to complex new triggers and actions that they would like to see. These feedbacks are usually captured in our forum ideas, and then we go about triaging and fixing the connectors. Sometimes, based on support tickets, we end up updating the connectors. But, like any feature, it takes time and we are limited by resources. We often end up recommending our customers to build a custom connector or use the HTTP connector to call the underlying API directly.
Open source connectors
As the number of connectors grow, we would like to empower the wider community. With that, I would like to announce that we are starting a new journey to open-source our connectors. Through an open sourced connector strategy, we hope to get more community developers involved in maintaining a large set of high-quality connectors. You can see how these connectors are authored, and try them out yourself. And, you should be able to fork these connectors to augment any feature gaps and bug fixes. In return, developers can submit those changes back so that the larger community can benefit.
As with any other feature, we like to make small but concrete steps. You can find out open source connector repository on GitHub. Today, we have a small set of connectors, but we are fully committed to add more connectors in the coming months. I would also like to state that we are going through an open-source by default strategy. All new connectors will be put up for open sourcing by default. While the ultimate decision to open source a connector lies with the owner of the connector, we strongly encourage all our partners to open source their connectors.
The repository also provides sample connectors to help developers get started. This is something that we would like to see your contributions as well. If you have built interesting custom connectors, we would like you to share your custom connector as a sample. In addition, we have updated our documentation as well with some new topics.
There are 2 platform features that enable us to open source our connectors. It will also highlight some of the challenge we have around open sourcing some of the connectors we have today.
Power Platform Connectors CLI
The CLI (Command Line Interface) is a powerful tool that can be used to download, create, or update any custom connector. This tool allows developers to save their custom connectors onto a local file storage, and have it managed using a source code management system. This workflow is not available with the portal – which is great to get started, but not great for developers. The CLI tool also provides the developers access to other advanced features not available in the portal like connection parameters.
To get started with the Power platform connectors CLI, follow the instructions here. The CLI is a cross platform utility that is based on the Azure CLI. So, if you are familiar with that, you will find that it is straightforward to use. Essentially, you need to install the Python runtime, and then install the CLI from the PyPI:
pip install paconn
Once installed, you can login and then start using the CLI to download, create or update a custom connector.
paconn login paconn download paconn create paconn update
In future, we will be adding more functionality to do validation of connectors as well. Just like our open source philosophy, the CLI itself is open sourced. You will be able to see the source code in the same connector repository on GitHub.
Policy support for custom connectors
Building a custom connector for Microsoft PowerApps and Flow is very straightforward. You simply describe the underlying API operations in OpenAPI format – which can be done by using our tooling in the portal. However, REST APIs are primarily designed to be used by developers who have intimate knowledge of the APIs. This can present a problem for custom connectors where the share of the operations exposed by the connector is determined directly by what is provided at the underlying APIs. This is where policies come in.
Policies can be used to modify the behavior of connectors at runtime. For example, policies are used to enforce throttling limits on API calls, to route calls to different endpoints, etc. Policies are used extensively by many of the out-of-box connectors we have today. We often end up writing many custom policies to modify the API behavior so that the end user experience is great. The use of these custom policies is a problem for us – and our partners. These policies are not available for custom connectors. That effectively means that partners cannot update their connectors or test the changes themselves. It also prevents us from open sourcing the connectors as there is no way for anyone to test those connectors.
That is, until now.
We now make available template-based policies to custom connectors as well. Policies are available in the Definition section for your custom connector.
We currently support the following templates:
- Dynamic host url – This policy allows the API calls to be routed to a host endpoint based on a connection parameter. This is useful if your connector is targeting different API URL. For instance, the Azure Key Vault connector sample leverages this policy to set the host.
- Route requests to a fixed endpoint: This policy can be used to route a request to another sub-path. Consider using this policy when there are multiple
- Set HTTP header: This policy can be used to set a specific HTTP header.
- Set query string parameter: This policy can be used to set a specific query parameter.
We will be adding more policy templates in future as we get more requirements.
Finally, putting it together – an example
In this example, the CLI and the policies are used to create a connector for Azure Key Vault that can dynamically route to different Key Vault endpoints based on a connection parameter. We believe there are many more examples like that, and we would love to hear them.
This marks an important step towards our journey to build a vibrant developer ecosystem. We would love to hear your feedback. Feel free to use our community forum or send an email directly to us: email@example.com. We appreciate all feedback!


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Seth Rogen Invites Duncan Jones To Direct 'Preacher' Episodes
Writers Seth Rogen and Evan Goldberg are slowly but surely working on the pilot for AMC's new TV adaptation of the Garth Ennis/Steve Dillon Vertigo series Preacher, and as they write, it appears they're also recruiting cool directors.
Rogen struck up a Twitter conversation with Duncan Jones, director of Moon (which is super great) and Source Code (which is flawed but well made) -- and also, incidentally, the son of David Bowie -- to gauge his interest. Right now, Jones is working on a Warcraft movie, but he seemed extremely enthusiastic about taking the reins on some Preacher episodes.