Single-inhaler fluticasone furoate/umeclidinium/vilanterol versus fluticasone furoate/vilanterol plus umeclidinium using two inhalers for chronic obstructive pulmonary disease: A randomized non-inferiority study

Background: Single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 μg has been shown to improve lung function and health status, and reduce exacerbations, versus budesonide/formoterol in patients with chronic obstructive pulmonary disease (COPD). We evaluated the non-inferiority of single-inhaler FF/UMEC/VI versus FF/VI + UMEC using two inhalers. Methods: Eligible patients with COPD (aged ≥40 years; ≥1 moderate/severe exacerbation in the 12 months before screening) were randomized (1:1; stratified by the number of long-acting bronchodilators [0, 1 or 2] per day during run-in) to receive 24-week FF/UMEC/VI 100/62.5/25 μg and placebo or FF/VI 100/25 μg + UMEC 62.5 μg; all treatments/placebo were delivered using the ELLIPTA inhaler once-daily in the morning. Primary endpoint: change from baseline in trough forced expiratory volume in 1 s (FEV1) at Week 24. The non-inferiority margin for the lower 95% confidence limit was set at − 50 mL. Results: A total of 1055 patients (844 [80%] of whom were enrolled on combination maintenance therapy) were randomized to receive FF/UMEC/VI (n = 527) or FF/VI + UMEC (n = 528). Mean change from baseline in trough FEV1 at Week 24 was 113 mL (95% CI 91, 135) for FF/UMEC/VI and 95 mL (95% CI 72, 117) for FF/VI + UMEC; the between-treatment difference of 18 mL (95% CI -13, 50) confirmed FF/UMEC/VI’s was considered non-inferior to FF/ VI + UMEC. At Week 24, the proportion of responders based on St George’s Respiratory Questionnaire Total score was 50% (FF/UMEC/VI) and 51% (FF/VI + UMEC); the proportion of responders based on the Transitional Dyspnea Index focal score was similar (56% both groups). A similar proportion of patients experienced a moderate/severe exacerbation in the FF/UMEC/VI (24%) and FF/VI + UMEC (27%) groups; the hazard ratio for time to first moderate/ severe exacerbation with FF/UMEC/VI versus FF/VI + UMEC was 0.87 (95% CI 0.68, 1.12). The incidence of adverse events was comparable in both groups (48%); the incidence of serious adverse events was 10% (FF/UMEC/VI) and 11% (FF/VI + UMEC). Conclusions: Single-inhaler triple therapy (FF/UMEC/VI) is non-inferior to two inhalers (FF/VI + UMEC) on trough FEV1 change from baseline at 24 weeks. Results were similar on all other measures of efficacy, health-related quality of life, and safety. Trial registration: GSK study CTT200812; ClinicalTrials.gov NCT02729051 (submitted 31 March 2016)

Effects of aqueous leaf extract of Asystasia gangetica on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats

Background: Asystasia gangentica (A. gangetica) belongs to the family Acanthaceae. It is used to treat hypertension, rheumatism, asthma, diabetes mellitus, and as an anthelmintic in South Africa, India, Cameroun, Nigeria, and Kenya respectively. It has also been reported to inhibit the angiotensin I converting enzyme (ACE) in-vitro. Therefore, the aim of this study is to investigate the in-vivo effect of aqueous leaf extract (ALE) of A. gangetica on the blood pressure (BP) and heart rate (HR) in anaesthetized male spontaneously hypertensive rats (SHR); and to elucidate possible mechanism(s) by which it acts. Methods: The ALE of A. gangetica (10–400 mg/kg), angiotensin I human acetate salt hydrate (ANG I, 3.1–100 μg/kg) and angiotensin II human (ANG II, 3.1–50 μg/kg) were administered intravenously. The BP and HR were measured via a pressure transducer connecting the femoral artery to a Powerlab and a computer for recording. Results: A. gangetica significantly (p<0.05), and dose-dependently reduced the systolic, diastolic, and mean arterial BP. The significant (p<0.05) reductions in HR were not dose-dependent. Both ANG I and ANG II increased the BP dose-dependently. Co-infusion of A. gangetica (200 mg/kg) with either ANG I or ANG II significantly (p<0.05) suppressed the hypertensive effect of both ANG I and ANG II respectively, and was associated with reductions in HR. Conclusions: A. gangetica ALE reduced BP and HR in the SHR. The reduction in BP may be a result of actions of the ALE on the ACE, the ANG II receptors and the heart rate.Web of Scienc

PRS45 Cost Effectiveness of Umeclidinium/Vilanterol (UMEC/VI) Combination Therapy Among Symptomatic COPD Patients

Fitxes dels barri

Ergo-effects of designed school furniture and sitting positions on students behaviour and Musculo-Skeletal Disorder in Nigerian tertiary institutions

Improper design of school furniture is one of the contributing factors to back pain among students as indicated in some studies. In the case of designing school furniture where sitting constitutes a considerable time in the school, seat becomes important for comfort. This study is carried out in three selected institutions in Nigeria to determine level of musculoskeletal disorder in students’ and the furniture that they use. 720 questionnaires with 240 students (120 boys and 120 girls) drawn from each participating institutions were administered and 675 responses were received. The results show that the number of students having MSD, accounted for 93.75%. However, the distributions of pain in the body parts in each school were different. The musculoskeletal pain, mostly concentrated on neck, right shoulders right elbow right wrist right hand, upper back and lower back. The result also reveals that most of the students are sitting on chairs with seat that are too high and too deep or too shallow and of tables that are too high. However, it is recommended that further study on effect of designed school furniture and sitting position in larger sample of students’ representative in Nigeria tertiary institutions should be carried out in order to reduce the effect of body pains

Investment, Training, Employment and Poverty Alleviation in Africa: A Critical Analysis

Today, it is overwhelmingly accepted that investing in training opens a large gate for the trained people for better jobs, high incomes, and improved living standards. It is in this regard that this paper endeavors to analyse the fundamental relationship between investment, training, employment and poverty alleviation in Africa. From the analyses, it has been noticed that the relationship between these factors is weak. Also, the latter are less integrated on the African continent, mainly due to inadequate investment in training required to trigger, strengthen, and sustain their integration. In addition, training and education are more theoretical and less adapted to the development needs of many African countries. To this effect, it is recommended that: first, the development programs on the continent should match the socio-economic needs of its people; second, more emphasis should be laid on providing quality, affordable and accessible technical and vocational training to the masses; lastly, the study and mastery of science, technology and innovation at all levels of education and training should be initiated, reinforced and/or enhanced by African governments. Keywords: Investment, Training, Employment, Poverty Alleviation, Africa DOI: 10.7176/DCS/10-3-06 Publication date:March 31st 2020

Time series analyses of mean monthly rainfall for drought management in Sokoto, Nigeria

This paper analyses the time series characteristics of rainfall data for Sokoto metropolis for 40 years with a view to understanding drought management. Data for this study was obtained from the Nigeria Metrological Agency (NIMET), Sokoto Airport; Sokoto. The data was subjected to time series tests (trend, cycle, seasonal and decomposition analyses) using additive and multiplicative modeling approach. The results showed an increasing trend of rainfall amount over the metropolis within the period under review. Analysis of seasonality in monthly precipitation showed a concentration of rainfall in the months of June, July and August while it decreases in September; however, the months of March, April, and October do experience some showers of rainfall sometimes. Obviously, result of the seasonality analysis showed that January, February, March, April, May, November and December are dry months. This implies that growing season in Sokoto do end around September. The implication is that farmers in the study area need to stream line their farming activities with a view to making effective use of the available rainfall. The paper also suggests a need for building micro dams, developed underground water resources and or adopts conjunctive water management as part of drought management efforts.Keywords: Rainfall, seasonality, cycle, decomposition, multiplicative modeling, drough

The impact of polio eradication on routine immunization and primary health care: a mixed-methods study.

BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). METHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. RESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. CONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts

EFFECTS OF THERMOMECHANICAL TREATMENTS ON THE CHEMICAL AND MECHANICAL PROPERTIES OF Al-Cu Alloy

In this work, the quest is to study the influence of thermo mechanical ageing on Aluminium alloy in which Aluminium is the principal element (parent metal) with traces of other elements such as Copper, Magnesium, Iron, and Zinc. Aluminium is subject to internal stresses and strains when it is overheated.The development of Al-9.37Cu alloy was characterized through metallographic examinations. The alloy having been cast using Die –Casting method was subjected to series of treatment such as solution treatment, water quenching and air-quenching as well as over –ageing. The result showed that the strength of Al9.37Cu was greatly enhanced when the alloy was rolled, and aged. This was as a result of the growth of large precipitates along and near the Aluminum grain boundaries which interfere with the movement of dislocations when the metal yields. However, when the alloy was heated beyond 200oC (500oC), the tensile values were observed to decline as a result of equilibrium tetragonal phase which is fully in –coherent and was characterized with low strengthening effect due to fibrous structures.Self-sponsore

Numerical Simulation and Modeling of UNSA91060 for Heat Transfer in Four-Stroke ICE Cylinder Head

This work concerns heat transfer principles in four strokes ICE from modeling and simulation standpoint.Heat transfer is one of a number of indispensable tools in studying of ICEs, due to its influence on decisive parameters of operation like temperature and pressure inside the cylinder. It is safe to say that modeling of the engine heat transfer is among the most complex problems for engineers. Application of numerical methods to predict the heat transfer in a cylinder of reciprocating ICEs is a process of high importance, which was recognized from the earliest stages of their development. This is done to examine performance optimization and design improvement in order to meet nowadays demands exhibited on the engines. This present study focuses on a 3-D transient state temperature distribution analysis on a gasoline engine model via formulated of models, simulating using FEM in-built in the COMSOL Multiphysics software 4.3a to determine the temperature distribution and gradient of the engine cylinder head model. The number of degrees of freedom solved for were 32685 in 383 s (12 minutes, 20 seconds) in the mesh optimization. From the result obtained it was discovered that the heat transfer in the combustion chamber of the ICE varies with time. Thus, it took the engine 10 minutes to complete a cycle vis-a-vis transfer of heat after combustion and that the heat transfer starts after 30 seconds of combustion. In addition, the temperature of the cylinder dropped from 1273.2 K to 301 K over a period of 10 minute.Self-sponsore