Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective.

BACKGROUND: Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective. METHODS: A linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George's Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model. RESULTS: Over a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (- 0.053; 95% CI: - 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: - £645, - £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (- 0.033; 95% CI: - 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses. CONCLUSIONS: For treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.Trial registration 201316, NCT02207829; 201315, NCT02236611

Cost-effectiveness analysis of a single-inhaler triple therapy for patients with advanced chronic obstructive pulmonary disease (COPD) using the FULFIL trial: A UK perspective

Objectives: The clinical benefit of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus twice-daily budesonide/formoterol (BUD/FOR) for patients with symptomatic chronic obstructive pulmonary disease (COPD) was demonstrated in a clinical trial setting (FULFIL [NCT02345161]). The lifetime cost-effectiveness analysis of FF/UMEC/VI versus BUD/FOR, based on FULFIL data, is reported here. Methods: A previously developed and validated GALAXY-COPD linked-risk equation model was used to assess the cost-effectiveness of FF/UMEC/VI from the UK National Health Service (NHS) perspective. Baseline characteristics and efficacy results from FULFIL and UK NHS reference cost data (2017) were included as inputs. Exacerbation rates (undiscounted), costs, life years (LYs; undiscounted) and quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were calculated over a lifetime horizon. Costs and QALYs were discounted at 3.5% per year, beyond one year, in accordance with National Institute for Health and Care Excellence (NICE) guidelines. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. Results: Predicted cumulative exacerbations per patient over a lifetime were 8.393 with FF/UMEC/VI and 10.456 with BUD/FOR. Patients receiving FF/UMEC/VI gained an additional 0.764 LYs and 0.492 QALYs, at an additional mean cost of £1,652, resulting in an ICER of £3,357 per QALY gained (95% confidence interval: £1,816, £5,194) compared with BUD/FOR. The ICER remained below £6,000 in all but one of the scenario and sensitivity analyses. Conclusions: Compared with BUD/FOR, treatment with FF/UMEC/VI was predicted to improve health outcomes at an additional cost that suggests it would be cost-effective for patients with COPD in the UK

EFFECT OF CORE STABILITY TRAINING ON DYNAMIC BALANCE IN HEALTHY YOUNG ADULTS - A RANDOMIZED CONTROLLED TRIAL

Background: Balance is a key component of normal daily activities. Therefore, it is necessary to find various programs to improve balance. The core functions to maintain postural alignment and balance during functional activities. The purpose was to study the effects of the core stability training on dynamic balance in healthy, young adults. Methods: It was an interventional study, in which 60 healthy young adults were selected. They were randomly divided into two groups of 30 each, one being experimental group and other control group. Measurement of their height, weight, BMI and leg length was taken. Subjects in both the groups were assessed for core stability with pressure biofeedback unit (PBU) and dynamic balance using Star Excursion Balance Test (SEBT) pre and post intervention. Subjects in the experimental group underwent progressive core stability training program for six weeks (3days/week) and control group was refrained from any type of structured training program. Results: There was statistically significant improvement in core stability and dynamic balance of the experimental group after six weeks of intervention. Conclusion: It is concluded that core stability training of six weeks duration is effective in improving dynamic balance in healthy, young adults

Dysarthric Speech Transformer: A Sequence-to-Sequence Dysarthric Speech Recognition System

Automatic Speech Recognition (ASR) technologies can be life-changing for individuals who suffer from dysarthria, a speech impairment that affects articulatory muscles and results in incomprehensive speech. Nevertheless, the performance of the current dysarthric ASR systems is unsatisfactory, especially for speakers with severe dysarthria who most benefit from this technology. While transformer and neural attention-base sequences-to-sequence ASR systems achieved state-of-the-art results in converting healthy speech to text, their applications as a Dysarthric ASR remain unexplored due to the complexities of dysarthric speech and the lack of extensive training data. In this study, we addressed this gap and proposed our Dysarthric Speech Transformer that uses a customized deep transformer architecture. To deal with the data scarcity problem, we designed a two-phase transfer learning pipeline to leverage healthy speech, investigated neural freezing configurations, and utilized audio data augmentation. Overall, we trained 45 speaker-adaptive dysarthric ASR in our investigations. Results indicate the effectiveness of the transfer learning pipeline and data augmentation, and emphasize the significance of deeper transformer architectures. The proposed ASR outperformed the state-of-the-art and delivered better accuracies for 73% of the dysarthric subjects whose speech samples were employed in this study, in which up to 23% of improvements were achieved

Comparative photographic evaluation of various geometric and mathematical proportions of maxillary anterior teeth: A clinical study

Aim: This study aimed to investigate the existence of the golden proportion, recurring esthetic dental (RED) proportion and golden percentage between the frontal view widths of the maxillary anterior natural dentition among students of Indian origin by the aid of digital photography. Materials and Methods: This study was conducted with 80 dental students (41 female and 39 male), with ages ranging from 20 to 23 years. Students whose natural smile did not develop any visual tension with regard to the study′s and their own criteria were selected as having an esthetic smile. Photographs were taken, and the mesiodistal widths of six maxillary anterior teeth were measured digitally using software. Once the measurements were recorded three different theories of proportion were applied and statistical analysis was done. Results: The golden proportion, i.e., 62% RED proportion and golden percentage were not observed in the subjects. According to the subjects evaluated, the average width of the maxillary lateral incisor was 72% of the frontal view width of the central incisor. The average width of the canine was 84% of the frontal view width of the lateral incisor. Conclusion: The golden proportion and RED proportion were not observed in the natural smiles of subjects who were deemed to have an esthetic smile. The values proposed for the golden percentage theory were not observed in subjects with an esthetic smile. Average frontal view percentage widths of the maxillary anterior dentition exist and can be useful in predicting naturally occurring widths in smiles deemed to be esthetic in a specific population

The efficacy and tolerability of perampanel and other recently approved anti-epileptic drugs for the treatment of refractory partial onset seizure: a systematic review and Bayesian network meta-analysis.

OBJECTIVES: This paper compares the efficacy and tolerability of perampanel (PER) relative to other recently approved anti-epileptic drug (AEDs) - lacosamide (LCS), retigabine (RTG), and eslicarbazepine (ESL) for the adjunctive treatment of partial onset seizures with or without secondary generalization and specifically in the secondary generalization subgroup. MATERIALS AND METHODS: A systematic literature review of all RCTs of PER and selected AEDs in EMBASE, Medline, and the Cochrane Central from 1998 to January 2011 with an update in PubMed in March 2013 was performed. A network meta-analysis was conducted for 50% responder rate for overall seizures; withdrawal due to adverse events; seizure freedom; and 50% responder rate for secondary generalized seizures. RESULTS: Twelve RCTs (three PER, three LCS, three RTG and three ESL) were included. PER performed significantly better than placebo for 'responder rate' (OR 2.151, 95% CrI 1.348-3.472) and 'seizure freedom' (OR 2.507, 95% CrI 1.067-7.429). When compared to other agents, PER was found to be equally effective. For 'withdrawal due to adverse events', PER had the lowest odds ratio vs. placebo compared with other AEDs. In the analysis for the subgroup of patients with secondary generalization, only four RCTs (three PER and one LCS) met the inclusion criteria for one outcome (responder rate) for LCS. In this subgroup, PER was statistically significantly better than placebo (OR 2.448, 95% CrI 1.088-5.828). CONCLUSION: PER was statistically significantly superior to placebo in responder rate, seizure freedom, and responder rate in the secondary generalization population. Though PER had statistically significant greater withdrawal compared to placebo, it had the lowest ORs vs. placebo, suggesting a superior safety profile among the comparators included in this analysis. In patients with partial onset seizure with secondary generalization, PER had a statistically significant effect on responder rate compared to placebo

A Building Permit System for Smart Cities: A Cloud-based Framework

In this paper we propose a novel, cloud-based framework to support citizens and city officials in the building permit process. The proposed framework is efficient, user-friendly, and transparent with a quick turn-around time for homeowners. Compared to existing permit systems, the proposed smart city permit framework provides a pre-permitting decision workflow, and incorporates a data analytics and mining module that enables the continuous improvement of both the end user experience and the permitting and urban planning processes. This is enabled through a data mining-powered permit recommendation engine as well as a data analytics process that allow a gleaning of key insights for real estate development and city planning purposes, by analyzing how users interact with the system depending on their location, time, and type of request. The novelty of the proposed framework lies in the integration of a pre-permit processing front-end with permit processing and data analytics & mining modules, along with utilization of techniques for extracting knowledge from the data generated through the use of the system. The proposed framework is completely cloud-based, such that any city can deploy it with lower initial as well as maintenance costs. We also present a proof-of-concept use case, using real permit data from New York City

Management of tubular oesophageal duplication - A novel approach

Background and aim: Oesophageal duplication is a rare congenital malformation which occurs due to embryogenesis errors. It accounts for 15% of all digestive tract duplications, most common being ileal duplications. Here we report a case of tubular Oesophageal duplication and a novel surgical approach for its management.6 year male child, 11 kgs, presented with progressive dysphagia to solids > liquids since birth. He had stunted growth, height and weight were less than 50th percentile. On investigations, Barium swallow and CECT neck with thorax was done to diagnose the pathology and define anatomy. It reported that the child had a congenital partial duplication of the proximal and mid esophagus with midline fold/membrane approximately 6 cm from C5 to D7 level with a dilated lower esophagus and a large hiatal hernia with focal stricture in the right lumen of proximal end. Surgical management was done by excision of oesophageal septum by endoscopic staplers via a gastrotomy under endoscopic guidance per orally and via gastrotomy. Results: Gradually diet started and well tolerated, to be kept on endoscopic surveillance. Conclusions: This is a novel approach to manage oesophageal tubular duplication with minimal risk of mediastinal complications that would occur otherwise by a thoracic approach