271 research outputs found
Long-acting inhaled therapy (beta-agonists, anticholinergics and steroids) for COPD: a network meta-analysis.
BACKGROUND: Pharmacological therapy for chronic obstructive pulmonary disease (COPD) is aimed at relieving symptoms, improving quality of life and preventing or treating exacerbations.Treatment tends to begin with one inhaler, and additional therapies are introduced as necessary. For persistent or worsening symptoms, long-acting inhaled therapies taken once or twice daily are preferred over short-acting inhalers. Several Cochrane reviews have looked at the risks and benefits of specific long-acting inhaled therapies compared with placebo or other treatments. However for patients and clinicians, it is important to understand the merits of these treatments relative to each other, and whether a particular class of inhaled therapies is more beneficial than the others. OBJECTIVES: To assess the efficacy of treatment options for patients whose chronic obstructive pulmonary disease cannot be controlled by short-acting therapies alone. The review will not look at combination therapies usually considered later in the course of the disease.As part of this network meta-analysis, we will address the following issues.1. How does long-term efficacy compare between different pharmacological treatments for COPD?2. Are there limitations in the current evidence base that may compromise the conclusions drawn by this network meta-analysis? If so, what are the implications for future research? SEARCH METHODS: We identified randomised controlled trials (RCTs) in existing Cochrane reviews by searching the Cochrane Database of Systematic Reviews (CDSR). In addition, we ran a comprehensive citation search on the Cochrane Airways Group Register of trials (CAGR) and checked manufacturer websites and reference lists of other reviews. The most recent searches were conducted in September 2013. SELECTION CRITERIA: We included parallel-group RCTs of at least 6 months' duration recruiting people with COPD. Studies were included if they compared any of the following treatments versus any other: long-acting beta2-agonists (LABAs; formoterol, indacaterol, salmeterol); long-acting muscarinic antagonists (LAMAs; aclidinium, glycopyrronium, tiotropium); inhaled corticosteroids (ICSs; budesonide, fluticasone, mometasone); combination long-acting beta2-agonist (LABA) and inhaled corticosteroid (LABA/ICS) (formoterol/budesonide, formoterol/mometasone, salmeterol/fluticasone); and placebo. DATA COLLECTION AND ANALYSIS: We conducted a network meta-analysis using Markov chain Monte Carlo methods for two efficacy outcomes: St George's Respiratory Questionnaire (SGRQ) total score and trough forced expiratory volume in one second (FEV1). We modelled the relative effectiveness of any two treatments as a function of each treatment relative to the reference treatment (placebo). We assumed that treatment effects were similar within treatment classes (LAMA, LABA, ICS, LABA/ICS). We present estimates of class effects, variability between treatments within each class and individual treatment effects compared with every other.To justify the analyses, we assessed the trials for clinical and methodological transitivity across comparisons. We tested the robustness of our analyses by performing sensitivity analyses for lack of blinding and by considering six- and 12-month data separately. MAIN RESULTS: We identified 71 RCTs randomly assigning 73,062 people with COPD to 184 treatment arms of interest. Trials were similar with regards to methodology, inclusion and exclusion criteria and key baseline characteristics. Participants were more often male, aged in their mid sixties, with FEV1 predicted normal between 40% and 50% and with substantial smoking histories (40+ pack-years). The risk of bias was generally low, although missing information made it hard to judge risk of selection bias and selective outcome reporting. Fixed effects were used for SGRQ analyses, and random effects for Trough FEV1 analyses, based on model fit statistics and deviance information criteria (DIC). SGRQ SGRQ data were available in 42 studies (n = 54,613). At six months, 39 pairwise comparisons were made between 18 treatments in 25 studies (n = 27,024). Combination LABA/ICS was the highest ranked intervention, with a mean improvement over placebo of -3.89 units at six months (95% credible interval (CrI) -4.70 to -2.97) and -3.60 at 12 months (95% CrI -4.63 to -2.34). LAMAs and LABAs were ranked second and third at six months, with mean differences of -2.63 (95% CrI -3.53 to -1.97) and -2.29 (95% CrI -3.18 to -1.53), respectively. Inhaled corticosteroids were ranked fourth (MD -2.00, 95% CrI -3.06 to -0.87). Class differences between LABA, LAMA and ICS were less prominent at 12 months. Indacaterol and aclidinium were ranked somewhat higher than other members of their classes, and formoterol 12 mcg, budesonide 400 mcg and formoterol/mometasone combination were ranked lower within their classes. There was considerable overlap in credible intervals and rankings for both classes and individual treatments. Trough FEV1 Trough FEV1 data were available in 46 studies (n = 47,409). At six months, 41 pairwise comparisons were made between 20 treatments in 31 studies (n = 29,271). As for SGRQ, combination LABA/ICS was the highest ranked class, with a mean improvement over placebo of 133.3 mL at six months (95% CrI 100.6 to 164.0) and slightly less at 12 months (mean difference (MD) 100, 95% CrI 55.5 to 140.1). LAMAs (MD 103.5, 95% CrI 81.8 to 124.9) and LABAs (MD 99.4, 95% CrI 72.0 to 127.8) showed roughly equivalent results at six months, and ICSs were the fourth ranked class (MD 65.4, 95% CrI 33.1 to 96.9). As with SGRQ, initial differences between classes were not so prominent at 12 months. Indacaterol and salmeterol/fluticasone were ranked slightly better than others in their class, and formoterol 12, aclidinium, budesonide and formoterol/budesonide combination were ranked lower within their classes. All credible intervals for individual rankings were wide. AUTHORS' CONCLUSIONS: This network meta-analysis compares four different classes of long-acting inhalers for people with COPD who need more than short-acting bronchodilators. Quality of life and lung function were improved most on combination inhalers (LABA and ICS) and least on ICS alone at 6 and at 12 months. Overall LAMA and LABA inhalers had similar effects, particularly at 12 months. The network has demonstrated the benefit of ICS when added to LABA for these outcomes in participants who largely had an FEV1 that was less than 50% predicted, but the additional expense of combination inhalers and any potential for increased adverse events (which has been established by other reviews) require consideration. Our findings are in keeping with current National Institute for Health and Care Excellence (NICE) guidelines
Graphene-Based Nanocomposites for Energy Storage
Since the first report of using micromechanical cleavage method to produce graphene sheets in 2004, graphene/graphene-based nanocomposites have attracted wide attention both for fundamental aspects as well as applications in advanced energy storage and conversion systems. In comparison to other materials, graphene-based nanostructured materials have unique 2D structure, high electronic mobility, exceptional electronic and thermal conductivities, excellent optical transmittance, good mechanical strength, and ultrahigh surface area. Therefore, they are considered as attractive materials for hydrogen (H2) storage and high-performance electrochemical energy storage devices, such as supercapacitors, rechargeable lithium (Li)-ion batteries, Li–sulfur batteries, Li–air batteries, sodium (Na)-ion batteries, Na–air batteries, zinc (Zn)–air batteries, and vanadium redox flow batteries (VRFB), etc., as they can improve the efficiency, capacity, gravimetric energy/power densities, and cycle life of these energy storage devices. In this article, recent progress reported on the synthesis and fabrication of graphene nanocomposite materials for applications in these aforementioned various energy storage systems is reviewed. Importantly, the prospects and future challenges in both scalable manufacturing and more energy storage-related applications are discussed
First Observation of a Three-Resonance Structure in {non-open} Charm Hadrons
We report the measurement of the cross sections for
{nOCH} (nOCH stands for non-open charm hadrons) with
improved precision at center-of-mass energies from 3.645 to 3.871 GeV. We
observe for the first time a three-resonance structure in the energy-dependent
lineshape of the cross sections, which are , and with significances of ,
, and , respectively. The is observed
for the first time. We found two solutions in analysis of the cross sections.
For solution I [solution II], we measure the mass, the total width and the
product of electronic width and nOCH decay branching fraction to be [] MeV/, [] MeV, and [] eV for the , respectively. In addition, we
measure the branching fractions {nOCH} for the first time, and {nOCH}. Moreover, we determine the open-charm (OC) branching fraction
{OC}, which supports the interpretation of as an OC pair molecular state, but contained a simple four-quark state
component. The first uncertainties are from fits to the cross sections, and the
second are systematic
Study of the doubly Cabibbo-suppressed decays and
Based on 7.33 fb of collision data collected at
center-of-mass energies between 4.128 and 4.226 GeV with the BESIII detector,
the experimental studies of the doubly Cabibbo-suppressed decays and are reported. We determine the
absolute branching fraction of to be
() . No
significant signal of is observed and the upper
limit on its decay branching fraction at 90\% confidence level is set to be
.Comment: 10 pages, 4 figures, 4 table
Search for an invisible muon philic scalar or vector via decay at BESIII
A light scalar or vector particles have been introduced as a
possible explanation for the anomaly and dark matter phenomena.
Using \jpsi events collected by the BESIII
detector, we search for a light muon philic scalar or vector in
the processes with invisible decays. No
obvious signal is found, and the upper limits on the coupling
between the muon and the particles are set to be between
and for the mass in the range
of ~MeV at 90 confidence level.Comment: 9 pages 7 figure
Study of the decay
Based on events collected with the
BESIII detector operating at the BEPCII collider, a partial wave analysis of
the decay is performed. We observe for the first
time two new structures on the invariant mass distribution, with
statistical significances of and ; the first with
= , mass M = (1911 6 (stat.) 14
(sys.))~MeV/, and width (149 12 (stat.) 23
(sys.))~MeV, the second with = , mass M = (1996 11
(stat.) 30 (sys.))~MeV/, and width = (148 16
(stat.) 66 (sys.))~MeV. These measurements provide important input for
the strangeonium spectrum. In addition, the mixing signal
in and the corresponding
electromagnetic decay are measured with improved
precision, providing crucial information to understand the nature of
and
Improved measurement of the decays and search for the rare decay
Using a sample of 10 billion events collected with the BESIII
detector, the decays , and are studied via the
process . The branching fractions of and
are measured to be and , respectively, which are consistent with previous measurements but
with improved precision. No significant signal is
observed, and the upper limit on the branching fraction of this decay is
determined to be less than at the confidence
level. In addition, an amplitude analysis of is performed to extract the doubly virtual
isovector form factor for the first time. The measured value of
, is in agreement with
the prediction of the VMD model
Search for hidden-charm tetraquark with strangeness in
We report a search for a heavier partner of the recently observed
state, denoted as , in the process , based on collision data
collected at the center-of-mass energies of , 4.682 and 4.699
GeV with the BESIII detector. The is of interest as it is
expected to be a candidate for a hidden-charm and open-strange tetraquark. A
partial-reconstruction technique is used to isolate recoil-mass spectra,
which are probed for a potential contribution from (). We find an excess of () candidates with a significance of , after
considering systematic uncertainties, at a mass of . As the data
set is limited in size, the upper limits are evaluated at the 90% confidence
level on the product of the Born cross section and the branching fraction of
, at the three energy points, under different assumptions
of the mass from 4.120 to 4.140 MeV and of the width from
10 to 50 MeV. Under various mass and width assumptions, the upper limits of
are found to lie in the range of ,
and pb at , 4.682 and 4.699 GeV,
respectively. The larger data samples that will be collected in the coming
years will allow a clearer picture to emerge concerning the existence and
nature of the state.Comment: 17 pages, 7 figure
Production of doubly-charged baryon in annihilation at energies from 2.3094 to 2.6464 GeV
The processes and
are studied for the first
time with of annihilation data collected with
the BESIII detector at center-of-mass energies from GeV to
GeV. No significant signal for the
process is observed and the upper limit of the Born cross section is estimated
at each energy point. For the process , a significant signal is observed at center-of-mass energies
near 2.6454 GeV and the corresponding Born cross section is reported.Comment: 10 pages, 4 figure
Measurement of the -even fraction of
A determination of the -even fraction in the decay is presented. Using fb of
data collected by the BESIII detector, one
charm meson is reconstructed in the signal mode and the other in a
eigenstate or the decay . Analysis of the relative
rates of these double-tagged events yields the result , where the first uncertainty is statistical and the second is
systematic. This is the first model-independent measurement of in decays.Comment: 13 pages, 5 figure
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