Fluticasone furoate/vilanterol (100/25; 200/25 μg) improves lung function in COPD: a randomised trial.

SummaryBackgroundOnce-daily combination treatment is an attractive maintenance therapy for COPD. However, the dose of inhaled corticosteroid to use in a once-daily combination is unknown. We compared two strengths of fluticasone furoate (FF) plus vilanterol (VI), the same strengths of the individual components, and placebo.MethodsMulticentre, randomised, 24-week, double-blind, placebo-controlled, parallel-group study in stable, moderate-to-severe COPD subjects (N = 1224). Subjects were randomised to FF/VI (200/25 μg; 100/25 μg), FF (200 μg; 100 μg), VI 25 μg, or placebo, once daily in the morning. Co-primary efficacy endpoints; 0–4 h weighted mean (wm) FEV1 on day 168, and change from baseline in trough (23–24 h post-dose) FEV1 on day 169. The primary safety objective was adverse events (AEs).ResultsThere was a statistically significant (p < 0.001) increase in wm FEV1 (209 ml) and trough FEV1 (131 ml) for FF/VI 200/25 μg vs. placebo; similar changes were seen for FF/VI 100/25 μg vs. placebo. Whereas the difference between FF/VI 200/25 μg and VI 25 μg in change from baseline trough FEV1 (32 ml) was not statistically significant (p = 0.224), the difference between FF/VI 200/25 μg and FF 200 μg for wm FEV1 (168 ml) was significantly different (p < 0.001). VI 25 μg significantly improved wm and trough FEV1 vs. placebo (209 ml and 131 ml, respectively). No increase was seen in on-treatment AEs or serious AEs (SAEs), with active therapy vs. placebo.ConclusionsFF/VI provides rapid and significant sustained improvement in FEV1 in subjects with moderate-to-severe COPD, which was not influenced by the dose of FF. These data suggest that FF/VI may offer clinical efficacy in COPD and warrants additional study.GSK study number: HZC112207.ClinicalTrials.gov: NCT01054885

Notel Health Services: A Role-Playing Simulation

This paper describes a simulation entitled “Notel Health Services” which integrates cost accounting, tactical operations, strategic planning, and interpersonal skills. This simulation is being used to give physician’s assistant majors an opportunity to experience the “business” of delivering health-care services. The Notel Health Services simulation, described in this paper, was designed to help students understand management issues faced by physicians in private practice. Although this simulation uses a medical setting, it would be suitable for any upper-level management class that includes a discussion of professional-services industries

Closteroviridae

International audienc

The family Closteroviridae revised

Recently obtained molecular and biological information has prompted the revision of the taxonomic structure of the family Closteroviridae. In particular, mealybug-transmitted species have been separated from the genus Closterovirus and accommodated in a new genus named Ampelovirus (fromampelos, Greek for grapevine). Thus, the family now comprises three genera. Their major properties are (i) Closterovirus: type species Beet yellows virus, genome monopartite, 15.5-19.3 kb in size, a 22-25 kDa major coat protein (CP), the gene encoding the divergent CP analogue (CPd) upstream of the CP cistron, transmission by aphids, a membership of 8 definitive and 4 tentative species; (ii) Ampelo-virus: type speciesGrapevine leafroll virus 3, genome monopartite 16.9-19.5 kb in size, a 35-37 kDa major CP, a CPd cistron generally located downstream of the CP gene, transmission by pseudococcid and coccid mealybugs, a membership of 6 definitive and 5 tentative species; (iii) Crinivirus: type species Lettuce infectious yellows virus, genome essentially bipartite 15.3-19 kb in size, a 28-33 kDa CP, a CPd cistron downstream of the CP gene, transmission by whiteflies (Bemisia, Trialeurodes), a membership of 7 definitive and 3 tentative species. There are five unassigned species in the family.Peer reviewe

Flexiviridae

International audienc