Crossover Patient Outcomes for Targeted Lung Denervation in Moderate to Severe Chronic Obstructive Pulmonary Disease:AIRFLOW-2

BACKGROUND: Targeted Lung Denervation (TLD) is a potential new therapy for COPD. Radiofrequency energy is bronchoscopically delivered to the airways to disrupt pulmonary parasympathetic nerves, to reduce bronchoconstriction, mucus hypersecretion, and bronchial hyperreactivity. OBJECTIVES: This work assesses the effect of TLD on COPD exacerbations (AECOPD) in crossover subjects in the AIRFLOW-2 trial. METHOD: The AIRFLOW-2 trial is a multicentre, randomized, double-blind, sham-controlled crossover trial of TLD in COPD. Patients with symptomatic COPD on optimal medical therapy with an FEV1 of 30-60% predicted received either TLD or sham bronchoscopy in a 1:1 randomization. Those in the sham arm had the opportunity to cross into the treatment arm after 12 months. The primary end point was rate of respiratory adverse events. Secondary end points included adverse events, changes in lung function and health-related quality of life and symptom scores. RESULTS: Twenty patients were treated with TLD in the crossover phase and were subsequently followed up for 12 months (50% female, mean age 64.1 ± 6.9 years). After TLD, there was a trend towards a reduction in time to first AECOPD (hazard ratio 0.65, p = 0.28, not statistically significant) in comparison to sham follow-up period. There was also a reduction in time to first severe AECOPD in the crossover period (hazard ratio 0.38, p = 0.227, not statistically significant). Symptom scores and lung function showed stability. CONCLUSIONS: AIRFLOW-2 crossover data support that of the randomization phase, showing trends towards reduction in COPD exacerbations with TLD

Political Communication

The term "strategic communication" traditionally has been understood as referring to external corporate communication, such as public relations, marketing communication, and advertising, with insufficient consideration beyond its role as a tool of persuasive influence. In recent years, however, the field of strategic communication has evolved to be more holistic in its approach and its role within sociocultural contexts. Articles, textbooks, and handbooks have attempted to define the scope, purpose, and nature of the concept, but as the first major comprehensive work of its kind, The International Encyclopedia of Strategic Communication captures the full scope of contemporary theory and practice in strategic communication.info:eu-repo/semantics/publishedVersio

Safety and Adverse Events after Targeted Lung Denervation for Symptomatic Moderate to Severe COPD (AIRFLOW):A Multicenter Randomized Controlled Trial

International audienc

Two-Year Outcomes for the Double-Blind, Randomized, Sham-Controlled Study of Targeted Lung Denervation in Patients with Moderate to Severe COPD:AIRFLOW-2

Purpose: COPD exacerbations are associated with worsening clinical outcomes and increased healthcare costs, despite use of optimal medical therapy. A novel bronchoscopic therapy, targeted lung denervation (TLD), which disrupts parasympathetic pulmonary innervation of the lung, has been developed to reduce clinical consequences of cholinergic hyperactivity and its impact on COPD exacerbations. The AIRFLOW-2 study assessed the durability of safety and efficacy of TLD additive to optimal drug therapy compared to sham bronchoscopy and optimal drug therapy alone in subjects with moderate-to-severe, symptomatic COPD two years post randomization. Patients and Methods: TLD was performed in COPD patients (FEV1 30-60% predicted, CAT≥10 or mMRC≥2) in a 1:1 randomized, sham-controlled, double-blinded multicenter study (AIRFLOW-2) using a novel lung denervation system (Nuvaira, Inc., USA). Subjects remained blinded until their 12.5-month follow-up visit when control subjects were offered the opportunity to undergo TLD. A time-to-first-event analysis on moderate and severe and severe exacerbations of COPD was performed. Results: Eighty-two subjects (FEV1 41.6±7.4% predicted, 50.0% male, age 63.7±6.8 yrs, 24% with prior year respiratory hospitalization) were randomized. Time-to-first severe COPD exacerbation was significantly lengthened in the TLD arm (p=0.04, HR=0.38) at 2 years post-TLD therapy and trended towards similar attenuation for moderate and severe COPD exacerbations (p=0.18, HR=0.71). No significant changes in lung function or SGRQ-C were found 2 years post randomization between groups. Conclusion: In a randomized trial, TLD demonstrated a durable effect of significantly lower risk of severe AECOPD over 2 years. Further, lung function and quality of life remained stable following TLD. Clinical Trial Registration: NCT02058459

A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (TRANSFORM)

Rationale: Single-center randomized controlled trials of the Zephyr endobronchial valve (EBV) treatment have demonstrated benefit in severe heterogeneous emphysema. This is the first multicenter study evaluating this treatment approach. Objectives: To evaluate the efficacy and safety of Zephyr EBVs in patients with heterogeneous emphysema and absence of collateral ventilation. Methods: This was a prospective, multicenter 2:1 randomized controlled trial of EBVs plus standard of care or standard of care alone (SoC). Primary outcome at 3 months post-procedure was the percentage of subjects with FEV1 improvement from baseline of 12% or greater. Changes in FEV1, residual volume, 6-minute-walk distance, St. George's Respiratory Questionnaire score, and modified Medical Research Council score were assessed at 3 and 6 months, and target lobe volume reduction on chest computed tomography at 3 months. Measurements and Main Results: Ninety seven subjects were randomized toEBV(n = 65) or SoC(n = 32). At 3 months, 55.4% of EBV and 6.5% of SoC subjects had an FEV1 improvement of 12% or more (P <0.001). Improvements were maintained at 6 months: EBV 56.3% versus SoC 3.2% (P <0.001), with a mean +/- SD change in FEV1 at 6 months of 20.7 +/- 29.6% and -8.6 +/- 13.0%, respectively. A total of 89.8% of EBV subjects had target lobe volume reduction greater than or equal to 350 ml, mean 1.09 +/- 0.62 L (P <0.001). Between-group differences for changes at 6 months were statistically and clinically significant: Delta EBV-SoC for residual volume, -700 ml; 6-minute-walk distance, +78.7 m; St. George's Respiratory Questionnaire score, -6.5 points; modified Medical Research Council dyspnea score, -0.6 points; and BODE(body mass index, airflow obstruction, dyspnea, and exercise capacity) index, 21.8 points (all P <0.05). Pneumothorax was the most common adverse event, occurring in 19 of 65 (29.2%) of EBV subjects. Conclusions: EBV treatment in hyperinflated patients with heterogeneous emphysema without collateral ventilation resulted in clinically meaningful benefits in lung function, dyspnea, exercise tolerance, and quality of life, with an acceptable safety profile

Effects of Wartime Crisis Perceptions on the Effectiveness of Political Advertising: The Moderating Role of Political Involvement

This research examines how political advertising is operated in a volatile context, such as a state of war or instability. The study employed a self-completing cross-sectional survey to gather the data in the period of the 2016 Syrian elections for members of parliament. The research tested the hypothetical model and its equivalency related to political involvement through the use of structural equation modelling. The outcomes of the tests revealed the structure of belief as a four-dimensional variate. The four dimensions encapsulate information, veracity, sarcasm, and cynicism. In addition, perceptions during conflicts had a negative effect on attitude through sarcasm displayed by voters with low political involvement. The results also found that negative attitude had a link with lower degrees of veracity with regards to voters who are less involved but to greater degrees of cynicism highly politically active individuals. We found that less favourable attitudes to political advertising lowered the likelihoods for voters to watch political ads or announcements, support a runner, and be willing to go to the poll. We found no relation between the fact of paying attention to political advertising and intention of voters to use their ballot

Local political marketing in the context of the conservative party

Local political marketing can be defined as marketing related strategy, activities, and tactics implemented by a political party in a local geographic constituency, in order to attempt to maximise aggregate potential voter satisfaction, and therefore maximise total number of votes and electoral support in the constituency. Through 12 in-depth interviews with Local Constituency Party representatives from the Conservative Party, the study found that local political marketing was acknowledged by a majority of respondents although this was not unequivocal, and was frequently conflated with campaigning. Local political marketing was associated with: visual identity, language/messages, values, image, communication devices, awareness raising, data management and targeting, and simplification. The support from higher levels of the party in local political marketing was varied across constituencies. There was evidence of growing coordination /influence by higher levels of the party in local political marketing. However, this tended to be in seats judged as ‘winnable’