Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

EVALUATION OF THE EFFECT OF AFRICAN SNAIL SHELL (ACHATINA FULICA) AS AN ADDITION IN CEMENT FOR COMPRESSIVE STRENGTH CORRELATED WITH VPU VALUES

Mediante la realización de este análisis se pretende investigar qué resultados se obtienen al adicionar porcentajes de conchas de caracol africano (Achatina fúlica) triturado, como un elemento novedoso de adición al cemento para mezclas de morteros hidráulicos. El objetivo principal es analizar el potencial de las conchas de caracol africano como sustituto parcial de los agregados tradicionales y/o como aditivo en el cemento ante la fabricación de mortero y concretos, los aditivos se utilizan para mejorar la resistencia, durabilidad y otras características del cemento, como la trabajabilidad y la fluidez. Se examinan las propiedades del cemento, agregando porcentajes de las conchas de caracol africano para conocer en cuanta adición podría mejorar sus características y el rendimiento del material. Al adicionar diferentes porcentajes de las conchas de caracol al cemento mediante experimentos en el laboratorio, se aprecian diferentes factores como la absorción de agua, porosidad, adherencia, y resistencia a compresión. Con estos resultados se puede determinar las ventajas y desventajas de agregar conchas de caracol africano, y los resultados experimentales muestran que agregar conchas de caracol africano al cemento puede mejorar significativamente algunas propiedades del material, debido al aumento de la resistencia a la compresión en 2% y 7%. Los resultados indican que la adición de las conchas de caracol africano puede contribuir a mejorar la durabilidad y resistencia del cemento como aditivo de morteros y concretos en ciertas condiciones de exposición. También se tiene en cuenta que esta especie invasora ha causado diversas problemáticas a nivel mundial ya que su capacidad reproductiva es masiva, es tolerante en diferentes condiciones ambientales, afecta la agricultura en general, portar enfermedades. Además, es importante tener en cuenta que esta especie invasora proveniente de África ha causado diversas problemáticas en diferentes partes del mundo debido a su alca capacidad reproductiva, su tolerancia a diferentes condiciones ambientales como puntos de basura, su capacidad de portar enfermedades y afectaciones en la agricultura, etc. Por lo tanto, por medio de esta técnica también se pretenden controlar los altos indicen de estos moluscos en el territorio nacional y por ende, este estudio se centra en la idoneidad del caracol gigante africano (A. fúlica) como aditivo para morteros y concretos y así remplazarlo en un porcentaje del cemento portland ordinario, el (A. fúlica) por ser una especie invasora en el territorio está generando desestabilización ambiental y a partir de esa composición fisicoquímica surge la idea del aprovechamiento de la concha que contiene material calcario.Universidad Libre Seccional Pereira -- Facultad de Ingeniería -- Ingeniería CivilThe purpose of this analysis is to investigate the results obtained by adding percentages of crushed African snail shells (Achatina fulica) as a novel addition to cement for hydraulic mortar mixtures. The main objective is to analyze the potential of African snail shells as a partial substitute for traditional aggregates and/or as an additive in cement for the manufacture of mortar and concrete. Additives are used to improve the strength, durability and other characteristics of cement, such as workability and fluidity. The properties of cement are examined, adding percentages of African snail shells to know how much addition could improve its characteristics and the performance of the material. By adding different percentages of snail shells to the cement through laboratory experiments, different factors such as water absorption, porosity, adherence, and compressive strength are appreciated. With these results, the advantages and disadvantages of adding African snail shells can be determined, and the experimental results show that adding African snail shells to cement can significantly improve some properties of the material, due to the increase of compressive strength by 2% and 7%. The results indicate that the addition of African snail shells can contribute to improve the durability and strength of cement as an additive in mortars and concretes under certain exposure conditions. It is also taken into account that this invasive species has caused several problems worldwide since its reproductive capacity is massive, it is tolerant in different environmental conditions, affects agriculture in general, and carries diseases. In addition, it is important to take into account that this invasive species from Africa has caused several problems in different parts of the world due to its high reproductive capacity, its tolerance to different environmental conditions such as garbage points, its capacity to carry diseases and affect agriculture, etc. Therefore, this technique is also intended to control the high levels of these mollusks in the national territory and therefore, this study focuses on the suitability of the giant African snail (A. fulica) as an additive for mortars and concrete and thus replace it in a percentage of ordinary portland cement, the (A. fulica) being an invasive species in the territory is generating environmental destabilization and from this physicochemical composition arises the idea of the use of the shell containing calcareous material