BackgroundIn people with mild asthma poor adherence to regular therapy is common and increases the risk of exacerbations, morbidity and mortality. The use of fixed-dose combination inhalers ...containing an inhaled corticosteroid (ICS) and a fast-acting β2-agonist (FABA) is established in moderate asthma, but they may also have potential utility in mild asthma.ObjectivesTo evaluate the efficacy and safety of single combined FABA/ICS inhaler only used as needed in people with mild asthma.Design and settingCochrane meta-analysis of available trial data.ParticipantsChildren aged 12+ and adults with mild asthma.Search methodsWe searched the Cochrane Airways Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE and Embase, ClinicalTrials.gov and the WHO trials portal on 19 March 2021.InterventionsA single fixed-dose FABA/ICS inhaler used as required compared with no treatment, placebo, short-acting beta agonist (SABA) as required, regular ICS with SABA as required, regular fixed-dose combination ICS/long-acting beta agonist (LABA), or regular fixed-dose combination ICS/FABA with as required ICS/FABA.We included randomised controlled trials (RCTs) and cross-over trial. We excluded trials shorter than 12 weeks. We included full texts, abstracts and unpublished data.Data collection and analysisWe used Cochrane’s standard methodological procedures and applied the GRADE approach to assess the evidence.Main outcome measuresWe included six studies from which 9657 participants contributed to the meta-analyses. All used dry powder budesonide and formoterol as the combination inhaler. Two studies included children aged 12+ years and two studies were open-label.FABA/ICS as-required versus FABA as-requiredCompared with as-required FABA alone, as-required FABA/ICS reduced exacerbations requiring systemic steroids (OR 0.45, 95% CI 0.34 to 0.60, 2 RCTs, 2997 participants, high-certainty evidence), equivalent to 109 people out of 1000 in the FABA alone group experiencing an exacerbation requiring systemic steroids, compared with 52 (95% CI 40 to 68) out of 1000 in the FABA/ICS as-required group. FABA/ICS as required may also reduce the odds of an asthma-related hospital admission or emergency department or urgent care visit (OR 0.35, 95% CI 0.20 to 0.60, 2 RCTs, 2997 participants, low-certainty evidence). Changes in asthma control were small and less than the minimal clinically important difference (MCID). FABA/ICS as required was associated with reductions in fractional exhaled nitric oxide, probably reducing the odds of an adverse event (OR 0.82, 95% CI 0.71 to 0.95) and may reduce total systemic steroid dose (mean difference (MD) −9.90, 95% CI −19.38 to −0.42).FABA/ICS as required versus regular ICS plus FABA as requiredThere may be little or no difference in the number of people with asthma exacerbations requiring systemic steroids with FABA/ICS as required compared with regular ICS (OR 0.79, 95% CI 0.59 to 1.07, 4 RCTs, 8065 participants, low-certainty evidence), equivalent to 81 people out of 1000 in the regular ICS plus FABA group experiencing an exacerbation requiring systemic steroids, compared with 65 (95% CI 49 to 86) out of 1000 in the FABA/ICS as-required group. The odds of an asthma-related hospital admission or emergency department or urgent care visit may be reduced in those taking FABA/ICS as required (OR 0.63, 95% CI 0.44 to 0.91, 4 RCTs, 8065 participants, low-certainty evidence). Changes in asthma control were small and less than MCID. Adverse events and total systemic corticosteroid doses were similar between groups. FABA/ICS as required was likely associated with less average daily exposure to ICS than those on regular ICS (MD −154.51 mcg/day, 95% CI −207.94 to −101.09).ConclusionsFABA/ICS as required is clinically effective in adults and adolescents with mild asthma and reduced exacerbations, hospital admissions or unscheduled healthcare visits and exposure to systemic corticosteroids and probably reduces adverse events compared with FABA as required alone. FABA/ICS as required is as effective as regular ICS and reduced asthma-related hospital admissions or unscheduled healthcare visits, and average exposure to ICS, and is unlikely associated with increased adverse events.
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In this study, novel smart drug release films were prepared by blending chitosan with polyethylene glycol methyl ether (PEGME), also named as methoxy polyethylene glycol (mPEG), for ...controlled drug release applications. The polymeric films were characterized by Fourier transform infra-red for functional groups analysis, scanning electron microscopy for morphology and X-ray photoelectron spectroscopy for chemical and surface analysis followed by mechanical and thermal analysis. The mechanical properties showed that with the addition of PEGME (40%), the tensile strength and elongation break were increased up to 34.14MPa and 26.40%, respectively as compared to the controlled sample (without PEGME). The developed biodegradable films were tested for Metformin hydrogen chloride release ability at a particular rate in phosphate buffer saline solution at pH 7.4. The results showed that chitosan/PEGME blends could be employed for controlled drug release and other biomedical applications.
The study was designed to compare Public Schools and Madarisof District
Mianwali regarding teaching of English as a subject and to find out satisfaction of
students with English teachers. Multi-stage ...sampling method was used to draw
sample. At first stage 6 public schools were selected through simple random
sampling method and all 6 Madaris where English was taught were selected. At
second stage, 120 students of 8th and 9th class were selected from each school and
Madrisa by giving equal representation. At third stage, 12 English teachers of 8th
and 9th class were selected through simple random sampling from public schools
and 12 teachers from Madaris were selected. Results of the study showed that
reading and writing were given some attention by the English teachers of both
Public Schools and Madaris while listening and speaking skills were not given
attention by teachers. Teachers of English of both types of institutions were using
simple method of grammar translation but students of Public Schools were able to
understand easy English without translation in Urdu as compared to students of
Madaris who were not able to do that. Moreover, students were satisfied with their
teachers. It is recommended that professional training of teachers should be
arranged in order to update them about English language
Background
Asthma affects 350 million people worldwide including 45% to 70% with mild disease. Treatment is mainly with inhalers containing beta₂‐agonists, typically taken as required to relieve ...bronchospasm, and inhaled corticosteroids (ICS) as regular preventive therapy. Poor adherence to regular therapy is common and increases the risk of exacerbations, morbidity and mortality. Fixed‐dose combination inhalers containing both a steroid and a fast‐acting beta₂‐agonist (FABA) in the same device simplify inhalers regimens and ensure symptomatic relief is accompanied by preventative therapy. Their use is established in moderate asthma, but they may also have potential utility in mild asthma.
Objectives
To evaluate the efficacy and safety of single combined (fast‐onset beta₂‐agonist plus an inhaled corticosteroid (ICS)) inhaler only used as needed in people with mild asthma.
Search methods
We searched the Cochrane Airways Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase, ClinicalTrials.gov and the World Health Organization (WHO) trials portal. We contacted trial authors for further information and requested details regarding the possibility of unpublished trials. The most recent search was conducted on 19 March 2021.
Selection criteria
We included randomised controlled trials (RCTs) and cross‐over trials with at least one week washout period. We included studies of a single fixed‐dose FABA/ICS inhaler used as required compared with no treatment, placebo, short‐acting beta agonist (SABA) as required, regular ICS with SABA as required, regular fixed‐dose combination ICS/long‐acting beta agonist (LABA), or regular fixed‐dose combination ICS/FABA with as required ICS/FABA. We planned to include cluster‐randomised trials if the data had been or could be adjusted for clustering. We excluded trials shorter than 12 weeks. We included full texts, s and unpublished data.
Data collection and analysis
Two review authors independently extracted data. We analysed dichotomous data as odds ratios (OR) or rate ratios (RR) and continuous data as mean difference (MD). We reported 95% confidence intervals (CIs). We used Cochrane's standard methodological procedures of meta‐analysis. We applied the GRADE approach to summarise results and to assess the overall certainty of evidence. Primary outcomes were exacerbations requiring systemic steroids, hospital admissions/emergency department or urgent care visits for asthma, and measures of asthma control.
Main results
We included six studies of which five contributed results to the meta‐analyses. All five used budesonide 200 μg and formoterol 6 μg in a dry powder formulation as the combination inhaler. Comparator fast‐acting bronchodilators included terbutaline and formoterol. Two studies included children aged 12+ and adults; two studies were open‐label. A total of 9657 participants were included, with a mean age of 36 to 43 years. 2.3% to 11% were current smokers.
FABA / ICS as required versus FABA as required
Compared with as‐required FABA alone, as‐required FABA/ICS reduced exacerbations requiring systemic steroids (OR 0.45, 95% CI 0.34 to 0.60, 2 RCTs, 2997 participants, high‐certainty evidence), equivalent to 109 people out of 1000 in the FABA alone group experiencing an exacerbation requiring systemic steroids, compared to 52 (95% CI 40 to 68) out of 1000 in the FABA/ICS as‐required group. FABA/ICS as required may also reduce the odds of an asthma‐related hospital admission or emergency department or urgent care visit (OR 0.35, 95% CI 0.20 to 0.60, 2 RCTs, 2997 participants, low‐certainty evidence).
Compared with as‐required FABA alone, any changes in asthma control or spirometry, though favouring as‐required FABA/ICS, were small and less than the minimal clinically‐important differences. We did not find evidence of differences in asthma‐associated quality of life or mortality. For other secondary outcomes FABA/ICS as required was associated with reductions in fractional exhaled nitric oxide, probably reduces the odds of an adverse event (OR 0.82, 95% CI 0.71 to 0.95, 2 RCTs, 3002 participants, moderate‐certainty evidence) and may reduce total systemic steroid dose (MD ‐9.90, 95% CI ‐19.38 to ‐0.42, 1 RCT, 443 participants, low‐certainty evidence), and with an increase in the daily inhaled steroid dose (MD 77 μg beclomethasone equiv./day, 95% CI 69 to 84, 2 RCTs, 2554 participants, moderate‐certainty evidence).
FABA/ICS as required versus regular ICS plus FABA as required
There may be little or no difference in the number of people with asthma exacerbations requiring systemic steroid with FABA/ICS as required compared with regular ICS (OR 0.79, 95% CI 0.59 to 1.07, 4 RCTs, 8065 participants, low‐certainty evidence), equivalent to 81 people out of 1000 in the regular ICS plus FABA group experiencing an exacerbation requiring systemic steroids, compared to 65 (95% CI 49 to 86) out of 1000 FABA/ICS as required group. The odds of an asthma‐related hospital admission or emergency department or urgent care visit may be reduced in those taking FABA/ICS as required (OR 0.63, 95% CI 0.44 to 0.91, 4 RCTs, 8065 participants, low‐certainty evidence).
Compared with regular ICS, any changes in asthma control, spirometry, peak flow rates (PFR), or asthma‐associated quality of life, though favouring regular ICS, were small and less than the minimal clinically important differences (MCID). Adverse events, serious adverse events, total systemic corticosteroid dose and mortality were similar between groups, although deaths were rare, so confidence intervals for this analysis were wide. We found moderate‐certainty evidence from four trials involving 7180 participants that FABA/ICS as required was likely associated with less average daily exposure to inhaled corticosteroids than those on regular ICS (MD ‐154.51 μg/day, 95% CI ‐207.94 to ‐101.09).
Authors' conclusions
We found FABA/ICS as required is clinically effective in adults and adolescents with mild asthma. Their use instead of FABA as required alone reduced exacerbations, hospital admissions or unscheduled healthcare visits and exposure to systemic corticosteroids and probably reduces adverse events. FABA/ICS as required is as effective as regular ICS and reduced asthma‐related hospital admissions or unscheduled healthcare visits, and average exposure to ICS, and is unlikely to be associated with an increase in adverse events.
Further research is needed to explore use of FABA/ICS as required in children under 12 years of age, use of other FABA/ICS preparations, and long‐term outcomes beyond 52 weeks.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To evaluate the efficacy and safety of single combined (long‐ or short‐acting beta₂ agonist plus an inhaled ...corticosteroid (ICS)) inhaler only used as needed in people with mild asthma.
The research study was designed to compare the safety and efficacy of the regimen of 5-flurouracil with cisplatin of investigational armwith the reference regimen of gemcitabine with cisplatin for ...the treatment of gallbladder cancer.Atotal of 60 patients were enrolled in the study.Out of 30 patients enrolledinarm-A (Gemcitabine withCisplatin) and 30 patients enrolledin arm-B (5-Flurouracilwith Cisplatin) for safety assessment. For the efficacy evaluation total of 16 patients enrolled which is equally divided in both arm.Total 150 cycles of chemotherapy were given to each arm of patients. Both armswere well balanced with respect to age, stage of disease and measurability.The overall response rate (ORR) was 62.5% in arm-A compared to 50% in arm-B (p = 0.34). Whereas 95% confidence interval (CI) for the efficacy was found 46.25-8.74%
32.67-67.32% between arm-A and arm-B.The most prevalent toxicities were found anemia (p < 0.05), neutropenia (p < 0.05) leucopenia (p<0.05) and thrombocytopenia (p < 0.05) and it occurred at a higher rate in arm-B than in arm-A of various grades.There was no statistically significant efficacy & toxicity for gemcitabine and cisplatin with 5-flurouracil and cisplatin however there was an overall more benefit in arm-A patients than arm-B patients.
This learning was directed acts discover the effect of Principals leadership strategies on teachers act of secondary school in D.I.Khan. The research was cross sectional and parametric in nature. The ...record was collected by both from principals and teachers of secondary school located in the district. The outcomes were fascinatingly opposing to the assumed statements i.e in this broadsheet the impact of transactional and transformational guidance style has been found contrary on teachers enactment. The reason for such phenomena has been deliberated in this broadsheet. The study concluded that both leadership styles i.e transformational and transactional styles of principles of the school understudy have been found not supporting in improvement in teachers performance
Pedestrian gender classification (PGC) is a key task in full-body-based pedestrian image analysis and has become an important area in applications like content-based image retrieval, visual ...surveillance, smart city, and demographic collection. In the last decade, convolutional neural networks (CNN) have appeared with great potential and with reliable choices for vision tasks, such as object classification, recognition, detection, etc. But CNN has a limited local receptive field that prevents them from learning information about the global context. In contrast, a vision transformer (ViT) is a better alternative to CNN because it utilizes a self-attention mechanism to attend to a different patch of an input image. In this work, generic and effective modules such as locality self-attention (LSA), and shifted patch tokenization (SPT)-based vision transformer model are explored for the PGC task. With the use of these modules in ViT, it is successfully able to learn from stretch even on small-size (SS) datasets and overcome the lack of locality inductive bias. Through extensive experimentation, we found that the proposed ViT model produced better results in terms of overall and mean accuracies. The better results confirm that ViT outperformed state-of-the-art (SOTA) PGC methods.
Learner autonomy in language classrooms received researchers' attention quite recently. The research intends to explore the prospects of promoting autonomy in Pakistani learners through collaborative ...tasks. The sample consists of 16 teachers working in public sector Engineering universities of Punjab. A qualitative approach and interpretive paradigm were selected for the present study. The role of collaborative learning in developing autonomy in learners is explored through gathering teachers' beliefs using semi-structured interviews and observing their practices in the classrooms. A constructivist's lens was employed in collecting and analyzing data. The findings show that teachers believe that collaborative learning is inculcating independence, responsibility, confidence, motivation, skills, and positive interdependence which are required for autonomy promotion. They also believe that collaborative tasks, famous among Pakistani learners and few teachers, can be utilized as the right medium in autonomy development. However, class-observations do not depict a promising situation. Teachers are found inclined towards traditional teaching pedagogy, and collaborative tasks are found lacking true spirit.
Gastrointestinal tract (GIT) infections such as ulcers, bleeding, polyps, Crohn's disease and cancer are quite familiar today worldwide. Wireless capsule endoscopy (WCE) is an efficient means of ...investigation of GIT diseases. However, still several challenges exist in this domain, such as lesion shape, colour, texture, size and irregularity. To deal with these problems, several computer-based methods are introduced in computer vision domain but they used only hand-crafted features which produced wrong predictions several times. In this research, a new technique is applied based on the fusion of deep convolutional (CNN) and geometric features. Initially, disease regions are extracted from given WCE images using a new approach named contrast-enhanced colour features . Geometric features are extracted from segmented disease region. Thereafter, unique VGG16 and VGG19 deep CNN features fusion are performed based on Euclidean Fisher Vector . The unique features are fused with geometric features which are later fed to conditional entropy approach for best features selection. The selected features are finally classified by K-Nearest Neighbour . A privately collected database which consists of 5500 WCE images is utilised for the evaluation of the proposed method and achieved best classification accuracy of 99.42% and precision rate of 99.51%. The classification accuracy proves the authenticity of the proposed approach.
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