Combination fluticasone and salmeterol versus fixed dose combination budesonide and formoterol for chronic asthma in adults and children

BackgroundCombination therapies are frequently recommended as maintenance therapy for people with asthma, whose disease is not adequately controlled with inhaled steroids. Fluticasone/salmeterol (FP/SAL) and budesonide/formoterol (BUD/F) have been assessed against their respective monocomponents, but there is a need to compare these two therapies on a head-to-head basis.ObjectivesTo estimate the relative effects of fluticasone/salmeterol and budesonide/formoterol in terms of asthma control, safety and lung function.Search strategyWe searched the Cochrane Airways Group register of trials with prespecified terms. We performed additional hand searching of manufacturers' web sites and online trial registries. Searches are current to May 2008.Selection criteriaRandomised studies comparing fixed dose FP/SAL and BUD/ F were eligible, for a minimum of 12 weeks. Crossover studies were excluded. Our primary outcomes were: i) exacerbations requiring oral steroid bursts, ii) hospital admission and iii) serious adverse events.Data collection and analysisTwo authors independently assessed studies for inclusion in the review. We combined continuous data outcomes with a mean difference (MD), and dichotomous data outcomes with an odds ratio (OR).Main resultsFive studies met the review entry criteria (5537 participants). Primary outcomes: The odds of an exacerbation requiring oral steroids did not differ significantly between treatments (OR 0.89; 95% CI 0.73 to 1.09, three studies, 4515 participants). The odds of an exacerbation leading hospital admission were also not significantly different (OR 1.29; 95% CI 0.68 to 2.47, four studies, 4879 participants). The odds of serious adverse events did not differ significantly between treatments (OR 1.47; 95% CI 0.75, 2.86, three studies, 4054 participants). Secondary outcomes: Lung function outcomes, symptoms, rescue medication, exacerbations leading ED visit/hospital admission and adverse events were not significantly different between treatments.Authors' conclusionsThe evidence in this review indicates that differences in the requirement for oral steroids and hospital admission between BUD/F and FP/SAL do not reach statistical significance. However, the confidence intervals do not exclude clinically important differences between treatments in reducing exacerbations or causing adverse events. The width of the confidence intervals for the primary outcomes justify further trials in order to better determine the relative effects of these drug combinations. Although this review sought to assess the effects of these drugs in both adults and children, no trials were identified in the under-12s and research in this area is of a high priority

Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma

Asthma patients who continue to experience symptoms despite being on regular inhaled corticosteroids (ICS) represent a management challenge. Long-acting beta2-agonists (LABA) or anti-leukotrienes (LTRA) are two treatment options that could be considered as add-on therapy to ICS.ObjectivesWe compared the efficacy and safety profile of adding either daily LABA or LTRA in adults and children with asthma who remain symptomatic on ICS.Search strategyWe searched the Cochrane Airways Group Specialised Register (up to and including March 2010). We consulted reference lists of all included studies and contacted authors and pharmaceutical manufacturers for other published or unpublished studies.Selection criteriaWe included randomised controlled trials (RCTs) conducted in adults or children with recurrent asthma that was treated with ICS and where a fixed dose of a long-acting beta2-agonist or leukotriene agent was added for a minimum of 28 days.Data collection and analysisTwo authors independently assessed the risk of bias of included studies and extracted data. We sought unpublished data and further details of study design, where necessary.Main resultsWe included 17 RCTs (7032 participants), of which 16 recruited adults and adolescents (6850) and one recruited children aged 6 to 17 years (182). Participants demonstrated substantial reversibility to short-acting beta-agonist at baseline. The studies were at a low risk of bias. The risk of exacerbations requiring systemic corticosteroids was lower with the combination of LABA and ICS compared with LTRA and ICS, from 11% to 9% (RR 0.83, 95% CI 0.71 to 0.97; six studies, 5571 adults). The number needed to treat (NNT) with LABA compared to LTRA to prevent one exacerbation over 48 weeks was 38 (95% CI 22 to 244). The choice of LTRA did not significantly affect the results. The effect appeared stronger in the trials using a single device to administer ICS and LABA compared to those using two devices. In the absence of data from the paediatric trial and the clinical homogeneity of studies, we could not perform subgroup analyses. The addition to ICS of LABA compared to LTRA was associated with a statistically greater improvement from baseline in several of the secondary outcomes, including lung function, functional status measures and quality of life. Serious adverse events were more common with LABA than LTRA, although the estimate was imprecise (RR 1.35, 95% CI 1.00 to 1.82), and the NNT to harm for one additional patient to suffer a serious adverse event on LABA over 48 weeks was 78 (95% CI 33 to infinity). The risk of withdrawal for any reason in adults was significantly lower with LABA and ICS compared to LTRA and ICS (RR 0.84, 95% CI 0.74 to 0.96).Authors' conclusionsIn adults with asthma that is inadequately controlled on low doses of inhaled steroids and showing significant reversibility with beta2-agonists, LABA is superior to LTRA in reducing oral steroid treated exacerbations. Differences favouring LABA in lung function, functional status and quality of life scores are generally modest. There is some evidence of increased risk of SAEs with LABA. The findings support the use of a single inhaler for the delivery of LABA and inhaled corticosteroids. We are unable to draw conclusions about which treatment is better as add-on therapy for children.PLAIN LANGUAGE SUMMARYWhat are the effects of long-acting beta2-agonists compared with anti-leukotrienes when added to inhaled steroids?People who continue to experience asthma symptoms despite regularly taking inhaled corticosteroids are a challenge for management. It is not clear whether the addition of a long-acting beta2-agonist (LABA) such as formoterol or salmeterol would provide more benefit in comparison with an oral anti-leukotriene agent (LTRA), for example zafirlukast or montelukast.Seventeen trials (16 in adults and one in children) were included in this review and were of good quality. We found that the addition of a LABA provides significantly greater protection against exacerbations requiring oral steroids when compared with a LTRA for adults. Based on the results of our analyses, approximately 38 adults (with a range of between 22 and 244) would need to be treated with a LABA rather than a LTRA for 48 weeks to prevent one experiencing an exacerbation needing a course of oral steroids. The trial on children did not contribute data on the main outcome and therefore we could not draw any conclusions for children.LABAs also led to a greater improvement in lung function, improvement in symptoms, use of rescue medication, quality of life and symptoms compared to the use of LTRAs. The magnitude of the improvements was modest. Serious adverse events were more frequent with LABA than with LTRAs although this result was imprecise. Based on our analyses, around 78 people would need to be treated for 48 weeks with a LABA rather than a LTRA for one of them to experience a serious adverse event. However, due to the lack of precision around our result, the true number could be between 33 and infinity. There are currently insufficient data to draw any conclusions about the effects of these drugs in children

Києво-Покровський жіночий монастир у соціокультурному просторі великого міста другої половини 19 – початку 20 ст.

Метою статті є дослідження історії заснування, просторового розвитку, фінансово-господарської та благодійницької діяльності Києво-Покровського жіночого монастиря та з’ясування значення жіночих монастирів та їх чернецтва у соціокультурному просторі великого міста другої половини 19 – початку 20 ст. Наукова новизна. Досліджено історію Києво-Покровського жіночого монастиря другої половин 19 – початку 20 ст., формування його архітектурно-господарського комплексу, соціального складу черниць, фінансово-господарської діяльності, місця у соціокультурному просторі Києва. До наукового обігу введено архівні матеріали, що відображають різні аспекти історії Києво-Покровського монастиря. Висновки. Друга половина 19 ст. ознаменувалася зміною урядової політики щодо Російської православної церкви та її монастирів, що дозволило Київській єпархії відновити окремі обителі та заснувати нові монастирі. Києво-Покровський жіночий монастир, заснований у 1889 р., був останнім монастирем збудованим у місті Києві в синодальний період. Однак, за короткий час обитель змогла стати важливим духовним центром, сформувати духовний авторитет черниць та естетичний вплив урочистих монастирських богослужінь, вплинувши на культурну атмосферу великого міста. Розташування обителі у центральній частині Києва стало вирішальним з точки зору її господарської та соціокультурної діяльності. Статус великого міста та мета його засновниці з організації такого монастиря впливали на формування складу черниць і послушниць, що відрізняло цей монастир від інших обителей єпархії. У першокласні монастирі, до яких належав і Києво-Покровський спільножительний жіночий монастир, частіше вступали представниці дворянського стану. На посаді настоятельниць цього монастиря були, як правило, представниці так званого «освіченого чернецтва». Соціально-економічні та суспільно-політичні зміни, що припали на другу половину 19 – початок 20 ст. сприяли тому, що традиційно релігійна функція православних монастирів уже не задовольняла потреб поставлених часом. У зв’язку з цим особлива увага приділялася відкриттю при монастирях навчальних закладів, посиленню благодійницької та культурно-просвітницької діяльності. Процеси урбанізації та торгово-промислового розвитку Києва спонукали керівництво та чернецтво монастиря йти в ногу з часом, відповідати запитам оточуючого соціуму. Завдяки монастирям, Київ, в умовах стрімких трансформаційних змін суспільства, продовжував зберігати свій неповторний образ древньої християнської столиці. У той же час монастирі ставали частиною міського середовища, вміло використовуючи результати урбанізації та економічного розвитку, поєднували значення релігійних та історико-культурних центрів. Їх відвідування прочанами та мандрівниками набувало не лише характеру поклоніння святині, але мало і просвітницький характер

The Reports of the Ober-Procurators of the Holy Ruling Synod as a Source for the Study of the Situation in the Kyiv Eparchy and Its Monasteries in the Second Half of the 19th and Early 20th Centuries

The purpose of the article is to cast light upon the problem of researching published sources on the history of the Orthodox Church in Ukraine, as well as to supplement the achievements of previous researchers and to propose a detailed analysis of the situation and activities of the Kyiv diocese and its monasteries, presented in the published reports of the ober-procurators of the Holy Ruling Synod between 1884 and 1914. The scientific novelty of the material presented in this article lies in the fact that, for the first time in the national historiography, “All-Public Reports of the Ober-Procurators of the Holy Synod” between 1884–1914, which were published and open to the general scientific community, were subjected to a detailed analysis. The authors also clarify the level and significance of information about the situation in the Kyiv Eparchy, its clergy, its numbers, its composition, as well as the cultural, educational and charitable activities of its monasteries. The article argues that the essence of the reports by the ober-procurators of the Holy Ruling Synod on the situation in the Kyiv Eparchy and its monasteries is practically undeveloped in the scientific literature. Such reports were addressed to the head of the Russian Orthodox Church – the Russian Emperor. They are an important and extremely informative source for modern researchers, familiarity with which will permit them to assess the general condition of the main confession in the empire. More specifically, these reports reveal the state of the Kyiv Eparchy for each calendar year. Every report had a relatively standard structure and was published as a separate book. An analysis of these sources makes it possible to establish the role and place of the hierarchs of the Kyiv Eparchy in the overall structure of the Russian Orthodox Church, as well as their personnel and activities. Furthermore, additional information, provided in the reports on the number of Orthodox monasteries in the Kyiv Eparchy and the number of monks, is of particular interest, which allows the authors to trace the dynamics in changes in these numbers over thirty years. The study of the reports reveals new information on the life in the Orthodox monasteries in the Kyiv region, in relation to their charitable, cultural and educational activities

Establishment and Organization of Activities of Professional School at Lebedyn St. Nikolas Convent of Kyiv Eparchy (the second half of the 19th – the beginning of the 20th century)

The purpose of the research paper is to study the contribution of Lebedyn St. Nikolas Convent of Kyiv Eparchy to the development of woman’s education in Ukraine in the second half of the 19th – the beginning of the 20th century and the peculiarities of the establishment and organization of the woman’s professional school at it. Scientific novelty. The contribution of Lebedyn St. Nikolas Convent and its reverend mothers to the development of education at the regional level is analyzed in the paper. The history of Lebedyn Women’s Professional School establishment is highlighted, and the stages of its activity and the level of material support from the convent are characterized. Attention is paid to the peculiarities of the educational process organization, as well as the staff composition and the formation of the female pupils’ contingent of the school. Conclusions. Four stages can be distinguished in the history of Lebedyn Women’s Professional School: 1859-1872 – establishment and development of a four-grade school; 1872-1886 – activities of a sixth-grade school; 1888-1890 – establishment of a two-grade women’s school; 1890-1918 – a two-grade, four-year women’s theological (professional) school. The history of the school shows that it was a fully formed educational institution with a distinctive management system, proper staffing, and teaching and educational process. The school aimed to give children a practically useful education. Learners mastered crafts, the basics of art, and various labor specialties that could have been useful in their future life. The process and methods of teaching were interconnected with spiritual and religious education. It is uncovered that the deterioration of the school’s financial situation and the lack of support from the state for such educational institutions made the convent leadership close the sixth-grade women’s school in 1886. In 1888, a two-grade women’s school of the type of two-grade parochial schools with a four-year term of study was established on its base. Since 1890, a two-grade, four-year women’s spiritual (professional) school had been functioning at the convent, the educational process of which ensured learners mastered the program of four-grade of the women’s eparchy school and various types of women’s needlework. Lebedyn St. Nikolas Second-Class Convent played an important role in supporting women’s education development on the territory of Kyiv Eparchy in the second half of the 19th – the beginning of the 20th century, and the school established by it made opportunities for orphans and children of the poor strata of society from the neighboring povits to get the education and begin professional training

Działalność charytatywna klasztorów eparchii kijowskiej w drugiej połowie XIX i w początkach XX stulecia

The article deals with charitable activities of Kyiv eparchy monasteries and convents during the second half of the 19th century and the early 20th century. It shows that charitable activities of the Orthodox church reached its peak in the post-reform period. The charitable activities within the specified time frame lay in the provision of schools, hospitals, orphanages, almshouses, and hotels for the poor and pilgrims. Kyiv eparchy monasteries and convents a) distributed alms, organized free lunches, provided material and medical assistance, b) handled education issues by establishing parish schools, c) supported almshouses by aiding sick people, lonely elderly people, people with special needs, and the mentally ill. At the beginning of World War I, Kyiv eparchy monasteries and convents became actively involved in the provision of assistance to the population, as well as the establishment and maintenance of shelters for children (orphans) of fallen soldiers. Such children were provided with proper care and timely medical assistance. Charitable institutions at the premises of Kyiv eparchy monasteries and convents operated at the expense of funds received from their economic activities, as well as donations from private individuals. Kyiv eparchy monasteries and convents  comprised the greatest number of hospitals and almshouses of all those operating in the territory of the then Kyiv Governorate.Artykuł dotyczy działalności charytatywnej klasztorów eparchii kijowskiej w drugiej połowie XIX i na początku XX w. Pokazuje, że działalność dobroczynna Cerkwi prawosławnej osiągnęła swój szczyt w okresie poreformacyjnym. Polegała ona na zaopatrzeniu szkół, szpitali, sierocińców, przytułków i hoteli dla ubogich i pielgrzymów. Kijowskie eparchie klasztorne: a) rozdzielały jałmużnę, organizowały bezpłatne obiady, udzielały pomocy materialnej i medycznej, b) zajmowały się sprawami oświaty poprzez zakładanie szkół parafialnych, c) wspierały przytułki, pomagając chorym, samotnym starszym ludziom, osobom specjalnej troski i chorym psychicznie. Na początku I wojny światowej kijowskie klasztory eparchiczne aktywnie zaangażowały się w niesienie pomocy ludności oraz zakładanie i utrzymywanie przytułków dla dzieci (sierot) poległych żołnierzy. Takim dzieciom zapewniono należytą opiekę i terminową pomoc lekarską. Instytucje charytatywne na terenie kijowskich klasztorów eparchii działały kosztem środków pochodzących z ich działalności gospodarczej oraz darowizn od osób prywatnych. Klasztory eparchii kijowskiej obejmowały największą liczbę szpitali i przytułków ze wszystkich funkcjonujących na terenie ówczesnej guberni kijowskiej

The fate of the orthodox church under the conditions of the new soviet law implementation 1920 – 1930

У 20­х рр. минулого століття спостерігалося намагання різних верств українського суспільства повернути церковній організації національні ознаки. Взаємовідносини радянської держави і Православної церкви викликали й викликають неабиякий інтерес як у вітчизняних, так і зарубіжних дослідників. Останнім часом помітно зріс інтерес науковців до проблеми державно­церковних відносин в Україні. Тому виникла необхідність дослідити радянське законодавство в перші десятиліття перебування більшовиків при владі, яке безпосередньо стосувалося та впливало на державно­церковні відносини в Україні.Одним із найважливіших знарядь більшовицької держави, за допомогою якого вона мала намір здійснити революційні перетворення у сфері державно­церковних відносин, було радянське право. Перші законодавчі акти радянської влади підірвали соціальну та економічну базу Церкви. Радянським законодавством оголошувалося про відокремлення церкви від держави і визначалися конкретні заходи для втілення цього законодавства в життя. Для радянської держави всі засоби відокремлення стали надзвичайно важливим етапом у справі усунення Церкви зі сфери економічного і політичного життя суспільства.Сформоване радянською владою законодавство по відокремленню церкви від держави було спрямоване на формування досить широкого кола правовідносин, визначало різноманітний об’єктивний склад цих правовідносин, різні превентивні, регулятивні, охоронні заходи та різні способи правового регулювання.У 20­х рр. минулого століття спостерігалося намагання різних верств українського суспільства повернути церковній організації національні ознаки. Взаємовідносини радянської держави і Православної церкви викликали й викликають неабиякий інтерес як у вітчизняних, так і зарубіжних дослідників. Останнім часом помітно зріс інтерес науковців до проблеми державно­церковних відносин в Україні. Тому виникла необхідність дослідити радянське законодавство в перші десятиліття перебування більшовиків при владі, яке безпосередньо стосувалося та впливало на державно­церковні відносини в Україні.Одним із найважливіших знарядь більшовицької держави, за допомогою якого вона мала намір здійснити революційні перетворення у сфері державно­церковних відносин, було радянське право. Перші законодавчі акти радянської влади підірвали соціальну та економічну базу Церкви. Радянським законодавством оголошувалося про відокремлення церкви від держави і визначалися конкретні заходи для втілення цього законодавства в життя. Для радянської держави всі засоби відокремлення стали надзвичайно важливим етапом у справі усунення Церкви зі сфери економічного і політичного життя суспільства.Сформоване радянською владою законодавство по відокремленню церкви від держави було спрямоване на формування досить широкого кола правовідносин, визначало різноманітний об’єктивний склад цих правовідносин, різні превентивні, регулятивні, охоронні заходи та різні способи правового регулювання.In the 20­s of the last century there were attempts of various strata of Ukrainian society in returning of national signs to the Church organization. The relationship between the Soviet state and the Orthodox Church has caused a great interest among both national and foreign researchers. In these latter days considerably increased the interest of scientists to the problem of Church­state relations in Ukraine. Therefore there was a need to explore the Soviet legislation in the first decades of the Bolsheviks stay in power, which is directly concerned and affected the state­Church relations in Ukraine.One of the most important tools of the Bolshevik state was Soviet law which had intended to carry out a revolution in the sphere of state­Church relations. The first legislative acts of the Soviet power blew up the social and economic base of the Church. Soviet law was declared on the separation of Church from state and defined specific measures to implement this legislation in life.For the Soviet state all tools of the separation became an important stage in removing the Church from the sphere of economic and political life of the society.Formed by the Soviet regime legislation on separation of Church and state was aimed at the formation of a rather wide range of legal relationships, defined variety objective of these legal relations, various preventive, regulatory, enforcement activities and the different methods of legal regulation

The CDIO-FCDI-FFCD Rubrics for Evaluation of Three-Cycle Engineering Programs

The aim of the paper is to propose Rubrics for self-evaluation of graduate and postgraduate engineering programs based on the FCDI (Forecast, Conceive, Design, Implement) Standards and FFCD (Foresight, Forecast, Conceive, Design) Standards by analogy with Rubrics for self-evaluation of undergraduate engineering programs based on the CDIO (Conceive, Design, Implement, Operate) Standards. The FCDI Standards and FFCD Standards were developed for Master’s and Doctoral engineering programs as a result of the CDIO approach evolution and by analogy with the CDIO Standards originally developed for Bachelor’s engineering programs. The CDIO/FCDI/FFCD Standards are recommended for the design and implementation of three-cycle engineering programs to train graduates for complex, innovative and research engineering activities, respectively, taking into account the features of the division of labor in the engineering profession. The 6-level scale Rubrics are helpful for evaluation the degree of Bachelor’s, Master’s and Doctoral engineering programs compliance with the recommendations of the CDIO, FCDI and FFCD Standards, respectively

Adaptation of the Core CDIO Standards 3.0 to STEM Higher Education

It is proposed to adapt the new version of the internationally recognized standards for engineering education the Core CDIO Standards 3.0 to the programs of basic higher education in the field of technology, natural and applied sciences, as well as mathematics and computer science in the context of the evolution of STEM. The adaptation of the CDIO standards to STEM higher education creates incentives and contributes to the systematic training of specialists of different professions for coordinated teamwork in the development of high-tech products, as well as in the provision of comprehensive STEM services. Optional CDIO Standards are analyzed, which can be used selectively in STEM higher education. Adaptation of the CDIO-FCDI-FFCD triad to undergraduate, graduate and postgraduate studies in the field of science, technology, engineering and mathematics is considered as a mean for improving the system of three-cycle STEM higher education

Pulmonary heart: A review

The review on the problem of the pulmonary heart pursues two goals: firstly, to restore historical justice and to show the priority studies of doctor Dmitry D. Pletnev on such problems as diagnosis of right ventricular myocardial infarction, clinical characteristics of congestive heart failure of the right ventricle; secondly, to outline the modern concept of the pulmonary heart. The review provides an analysis of the pathogenetic mechanisms of the development of heart failure in the pulmonary heart. Much attention is paid to echo cardiography data and biological markers are emphasized in assessing the function of the right atrium, right ventricle, tricuspid valve regurgitation, pulmonary artery pressure. Prognostically unfavorable signs of the course of the pulmonary heart have been identified, which include a high degree of tricuspid valve regurgitation, the amplitude of movement of the fibrous valve ring (TAPSE) and atrial fibrillation developing with dilation of the right atrium