Impact of tiotropium on the course of moderate-to-very severe chronic obstructive pulmonary disease: the UPLIFT trial.
ABSTRACT The Understanding Potential Long-term Improvements in Function with Tiotropium (UPLIFT) trial was a global 4-year randomized placebo-controlled clinical trial that evaluated the long-term impact of tiotropium bromide 18 microg once daily on the accelerated age-related decline in pre- and post-bronchodilator forced expiratory volume in 1 s (FEV(1); co-primary end points). Secondary end points included lung function at serial clinic visits, health-related quality of life, exacerbations, exacerbation-related hospitalizations, mortality, safety and tolerability. The study was carried out in 5992 patients (75% male, mean age 65 years, 30% current smokers) with moderate-to-very severe chronic obstructive pulmonary disease who were permitted to receive prescribed treatment with long-acting beta(2)-agonists and/or inhaled corticosteroids in addition to the study drug. While the results failed to show an effect of tiotropium on the primary end points (rate of decline in pre- and post-bronchodilator FEV(1)), they did show improvements in lung function and health-related quality of life that were maintained throughout the study and a reduction in the risk of exacerbations and related hospitalizations. Tiotropium also reduced all-cause mortality in patients on treatment over the 4-year trial period and reduced lower respiratory and cardiovascular morbidity, including respiratory failure and myocardial infarction. Adverse events were consistent with the drug's known anticholinergic pharmacology.
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Article: Scaling Teamwork to Very Large Teams[show abstract] [hide abstract]
ABSTRACT: As a paradigm for coordinating cooperative agents in dynamic environments, teamwork has been shown to be capable of leading to flexible and robust behavior. However, when we apply teamwork to the problem of building teams with hundreds of members, fundamental limitations become apparent. We have developed a model of teamwork that addresses the limitations of existing models as they apply to very large teams. A central idea of the model is to organize team members into dynamically evolving subteams. Additionally, we present a novel approach to sharing information, leveraging the properties of small worlds networks. The algorithm provides targeted, e#cient information delivery. We have developed domain independant software proxies with which we demonstrate teams at least an order of magnitude bigger than previously published. Moreover, the same proxies proved e#ective for teamwork in two distinct domains, illustrating the generality of the approach.07/2004;