The findings of this NMA suggest favorable efficacy with SITT comprising FF/UMEC/VI versus long-acting β 2-agonist (LABA)/long-acting muscarinic antagonist, LABA/inhaled corticosteroid, multiple-inhaler triple therapy, and other SITTs. This network meta-analysis (NMA) investigated the comparative efficacy of SITT with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI 100/62.5/25 µg) versus other triple and dual therapies in patients with COPD.įF/UMEC/VI showed significant improvement in trough forced expiratory volume in 1 s, and a significant reduction in combined annualized moderate and severe exacerbations, when compared with other therapies.Īs expected, there were some differences in the study design and inclusion/exclusion criteria of the trials included in the analysis, the estimates used as inputs (due to availability in the publications), and definitions of events between trials however, the similarity assumption held, confirming that the variability was not too high to prevent pooling of the data. Randomized controlled trials comparing different triple therapy regimens for the treatment of chronic obstructive pulmonary disease (COPD) are limited and there are no head-to-head trials for single-inhaler triple therapies (SITTs). Further analysis is required as additional evidence becomes available. The findings of this NMA suggest favorable efficacy with single-inhaler triple therapy comprising FF/UMEC/VI. ![]() FF/UMEC/VI also demonstrated improvements in mean SGRQ score versus other triple therapy comparators at 24 weeks, and a significant reduction in RMU compared with BUD/GLY/FOR (160/18/9.6). FF/UMEC/VI showed statistically significant improvements in annualized rate of combined moderate or severe exacerbations versus UMEC + FF/VI and BUD/GLY/FOR. At 24 weeks, the NMA was informed by five trials. FF/UMEC/VI demonstrated statistically significant improvements in annualized rate of combined moderate or severe exacerbations versus single-inhaler budesonide/glycopyrronium bromide/formoterol fumarate (BUD/GLY/FOR). The NMA was informed by 17 trials reporting moderate or severe exacerbation endpoints. FF/UMEC/VI was statistically significantly more effective at increasing trough FEV 1 (based on change from baseline) than all triple comparators in the network apart from UMEC + FF/VI. The NMA was informed by five trials reporting FEV 1 at 24 weeks. Analyses were conducted at 24 weeks (primary endpoint), and 12 and 52 weeks (if feasible). Outcomes of interest included forced expiratory volume in 1 s (FEV 1), annualized rate of combined moderate and severe exacerbations, St George’s Respiratory Questionnaire (SGRQ) total score and SGRQ responders, transition dyspnea index focal score, and rescue medication use (RMU). The RCTs compared different ICS/LABA/LAMA combinations or an ICS/LABA/LAMA combination with any dual therapy (ICS/LABA or LAMA/LABA). This NMA was conducted on the basis of a systematic literature review (SLR), which identified RCTs in adults aged at least 40 years with COPD. This network meta-analysis (NMA) investigated the comparative efficacy of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus any triple (ICS/LABA/LAMA) combinations and dual therapies in patients with COPD. Randomized controlled trials (RCTs) comparing triple therapies (inhaled corticosteroid, long-acting β 2-agonist, and long-acting muscarinic antagonist ) for the treatment of chronic obstructive pulmonary disease (COPD) are limited.
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The story is enjoyable with a lot to offer but it isn't as deep or complex as it could have been. Nothing about the combat stands out as exceptional when compared to other RPGs. Overall, I think Dragon Quest 8 is good but it is held back by repetitive somewhat boring gameplay. The environments also have really nice atmospheric sound effects that create a sense of immersion. The voice acting is a mixed bag, most of the accents sound pretty unnatural but for its time I think the voice work is pretty decent and the game gives you the option to disable it so it deserves some credit for that. Sound design is quite good, the soundtrack is orchestrated and has some really appealing songs. The visuals fit the game fine and have aged pretty well but it is average looking for the most part. The visual design is clean and cartoony, it looks good enough but there are many older games that look better. Their relationship is surprisingly quite fun to watch and is an interesting way to present a silent hero. The protagonist is silent but the game does a great job of making him appealing by having Yangus communicate for him. The characters are quirky and enjoyable enough to watch although they aren't particularly deep. I was interested enough that I always wanted to know what would happen next and it is a very long story. The story is probably the best part about the game although it is fairly simple compared to most Final Fantasy games but it is full of fun interactions. The crafting system is quite good though and can be very rewarding as it gets you many of the best weapons in the game. There aren't really any puzzles to solve and exploration is hindered by annoying random encounters. Outside of combat the gameplay is nothing special. Compared to games like Tales or Symphonia, Final Fantasy X, and Shadow Hearts: Covenant, all games that came out before, the battle system in Dragon Quest 8 feels extremely basic and boring. Even late in the game I was still using basic attacks. Another problem I have is that there are very few combat abilities. The problem that I have is when you get late in the game pretty much the only way to level up is by hunting metal slimes and they are extremely boring to fight against. The main quest is very long and there are lots of secrets. I love long RPGs and this game is certainly that. Personally I enjoyed the story but I found the gameplay to be very boring and repetitive. That can either be seen as a good thing or a bad thing. It does a few things really well but it feels like a game out of the past. 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He was one of several eyewitnesses invited to address the meeting, providing evidence that sexual violence and rape occurred and were weaponized by Hamas during the attacks.ĬNN cannot independently verify individual allegations and claims. Greyman was testifying at a United Nations session on sexual and gender-based violence in the October 7 Hamas terror attack, hosted by Israel at the UN headquarters in New York on Monday. Her body was brutalized in a way that we could not identify her,” he added, the trauma clearly visible on his face. “She had nails and different objects in her female organs. She was naked and she had nails …,” Greyman managed to say before pausing for a long time, struggling to get the words out. I saw in front of my eyes a woman, laying (down). “I was called into a house, I was told there are few bodies over there. ![]() A live grenade was planted in her hand.Īnd then there was the body with the nails. 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This over-inflated charge of $742.50 has been a vast hardship and catastrophic to demand payment of charges and services I was never made aware of or requested. However, I did not request any work order for the gutters. I received an email notification on Tuesday, August 1,2023, regarding a charge of $742.50 for the back exterior gutters of the property. I showed him the hole in the front exterior of the house, and he acknowledged it. He mentioned that First Key Homes had sent him to fix a hole in the roof. Upon inspection of the property, a First Key Maintenance personnel indicated that they would engage First Key Homes to hire a contractor to fix the hole caused by the raccoon in the roof of the front exterior of the property.Ī contractor arrived when I was leaving my house to run some errands. He inspected the front exterior of the roof and discovered the hole that a raccoon caused. on May 12,2023, a maintenance man from First Key Homes visited the property located in Memphis, Tennessee. The hole was roughly the size of a basketball and allowed squirrels to enter the attic of the house. I reported that there was a hole in the roof caused by a raccoon gnawing at the front exterior of the roof. On May 5,2023, I called First Key Homes to request maintenance. They're not going to listen to your concerns and a property manager doesn't even call or respond to emails! Now I have to figure out what to do with my dogs because they keep escaping out of this raggedy gate! AND I PAY PET RENT! The worker came out and said this is a two man job, so submit another work order requesting two people come out! Over a month of time will have been spent before the issue will be fixed! There's so much more I could say, but I'll end with DO NOT RENT from them. I recently requested the sliding glass door be fixed. They mark the work order as COMPLETE and then you have to call again to request another work order for the follow up. Then, if they come out and look at the issue and there's more work to be done. Only for someone else to call later to actually schedule! I have missed so much work it's not funny. The maintenance request process is asinine! You have to call, give them the issue, and be booked for a tentative appointment. This isn't the first time this has happened yet they come out and do a half job or report to the main office that nothing is wrong with the fence. We're going into hurricane season and the wind recently blew the gate open from the back corner. I have requested numerous times for them to fix the gate and have only had them come out and half patch it up. 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Standard elevators, which can span a maximum of 30 floors, and express elevators, which can span the entire height of the building, must be used efficiently to decrease tenant stress. The tower is limited to a maximum of 100 floors above ground and nine stories below ground. The highest achievable rating is the designation of "Tower" which can only be awarded by building a cathedral at the very top of a five-star building with all possible tower levels above ground developed. New facilities are made available while the tower progresses from a one-star rating to a five-star rating. To increase the tower's star rating, it must attract more tenants by providing more living space (or office space, and later in the game, hotel and various types of commercial space). ![]() The game begins with a one-star tower with limited building options. SimTower, which was built around an elevator simulation program, places a strong emphasis on good elevator management. To prevent tenants from vacating their properties, the player must keep their stress low by fulfilling their demands for medical centers, parking lots, recycling facilities, clean hotel rooms staffed with housekeepers, and an efficient transportation system, which involves managing elevator traffic. They must plan where to place facilities in the tower that include restaurants, condominiums, offices, hotel rooms, retail stores and elevators. SimTower allows the player to build and manage the operations of a modern, multi-use skyscraper. Gameplay The player views a cross-section of the building from the side. The in-game speed was also criticized for being too slow, which was a crucial issue in the game because time must pass for the player to earn income to purchase new facilities. Criticism targeted the game's lack of documentation, which some reviewers found made it harder to learn how to play the game. ![]() Reviews praised the game's formula, including its open-ended nature and its ability to immerse the player into the game. Random events take place during play, such as terrorist acts that the player must respond to immediately.Ĭritical reception towards the game was generally positive. The game allows players to build and manage a tower and decide what facilities to place in it, in order to ultimately build a five-star tower. In Japan, it was published by OPeNBook that same year and was later released for the Sega Saturn and 3DO in 1996. SimTower: The Vertical Empire (known as The Tower ( ザ・タワー, Za Tawā) in Japan) is a construction and management simulation video game developed by OPeNBooK and published by Maxis for the Microsoft Windows and Macintosh System 7 operating systems in November 1994. |
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