How can we minimise the use of regular oral corticosteroids in asthma?

Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key “research statement proposals” were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn’t be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year−1 should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.

Sequential metabolizable energy plans for piglets from 7 to 30 kg

ABSTRACT: The objective of this study was to evaluate sequential metabolizable energy (ME) plans, maintaining the lysine: calorie ratio for piglets from 7 to 30 kg. Forty eight female piglets with initial weight of 6.9 ± 1.2 kg and final weight of 30.5 ± 3.8 kg were randomly allocated in a randomized complete blocks design to three nutritional plans with eight replicates and two animals per experimental unit. Sequential plans provided four ME levels: plan 1: 3,300-3,250-3,200-3,150 kcal ME kg-1, plan 2: 3,400-3,350-3,300-3,250 kcal ME kg-1, and plan 3: 3,500-3,450-3,400-3,350 kcal ME kg-1 of feed, from 7 to 10 kg, 10 to 15 kg, 15 to 20 kg and 20 to 30 kg, respectively. From 7 to 10 kg, there was no effect (P>0.05) of the nutritional plans in the evaluated variables. From 7 to 15 kg, a higher (P<0.05) energy intake and weight gain and a better (P < 0.05) feed conversion was observed in animals fed with nutritional plans 2 and 3. Nutritional plans 2 and 3 resulted in higher (P<0.05) final weight, feed intake, energy intake, digestible lysine intake, weight gain, and better feed conversion in the 7 to 20 kg, 7 to 25 kg and 7 to 30 kg. It is recommended the sequential plan containing 3,400-3,350-3,300-3,250 kcal ME kg-1 of feed from 7 to 10 kg, from 10 to 15 kg, 15 to 20 kg, and from 20 to 30 kg; respectively, equivalent to levels of 2,546-2,513-2,501-2,475 kcal net energy (NE) kg-1 of feed for piglets.

Optimal Partial-Order Plan Relaxation via MaxSAT

Partial-order plans (POPs) are attractive because of their least-commitment nature, which provides enhanced plan flexibility at execution time relative to sequential plans. Current research on automated plan generation focuses on producing sequential plans, despite the appeal of POPs. In this paper we examine POP generation by relaxing or modifying the action orderings of a sequential plan to optimize for plan criteria that promote flexibility. Our approach relies on a novel partial weighted MaxSAT encoding of a sequential plan that supports the minimization of deordering or reordering of actions. Using a similar technique, we further demonstrate how to remove redundant actions from the plan, and how to combine this criterion with the objective of maximizing a POP's flexibility. Our partial weighted MaxSAT encoding allows us to compute a POP from a sequential plan effectively. We compare the efficiency of our approach to previous methods for POP generation via sequential-plan relaxation. Our results show that while an existing heuristic approach consistently produces the optimal deordering of a sequential plan, our approach has greater flexibility when we consider reordering the actions in the plan while also providing a guarantee of optimality. We also investigate and confirm the accuracy of the standard flex metric typically used to predict the true flexibility of a POP as measured by the number of linearizations it represents.