And I separated out the info specific to an amp into a number of "technical supplements" more specific to one amp per supplement than the general stuff in the Safety Net. Grew to about 180 pages.Īt this point, I thought, why not tell every Vox owner how to fix the rest of the amp, as not all the problems were related to the repro PCBs, so I word-processed out the "how to fix the rest of the amp" into what has become "The Vox Owner's Safety Net", being a compendium of what I know about Thomas Vox amps. to work if it's not the board?" meant that I needed to write up "how to fix the rest of the amp, too". Then I started getting commentary that this or that didn't work after the board was in the amp, and it slowly dawned on me that the questions on "well, how do I get this. As the first adopters fed back info, that grew to about 85+ pages per board. Originally I did the docos for a board as simply as possible, just parts list, schematic, and some helpful advice. I got one trace in the wrong place, and reversed a TO-220 but they do work. I forgot to say - checkout period is over. They all work properly, sound like the original, but I get a comment from each builder - there's none of the hiss I remember. The recommended sink is $0.23 in ones at Mouser.Īs a bit of review, there are now about 8-10 (I'd have to go count) of the Vox preamp works-alike boards out in the world now. The reverb driver(s) were even cooler, but still warm, so I suggest that any builders use sinks there. Only the 7824 really needed it, and that was marginal. Then I tested the temperature rise on them without heat sinks on the first populated board. I actually laid the board out for heat sinks for all the TO-220 parts, just so there would be space. It was handy and more reliable, and only $1.00 more in parts for a big board, so I went with three.Įliminating heatsinks was a welcome side effect. But three lets you de-power a section during debug to see what's wrong. It is likely that one 7818 would have done it. I wanted to make sure that the works-like-a-Vox boards didn't have grounding or interference problems, so I checked to see if the extra board area for separate domains for each circuit section would fit it would, so I did. They were as quiet and hum free as any tube amp I've ever heard, so I knew it worked. I did on-PCB star grounding for the Visual Sound Workhorse amps, and it worked really well. The original Thomas Vox amps had individual power and ground domains, each star-wired back to decoupling caps. The question behind that is why one? I originally split the power sections for what may turn out to be silly reasons. Ordinary three terminal regulators don't need a minimum load, so why not use the higher-power parts and let them loaf. I did start with TO-92s and was reminded when I started looking up parts that the TO-220 and the TO-92 voltage regulators are very nearly the same price. It was a compendium of those, plus some star grounding. I have about half a dozen from the first proto batch. I was holding off on letting anyone use them until someone other than me had taken a board, built it, and successfully put it into an amp. The ICs are CD4052 CMOS switches that replace the old hard-wired 4P3T switching so that the signal doesn't have to go off the board on six wires to get to the switch, which was its own nest of wires.īut except for that, it's the same circuit schematics. I did fix the power circuits, subbing in linear regulators (those to-220 packages) for the resistor/capacitor voltage supplies in the originals. The signal circuits are verbatim the same as the old ones, just new resistors, caps, and 2N5088 transistors instead of the old special-part-numbered 2N2925 types. No tracing wires through the bundle and breaking other wires by flexing the bundles. The general idea was to make "fixing" one of these amps be to clip off all the wires at the controls and jacks, then wire in the new board. I only know of four techs *in the USA* that will. It was so bad to work on the old boards that pretty much no amp tech will work on them.
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Focus seasonal engrams and complete seasonal activities. Legacy DTR Fortnite Valorant Apex Legends Destiny 2 Call of Duty Rainbow Six League of Legends Teamfight Tactics Battlefield PUBG Rocket League Soul Arena CS:GO Halo Infinite Bloodhunt MultiVersus Splitgate Brawlhalla For Honor Rocket Arena Overwatch V … In Destiny 2 Season of the Witch, players can earn a new ritual armor set for each class. Properly combining your Exotic with some … In this post, we’ll cover all the new armor sets released with Beyond Light, including the basic Europa armor set, but also the more premium sets such as the Deep … Find full set images of every Armor set (Titan, Hunter, and Warlock) in our Destiny 2 Armor Collection. Back then, players barely had any late-game stats to chase outside of … Armor in Destiny 2 plays a practical and fashionable role for all players but since most armors have randomized stats we can focus more on the latter. What was once Solstice of Heroes - a name synonymous with the Destiny grind - is now Solstice is a PvE event that runs from July 19 to August 9. This set is one of the best looking armor sets for each class to date. The Solstice Cloak (Rekindled) is the perfect base for any outfit. Tess’ stock changes at reset every Tuesday Festival of the Lost 2022 is upon us, and like every year, it features lots of themed gear and cosmetics to chase. Interestingly enough, all the … The armor in Destiny 2 has grown in complexity since the game first launched in 2017. Not only does it have the neat Moonfang-X7 Prophecy Armor Set, it also has the weapons and armor sets that Guardians were only able to get through the … This guide covers every Solstice armor set in Destiny 2, including the brand-new set released this year. By the way, we cover all the current Bright Dust sources here. Each of the pieces has random roll perks, but the pools contain … DIM’s Loadout Optimizer analyzes all the armor in the inventory, vault and postmaster. Destiny 2: Lightfall Review - Deft Stranding 07 March 2023. Destiny 2’s 2022 Dawning event is here, and it features exclusive gear (including sparrows!), a new game mode, and improvements to its core mechanics and rewards. Purchases help support the growth of our community! Heroic Membership Tess Everis runs Destiny 2’s Eververse store, where players can spend their Silver or Bright Dust to acquire a rotating collection of cosmetics. We don't know if this pack will be sunset anytime soon. Crota's End The first piece of armor you will obtain is called Unyielding Favor Gauntlets. For the … Here's the complete rundown of Xur's exotic stock in Destiny 2 for September 8, 2023: Crown of Tempests (Warlock helmet) – 23 Legendary Shards. Year 5 Year 4 Year 3 Year 2 Year 1 Strikes All Items Catalysts Mods. Bungie is also adding the Claymore Sword from the Myth game series that was developed Wordle-inspired game for Destiny 2 fans. If you play on multiple platforms, pick one now. For those who haven’t been playing Destiny 2 since it was released in 2017, you might not have the New Monarchy faction’s Sovereign armor. While it’s … Destiny-2-beta-swordflight-4. If you are unfamiliar or need a refresher, Ornaments are armor cosmetics that can usually come in … Solstice 2023 is the second edition of Destiny 2’s summer holiday event after its major overhaul in 2022. … Destiny 2: All New Armor From Shadowkeep, Season Of Undying. APEX Destiny 2 WoW Division 2 Diablo 4 Valorant Call of Duty Escape from Tarkov Overwatch 2 FFXIV WoW Lich King WoW TBC Path of Exile Outriders New World Diablo 2 Diablo Immortal Select the platform you play Destiny on. An f/10 paraboloid's sweet spot, by contrast, spans 22 mm (0.87 inch). For instance, even a perfect f/4.5 mirror, small or large, can provide "diffraction limited" performance only within a 2-millimeter (0.08-inch) circle at the focal plane. Surprisingly, the size of the "sweet spot" depends only on the main mirror's focal ratio (the mirror's focal length divided by its diameter) and not its size. In particular, this aberration can dramatically reduce the clarity of planetary detail. Coma makes stars appear asymmetric even if the telescope is perfectly focused - the farther the star is from the center of the focal plane, the worse it gets. Outside the sweet spot, an aberration known as coma visibly degrades the image. On this axis, at the focal point, is a "sweet spot" where images of stars and planets are as sharp and crisp as they can be. The important thing to know that it has an axis of symmetry - the optical axis. It has an aluminized surface that reflects starlight to form an image at the focal plane. This is the paraboloidal mirror at the bottom of the tube. Here are the components that you will be lining up: The Primary Mirror If you aren't already acquainted with the optical parts of your telescope, now is the time. Aligning and centering these components is necessary for optimal optical performance. This diagram illustrates the Newtonian reflector's optical components and some of the structures that support them. You can master it, and in only a minute or two you'll have your instrument ready for a star performance. I hope to convince you that it is none of these things. You may have heard that it is incomprehensible, tedious, time-consuming, a pain in the neck, and best avoided. The "tuning" of a telescope is known as collimation. Your Newtonian reflector will give great images of stars and planets - but only as long as you keep it well tuned. What do you do? Learn how to tune it, or trade it in for a piano? Enter the importance of learning how to align your Newtonian reflector telescope. But after a while, you notice that it has gone slightly out of tune. Suppose you have bought a fine guitar with a lovely sound and are learning to play it. However, this supposed disadvantage can be reduced to a minor task if lining up the optical elements is approached logically and methodically. One of the most frequently noted disadvantages attributed to the Newtonian reflector telescope is its need for regular collimation (also know as alignment). Backfill the soil, tamp down, and water well. When planting, dig a hole about twice as wide as the nursery pot it came in, then place the plant in the hole so that it’s at the same depth as it was in the pot. If you give Autumn Joy too much shade, it will stretch toward the sun and become leggy. It eventually reaches about two feet tall and three feet wide.įind a spot in full sun, which is considered 6 or more hours of direct sunlight per day. It doesn’t mind heat and humidity, comes back reliably even after a very cold winter, and tolerates poor soil. It’s is suited for USDA Hardiness zones 3 to 9 (find yours here), so you can grow it in most regions of the country. Here’s what else you need to know about this almost-perfect perennial: Is Autumn Joy sedum easy to grow?Ībsolutely! This is one of the most carefree perennials you can grow, and no garden should be without it. Other varieties that are similar include more compact types such as Pure Joy, densely-mounded Pride and Joy, and Superstar, which boasts nearly turquoise foliage. The blooms also last for weeks and weeks in a vase, and they dry well, too.Īfter the first heavy frost, the spent flower heads remain a handsome accent in the winter landscape. The flowers are a great source of late-season nectar for pollinators, which flock to the profuse blooms. Plus, it’s one of the least expensive perennials you can add to your garden!Īutumn Joy’s flowers start light pink and deepen to mauve-red throughout the fall. It’s an excellent plant in mixed borders, lining walkways, in rock gardens, or when planted in masses, and Autumn Joy does equally well in pots or garden beds. (Here are more great full-sun perennial plants.) With an upright form, fleshy pale green leaves, and abundant clusters of flowers that appear late in the season when the rest of the garden is winding down, it’s a stellar perennial. (It’s always fascinating to have plants in the garden that disappear and then reappear suddenly when you least expect them to.) Make the most of this charming little plant its galaxies of star-shaped flowers will twinkle in your garden through summer and autumn.There are more than 300 different species of sedum, known popularly as stonecrop, growing around world, but the varietial called Autumn Joy is one of the most popular. It is ideal for combining with rocks and pebbles as they will continue to provide visual interest when the plant disappears during winter. Use it in herbaceous borders, rock gardens, pots, containers, massed plantings – either on its own or with soft textured grasses – and to fill up any holes and gaps that appear unexpectedly. The preferred form on the local market is Sedum Spectabile ‘Autumn Joy’ and is a fine garden plant. Various named hybrids and cultivars of this versatile little plant are available in shades of pink and mauve. It is not recommended for hot, humid sub-tropical climates. It is ideally suited to the colder, temperate regions of South Africa and will also grow in maritime conditions in the cooler parts of our country. Sedum Spectabile grows best in rich, sandy, free draining soil in a full sun position. The spent flower spikes must be cut back to ground level in winter. The blooms attract myriads of insects, especially bees and butterflies. During late summer and early autumn flat heads of tiny mauve to pink flowers appear at the top of each stout stem. TD2TL has also developed other similar games such as Soccer Random and Gun Night.io. Who is the developer of Basket Random?The game was developed by TD2TL, an Istanbul game studio created by Bilge Kaan. The two player mode will offer fun moments in epic matches! What are the game modes of Basket Random ?You can play solo against the computer but also with a friend, both on the same computer. Proof your skill and challenge yourself by beating all the levels available. Avoid obstacles that get in the way and use the portal to teleport the ball. Top 2 Player Games Basket Random Soccer Random Getaway Shootout House of Hazards Boxing Random. Basket-Ball is a 2D arcade basketball game where you must throw the ball in one shot and be able to catch the star and put the ball into the basket. Basketball Stars is the prequel to the popular game Basketball Legends, another fun. Shoot b-ball with the likes of LeBron James, James Harden, and Stephen Curry in Basketball Stars You can play solo or with a friend as a variety of legendary basketball players. To win a game you have to score more points than the opposing team and try to defend your basket by blocking their shots. You can play Soccer Random solo or with a friend. Crazy Gamwscrazy games online on Agame>Crazygames. Basketball Stars is a 2-player basketball game created by Madpuffers. How to play Basket Random?It's very simple, just press a single button, and release it, to make your two players jump or shoot to the basket. GAMES 76 SURVEY Smash Karts Basket Random OvO Eggy Car Choppy Orc Clicker. After each basket, the field, the players and the physics of the ball will change. What are the best free Crazy Games online Life - The Game JollyWorld YoHoHo. In the game Basket Random you can participate in Basketball games which are often random but also very funny! Try to manage your two players in the form of sticks, rigid, and often uncontrollable, with the aim of scoring baskets, countering opposing players or stealing the ball. In Crate Arbitrary game, attempt to score a container by utilizing just one key with various varieties from one another Evolving fields, changing players and changing balls dont astound you You can be the most amazing aspect them all. Basket Random Author : TD2TL | RHM Interactive - 1 928 452 plays Play Basket Random Ball is here with its generally clever and arbitrary way. I would have preferred if it was 1 owner or user and have multiple devices get added on to 1 plan. The lack of a free version is also irritating (though you do get a Free trial through TechVise). While the business solutions are excellent and offer a lot of security, the personal plans do not offer as much “bang for your buck.” While unlimited storage is nice, it is frustrating to be limited to one computer. The VerdictĬarbonite offers a lot of great services for cloud storage, though it can be a bit pricey. Backup Alliance is included in the Bundle solution. With its all in one solutions, Backup Alliance can help you easily recover your business data. The Backup Alliance solution is basically your security for data recovery. All plans work with physical and digital servers, and all plans can be deeply customised to include local or cloud content. With this solution, your business can back up its server data using Carbonite. The varying plans ultimately determine how much data you get store. Plus you get a friendly customer service, and remote access and management of PCs. The nice thing about Pro is it allows you to backup unlimited numbers of computers, there is just a cap on how much data you can store. Here are the solutions under their business plans (note that the bundle plan includes all three services): Carbonite ProĬarbonite Pro is the service you’ll want to backup all of your business data. There is a free trial for business solutions as well, and its for 30 days. The business solutions for Carbonite are quite different from the personal plans and are really aimed at small to medium sized businesses. It really does sound like an awesome feature. The best feature of premium is its courier service in which Carbonite will send you a hard copy of all of your backed up files. With Premium, you can finally backup videos (which you cannot do on a lower tier account). Premium is probably the best, even though it is still roughly priced at $149.99 a year. For such a price jump, it is hard to say whether or not that is even worth it. The next tier, Plus, costs $111.99 a year and allows you to backup a single external hard drive. That can add up quickly for a family of four. That means if you have multiple computers you want backed up, you will have to create and purchase separate accounts for each one. But allowing only one computer to be backed up is frustrating (I personally have things spread between two devices). It isn’t a bad price, especially for unlimited backup storage. It matches many other basic options for cloud services, and it does so at roughly the same price: $71.99 per year. The first tier, Basic, gets users unlimited backup for 1 device, customer service, and remote access to all of your files. The personal plans are separated into three tiers. The drawback is that Carbonite only covers one computer. The real difference in the plans then ultimately comes down to what you want to backup. The one nice thing about Carbonite is that it offers unlimited backup, no matter what. But if you want to try it out, there is a 15 day free trial. This is somewhat frustrating because someone may not want to pay for a solution if they have a nominal amount of data to backup. The first thing you will notice is that Carbonite does not have a free plan: something most of its competition offers. Its pretty cut and dry, and the process doesn’t really differ from other cloud storage clients.Ĭarbonite offers several packages for personal solutions. You download it from the website, log into your account, and immediately start syncing your files with the website. The Carbonite client works the way you would expect it to. The Verdict Carbonite – Personal Solutions Now that we’re a bit clear on what is what, lets take a look at what Carbonite offers.ģ. If for some reason something happens to your computer while the syncing software is running in the background you may lose all your data. A syncing file and folder software that essentially maintains replica copies of your data on a cloud. With physical disks you also run the risk of losing them, corrupt data and physical drive failures (something that happened to me a few years ago).Ī cloud storage solution is essentially what the likes of Dropbox, OneDrive and many other services offer. A cloud backup means that your data in the cloud is safe from physical damage that happens with physical hard drives. Carbonite is a cloud storage and backup solution. So what is a cloud backup solution and why would you need it? A backup solution in the cloud means everything on your hard drive is also on a storage device elsewhere. There are all kinds of cloud storage services out there, but most of them only come with general plans and they are not full cloud backup solutions. Administrators can choose to renew the certificate ahead of time. If you are a current customer that has existing cloud-connected pods prior to this date, additional release items are described in the May 2023 and April 2023 sections of the documentation topic About the Latest Horizon Cloud Release.Īdministrators can now change the Connection Server credentials configured in the Horizon Cloud Connector when Active Directory is registered.Īdministrators can now configure a certificate in the Horizon Cloud Connector to allow a connection to the Horizon Cloud control plane when SSL offloading is configured for outbound traffic.Īdministrators will now receive a notification when the Horizon Cloud Connector's internal Kubernetes certificate is approaching its expiration date. Refer to the Microsoft article KB5021131: How to manage the Kerberos protocol changes related to CVE-2022-37966 ( )īelow are this release's highlights provided by the Product Management Team. To avoid issues, update the encryption types used in your Active Directory domains to avoid using those weaker encryption ETypes. If you are still using those weaker Etypes for the Active Directory domains that you have registered with your tenant for use with the Horizon Cloud on Microsoft Azure deployments, then after you upgrade your existing deployments to manifest 4136.x or doing brand new deployments, issues related to Horizon Cloud Active Directory workflows will occur. The content of the April 2023 section is included here for convenience in having it all together in this section.įor Horizon Cloud on Microsoft Azure deployments starting from release v2303 and pod manifest 4136.x, the weaker Kerberos encryption Etypes DES and RC4-HMAC (16 and 23) are unsupported. Note: This May update adds the release of Horizon Cloud Connector 2.4.x to the previously released Horizon Cloud Service on Microsoft Azure 2303 pod manifest and HAI versions. The versions of the relevant binaries are located in the downloads pages with that date. Note: When downloading the above binary versions for the Horizon Cloud Connector and Horizon Universal Broker Plugin Installer from VMware Customer Connect, look for the release date. For pods at earlier manifests, the Import VM from Marketplace wizard uses the HAI version that was built into their respective pod manifests. This HAI version is also supported for manual installation for imported VMs in pods of manifest 4136.x. Running the Import VM wizard in a pod of 4136.x will install the agents from this HAI version. VMware Horizon Cloud Service on Microsoft Azure 2303 | pod manifest 4136.x | VMware Horizon Cloud Connector 2.4.x | VMware Horizon Universal Broker Plugin Installer 22.01 | VMware Horizon Agents Installer (HAI) 23.1.x | Unless otherwise noted in the documentation, this HAI version is built into manifest 4136.x. New versions of each key binary are made available at various times. The latest versions of the key binaries are listed in this page's most recent monthly section. Check back regularly for additions and updates to these release notes. This document is revised periodically as needed with information about the service. For a list of currently known issues in the first-generation service, see Horizon Cloud - Known Issues. When you are an existing customer in the first-gen Horizon Cloud control plane, use this page to learn about new features and the enhancements made in each release of the service and its related products. Horizon Plus subscribers, see this page about Horizon Plus for the initial steps to onboard to the next-gen control plane and start deploying the Horizon Edge. Do not onboard those Horizon deployments to this first-generation control plane when you have a Horizon Plus subscription. When you are a Horizon Plus subscriber, to obtain use of those features that are licensed under the Horizon Plus subscriptions, you must onboard those Horizon deployments to the next-gen control plane. Pasta sauces, stews, and soups: homemade Calabrian chili paste, sambal oelek, fresh chili peppers (anaheim or serrano) Marinades, dipping sauces, and vinaigrettes: homemade. In addition to her pantry staples, her weekly grocery shop includes lemons, chicken breasts for her cat and dog (Bella and Bruno-yeah, she cooks them homemade food), arugula, bananas, green grapes, fennel, salami and cheese packs for daughter Jade’s lunch, dried pasta, broccoli, and of course her new Simply 7 popcorn. Here are some common uses for Calabrian chili paste and the best substitutes for that situation: Condiment/garnish: homemade Calabrian chili paste, sriracha, tabasco sauce. The first chapter of her latest cookbook, Giada’s Italy ($21 on Amazon), outlines her Italian pantry and essential fridge ingredients (copious amounts of Parmiggiano-Reggiano and Finocchio salami), but she spoke with us to share the specific brand of Calabrian chili paste she keeps on hand, a buttery olive she’d eat day and night, and more. Stir and cook until most of the vodka has evaporated. Turn off the heat, add the vodka, and immediately turn the heat back on. The small, extremely spicy, bright red peppers add a uniquely fruity, smoky taste to the Calabrian chili paste. The Food Network star keeps her shelves lined with the best olive oil, artisanal dried Italian pasta, and jars upon jars of mix-and-match ingredients and condiments to throw together dozens of recipes on the fly. Stir in the Calabrian chili peppers and tomato paste and continue to sauté for 1-2 minutes, stirring frequently until the mixture turns dark red and some of it sticks and browns against the bottom fo the pan. Giada De Laurentiis’ pantry is stocked as well as a gourmet Italian grocery store. And that often provokes other artists to spray over the same surface again, and often with less beautiful artworks.Ĭritics of our liberal approach say legal walls incite more illegal graffiti elsewhere, but we haven’t seen that. You can fix a window, but when you paint over a graffiti you destroy an artwork. Are you not convinced by that argument? The broken windows theory cannot be really applied to graffiti in a straightforward way. The most commonly cited argument against graffiti is the “ broken windows theory”, proposed by social scientists James Q Wilson and George L Kelling in 1982 : that allowing visual signs of civic disorder creates an environment that breeds more of the same disorder. Now we have official walls where people can paint all around the city, and see graffiti as a colourful part of our city’s culture. In 2008, we succeeded in scrapping the zero-tolerance policy of old. I campaigned against Helsinki’s harsh measures and the waste of taxpayers’ money for seven years, and eventually people started to listen. Young men were fined or sent to prison: the war on graffiti was destroying lives. After I initiated a motion to paint back an erased graffiti in east Helsinki, I got a lot of phone calls from the mums of kids who had been beaten up by security staff. I got back into graffiti through politics, when I got elected as a member of Helsinki city council as a 23-year-old in 2000. There was a huge campaign trying to paint them as criminal and drug addicts, and the city hired plain-clothes security guards to catch them in the act. Graffiti writers were effectively declared enemies of the state. Paradoxically, the idea was to clean away lots of culture to make way for culture. Things really changed when Helsinki was announced as the cultural capital of Europe for the year 2000, and the city started a big anti-graffiti campaign in the run-up. I campaigned against harsh measures - and in 2008, we succeeded in scrapping the zero-tolerance policy of old We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.Īfter newsletter promotion The war on graffiti was destroying lives. For more information see our Privacy Policy. Privacy Notice: Newsletters may contain info about charities, online ads, and content funded by outside parties. It wasn’t legal then, but it also wasn’t taken too seriously. So graffiti arrived a bit later, but there was a massive boom in the late 80s: every boy and girl at my school had their own tag. What’s the history of graffiti in Finland? In a way graffiti came to Finland via the same route it came to most countries in Europe: there was the 1983 documentary Style Wars, Martha Cooper and Henry Chalfant’s 1984 book Subway Art, and the more Hollywood-style film Beat Street around the same time.įinland was a special case because even though we weren’t on the wrong side of the iron curtain, we were still somewhere in between east and west. But I can see why, because it would have probably become a tourist attraction otherwise. It’s a shame that it had to be removed so quickly – I didn’t even get a chance to take proper pictures. My friend and I will also pay the cleaning costs, which may be around €3,000. Of course, it was a really stupid thing to do. Have you been fined? Not yet, the police hearing will be after the summer. ‘Pasila’s two famous tower blocks’ … the impromptu work of Arhinmäki and his friend. Which I guess is ironic given that I got caught and some people even called on me to resign. The words I painted are really a reference to the early New York graffiti of the 70s: “GCM”, which stands for “great career moves”. The two grey things in the middle of the text are two famous tower blocks in the neighbourhood. We painted the skyline of Pasila, with the sun going down. What kind of graffiti did you paint? These days, graffiti is mainly about the lettering, but when my friends and I got into painting in the 80s, the backgrounds were more important. I mean, were were two middle-aged guys, we weren’t going to run anywhere. We were about to take pictures of our work when there were suddenly guards everywhere, shouting at us not to try to escape. It took us two hours to finish the painting. The tunnel wall wasn’t an official wall for graffiti, but there were already lots of old paintings on it that no one had cleaned up for years, so we thought people just didn’t care. We stopped the car and got our spray cans out. Pharmacological treatment relies predominately on inhaled bronchodilators and anti-inflammatory agents. Trial registrationĬhronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide. Future research on specific patient phenotype thresholds that can support treatment and funding decisions is now required from well-designed, robust, clinical trials. The decision to prescribe triple therapy should consider patient phenotype, magnitude of benefit and increased risk of adverse events. There were important differences in study designs and populations impacting the interpretation of the results and indicating there would be significant heterogeneity in cross-trial comparisons. In the largest study, there was a significantly higher incidence of pneumonia in the triple therapy arm. The absolute benefit appeared to be greater in patients with higher eosinophil counts or historical frequency of exacerbations and ex-smokers. The patient-based number needed to treat for the moderate or severe exacerbation outcome ranged between approximately 25–50 (preventing one patient from having an event) and the event-based number needed to treat of around 3–11 (preventing one event). Triple therapy resulted in the reduction of the annual rate of moderate or severe exacerbations in the range of 15–52% compared with LAMA/LABA, 15–35% compared to LABA/ICS and 20% compared to LAMA. We identified 523 records, of which 15 reports/abstracts from six RCTs were included. The primary outcome was the annual rate of moderate and severe exacerbations. We conducted a systematic search, from inception to December 2018, of randomised controlled trials (RCTs) of single-inhaler triple therapy in patients with COPD. We also evaluated and compared study designs and population characteristics to assess the strength of the evidence base. We compared the efficacy and safety of single-inhaler triple therapy to assess the magnitude of benefit and to identify patients with the best risk-benefit profile for treatment. A number of single-inhaler triple therapies are now available and important clinical questions remain over their role in the patient pathway. triple therapy, is reserved for a select group of symptomatic patients with chronic obstructive pulmonary disease (COPD) who continue to exacerbate despite treatment with dual therapy (LABA/LAMA). Guidelines recommend that treatment with a long-acting β 2 agonist (LABA), a long-acting muscarinic antagonist (LAMA), and inhaled corticosteroids (ICS), i.e. |
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