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Victoria S Benson,1,* James Siddall,2,* Adam Haq,2 Mark Small,2 Zhiliu Tang,3 Tao Ye,4 Peter Howarth,5 Anna Richards,6 Rafael Alfonso-Cristancho7 1Epidemiology, Value Evidence & Outcomes, GSK, London, UK; 2Adelphi Real World, Bollington, UK; 3Value Evidence & Outcomes, GSK, Shanghai, People’s Republic of China; 4Medical Affairs, Respiratory, GSK, Shanghai, People’s Republic of China; 5Global Respiratory Franchise, GSK, Brentford, UK; 6Value Evidence & Outcomes, GSK, London, UK; 7Value Evidence & Outcomes, GSK, Philadelphia, Pennsylvania, USA*These authors contributed equally to this workCorrespondence: Tao Ye, Medical Affairs, Respiratory, GSK, 902 halei Road, Pudong, Shanghai, People’s Republic of China, Email ark.x.ye@gsk.comPurpose: To inform effective management strategies for severe asthma in China, this study aimed to comprehensively characterize clinical characteristics, treatment patterns, disease control status, and healthcare resource utilization among patients on GINA Step 4/5 therapies by analyzing data from the Adelphi Asthma Disease Specific Program conducted in China.Patients and methods: All information was retrieved from medical records or collected from physicians and patients on the survey date (August–December 2018); no follow-up was conducted. Results were summarized descriptively for patients on GINA Step 4/5 therapies, who were pooled from a consecutive sample (comprising three or more consecutive patients with physician-diagnosed asthma from each participating physician) and an oversample (comprising the next two patients with physician-perceived severe asthma from each participating physician).Results: Of the included patients (n=754), 51.5% had ever had a blood eosinophil measurement taken, 22.1% had available records for their most recent blood eosinophil measurements (68.9% of them had an elevated level ≥ 150 cells/μL), 39.9% had ever been tested for specific immunoglobulin E or radioallergosorbent, and 8.0% were prescribed maintenance oral corticosteroids. Asthma was not well controlled in 69.2% of patients. In the prior year, 27.1% experienced at least one severe exacerbation and 22.8% experienced at least one hospitalization (emergency visit or overnight stay) due to asthma.Conclusion: In Chinese patients with asthma on GINA Step 4/5 therapies, biomarker testing was underutilized, asthma was not well controlled, and severe exacerbations were not infrequent. These findings highlight the urgent need for optimized asthma management for patients on GINA Step 4/5 therapies in China.Keywords: severe asthma, type-2 high asthma, real-world, phenotype, exacerbations, health care resource utilization, eosinophils

Victoria S Benson,1,* James Siddall,2,* Adam Haq,2 Mark Small,2 Rafael Alfonso-Cristancho,3 Zhiliu Tang,4 Peter Howarth,5 Tao Ye,6 Anna Richards7 1Epidemiology, Value Evidence & Outcomes, GSK, London, UK; 2Adelphi Real World, Bollington, UK; 3Value Evidence & Outcomes, GSK, Philadelphia, Pennsylvania, USA; 4Value Evidence & Outcomes, GSK, Shanghai, People’s Republic of China; 5Global Respiratory Franchise, GSK, Brentford, UK; 6Medical Affairs, Respiratory, GSK, Shanghai, People’s Republic of China; 7Value Evidence & Outcomes, GSK, Brentford, UK*These authors contributed equally to this workCorrespondence: Tao Ye, Medical Affairs, Respiratory, GSK, 902 halei Road, Pudong, Shanghai, People’s Republic of China, Email ark.x.ye@gsk.comPurpose: To inform better asthma management in China, this study aimed to comprehensively investigate clinical characteristics, treatment patterns, asthma control status, exacerbations, and humanistic burden among adult patients seeking hospital-based asthma care by analyzing data from Adelphi Asthma Disease Specific Program conducted in China.Patients and Methods: All information was collected on survey date (August–December 2018) from medical records, physicians, or patients, without follow-up being conducted. Results are summarized descriptively for the overall population as well as subgroups defined by GINA 2018 treatment step.Results: Of the included 765 patients, 46.0%, 40.4%, and 29.2% had undergone lung function, blood eosinophil count, and specific immunoglobulin E/radioallergosorbent testing, and 17.2%, 24.1%, and 58.7% were managed at GINA Steps 1– 2, 3, and 4– 5, respectively. Asthma was not well controlled in 57.3% of patients based on definitions adapted from the ERS/ATS and 10.7% of patients had experienced ≥ 1 severe exacerbation in the preceding year. According to patient self-reporting (n=603), the mean (SD) was 0.9 (0.1) for utility on EQ-5D-3L and was 7.8% (10.4%), 36.9% (20.0%), 40.8% (22.2%), and 37.9% (22.3%) for absenteeism, presenteeism, work productivity loss, and activity impairment, respectively, on WPAI. Both asthma control and humanistic burden worsened with progressive GINA treatment steps.Conclusion: In patients seeking hospital-based asthma care in China, lung function and biomarker tests were underutilized, impairment in productivity and quality of life was observed, and more than half did not achieve well-controlled asthma despite approximately 60% being managed at GINA treatment Steps 4– 5. These findings highlight the urgent need for optimizing asthma management in China.Keywords: asthma control, exacerbation, treatment patterns, health care resource utilization, humanistic burden

David Mannino,1 James Siddall,2 Mark Small,2 Adam Haq,2 Marjorie Stiegler,3 Michael Bogart3 1Department of Medicine, University of Kentucky, Lexington, KY, USA; 2Respiratory DSP Franchise, Adelphi Real World, Bollington, UK; 3US Value Evidence and Outcomes, GlaxoSmithKline plc, Durham, NC, USACorrespondence: Michael Bogart, US Value Evidence and Outcomes, GlaxoSmithKline plc, 5 Moore Dr, Research Triangle Park, Durham, NC, USA, Tel +19198897413, Email michael.r.bogart@gsk.comPurpose: There is a high prevalence of chronic obstructive pulmonary disease (COPD) in the United States (US). Although guidelines are available for the treatment of COPD, evidence suggests that management of COPD in clinical practice is not always aligned with this guidance. This study aimed to further understand the current use of COPD maintenance medication in the US.Patients and Methods: This study was an analysis of data from the Adelphi Respiratory Disease Specific Programme (DSP™) 2019. Point-in-time data were collected from participating US physicians and their COPD patients. Physicians were either primary care physicians (PCPs) or pulmonologists, with a minimum workload of ≥ 3 COPD patients per month. Patients were aged ≥ 18 years with a physician-confirmed diagnosis of COPD.Results: In total, 171 physicians completed the survey (92 PCPs and 79 pulmonologists). Mean patient age was 66.4 years, 45% were female, with moderate COPD in 49.4% of patients and severe/very severe in 19.3%. Pulmonologists more frequently prescribed dual bronchodilation and triple therapy than PCPs, whereas inhaled corticosteroid/long-acting β2-agonist was more frequently prescribed by PCPs than pulmonologists. For both physician types, the most common reason for prescribing their patients’ current treatment was 24-hour symptom relief. The majority of PCPs (70.1%) and pulmonologists (71.9%) reported referring to COPD guidelines when making treatment decisions.Conclusion: Prescribing patterns for COPD patients were found to differ between PCPs and pulmonologists. Improved physician understanding of how to tailor treatment for each patient, based on current symptoms and exacerbation risk, could help optimize patient care in COPD.Keywords: COPD, inhaled corticosteroids, long-acting β2-agonist, long-acting muscarinic antagonist, maintenance therapy, survey

The study aimed to evaluate the effective role of Bacillus clausii on immunity and hepato-protection in broiler chickens. Total one hundred and twenty (120) day-old broiler chicks were alienated into four groups as group-A (Control), group-B {0.01 ml/ L (4 × 106 Spore)}, group-C {0.02 ml/ L (8 × 106 Spore)} and group-D {0.03 ml/ L (12 × 106 Spore)}. Each group was consisting of 3 replicate per group (10 birds/replicate). Immunization of birds was performed according to standard vaccination schedule of broiler chicks during the trial period of 35 days. The Serum biochemical parameters analyzed were liver function tests like Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), the total proteins and alkaline phosphates (ALP). Similarly the Humoral antibody titers of Newcastle Disease (ND) Immunoglobulin-M (IgM), Immunoglobulin-G (IgG) and Immunoglobulin-A (IgA) were also determined. The results showed that Bacillus clausii supplementation @ 0.03 ml/L significantly maintained the liver biomarkers (AST, ALT and ALP) at normal level as compared to control and other treated groups. Immuno-globulins (G, M and A) level was significantly elevated with highest supplementation (0.03 ml/L). No significant (p > 0.05) changes were observed for antigen specific antibody titer against ND. In conclusion, supplementation of Bacillus clausii @ 0.03 ml/L as probiotic in drinking water significantly improved the liver function and humoralimmunity of broiler chicks.

Nematode–microbe symbiosis plays a key role in determining pathogenesis against pests. The modulation of symbiotic bacteria may affect the virulence of entomopathogenic nematodes (EPNs) and the biological management of pests. We tested the influence of asafoetida (ASF) extract on the virulence of Steinernema carpocapsae and its symbiotic bacterium, Xenorhabdus nematophila, in Pyrrhocoris apterus. A total of 100 mg of ASF killed 30% of EPNs in 48 h, while P. apterus remained unaffected. The EPNs pre-treated with 100 mg of ASF influenced P. apterus’s mortality by 24–91.4% during a period of 24 to 72 h. The topical application of ASF acted as a deterrent to S. carpocapsae, lowering host invasion to 70% and delaying infectivity with 30% mortality for 168 h. Interestingly, Steinernema’s symbiotic bacterium, Xenorhabdus, remained unaffected by ASF. An in vitro turbidity test containing 100 mg of ASF in a medium increased the growth rate of Xenorhabdus compared to a control. A disc diffusion assay confirmed the non-susceptibility of Xenorhabdus to ASF compared to a positive control, streptomycin. Pro-phenol oxidase (PPO) and phenol oxidase (PO) upregulation showed that ASF influences immunity, while EPN/ASF showed a combined immunomodulatory effect in P. apterus. We report that ASF modulated the virulence of S. carpocapsae but not that of its symbiotic bacterium, X. nematophila, against P. apterus.

The study was conducted to elucidate the effect of a single or combined supplementation of zinc sulphate monohydrate (ZnSO4.H2O) and a probiotic (Protexin®) on the pectoral muscle, tibial bone and serum biochemistry in broilers. Day-old chicks (n = 192) were divided into: Control (basal diet), Zn30 (basal diet + ZnSO4.H2O 30 mg/kg feed), Zn60 (basal diet + ZnSO4.H2O 60 mg/kg feed), Pro (basal diet + Protexin® 0.1 g/kg feed), Com30 (basal diet + ZnSO4.H2O 30 mg/kg feed + Protexin® 0.1 g/kg feed) and Com60 (basal diet + ZnSO4.H2O 60 mg/kg feed + Protexin® 0.1 g/kg feed). The birds were slaughtered on the 42nd day and blood was collected to determine the cortisol, cholesterol and zinc concentrations. The pectoral muscle was selected for the assessment of the pH and water holding capacity (WHC) along with the histological sections. After defleshing, tibial bone measurements were also taken. Statistical analysis revealed a significant (P < 0.05) increase in the ultimate pH (pHu), WHC and muscle fascicle diameter in the Zn30, Zn60, Pro, Com30 and Com60 groups compared to the control group. Myofibre area showed a significant increase (P > 0.05) in the Com30 and Com60 groups against the control group. The medullary canal diameter of the tibia was smaller (P > 0.05) in the Zn60, Pro, Com30 and Com60 groups than in the control group. The tibiotarsal index was greater (P > 0.05) in the Zn60, Pro, Com30 and Com60 groups. The serum cholesterol was decreased (P > 0.05) in the Pro and Com30 groups when compared to the control group. It is concluded that zinc sulfate monohydrate and probiotic supplementation individually or in combination positively affected the histological characteristics of the muscle, tibial bone strength and haematobiochemical indicators.

Group theory, the ultimate theory for symmetry, is a powerful tool that has a direct impact on research in robotics, computer vision, computer graphics and medical image analysis. Symmetry is very important in chemistry research and group theory is the tool that is used to determine symmetry. Usually, it is not only the symmetry of molecule but also the symmetries of some local atoms, molecular orbitals, rotations and vibrations of bonds, etc. that are important. Harada-Norton group is an example of a sporadic simple group. There are 14 maximal subgroups of Harada-Norton group. Generators (also known as words) of 11 maximal subgroups are already known. The aim of this note is to give generators of the remaining 3 maximal subgroups, which is an open problem mentioned on A World-wide-web Atlas of Group Representations (http://brauer.maths.qmul.ac.uk/Atlas) [1]. In this report we compute the generators of A6 × A6.D8, 23+2+6.(3 × L3(2)) and 34 : 2.(A4 × A4).4. Moreover we also compute the generators for the Maximal subgroups of some linear groups.

While reference societies as an "externalization" process are often used to justify borrowing policies from abroad, a concerted attempt to understand how "power" influences this process, particularly regarding "semiperipheral" references to the periphery, remains absent. This article explores the externalization process in the formulation of higher education (HE) policy in Bangladesh. Using a qualitative approach, it employs thematic analysis of interviews with ten state-level policy actors. Drawing on the concept of "coloniality of knowledge," the article examines the microprocess of using localized reference points from nearby Asian countries to justify adopting contested neoliberal ideas in Bangladesh. I identify this process as one of advancing semiperipheral references to garner support for contested ideas in postcolonial contexts. The use of a coloniality framework within the dynamics of semiperipheral references adds complexity to the concept of "externalization" and enhances the understanding of how ideas travel and are justified in different policy.

Lifespan is a pool of stories that, in the beginning, sets the tone. It lays the foundation for students' long-life learning, attitudes formation, behavioral modifications, and shapes the trajectories of students' early childhood development (an important thread of United Nations Sustainable Development Goals Target 4.2 bedrock on "access to quality early childhood development, care pre-primary education" till 2030 with specific thread 4.2.1). Predominantly, a child's healthy dynamics nail down to his/her cognitive development and emotional regulations are excogitated as a building block that gets a load on the teachers' socio-demographic attributes. They are tossed around a supreme indicator and paramount countenance which works as an appetizer and nurtures infants' cognitive and emotional empathy in schools. Knuckle down to the excellence of teachers' socio-demographic attributes, the authors iced on the cake through quantitative ex-post-facto research leading to the positivist paradigm, on a sample of randomly selected 800 participants. The current research is planned in the sweat of the authors' brow to ramify how teachers' socio-demographic attributes prioritizes to promoting early childhood development and transitioning children's cognitive and emotional empathy into school. After obtaining unfetter and unrestricted permission from the authors and ensuring ethical considerations, the researchers piloted a questionnaire to confirm Cronbach's Alpha reliability statistics 0.798, 0.805, and 0.797. After applying the regression analysis technique, the researchers unmasked that teachers' socio-demographic attributes affected 78.10% of children's early childhood development, 59.70% of cognitive, and 72.40% of emotional development. Based on the results, the present research recommends that the Government of the Punjab has a lot on their plate through hiring experienced staff and providing them with induction and in-service training with good incentives to promote extra children's social, emotional, cognitive and intellectual growth for empathy in schools. Moreover, the current quantifiable stumbling blocks might be examined through conducting qualitative and mixed-method research in public and private educational institutions; a burning dilemma neglected since independence and is a cause of concern for stakeholders.

Synthetic dyes are persistent pollutants with poor biodegradability. The present study is about the degradation of direct Congo red dye in aqueous media using the Co-60 gamma radiation source. The experimental conditions such as gamma-ray absorbed doses, amount of oxidant (H2O2) and pH conditions were evaluated. The λmax of dye solution was noted as 498 nm, and then, decrease in absorbance and reduction in chemical oxygen demand (COD) were examined. The complete colour removal of dye was observed at 5 kGy, while a significant COD removal was observed at 15 kGy gamma-ray absorbed dose in conjunction with oxidant for 50 mg/L concentration. It was found that pH has no influence on degradation efficiency. A possible degradation pathway was proposed. The radiolytic end products were monitored by Fourier transform infrared (FTIR) and gas chromatography coupled with mass spectrometry (GC-MS) to explore the degradation mechanism. It was imperative to study the oxidative degradation pathway to provide directions for potential applicability of advanced oxidation process (AOP) in industrial wastewater treatment.

A prominent characteristic of clinical data is their heterogeneity—such data include structured examination records and laboratory results, unstructured clinical notes, raw and tagged images, and genomic data. This heterogeneity poses a formidable challenge while constructing diagnostic and therapeutic decision models that are currently based on single modalities and are not able to use data in different formats and structures. This limitation may be addressed using data fusion methods. In this paper, we describe a case study where we aimed at developing data fusion models that resulted in various therapeutic decision models for predicting the type of treatment (surgical vs. non-surgical) for patients with bone fractures. We considered six different approaches to integrate clinical data: one fusion model based on combination of data (COD) and five models based on combination of interpretation (COI). Experimental results showed that the decision model constructed following COI fusion models is more accurate than decision models employing COD. Moreover, statistical analysis using the one-way ANOVA test revealed that there were two groups of constructed decision models, each containing the set of three different models. The results highlighted that the behavior of models within a group can be similar, although it may vary between different groups.

The present study investigates a comparative study of the sorption of Cr3+ and Cr6+ from water using an agricultural by-product; mango peels in batch system under the effect of initial metal ion concentrations, solution pH, temperature, sorbent dose and contact time. Characterization of the mango peels was done before and after sorption of Cr3+ and Cr6+ using scanning electron microscopy, surface area pore size analyzer and FTIR spectroscopy. The pH study revealed that that maximum removal of Cr3+ and Cr6+ was obtained at pH 5.0 and 7.0 respectively. Among various kinetic models, pseudo-2nd order well explained the data owing to the higher values of R2 and the nearness between the values of experimental and calculated sorption capacities. The isotherms study revealed that Freundlich is the suitable isotherm for explanation of the equilibrium data due to higher R2 values. The monolayer sorption capacity of mango peels was found to be 98.039 mg g-1 for Cr3+ and 66.666 mg g-1 for Cr6+. The spontaneity and exothermic nature of the sorption process of Cr3+ and Cr6+ using mango peels was reflected from thermodynamic study.

Since its launch in 1988, the Global Polio Eradication Initiative (GPEI) has made substantial progress towards eradication of wild poliovirus (WPV), including eradicating 2 of the 3 serotypes and reducing the number of countries with ongoing endemic transmission of WPV type 1 (WPV1) to Afghanistan and Pakistan. The two countries are considered a single epidemiological block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 during the subsequent 12 months, specifically in the historical reservoirs of the cities of Quetta, Karachi and Peshawar. As of 30 June 2024, 8 WPV1 cases had been reported in Pakistan, as compared with 6 reported during all of 2023. These cases, and >300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels is necessary. Systematic tracking and vaccination of children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy. Depuis le lancement de l'Initiative mondiale pour l'eradication de la poliomyelite (IMEP) en 1988, des progres substantiels ont ete accomplis vers l'eradication des poliovirus sauvage (PVS). Ainsi, 2 des 3 serotypes sont desormais eradiques et seuls l'Afghanistan et le Pakistan enregistrent encore une transmission endemique du PVS de type 1 (PVS1). Ces deux pays forment un bloc epidemiologique unique. Bien qu'ayant observe un seul cas confirme de poliomyelite due au PVS1 au premier semestre 2023, le Pakistan a connu une circulation a grande echelle du PVS1 au cours des 12 mois suivants, en particulier dans les villes de Quetta, Karachi et Peshawar, qui constituent des reservoirs traditionnels du virus. Au 30 juin 2024, 8 cas de PVS1 avaient ete signales au Pakistan depuis le debut de l'annee, contre 6 notifies sur l'ensemble de l'annee 2023. Ces cas, ainsi que les >300 echantillons de surveillance environnementale (eaux usees) positifs pour le PVS1 qui ont ete recenses en 20232024, indiquent que le Pakistan n'est pas en voie d'interrompre la transmission du PVS1. Le contexte sociopolitique et securitaire complexe du pays demeure un obstacle majeur a l'elimination des poliovirus. Pour interrompre la transmission du PVS1, un engagement politique durable en faveur de l'eradication de la poliomyelite, assorti d'une responsabilisation accrue a tous les niveaux, est indispensable. Des efforts plus soutenus doivent etre deployes pour suivre et vacciner de maniere systematique les enfants qui continuent d'echapper aux activites de vaccination antipoliomyelitique, ce qui implique d'apporter de meilleures solutions aux problemes operationnels existants, ainsi qu'aux facteurs qui sous-tendent la reticence a la vaccination et la resistance des communautes., Introduction Although the GPEI has achieved substantial progress since its establishment in 1988, the goal of polio eradication has remained elusive. Indigenous WPV1 circulation has never been interrupted in Pakistan, [...]