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Abstract Background Headache disorders, including migraine, pose a significant burden globally, with varying prevalence rates across different regions. However, research on migraine in Nigeria and other low-income countries is limited. Understanding the prevalence, characteristics, and treatment outcomes of migraine in Nigeria is essential for informing healthcare policies and improving patient care. Methods This systematic review and meta-analysis aimed to synthesize existing literature on migraine prevalence, characteristics, and treatment outcomes in Nigeria. Eligible studies were identified through comprehensive searches of multiple electronic databases and grey literature sources. Studies reporting migraine prevalence, diagnostic criteria, treatment modalities, and outcomes were included. Data extraction and quality assessment were performed following established guidelines. Results Ten studies involving 7,768 participants met the inclusion criteria and were included in the meta-analysis. The pooled prevalence of migraine headache in Nigeria was calculated to be 16% (95% CI = 7–28), with significant heterogeneity observed among studies (I² = 99.35%, P

Abstract Over the past decade, the prevalence of neurological diseases has significantly risen due to population growth and aging. Individuals suffering from spastic paralysis, brain attack, and idiopathic Parkinson’s disease (PD), among other neurological illnesses, commonly suffer from dysarthria. Early detection and treatment of dysarthria in these patients are essential for effectively managing the progression of their disease. This paper provides UTrans-DSR, a novel encoder-decoder architecture for analyzing Mel-spectrograms (generated from audios) and classifying speech as healthy or dysarthric. Our model employs transformer encoder features based on a hybrid design, which includes the feature enhancement block (FEB) and the vision transformer (ViT) encoders. This combination effectively extracts global and local pixel information regarding localization while optimizing the mel-spectrograms feature extraction process. We keep up with the original class-token grouping sequence in the vision transformer while generating a new equivalent expanding route. More specifically, two unique growing pathways use a deep-supervision approach to increase spatial data recovery and expedite model convergence. We add consecutive residual connections to the system to reduce feature loss while increasing spatial data retrieval. Our technique is based on identifying gaps in mel-spectrograms distinguishing between normal and dysarthric speech. We conducted several experiments on UTrans-DSR using the UA speech and TORGO datasets, and it outperformed the existing top models. The model performed significantly in pixel’s localized and spatial feature extraction, effectively detecting and classifying spectral gaps. The Tran-DSR model outperforms previous research models, achieving an accuracy of 97.75%.

Abstract Background Preeclampsia and eclampsia (PE/E) are hypertensive disorders of pregnancy with significant morbidity and mortality for both mothers and fetuses. This study aimed to investigate the prevalence of PE/E, associated complications, and mortality rates in pregnant women in Nigeria using a systematic review and meta-analysis approach. Methods A search strategy was employed to identify relevant studies published in English from electronic databases like PubMed, Google Scholar, Science Direct, AJOL, DOAJ and Cochrane Library. Studies investigating the prevalence of PE/E, associated complications, and mortality rates in pregnant women in Nigeria were included. Data extraction and quality assessment were conducted using standardized tools. Pooled prevalence estimates were calculated using random-effects models. Statistical heterogeneity was assessed using the I 2 statistic. Publication bias was evaluated using the Egger test. Results The analysis revealed a pooled prevalence of 4.51% (95% CI 3.82–5.29) for preeclampsia and 1.39% (95% CI 1.02–1.84) for eclampsia in Nigerian pregnant women. Significant heterogeneity was observed for both PE (I 2 = 99.20%, P

Abstract Background Excimer laser coronary angioplasty (ELCA) has evolved as a pivotal element in percutaneous coronary intervention (PCI), significantly influencing procedural efficacy and safety. This mini-narrative review explores ELCA's applications, focusing on its efficacy and clinical outcomes. Body A search of major databases identified studies from ELCA's inception. Inclusion criteria encompassed diverse study designs exploring ELCA in coronary interventions, with rigorous data extraction ensuring accuracy and completeness. A narrative synthesis presented key findings across studies. ELCA demonstrated promising outcomes compared to traditional PCI and stent placement. Reduced reperfusion time, enhanced microcirculation, and lower postoperative major adverse cardiac events (MACE) rates highlighted its efficacy. Improved vascular and lumen dynamics, plaque modification, and successful treatment of complex lesions showcased its versatility. Quality of life enhancements positively impacted long-term recovery, particularly in acute coronary syndrome (ACS) cases. ELCA's success in challenging scenarios and its role in refining in-stent restenosis (ISR) treatment indicated broader applications. Despite limitations in some studies, ELCA presented a favorable safety profile. Conclusion The review underscores ELCA's dynamic role in coronary interventions, offering a promising tool for enhancing procedural outcomes. Clinical implications include improved reperfusion, adaptability in complex lesions, and potential long-term benefits for ACS patients. While integration into routine practice requires careful consideration, ELCA's positive outcomes encourage further exploration and innovation in interventional cardiology.

This study investigated the impact of mobile apps on language learning, focusing on the improvement of linguistic competencies and student motivation. Five popular applications (Duolingo, Babbel, Rosetta Stone, Memrise, and Busuu) were analyzed in an experimental group through standardized tests and qualitative evaluations, before and after a study period. The results showed that students who used these apps experienced significant improvements in their language skills compared to a control group. Interactivity, personalization and gamification were identified as the main contributions to these positive outcomes, with gamification highlighted as a crucial driver of motivation. Nonetheless, the study also emphasized the need for a more robust pedagogical design in the apps to equitably address all language areas.

Background: Sickle cell disease (SCD) is an autosomal recessive haemoglobin disorder, affecting about 7.74 million individuals worldwide, but it is more prevalent among Africans and Asians. SCD is characterised by many complications, and it is a major health issue in Nigeria, the country with the largest burden of the disease globally. This work aims to present the design and implementation of electronic registries (ER) for SCD in a tertiary hospital in Nigeria. Methods: Registry design was initiated during a staff exchange programme within the ARISE initiative (EU grant agreement no. 824021). Ethical approval was obtained, and paper records were retrieved and transferred into one adult and one paediatric database, developed with Microsoft Access. Results: Data from 2659 SCD patients were entered in the ERs, including 698 (26.3%) adults and 1961 (73.7%) children. There were 287 (41%) male adults, 404 (58%) female and 7 (1%) patients whose gender was missing. There were 1041 (53.1%) male children, 906 (46.2%) female and 14 (0.7%) whose gender was missing. Information on phenotype was available for 2385 subjects, and most of them (2082, 87.3%) were SS. The most prevalent SCD-related complication was painful events (26.6% in adults and 68.7% in children, considering valid cases). Conclusions: About 60% of SCD patients in the centre were included in the ERs providing useful, hands-on recommendations for future ER design in SCD. These ERs might be an appropriate tool for collecting and analysing SCD patients’ data.

Abstract Ischaemic stroke, a leading cause of global morbidity and mortality, necessitates effective biomarkers for enhanced diagnostic and prognostic stratification. MicroRNAs (miRNAs), particularly miR-210, have emerged as promising candidates due to their intricate regulatory roles in cellular responses to hypoxia and neuroprotective effects. This study explores the potential of miR-210 as a biomarker for ischaemic stroke, considering its expression patterns, regulatory functions and diagnostic/prognostic implications. A literature search was conducted on PubMed, Scopus, Google Scholar and Web of Science to identify studies focusing on miR-210 in ischaemic stroke. Inclusion criteria comprised reports on miR-210 expression in ischaemic stroke patients, excluding non-English studies, reviews, commentaries and conference abstracts lacking primary data. Studies investigating miR-210 levels in ischaemic stroke patients revealed significant alterations in expression patterns compared to healthy controls. Diagnostic potential was explored, indicating miR-210’s sensitivity and specificity in distinguishing ischaemic stroke from other neurological conditions. Prognostic value was evident through associations with infarct size, functional outcomes and long-term survival. Challenges included variability in miR-210 levels, limited diagnostic specificity, absence of standardised assays and concerns regarding cost-effectiveness and accessibility. While miR-210 holds promise as an ischaemic stroke biomarker, challenges must be addressed for its successful integration into clinical practice. Standardised reference ranges, validation studies in diverse populations and collaborative efforts for assay standardisation are crucial. Despite challenges, miR-210’s diagnostic and prognostic potential, particularly in predicting therapeutic responses, suggests a significant role in advancing ischaemic stroke management.

Abstract Background This study aimed to compare serum prostate specific antigen (PSA), Soluble E-cadherin (sE-cad), and Inosine Monophosphate Dehydrogenase-2 in predicting prostate cancer aggressiveness by determining their correlations with Gleason score and International Society of Urological Pathology (ISUP) Grade Groups. Methods This was a hospital-based descriptive quantitative cross-sectional study whereby we enrolled 48 newly diagnosed prostate adenocarcinoma patients in the study. Their serum was analysed for PSA, sE-cad, and IMPDH-2. Pearson correlation coefficient was used to test the correlation between the serum sE-cad and Gleason score while Spearman rho correlation coefficient was used for PSA and IMPDH-2. The correlation coefficient (r) was graded as very weak (

Claus F Vogelmeier,1 Kai-Michael Beeh,2 Michael Schultze,3 Nils Kossack,4 Lena M Richter,4 Jing Claussen,5 Chris Compton,6 Stephen G Noorduyn,7,8 Afisi S Ismaila,8,9 Gema Requena10 1Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany; 2Insaf Respiratory Research Institute, Wiesbaden, Germany; 3ZEG – Berlin Center for Epidemiology and Health Research GmbH, Berlin, Germany; 4WIG2 GmbH (Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung) - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany; 5Global Medical Affairs, GSK, Munich, Germany; 6Global Medical, GSK, Brentford, UK; 7Value Evidence and Outcomes, R&D Global Medical, GSK, Mississauga, ON, Canada; 8Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 9Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA; 10Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, UKCorrespondence: Gema Requena, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK, Tel +44 20 80476893, Email gema.x.requena@gsk.comPurpose: Triple therapy (long-acting muscarinic antagonist/long-acting β2-agonist/inhaled corticosteroid) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence. This study assessed comparative adherence and persistence to single-inhaler triple therapy (SITT) versus MITT among patients with COPD in a real-world setting in Germany.Patients and Methods: This retrospective analysis using the WIG2 benchmark database identified patients with COPD newly initiating triple therapy with MITT or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or formoterol/beclomethasone/glycopyrronium bromide [FOR/BDP/GLY]) November 2017–June 2019. Eligible patients were ≥ 35 years with 1 year’s continual insurance prior to triple therapy initiation and no previous record of triple therapy. Inverse probability of treatment weighting was used to balance baseline characteristics. Adherence was measured using proportion of days covered (PDC) at 6, 12, and 18 months post-treatment initiation; persistence (time until treatment discontinuation) was measured at 6, 12, and 18 months, with a gap of > 30 days used to define non-persistence.Results: Of 5710 patients included in the analysis (mean age 66 years), 71.4% initiated MITT and 28.6% initiated SITT (FF/UMEC/VI: 41.4%; FOR/BDP/GLY: 58.6%). Mean PDC was higher among SITT versus MITT users at all time points; at each time point, mean PDC was highest among FF/UMEC/VI users. During the first 6 months following treatment initiation, higher adherence was exhibited by FF/UMEC/VI (29%) and FOR/BDP/GLY (19%) users versus MITT users. Over the entire observation period, FF/UMEC/VI users had the highest proportion of persistent patients; at 18 months, 16.5% of FF/UMEC/VI users were persistent versus 2.3% of MITT users.Conclusion: Patients initiating SITT in Germany had significantly higher adherence and persistence compared with patients initiating MITT over 6 to 18 months following treatment initiation. Among SITT, FF/UMEC/VI users had the highest proportion of adherence and persistence.Keywords: comparative, multiple- or single-inhaler triple therapy, new-user, proportion of days covered, real-world analysis, treatment discontinuation

During March and April 2024, we studied dairy cattle specimens from a single farm in Texas, USA, using multiple molecular, cell culture, and next-generation sequencing pathogen detection techniques. Here, we report evidence that highly pathogenic avian influenza A(H5N1) virus strains of clade 2.3.4.4b were the sole cause of this epizootic.

Abstract This paper explores the potential of stem cell therapies in revolutionising stroke recovery, addressing the limitations of current treatments and emphasising regenerative medicine as a promising alternative. Stroke, a leading cause of disability and death worldwide, necessitates innovative approaches due to the temporal constraints and regenerative deficiencies in existing therapeutic modalities. The review explores the diverse mechanisms underlying stem cell-mediated recovery, encompassing neuroprotection, neurogenesis, angiogenesis, modulation of inflammatory responses, and induction of host brain plasticity. We searched prominent databases (PubMed, Scopus, Google Scholar, and Web of Science) from inception to January 2024 for studies on “stem cell therapy” or “regenerative medicine” combined with “stroke recovery” or “cerebrovascular accident”. Studies in humans and animals, published in peer-reviewed journals, and investigating the impact of stem cell therapy on stroke recovery were included. We excluded non-English publications and those lacking sufficient outcome data. Evidence from animal studies demonstrates the efficacy of various stem cell types, while human studies, though limited, contribute valuable insights into safety and potential efficacy. Safety considerations, crucial for successful clinical application, emphasise the need for rigorous preclinical and clinical studies, long-term follow-up data, and ethical standards. Challenges in the field, such as study design heterogeneity, optimising stem cell delivery methods, and identifying subpopulations likely to benefit, require concerted efforts to overcome. Standardising methodologies, refining delivery routes, and personalising interventions based on biomarkers are essential. This review positions stem cell therapies as promising for comprehensive neural tissue recovery following stroke.

Abstract Phases with spontaneous time-reversal ( $${{{{{{{\mathcal{T}}}}}}}}$$ T ) symmetry breaking are sought after for their anomalous physical properties, low-dissipation electronic and spin responses, and information-technology applications. Recently predicted altermagnetic phase features an unconventional and attractive combination of a strong $${{{{{{{\mathcal{T}}}}}}}}$$ T -symmetry breaking in the electronic structure and a zero or only weak-relativistic magnetization. In this work, we experimentally observe the anomalous Hall effect, a prominent representative of the $${{{{{{{\mathcal{T}}}}}}}}$$ T -symmetry breaking responses, in the absence of an external magnetic field in epitaxial thin-film Mn5Si3 with a vanishingly small net magnetic moment. By symmetry analysis and first-principles calculations we demonstrate that the unconventional d-wave altermagnetic phase is consistent with the experimental structural and magnetic characterization of the Mn5Si3 epilayers, and that the theoretical anomalous Hall conductivity generated by the phase is sizable, in agreement with experiment. An analogy with unconventional d-wave superconductivity suggests that our identification of a candidate of unconventional d-wave altermagnetism points towards a new chapter of research and applications of magnetic phases.

Abstract Scientists predict ongoing global climate change to trigger adverse events affecting about 143 million people in the Global South by 2050, leading to various forms of migration and mobility. While existing literature extensively examines climate-induced migration, there is a lack of studies considering the compounding impacts of multiple climate hazards on migration, mobility, and immobility. To address this gap, we conducted a systematic literature review to explore how climate-induced stressors, specifically rising temperatures, water stress and droughts, and floods and sea-level rise, have affected populations in the Global South, leading to voluntary and/or forced migration. Our findings show that these stressors have displaced and profoundly impacted millions of people, resulting in both internal and transboundary migration. Climate-induced stressors often trigger migration through indirect pathways influenced by multiple intervening institutional, political, and socio-economic factors and programmatic and policy gaps. Effectively addressing challenges related to climate-induced migration necessitates adaptation strategies that adequately consider the impacts of these intervening factors while recognizing their differential effects on various socio-demographic groups. We argue that support from Global North countries, including compensation for loss and damage, along with continued institutional and financial support from international non-governmental organizations, is crucial for managing climate-induced migration in the Global South. Without proper planning and adequate resources, migration may escalate and significantly impact human security. The findings of this study can inform climate migration policies and assist adaptation and migration experts in identifying intervention mechanisms and opportunities for people-centered climate solutions.

Abstract Background The present study draws motivation from the United Nations Sustainable Development Goals and explores the nexus between access to modern cooking energy sources, responsible energy consumption, climate change mitigation, and economic growth. Using 2018 demographic and health survey data, the study examines the influence of key socioeconomic and demographic factors on household choice of cooking energy in Nigeria. Results The empirical results show that traditional energy sources are dominant among Nigerian households (74.24%) compared to modern energy sources (25.76%). Regarding energy demographics, male-headed households show more usage of modern energy sources (19.86%) compared to female-headed households (5.90%). Regional analysis reveals that the northwest region predominantly uses traditional energy sources (18.60% of the share of total traditional energy sources), while the southwest region shows the greatest usage of modern energy sources (10.52% of the share of total modern energy sources). Binary logistic regression analysis reveals the positive and statistically significant influence of wealth index, education, and geopolitical region on the likelihood of utilizing modern energy sources. Conversely, household size and place of residence indicate an inverse relationship with the likelihood of adopting modern energy sources. Conclusions These findings have important policy implications for energy efficiency, environmental sustainability, and improving the quality of life in Nigeria, which is currently plagued with significant energy poverty, especially in rural communities.

Hepatocellular carcinoma is a prevalent form of liver cancer that is life threatening. Many chemically synthesized anti-cancer drugs have various degrees of side effects. Hence, this study investigated the effect of FEAC interventions on NDEA-CCl4-induced HCAR in male Wistar rats. HCAR was induced by intraperitoneal administration of 200 mg/kg of NDEA and 0.5 mL/kg CCl4 (as a promoter of HCAR). Following the induction of HCAR, rats were treated differently with two different doses (25 and 50 mg/kg) of FEAC. HCAR induction was confirmed by the significant elevation of serum levels of ALT, AST, and α-FP. Also elevated significantly were liver levels of Akt/PKB, NF-κB, TNF-α, MDA, GSH, and activities of GST, SOD, and CAT, while levels of liver p53 and Nrf2 were significantly lowered compared with normal rats. Treatment interventions with both 25 and 50 mg/kg of FEAC against the DEN-CCl4-induced HCAR gave comparable effects, marked by a significant reduction in the levels of serum ALT, AST and α-FP, as well as liver levels of MDA, GSH, Akt/PKB, NF-κB, TNF-α, GST, SOD, and CAT, while levels of liver p53 and Nrf2 were significantly elevated compared with normal rats. Put together and judging by the outcomes of this study, FEAC being a potent antioxidant may also be potent against chemical-induced HCAR via upregulation of p53 and Nrf2, as well as downregulation of the Akt/PKB-NF-κB pathway in rats.

Background: Little is known about attitudes towards COVID-19 vaccination in sub-Saharan Africa, where immunisation coverage is the lowest in the world. Aim: The study aimed to identify factors associated with COVID-19 vaccine hesitancy and uptake in Cameroon, and assess changes in these factors over a period of time. Setting: The study was conducted in the ten regions of Cameroon. Methods: The authors conducted a two-phase cross-sectional survey in the 10 regions of Cameroon, from July 2021 to August 2021 (Phase one) and from August 2022 to September 2022 (Phase two). We analysed reasons for vaccine hesitancy descriptively and used logistic regression to assess factors associated with hesitancy. Results: Overall, we enrolled 12 109 participants: 6567 (54.23%) in Phase one and 5542 (45.77%) in Phase two. Of these, 8009 (66.14%) were not interested in receiving the COVID-19 vaccine (n = 4176 in Phase one, n = 3833 in Phase two). The refusal rate increased significantly in the northern region from 27.00% in Phase 1 to 60.00% in Phase two. The leading contributor to COVID-19 vaccine hesitancy was fear that the vaccine was dangerous, which was significantly associated (95% confidence interval [CI], p 0.05%) with vaccine refusal in both phases. Overall, 32.90% of participants (n = 2578) perceived the COVID-19 vaccine to be dangerous. Advanced age, male gender, Muslim religion and low level of education were associated with vaccine acceptance. Participants reported that healthcare workers were the most trusted source of information about the COVID-19 vaccine by 5005 (42.84%) participants. Conclusion: Despite the investment of the Ministry of Health and its partners in community engagement, focussing on communication about the vaccine efficacy, tolerance and potential adverse events, fear of the vaccine remains high, likely leading to vaccine hesitancy in Cameroon between 2021 and 2022. Contribution: The study highlight regional variations in COVID-19 vaccine acceptance in Cameroon, with factors age, gender, religion and education influencing willingness to vaccine. Trust in health workers was high, indicating that, tailored, community-led vaccination strategies are key for improving vaccine uptake, not only for COVID-19 but also for future epidemics.

The COVID-19 pandemic has caused the death of 7.1 million people worldwide as of 7 July 2024. In Nigeria, the first confirmed case was reported on 27 February 2020, subsequently followed by a nationwide spread of SARS-CoV-2 with morbidity and mortality reaching 267 173 and 3155, respectively, as of 7 July 2024. At the beginning of the pandemic, only a few public health laboratories in Nigeria had the capacity for SARS-CoV-2 molecular diagnosis. The National Veterinary Research Institute (NVRI), already experienced in influenza diagnosis, responded to the public health challenge for the diagnosis of COVID-19 samples from humans. The feat was possible through the collective utilisation of NVRI human and material resources, including biosafety facilities, equipment, reagents and consumables donated by international partners and collaborators. Within 6 months of the reported COVID-19 outbreak in Nigeria, over 33 000 samples were processed in NVRI facilities covering five states. Thereafter, many field and laboratory projects were jointly implemented between NVRI and collaborating sectors including the Nigerian Centre for Disease Control (NCDC) and the National Institute for Medical Research (NIMR), which brought together professionals in the health, veterinary, education and socio-sciences. In addition, One Health grants were secured to enhance surveillance for coronavirus and other zoonoses and build capacity in genomics. Bio-surveillance for coronaviruses and other emerging zoonotic pathogens at the human–animal interface was activated and continued with sample collection and analysis in the laboratory for coronaviruses, Lassa fever virus and Mpox. One Health approach has shown that inter-sectoral and multinational collaboration for diagnosis, research and development in animals, and the environment to better understand pathogen spillover events at the human–animal interface is an important global health priority and pandemic preparedness.

Background: People living with HIV/AIDS (PLHIV) are prone to other health issues that may result from the disease or antiretroviral medicines. These persons experience other psychosocial aspects of the illness, which may negatively affect their quality of life and overall treatment outcomes. This study assessed the medication-related burden and virological response of adult PLHIV. Method: This cross-sectional study involved 417 HIV-positive adults who had been on combined antiretroviral therapy for at least a year at the State Specialist Hospital Gombe. Nigeria. Patient medication experience was measured using the Living with Medication Questionnaire version-3 (LMQ-3). Virological suppression was assessed at viral loads

In this study, we addressed the prevalent issue of untreated greywater discharge into waterbodies in many developing countries, despite the associated public health risks. Our approach involved utilizing fibers extracted from plantain pseudo-stems to enhance the quality of greywater through simple biofiltration setups. Greywater sourced from the GETFund Hostel of the University of Energy and Natural Resources in Sunyani, Ghana, served as the focal point of our investigation. Through the application of this biofilter, we achieved notable reductions in two crucial parameters for assessing greywater quality: biochemical oxygen demand (BOD) and chemical oxygen demand (COD), averaging at 30.4 % and 28.67 %, respectively. Furthermore, we conducted comparative analyses between the efficacy of plantain pseudo-stem fibers and carbonized coconut shell adsorbent, both individually and in composite form as biosorbents. While certain combinations of biofilters led to slight increases in conductivity, pH, and total dissolved solids (TDS) in the treated greywater, these variations were anticipated and attributed to potential organic matter leaching during the biofiltration process. Employing Fourier-transform infrared (FT-IR) spectroscopy, we detected significant spectral changes indicative of successful organic matter removal from the greywater. Specifically, we observed an intensified phenolic hydroxyl (OH) peak at 3300 cm⁻¹, which shifted marginally to 3335 cm⁻¹ post-biofiltration. Additionally, the emergence of a carboxylic hydroxyl stretch at 2850 cm⁻¹ post-biofiltration provided strong evidence supporting the efficacy of our approach in mitigating organic contaminants in greywater.

Climate change poses a significant threat to the security and sustainability of global food systems, particularly in vulnerable regions such as Bangladesh. This paper comprehensively reviews the impact of climate change on food system security and sustainability in Bangladesh. Specifically, it examines the country's food system and, the climatic conditions endangering food systems and associated vulnerabilities. A systematic review methodology was adopted to select the relevant literature, based on predefined inclusion criteria and research questions. To mitigate selection bias, the research team independently screened and evaluated the articles for inclusion in the review process. Our review reveals increasing trends in temperature fluctuations and irregular rainfall occurrences, posing significant challenges in terms of crop management and planning. The occurrence of floods due to extreme rainfall and sea-level rise exacerbates food insecurity in affected areas. Additionally, moderate to severe droughts have been identified in some regions. The paper also evaluates the effectiveness of current adaptation initiatives and the degree of integration among relevant stakeholders. Through this analysis, the paper emphasizes the importance of local climate-change adaptation strategies and stakeholder collaboration in mitigating the adverse impacts of climate-change on food system security. HIGHLIGHTS The study identifies the climate-change challenges to Bangladesh's fragile food system.; Economic losses and rice production decline are identified due to climate change.; Emphasis on local adaptation initiatives to build resilience among farmers.; Recognition of challenges in existing adaptation efforts.; Call for government-led scaling-up of adaptation programs to enhance food system security and sustainability.;

Abstract Dirac and Weyl semimetals are a central topic of contemporary condensed matter physics, and the discovery of new compounds with Dirac/Weyl electronic states is crucial to the advancement of topological materials and quantum technologies. Here we show a widely applicable strategy that uses high configuration entropy to engineer relativistic electronic states. We take the AMnSb2 (A = Ba, Sr, Ca, Eu, and Yb) Dirac material family as an example and demonstrate that mixing of Ba, Sr, Ca, Eu and Yb at the A site generates the compound (Ba0.38Sr0.14Ca0.16Eu0.16Yb0.16)MnSb2 (denoted as A 5MnSb2), giving access to a polar structure with a space group that is not present in any of the parent compounds. A 5MnSb2 is an entropy-stabilized phase that preserves its linear band dispersion despite considerable lattice disorder. Although both A 5MnSb2 and AMnSb2 have quasi-two-dimensional crystal structures, the two-dimensional Dirac states in the pristine AMnSb2 evolve into a highly anisotropic quasi-three-dimensional Dirac state triggered by local structure distortions in the high-entropy phase, which is revealed by Shubnikov–de Haas oscillations measurements.

Kai-Michael Beeh,1 Kieran J Rothnie,2 Jing Claussen,3 Fränce Hardtstock,4 Rachel K Knapp,4 Thomas Wilke,5 Alexandrosz Czira,2 Chris Compton,6 Afisi S Ismaila7,8 1Insaf Respiratory Research Institute, Wiesbaden, Germany; 2Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, UK; 3Global Medical Affairs, GSK, Munich, Germany; 4Real World & Advanced Analytics (RWAA), Cytel, Berlin, Germany; 5IPAM e.V., Institute affiliated with University of Wismar, Wismar, Germany; 6Global Medical, GSK, London, UK; 7Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA; 8Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Afisi S Ismaila, Value Evidence and Outcomes, GSK, 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USA, Tel +1 919 315 8229, Email afisi.s.ismaila@gsk.comPurpose: To assess patient characteristics of users and new initiators of triple therapy for chronic obstructive pulmonary disease (COPD) in Germany.Patients and Methods: Retrospective cohort study of patients with COPD and ≥ 1 prescription for single-inhaler triple therapy (SITT; fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or beclomethasone dipropionate/glycopyrronium bromide/formoterol [BDP/GLY/FOR]) or multiple-inhaler triple therapy (MITT), using data from the AOK PLUS German sickness fund (1 January 2015– 31 December 2019). The index date was the first date of prescription for FF/UMEC/VI or BDP/GLY/FOR (SITT users), or the first date of overlap of inhaled corticosteroid, long-acting β2-agonist, and long-acting muscarinic antagonist (MITT users). Two cohorts were defined: the prevalent cohort included all identified triple therapy users; the incident cohort included patients newly initiating triple therapy for the first time (no prior use of MITT or SITT in the last 2 years). Patient characteristics and treatment patterns were assessed on the index date and during the 24-month pre-index period.Results: In total, 18,630 patients were identified as prevalent triple therapy users (MITT: 17,945; FF/UMEC/VI: 700; BDP/GLY/FOR: 908; non-mutually exclusive) and 2932 patients were identified as incident triple therapy initiators (MITT: 2246; FF/UMEC/VI: 311; BDP/GLY/FOR: 395; non-mutually exclusive). For both the prevalent and incident cohorts, more than two-thirds of patients experienced ≥ 1 moderate/severe exacerbation in the preceding 24 months; in both cohorts more BDP/GLY/FOR users experienced ≥ 1 moderate/severe exacerbation, compared with FF/UMEC/VI and MITT users. Overall, 97.9% of prevalent triple therapy users and 86.4% of incident triple therapy initiators received maintenance treatment in the 24-month pre-index period.Conclusion: In a real-world setting in Germany, triple therapy was most frequently used after maintenance therapy in patients with recent exacerbations, in line with current treatment recommendations.Plain Language Summary: Triple therapy (a combination of three different respiratory inhaled medications) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience repeated short-term symptom flare-ups when taking dual therapy (a combination of two different respiratory medications). Previously, patients had to take triple therapy using two or three separate inhalers. More recently, single-inhaler triple therapies have been developed, meaning patients can take all three different medications at the same time via one single inhaler. This study assessed the characteristics of patients who were already receiving triple therapy, or who started triple therapy (either via multiple inhalers or a single inhaler), in Germany between January 2015 and December 2019.In total, 18,630 patients who were already receiving triple therapy during the study period, and 2932 patients who newly started using triple therapy were included. The study reported that more than two-thirds of included patients had experienced at least one flare-up of COPD symptoms in the 2 years before starting triple therapy. Most patients had also received another therapy for COPD before starting triple therapy. A small proportion of patients started taking triple therapy after receiving no other therapy for COPD in the previous 2 years.The results of the study suggest that triple therapy for COPD in Germany is most often used in accordance with recommendations (patients already receiving therapy and experiencing repeated symptom flare-ups).Keywords: COPD, Germany, MITT, patient characteristics, real-world treatment, SITT

In a survey conducted in March 2023, Euphorbia hypogaea plants cultivated within greenhouses in Yongin, Korea exhibited water-soaked areas near the stem base, close to the soil. Subsequent isolation from diseased E. hypogaea led to the identification of a bacterial strain, designated as CBNUMPBL-103. The isolate was identified as Dickeya dadantii through sequencing of the 16s rRNA and phylogenetic analysis. The pathogenicity of the isolate was confirmed by inoculating it into healthy E. hypogaea, resulting in the manifestation of similar symptoms observed during the survey. The re-isolated strain recovered from inoculated plants showed a similar morphology with the inoculated strain. This is the first documentation of D. dadantii causing soft rot of E. hypogaea in Korea.

Abstract Background Neuropsychiatric disorders significantly burden individuals and society, necessitating the exploration of innovative treatment approaches. Non-invasive brain stimulation techniques have emerged as promising interventions for these disorders, offering potential therapeutic benefits with minimal side effects. This narrative review provides a comprehensive overview of non-invasive brain stimulation techniques' current applications and future directions in managing neuropsychiatric disorders. Methods A thorough search of relevant literature was conducted to identify studies investigating non-invasive brain stimulation techniques in neuropsychiatric disorders. The selected studies were critically reviewed, and their findings were synthesised to provide a comprehensive overview of the current state of knowledge in the field. Results The review highlights the current applications of non-invasive brain stimulation techniques in neuropsychiatric disorders, including major depressive disorder, Parkinson's disease, schizophrenia, insomnia, and cognitive impairments. It presents evidence supporting the efficacy of these techniques in modulating brain activity, alleviating symptoms, and enhancing cognitive functions. Furthermore, the review addresses challenges such as interindividual variability, optimal target site selection, and standardisation of protocols. It also discusses potential future directions, including exploring novel target sites, personalised stimulation protocols, integrating with other treatment modalities, and identifying biomarkers for treatment response. Conclusion Non-invasive brain stimulation techniques offer promising avenues for managing neuropsychiatric disorders. Further research is necessary to optimise stimulation protocols, establish standardised guidelines, and identify biomarkers for treatment response. The findings underscore the potential of non-invasive brain stimulation techniques as valuable additions to the armamentarium of neuropsychiatric treatments.

IntroductionCancers are a major cause of childhood mortality worldwide especially in LMICs where underdiagnoses and lack of quality cancer data hampers effective cancer control efforts. This study aimed to document and describe the patterns and characteristics of childhood cancers in the North East geopolitical zone of Nigeria.MethodsThis was a retrospective cross-sectional study that collected cancer data from 4 out of the 6 states in the North East of Nigeria. The data included all malignancies diagnosed in children aged 0-19 years between 2019 and 2022. The age-specific incidence rates were also calculated for the individual 5-year age groups (0–4 years, 5–9 years, 10–14 years, and 15–19 years). The crude incidence rates (CIR) were calculated as the weighted averages of the respective ASRs in each age range within 0-14 years and 0-19 years respectively. The cancers were grouped according to the International Incidence of Childhood Cancers, volume 3 (IICC3).ResultsCancers in people

BackgroundTo effectively control tuberculosis (TB), it is crucial to distinguish between active TB disease and latent TB infection (LTBI) to provide appropriate treatment. However, no such tests are currently available. Immune responses associated with active TB and LTBI are dynamic and exhibit distinct patterns. Comparing these differences is crucial for developing new diagnostic methods and understanding the etiology of TB. This study aimed to investigate the relationship between pro- and anti-inflammatory CD4+ cytokine production following stimulation with two types of latency-associated Mycobacterium tuberculosis (M.tb) antigens to allow differentiation between active TB and LTBI.MethodsCryopreserved PBMCs from patients with active TB disease or LTBI were stimulated overnight with replication-related antigen [ESAT-6/CFP-10 (E/C)] or two latency-associated antigens [heparin-binding hemagglutinin (HBHA) and alpha-crystallin-like protein (Acr)]. Responses were analyzed using multiparameter flow cytometry: active TB disease (n=15), LTBI (n=15) and ELISA: active TB disease (n=26) or LTBI (n=27).ResultsCD4+ central memory T cells (Tcm) specific to E/C and CD4+ effector memory T cells specific to Acr and HBHA were higher in LTBI than in TB patients. IFN-γ+Tcm and IL-17+ Tem cells was higher in the LTBI group (p= 0.012 and p=0.029 respectively), but IL-10+ Tcm was higher in the active TB group (p= 0.029) following HBHA stimulation. Additionally, following stimulation with HBHA, IL-10 production from CD4+ T cells was significantly elevated in patients with active TB compared to those with LTBI (p= 0.0038), while CD4+ T cell production of IL-17 and IFN-γ was significantly elevated in LTBI compared to active TB (p= 0.0076, p< 0.0001, respectively). HBHA also induced more CCR6+IL-17+CD4Tcells and IL-17+FoxP3+CD25+CD4Tcells in LTBI than in TB patients (P=0.026 and P=0.04, respectively). HBHA also induced higher levels of IFN-γ+IL-10+CD4+ T cells in patients with active TB (Pp=0.03) and higher levels of IFN-γ+IL-17+ CD4+ T cells in those with LTBI (p=0.04). HBHA-specific cytokine production measured using ELISA showed higher levels of IFN-γ in participants with LTBI (P=0.004) and higher levels of IL-10 in those with active TB (P=0.04).ConclusionStimulation with HBHA and measurement of CD4+ T cell production of IFN-γ, IL-10, and IL-17 could potentially differentiate active TB from LTBI. The characteristics of cytokine-expressing cells induced by HBHA also differed between participants with active TB and LTBI.

The research is set to predict solar irradiation using various machine learning algorithms. This is done in order to construct and develop a high-efficiency prediction model that uses actual meteorological data to predict daily solar irradiance for the town of Zaria, Nigeria. To assist utilities working in various solar energy generation and monitoring stations in making effective solar energy generation management system decisions. Four machine learning models (artificial neural network (ANN), decision tree (DT), random forest (RF), and gradient boost tree (GBT).) were used to predict and compare actual and anticipated solar radiation values. The results reveal that meteorological characteristics (min-humidity, max-temperature, day, month, and wind direction) are critical in machine learning model training. The solar radiation prediction skills of multi-layer perceptron and decision tree models were low. In the prediction of daily solar irradiation, the ensemble learning models of random forest and gradient boost tree outperformed the other models. The random forest model is shown to be the most accurate in predicting solar irradiation.

BackgroundType 1 (T1D) and type 2 (T2D) diabetes lead to an aberrant metabolism of sialoglycoconjugates and elevated free serum sialic acid (FSSA) level. The present study evaluated sialidase and sialyltranferase activities in serum and some organs relevant to diabetes at early and late stages of T1D and T2D.MethodsSialic acid level with sialidase and sialyltransferase activities were monitored in the serum, liver, pancreas, skeletal muscle and kidney of diabetic animals at early and late stages of the diseases.ResultsThe FSSA and activity of sialidase in the serum were significantly increased at late stage of both T1D and T2D while sialic acid level in the liver was significantly decreased in the early and late stages of T1D and T2D, respectively. Furthermore, the activity of sialidase was significantly elevated in most of the diabetes-relevant organs while the activity of sialyltransferase remained largely unchanged. A multiple regression analysis revealed the contribution of the liver to the FSSA while pancreas and kidney contributed to the activity of sialidase in the serum.ConclusionsWe concluded that the release of hepatic sialic acid in addition to pancreatic and renal sialidase might (in)directly contribute to the increased FSSA during both types of diabetes mellitus.

Whitefly-transmitted viruses have emerged as a major threat to cucurbit production in the United States during the past several decades. Cucurbit chlorotic yellows virus (CCYV), Cucurbit yellow stunting disorder virus (CYSDV), and Cucurbit leaf crumple virus (CuLCrV) are the main arthropod-borne plant viruses in cucurbit crops, including yellow squash (Cucurbita pepo). Symptoms of these viruses include interveinal chlorosis, chlorotic spots, yellowing, and curling of the leaves. The evaluation of specific viruses affecting a plant is challenging because of the prevalence of mixed infections in naturally infected fields. To devise an efficient breeding-based management approach, two PI lines (PI 171625 and PI 171627) were screened in a greenhouse to assess their resistance to individual infections of CCYV and CuLCrV. These lines were compared against a susceptible cultivar Gentry in two separate trials. PI 171627 displayed delayed symptoms, a reduced virus load, and a smaller area under the disease progress curve (AUDPC) compared with PI 171625 and susceptible cultivar Gentry when the plants were infected with CCYV. However, the AUDPC for CuLCrV was the same for both genotypes and the commercial line. Accession PI 171627, which displayed delayed and milder symptoms, could potentially provide a source for resistance against CCYV for breeding program. Future research is needed to comprehend the underlaying mechanism to understand this response.

Anthropogenic exposure of domestic animals, as well as wildlife, can result in zoonotic transmission events with known and unknown pathogens including sarbecoviruses. During the COVID-19 pandemic, SARS-CoV-2 infections in animals, most likely resulting from spill-over from humans, have been documented worldwide. However, only limited information is available for Africa. The anthropozoonotic transmission from humans to animals, followed by further inter- and intraspecies propagation may contribute to viral evolution, and thereby subsequently alter the epidemiological patterns of transmission. To shed light on the possible role of domestic animals and wildlife in the ecology and epidemiology of sarbecoviruses in Nigeria, and to analyze the possible circulation of other, undiscovered, but potentially zoonotic sarbecoviruses in animals, we tested 504 serum samples from dogs, rabbits, bats, and pangolins collected between December 2020 and April 2022. The samples were analyzed using an indirect multi-species enzyme-linked immunosorbent assay (ELISA) based on the receptor binding domain (RBD) of SARS-CoV and SARS-CoV -2, respectively. ELISA reactive sera were further analyzed by highly specific virus neutralization test and indirect immunofluorescence assay for confirmation of the presence of antibodies. In this study, we found SARS-CoV reactive antibodies in 16 (11.5%) dogs, 7 (2.97%) rabbits, 2 (7.7%) pangolins and SARS-CoV-2 reactive antibodies in 20 (13.4%) dogs, 6 (2.5%) rabbits and 2 (7.7%) pangolins, respectively. Interestingly, 2 (2.3%) bat samples were positive only for SARS-CoV RBD reactive antibodies. These serological findings of SARS-CoV and/or SARS-CoV-2 infections in both domestic animals and wildlife indicates exposure to sarbecoviruses and requires further One Health-oriented research on the potential reservoir role that different species might play in the ecology and epidemiology of coronaviruses at the human-animal interface.

Artificial intelligence (AI) education in K–12 schools is a global initiative, yet planning and executing AI education is challenging. The major frameworks are focused on identifying content and technical knowledge (AI literacy). Most of the current definitions of AI literacy for a non-technical audience are developed from an engineering perspective and may not be appropriate for K–12 education. Teacher perspectives are essential to making sense of this initiative. Literacy is about knowing (knowledge, what skills); competency is about applying the knowledge in a beneficial way (confidence, how well). They are strongly related. This study goes beyond knowledge (AI literacy), and its two main goals are to (i) define AI literacy and competency by adding the aspects of confidence and self-reflective mindsets, and (ii) propose a more comprehensive framework for K–12 AI education. These definitions are needed for this emerging and disruptive technology (e.g., ChatGPT and Sora, generative AI). We used the definitions and the basic curriculum design approaches as the analytical framework and teacher perspectives. Participants included 30 experienced AI teachers from 15 middle schools. We employed an iterative co-design cycle to discuss and revise the framework throughout four cycles. The definition of AI competency has five abilities that take confidence into account, and the proposed framework comprises five key components: technology, impact, ethics, collaboration, and self-reflection. We also identify five effective learning experiences to foster abilities and confidences, and suggest five future research directions: prompt engineering, data literacy, algorithmic literacy, self-reflective mindset, and empirical research.

There is a need for teachers who are prepared to teach Artificial Intelligence (AI) across the K-12 learning contexts. Owing to the dearth of teacher education programmes on AI, it is helpful to explore factors to be considered in designing an effective AI programme for future teachers. We posit that understanding how to encourage pre-service teachers to learn AI is thus critical for practitioners and policymakers while designing effective instructional AI teacher education programmes. This exploratory study examined the perceptions of pre-service teachers and their behavioral intention to learn AI, by identifying factors that might affect learning and promoting AI in teacher preparation programmes. This study proposed a research model supported by the theory of planned behavior and expanded with other constructs. The factors that were examined include basic knowledge of AI, subjective norm, AI for social good, perceived self-efficacy, self-transcendent goals, personal relevance, AI anxiety, behavioral intention to learn AI, and actual learning of AI. Using a duly validated questionnaire, we surveyed 796 pre-service teachers in Nigerian Universities. Through structural equation modeling approach analyses, our proposed model explains about 79% of the variance in pre-service teachers' intention to learn AI. Basic knowledge and subjective norm were found to be the most important determinant in pre-service teachers’ intention to learn AI. All our hypotheses were supported except for self-efficacy and personal relevance, personal relevance and social good, and behavioral intention and actual learning behavior. The findings provide practitioners, researchers, and policymakers with valuable information to consider in designing effective AI teacher education programmes.

This study investigates how gender diversity and CEO culture affect sustainability performance in the banking industry. The sample used in the study was drawn from listed banks on the floor of the NGX group. The data were obtained from the Bloomberg Database with 88 firm-year observations (2011 to 2018). The regression estimate is based on a panel data approach. We found that female directors’ and CEOs’ cultures have greater tendencies to enhance sustainability performance proxied by ESG. Thus, the findings provide additional insight into the existing literature on sustainability and diversity initiatives as well as the resource dependency theory. It also adds to the existing literature on sustainability reporting. The findings, moreover, allude to the initiatives of the regulatory authority in the industry that emphasise the need to have a diversified board that includes female directors and other forms of diversity, for example, ethnicity.

The global shocks of COVID-19 and the Ukraine war on FDI inflows in European countries, particularly Eastern Europe, have been subjects of a serious debate among EU policymakers. This study assesses the level of impact of the two global shocks on FDI in 39 European countries (ECs) and 20 Eastern European countries (EECs) from 2020 Q1 to 2022 Q4. For the comparative analysis, a static panel regression is used. Our findings demonstrate that variations in the levels of stringency measures related to COVID-19 in individual countries are significantly associated with increased FDI inflows. This suggests that investors will increase investment in countries with stricter measures to limit crises. While variations in COVID19 total cases are associated with increased FDI inflows in Europe but with decreased FDI inflows in Eastern Europe, we find that the crisis may have created new opportunities or incentives for foreign investors in Europe compared to Eastern Europe.

This study was carried out to determine the nutritional and phytochemical properties of freshly harvested grains of Sorghum bicolor and Zea mays using standard biochemical procedures. Nutritional properties analyzed included proximate composition analyzed using Soxhlet extraction, AOAC Kjeldal methods. Mineral contents were determined using Atomic Absorption Spectrophotometry [AAS] while the phytochemicals were determined using standard procedures. All analyses were replicated three times. From the results, crude protein content was low, with values, 7.81% and 6.66% for Sorghum bicolor and Zea mays respectively. Lipid analysis showed that Sorghum bicolor had a higher lipid content of 16.57%. Crude carbohydrate content was higher in both seeds. Percentage of crude fiber was 11.20% and 8.11% for Sorghum bicolor and Zea mays respectively. Vitamin C analysis showed that Zea mays had a higher content of 122.14 mg/100 g. Available energy kj/100 g was also analyzed for Sorghum bicolor and Zea mays respectively. Significant differences (P=0.05) was observed in crude lipid, crude fiber, vitamin C, and available energy between the two seeds. Mineral analysis revealed appreciable contents of minerals necessary for healthy growth and development. Calcium content was highest in Sorghum bicolor. Significant differences (P=0.05) was observed in phosphorus, magnesium, calcium, and iron between the two seed types. Phytochemical contents of the seeds showed significant differences (P=0.05) in tannins, nitrates and saponin with 12.57 mg/100 g, 18.18 mg/100 g and respectively in Sorghum bicolor and Zea mays. Nitrate and saponin content was higher in Zea mays. Alkaloid, flavonoids and phytate contents was detected in both seeds. Minute amounts of oxalate and cyanide were detected in both seed types. It is important to note that Zea mays is under pressure as one of formidable food source due to the increasing demand, and thus, increasing the cultivation of Sorghum bicolor could alleviate the over dependence on maize as the primary source of nutrition for humans and animal feed formulation.

Plant pathogenic bacteria colonize plant surfaces and inner tissues to acquire essential nutrients. Nonstructural sugars hold paramount significance among these nutrients, as they serve as pivotal carbon sources for bacterial sustenance. They obtain sugar from their host by diverting nonstructural carbohydrates en route to the sink or enzymatic breakdown of structural carbohydrates within plant tissues. Despite the prevalence of research in this domain, the area of sugar selectivity and preferences exhibited by plant pathogenic bacteria remains inadequately explored. Within this expository framework, our present review endeavors to elucidate the intricate variations characterizing the distribution of simple sugars within diverse plant tissues, thus influencing the virulence dynamics of plant pathogenic bacteria. Subsequently, we illustrate the apparent significance of comprehending the bacterial preference for specific sugars and sugar alcohols, postulating this insight as a promising avenue to deepen our comprehension of bacterial pathogenicity. This enriched understanding, in turn, stands to catalyze the development of more efficacious strategies for the mitigation of plant diseases instigated by bacterial pathogens.

Alexandrosz Czira,1 Shoko Akiyama,2 Takeo Ishii,2 Robert P Wood,3 Lucinda J Camidge,3 Hannah Wallis,3 Thomas Jennison,3 Rosie AC Wild,3 Masao Yarita,2 Kenichi Hashimoto,2 Kieran J Rothnie,1 Afisi S Ismaila4,5 1Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, Middlesex, UK; 2Value Evidence and Outcomes, Japan Medical and Development, GSK, Tokyo, Japan; 3Real-World Evidence, Adelphi Real World, Bollington, UK; 4Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA; 5Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Kieran J Rothnie, Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, Middlesex, TW8 9GS, UK, Tel +44 7920 369573, Email kieran.j.rothnie@gsk.comPurpose: There is currently limited evidence for the optimal timing of triple therapy initiation in Japan, which is crucial for optimizing strategies for the effective treatment of chronic obstructive pulmonary disease (COPD). This study assessed the impact of prompt vs delayed initiation of triple therapy following a COPD exacerbation on clinical and economic outcomes in patients in Japan.Patients and Methods: Retrospective cohort study of patients in the Medical Data Vision Co., Ltd. database initiating triple therapy as single-inhaler triple therapy (fluticasone furoate/umeclidinium/vilanterol or budesonide/glycopyrronium/formoterol) or multiple-inhaler triple therapy within 180 days of a moderate-to-severe exacerbation (index). For the main analysis, patients were categorized as prompt or delayed initiators, initiating triple therapy within 0– 30 days or 31– 180 days of index, respectively. Inverse probability of treatment weighting based on propensity scores was used to adjust for measured confounders between prompt and delayed cohorts.Results: For the main analysis, 610 (60.3%) and 402 (39.7%) patients were prompt and delayed initiators, respectively. The rate of subsequent moderate-to-severe exacerbations following index exacerbation was numerically lower in prompt vs delayed initiators (weighted rate ratio 0.95, 95% confidence interval [CI]: 0.74– 1.21; P = 0.6603). Time-to-first subsequent moderate-to-severe exacerbation increased significantly in prompt vs delayed initiators (weighted hazard ratio 0.77, 95% CI: 0.64– 0.93; P = 0.0053). In patients indexed on a severe exacerbation, delayed initiation resulted in significantly higher 90-day all-cause readmissions vs prompt initiation (42.1% vs 30.6%; P = 0.0329 [weighted estimates]). Weighted healthcare resource utilization rates were numerically lower in prompt vs delayed initiators, and weighted direct costs (all cause and COPD-related) were significantly lower in prompt initiators.Conclusion: This real-world study demonstrated that earlier initiation of triple therapy resulted in several benefits in clinical outcomes for COPD and may also reduce the economic burden of COPD management in Japan.Plain Language Summary: Patients with chronic obstructive pulmonary disease (COPD) can experience flare-ups in their symptoms, known as exacerbations. If exacerbations continue despite patients taking either one or a combination of two respiratory medications, guidelines suggest that they should take a combination of three treatments, known as triple therapy. In Japan, the best timing for patients to start triple therapy following an exacerbation is currently unknown, therefore this study compared the impact on clinical and economic outcomes of patients starting triple therapy 0– 30 days (prompt initiators) or 31– 180 days (delayed initiators) after their first exacerbation. When looking at clinical outcomes for COPD, we found that prompt initiators had a significantly longer time period from starting triple therapy to experiencing their next moderate-to-severe exacerbation, and those who had an initial severe exacerbation had significantly fewer hospital readmissions during the 90 days that followed their initial exacerbation than delayed initiators. When looking at economic outcomes for COPD, we found that medical costs were significantly lower in prompt versus delayed initiators. Findings of this study suggest that starting triple therapy earlier following an exacerbation may lead to improved clinical outcomes for patients with COPD in Japan and can reduce the cost of managing this disease.Keywords: healthcare resource utilization, hospital readmissions, direct medical costs, inverse probability of treatment weighting, single inhaler triple therapy, multiple inhaler triple therapy

Este artículo se enfocó en realizar un análisis documental sobre la educación inclusiva, identificando las ideas clave y más significativas que resaltan la presencia de la diversidad en el ámbito educativo. Se destacó la importancia de recabar información sobre métodos pedagógicos que permitan a los educadores adaptarse a los cambios hacia una educación más inclusiva. Se llegó a la conclusión de que es imprescindible para los docentes desarrollar estrategias que promuevan valores de inclusión educativa. En este sentido, la postura y el comportamiento del docente dentro del aula juegan un papel crucial en el éxito de este proceso inclusivo, el cual está marcado por una diversidad de creencias y emociones, algunas de las cuales pueden ser favorables y otras no.

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

With the advancement of technology, emerging technologies like Artificial Intelligence (AI) have also been growing rapidly and becoming more common than ever before. Kenya has taken tremendous steps in adopting the use of emerging technology in different sectors of the economy. In realization of the need to have a skilled digital workforce to develop solutions using these emerging technologies, Kenya has undertaken curriculum reforms and introduced the Competency-Based Curriculum (CBC) which has included digital literacy and coding in elementary school. Furthermore, computer science has been introduced in Junior Secondary School. In view of these changes, teachers should be adequately prepared with knowledge, skills, and attitudes to effectively teach these new technologies. However, in Kenya, AI was not and still is not part of the teacher training curriculum. Additionally, there are inadequate professional development opportunities in AI for both pre-service and in-service teachers since AI is not part of the CBC curriculum. That notwithstanding, it is inevitable for teachers in the current world to introduce AI to learners. Therefore, this study's objectives were to assess the confidence in AI, attitudes toward AI, AI ethics, subjective norms, perceived threats, and the readiness to teach AI among Kenyan K-12 in-service teachers and to assess how these factors influence their readiness to teach AI. To achieve these objectives, this study employed a quantitative research methodology by administering a survey using Google Forms to a random sample of 308 teachers from different grades from 37 out of 47 counties in Kenya. The findings showed that confidence in AI, AI ethics and subjective norms significantly influenced AI readiness while attitude towards AI and perceived threats did not significantly influence AI readiness. These results are significant in providing a basis for education policy change on AI education in Kenya, such as transforming the teacher training curriculum to include AI and designing AI professional development programs for in-service teachers to ensure they are well-equipped to teach AI.

Urban water consumption has significant implications for both human welfare and the environment, especially in arid regions. In Saudi Arabia, where 60% of the urban water supply relies on energy-intensive desalination processes, the average per capita water consumption rate of 300 L/day is one of the highest worldwide. This study investigates potential behavioral patterns in residential water consumption among households in Saudi Arabia. A segmentation approach is employed to classify residents into clusters and evaluate their potential water consumption behavioral patterns. Data from 618 households were collected via a structured questionnaire and analyzed using descriptive statistics, principal component analysis (PCA), and cluster analysis (CA). Participants were categorized into six segments based on the relationship between their behaviors and water consumption derived from the factor analysis. The outcomes of PCA and CA analyses indicate a relationship between respondents’ socio-demographic factors and their potential behavioral patterns in residential water consumption. The findings highlight that education, household size, income, housing type, age, and nationality, in increasing order of significance, are the key factors influencing household water consumption and conservation tendencies. The paper concludes that comprehending residential water consumption patterns is crucial for effective interventions, social marketing strategies, and communication campaigns for behavioral changes. The study can inform water conservation policies and programs that promote sustainable water consumption practices, benefiting agencies, policymakers, and scholars in the water sector.

Kieran J Rothnie,1 Beade Numbere,1 Steven Gelwicks,2 Yifei Lu,1,3 Raj Sharma,4 Chris Compton,4 Afisi S Ismaila,2,5 Jennifer K Quint6 1Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK; 2Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA; 3Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 4Global Medical, GSK, London, UK; 5Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 6National Heart and Lung Institute, Imperial College London, London, UKCorrespondence: Kieran J Rothnie, Value Evidence and Outcomes, R&D Global Medical, GSK, 980 Great West Road, Brentford, Middlesex, London, TW8 9GS, UK, Tel +44 208 990 3439, Email kieran.j.rothnie@gsk.comPurpose: Risk factors for exacerbations of chronic obstructive pulmonary disease (COPD) have been previously characterized for patients with more severe cases of COPD. It is unclear how the risk of first exacerbation may best be identified in patients with less severe disease. This study investigated risk factors for first exacerbation among English patients with COPD classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A or B.Patients and Methods: A retrospective cohort study using data from the UK Clinical Practice Research Datalink (CPRD) AURUM linked to Hospital Episode Statistics. Patients with COPD aged ≥ 35 years and classified as GOLD group A or B (2020 criteria) from January 2013–December 2019 were eligible. Patients were required to have 24 months history in CPRD (baseline). Two cohorts were defined: cohort 1 included patients with no severe exacerbations during baseline; cohort 2 included patients with no moderate or severe exacerbations during baseline. Risk factors associated with severe, or combined moderate and severe exacerbation were examined for up to 5 years of follow-up.Results: Overall, 194,948 patients were included in cohort 1 (mean age 66.2 years; 55.2% male), and 148,396 patients in cohort 2 (mean age 66.1 years; 56.6% male). Identified risk factors for exacerbation (and associated 1-year absolute risk of severe, or combined moderate and severe exacerbation, respectively) included: Medical Research Council dyspnea scale score (15.9%/28.4%); COPD Assessment Test score (9.6%/25.3%); GOLD grade of airflow limitation (forced expiratory volume in 1 second % predicted; 13.6%/27.5%); and lung cancer (8.1%/23.6%). After adjustment for risk factors, these factors remained independently associated with severe exacerbation at 1, 3, and 5 years of follow-up.Conclusion: The identified risk factors may aid physicians in the early recognition of patients with COPD classified as GOLD group A or B at risk of first exacerbation.Keywords: COPD, CPRD, exacerbation, GOLD A/B, risk factor, UK

Abstract Background The non-medical use of prescription drugs is a growing public health problem worldwide. Recent trends in Cameroon show that the use of psychoactive substances, among which are prescription drugs by adolescents is becoming a public health issue and is linked to juvenile delinquency and violence in schools. However, there is a paucity of data on the burden of this phenomenon among adolescent secondary school students in the country. The aim of this study was to determine the prevalence and factors associated with the use of non-prescription drugs in secondary schools in Buea, South West region of Cameroon. Methods We conducted a cross-sectional study from 1st February 2021 to 30th April 2021. Secondary school students were recruited using a multistage stratified cluster sampling. A modified and standardized version of the World Health Organization student drug-use survey model questionnaire was used. Ethical approval was obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea (No. 2021/1273–02/UB/SG/IRB/FHS). The Statistical Package for Social Sciences, IBM SPSS Statistics for Windows, Version 25.0. was used for data analysis. Descriptive statistics were used to describe the sociodemographic characteristics of participants. Univariate and multivariate logistic regression models were used to explore associated factors of non-medical use of prescription drugs. Results A total of 570 participants were enrolled for the study, and 510 participants responded giving a response rate of 89.5%. The prevalence of non-medical use of prescription drugs was 15.3%, tramadol being the most used. Motivators for non-medical use of prescription drugs were “to work longer”, “to be courageous”, and “curiosity”. Logistic regression results showed that alcohol consumption [OR 3.68; 95% CI: 2.24–6.06; p

Abstract There is tremendous interest in employing collective excitations of the lattice, spin, charge, and orbitals to tune strongly correlated electronic phenomena. We report such an effect in a ruthenate, Ca3Ru2O7, where two phonons with strong electron-phonon coupling modulate the electronic pseudogap as well as mediate charge and spin density wave fluctuations. Combining temperature-dependent Raman spectroscopy with density functional theory reveals two phonons, B 2 P and B 2 M, that are strongly coupled to electrons and whose scattering intensities respectively dominate in the pseudogap versus the metallic phases. The B 2 P squeezes the octahedra along the out of plane c-axis, while the B 2 M elongates it, thus modulating the Ru 4d orbital splitting and the bandwidth of the in-plane electron hopping; Thus, B 2 P opens the pseudogap, while B 2 M closes it. Moreover, the B 2 phonons mediate incoherent charge and spin density wave fluctuations, as evidenced by changes in the background electronic Raman scattering that exhibit unique symmetry signatures. The polar order breaks inversion symmetry, enabling infrared activity of these phonons, paving the way for coherent light-driven control of electronic transport.

Gema Requena,1 Alexandrosz Czira,1 Victoria Banks,2 Robert Wood,2 Theo Tritton,2 Catherine Castillo,2 Jie Yeap,2 Rosie Wild,2 Chris Compton,1 Kieran J Rothnie,1 Felix JF Herth,3 Jennifer K Quint,4 Afisi S Ismaila5,6 1GSK, R&D Global Medical, Brentford, Middlesex, UK; 2Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK; 3Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, Heidelberg, Germany; 4National Heart and Lung Institute, Imperial College London, London, UK; 5Value Evidence and Outcomes, GSK, Collegeville, PA, USA; 6Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Gema Requena, Epidemiology, Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, Middlesex, UK, Tel +44 20 80476893, Email gema.x.requena@gsk.comPurpose: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with significant morbidity and mortality and increased economic healthcare burden for patients with COPD. Long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) dual therapy is recommended for patients receiving mono-bronchodilator therapy who experience exacerbations or ongoing breathlessness. This study compared two single-inhaler LAMA/LABA dual therapies, umeclidinium/vilanterol (UMEC/VI) and indacaterol/glycopyrronium (IND/GLY), on moderate-to-severe exacerbation rates in patients with COPD in England.Patients and Methods: This retrospective cohort study used linked primary care electronic health record data (Clinical Practice Research Datalink-Aurum) and secondary care data (Hospital Episode Statistics) to assess outcomes for patients with COPD who had a first prescription for single-inhaler UMEC/VI or IND/GLY (index date) between 1 January 2015 and 30 September 2019 (indexing period). Analyses compared UMEC/VI and IND/GLY on moderate-to-severe, moderate, and severe exacerbations, healthcare resource utilization (HCRU), and direct costs at 6, 12, 18, and 24 months, and time-to-first on-treatment exacerbation up to 24 months post-index date. Following inverse probability of treatment weighting (IPTW), non-inferiority and superiority of UMEC/VI versus IND/GLY were assessed.Results: In total, 12,031 patients were included, of whom 8753 (72.8%) were prescribed UMEC/VI and 3278 (27.2%) IND/GLY. After IPTW, for moderate-to-severe exacerbations, weighted rate ratios were < 1 at 6, 12, and 18 months and equal to 1 at 24 months for UMEC/VI; around the null value for moderate exacerbations and < 1 at all timepoints for severe exacerbations. UMEC/VI showed lower HCRU incidence rates than IND/GLY for all-cause Accident and Emergency visits and COPD-related inpatient stays and associated all-cause costs at 6 months post-indexing. Time-to-triple therapy was similar for both treatments.Conclusion: UMEC/VI demonstrated non-inferiority to IND/GLY in moderate-to-severe exacerbation reduction at 6, 12 and 18 months. These results support previous findings demonstrating similarity between UMEC/VI and IND/GLY on reduction of moderate-to-severe exacerbations.Plain Language Summary: Sudden exacerbations, or flare-ups, of chronic obstructive pulmonary disease (COPD) are linked with worsening health and increased risk of death, as well as increased healthcare costs for people with COPD. Long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) dual therapy is recommended for patients with COPD who take LAMA or LABA monotherapy but continue to experience flare-ups or ongoing breathlessness. This study compared two single-inhaler LAMA/LABA dual therapies, umeclidinium/vilanterol (UMEC/VI) and indacaterol/glycopyrronium (IND/GLY), in terms of flare-ups in patients with COPD in England.We used two linked databases of de-identified medical records from general practitioners and hospitals for patients with COPD who had a first prescription for UMEC/VI or IND/GLY between 1 January 2015 and 30 September 2019. We compared the two treatments on COPD flare-ups, healthcare resource utilization and related costs, and changes in medication over the 2 years following starting treatment.We found that the treatments were comparable for moderate-to-severe flare-ups. Patients taking UMEC/VI had less Accident and Emergency (A&E) visits in total and less inpatient stays related to their COPD, and had a lower overall cost of healthcare for A&E visits and inpatient stays than patients taking IND/GLY. Changes to treatment and time before their first flare-up were similar for all patients, regardless of their prescribed treatment.This study showed that UMEC/VI is as effective as IND/GLY at preventing moderate-to-severe flare-ups. These results support previous findings demonstrating similarity between UMEC/VI and IND/GLY in reducing the rate of moderate-to-severe exacerbations after starting treatment.Keywords: COPD dual therapy, LABA/LAMA new users, healthcare resource utilization, exacerbations, comparative effectiveness, single-inhaler dual therapy

Abstract Our understanding of the drivers of the temporal dynamics of livestock mobility networks is currently limited, despite their significant implications for the surveillance and control of infectious diseases. We analyzed the effect of time-varying environmental and economic variables—biomass production, rainfall, livestock market prices, and religious calendar on long-distance movements of cattle and small ruminant herds in Senegal in the years 2014 and 2019. We used principal component analysis to explore the variation of the hypothesized explanatory variables in space and time and a generalized additive modelling approach to assess the effect of those variables on the likelihood of herd movement between pairs of administrative units. Contrary to environmental variables, the patterns of variation of market prices show significant differences across locations. The explanatory variables at origin had the highest contribution to the model deviance reduction. Biomass production and rainfall were found to affect the likelihood of herd movement for both species on at least 1 year. Market price at origin had a strong and consistent effect on the departure of small ruminant herds. Our study shows the potential benefits of regular monitoring of market prices for future efforts at forecasting livestock movements and associated sanitary risks.

In this study, we used a recently developed causal methodology, called Probabilistic Easy Variational Causal Effect (PEACE), to distinguish gliosarcoma (GSM) from glioblastoma (GBM). Our approach uses a causal metric which combines Probabilistic Easy Variational Causal Effect (PEACE) with the XGBoost, or eXtreme Gradient Boosting, algorithm. Unlike prior research, which often relied on statistical models to reduce dataset dimensions before causal analysis, our approach uses the complete dataset with PEACE and the XGBoost algorithm. PEACE provides a comprehensive measurement of direct causal effects, applicable to both continuous and discrete variables. Our method provides both positive and negative versions of PEACE together with their averages to calculate the positive and negative causal effects of the radiomic features on the variable representing the type of tumor (GSM or GBM). In our model, PEACE and its variations are equipped with a degree d which varies from 0 to 1 and it reflects the importance of the rarity and frequency of the events. By using PEACE with XGBoost, we achieved a detailed and nuanced understanding of the causal relationships within the dataset features, facilitating accurate differentiation between GSM and GBM. To assess the XGBoost model, we used cross-validation and obtained a mean accuracy of 83% and an average model MSE of 0.130. This performance is notable given the high number of columns and low number of rows (code on GitHub).

The use of low-cost environmental sensors has gained significant attention due to their affordability and potential to intensify environmental monitoring networks. These sensors enable real-time monitoring of various environmental parameters, which can help identify pollution hotspots and inform targeted mitigation strategies. Low-cost sensors also facilitate citizen science projects, providing more localized and granular data, and making environmental monitoring more accessible to communities. However, the accuracy and reliability of data generated by these sensors can be a concern, particularly without proper calibration. Calibration is challenging for low-cost sensors due to the variability in sensing materials, transducer designs, and environmental conditions. Therefore, standardized calibration protocols are necessary to ensure the accuracy and reliability of low-cost sensor data. This review article addresses four critical questions related to the calibration and accuracy of low-cost sensors. Firstly, it discusses why low-cost sensors are increasingly being used as an alternative to high-cost sensors. In addition, it discusses self-calibration techniques and how they outperform traditional techniques. Secondly, the review highlights the importance of selectivity and sensitivity of low-cost sensors in generating accurate data. Thirdly, it examines the impact of calibration functions on improved accuracies. Lastly, the review discusses various approaches that can be adopted to improve the accuracy of low-cost sensors, such as incorporating advanced data analysis techniques and enhancing the sensing material and transducer design. The use of reference-grade sensors for calibration and validation can also help improve the accuracy and reliability of low-cost sensor data. In conclusion, low-cost environmental sensors have the potential to revolutionize environmental monitoring, particularly in areas where traditional monitoring methods are not feasible. However, the accuracy and reliability of data generated by these sensors are critical for their successful implementation. Therefore, standardized calibration protocols and innovative approaches to enhance the sensing material and transducer design are necessary to ensure the accuracy and reliability of low-cost sensor data.

The COVID-19 pandemic has significantly disrupted human socioeconomic activities, leaving an everlasting impact on urban systems. As a result, there is a growing scholarly focus on exploring how urban planning strategies and tools can help create resilient cities. In Saudi Arabia, the pilgrimage city of Makkah, which has always faced the challenge of managing crowds during the annual pilgrimage, was left deserted due to lockdowns and social distancing measures. To quickly revive socioeconomic and pilgrimage activities in the city, a set of digital tools and communication technologies were deployed to manage crowds and enforce social distancing to minimize the spread of the COVID-19 virus. This study examines the role of digitalization and smartification in reviving the city and the importance of context in building urban resilience. This study used desktop research and case study analysis to highlight the transformation to the new normal and the development of future smart technologies for the city. Smart solutions provided valuable support in reducing the impacts of the pandemic and restarting Makkah’s economy. Although most activities have been restored, some facilities and services are still operating below capacity. Digitalization and smartification of urban services could play a major role in improving service delivery and urban resilience.

Robyn Kendall,1 Alan A Martin,2 Dhvani Shah,3 Soham Shukla,4 Chris Compton,5 Afisi S Ismaila4,6 1ICON Health Economics, ICON plc, Vancouver, BC, Canada; 2Value Evidence and Outcomes, GSK, London, UK; 3ICON Health Economics, ICON plc, New York, NY, USA; 4Value Evidence and Outcomes, GSK, Collegeville, PA, USA; 5Global Respiratory Franchise, GSK, London, UK; 6Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Afisi S Ismaila, Value Evidence and Outcomes, GSK, 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USA, Tel +1 919 315 8229, Email afisi.s.ismaila@gsk.comPurpose: For patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite maintenance treatment, clinical management guidelines recommend a stepwise escalation from monotherapy to dual therapy, and from dual therapy to triple therapy. However, in clinical practice, patients are often escalated directly from monotherapy to triple therapy based on disease severity. This study evaluated the cost-effectiveness of once-daily, single-inhaler fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) triple therapy compared with long-acting muscarinic antagonist monotherapy with once-daily tiotropium (TIO) in patients with symptomatic moderate-to-very severe COPD, from a UK National Health Service perspective.Patients and Methods: The validated GALAXY-COPD disease progression model was populated with patient baseline characteristics and treatment effect data from the 12-week GSK Study 207626 comparing FF/UMEC/VI with TIO in patients with moderate-to-very severe COPD. UK unit costs and drug costs (British Pound, 2021) were applied to healthcare resource utilization and treatments. The base case analysis was conducted over a lifetime horizon, and costs and health outcomes (except for life years [LYs]) were discounted at 3.5% per year. Model outputs included exacerbation rates, healthcare costs, LYs, quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios.Results: Overall, treatment with FF/UMEC/VI resulted in increased clinical benefit (reduction in total exacerbations and increased overall survival and QALYs), coupled with cost savings (derived from lower maintenance and exacerbation healthcare costs) compared with TIO monotherapy. In the base case analysis, FF/UMEC/VI provided an additional 0.393 LYs (95% range: 0.176, 0.655) and 0.443 QALYs (0.246, 0.648), at a cost saving of £ 880 (£ 54, £ 1608) versus TIO. FF/UMEC/VI remained the cost-effective (dominant) treatment option across sensitivity and scenario analyses.Conclusion: FF/UMEC/VI offers greater clinical benefits and is a cost-effective treatment option compared with TIO for the treatment of adult patients with COPD with persistent symptoms and/or who are at risk of exacerbation in the UK.Keywords: chronic obstructive pulmonary disease, health technology assessment, economic evaluation, real-world, single-inhaler triple therapy