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Evidence for management of asthma comes from closely monitored efficacy trials done in highly selected patient groups. There is a need for randomised trials that are closer to usual clinical practice. We did an open-label, randomised, controlled, two-arm effectiveness trial at 74 general practice clinics in Salford and South Manchester, UK. Patients aged 18 years or older with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy were randomly assigned to initiate treatment with a once-daily inhaled combination of either 100 μg or 200 μg fluticasone furoate with 25 μg vilanterol or optimised usual care and followed up for 12 months. The primary endpoint was the percentage of patients who achieved an asthma control test (ACT) score of 20 or greater or an increase in ACT score from baseline of 3 or greater at 24 weeks (termed responders), in patients with a baseline ACT score less than 20 (the primary effectiveness analysis population). All effectiveness analyses were done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01706198. Between Nov 12, 2012, and Dec 16, 2016, 4725 patients were enrolled and 4233 randomly assigned to initiate treatment with fluticasone furoate and vilanterol (n=2114) or usual care (n=2119). 1207 patients (605 assigned to usual care, 602 to fluticasone furoate and vilanterol) had a baseline ACT score greater than or equal to 20 and were thus excluded from the primary effectiveness analysis population. At week 24, the odds of being a responder were higher for patients who initiated treatment with fluticasone furoate and vilanterol than for those on usual care (977 [71%] of 1373 in the fluticasone furoate and vilanterol group vs 784 [56%] of 1399 in the usual care group; odds ratio [OR] 2·00 [95% CI 1·70–2·34], p<0·0001). At week 24, the adjusted mean ACT score increased by 4·4 points from baseline in patients initiated with fluticasone furoate and vilanterol, compared with 2·8 points in the usual care group (difference 1·6 [95% CI 1·3–2·0], p<0·0001). This result was consistent for the duration of the study. Pneumonia was uncommon, with no differences between groups; there was no difference in other serious adverse events between the groups. In patients with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy, initiation of a once-daily treatment regimen of combined fluticasone furoate and vilanterol improved asthma control without increasing the risk of serious adverse events when compared with optimised usual care. GlaxoSmithKline.

Members of the genus are abundant in the feces of babies during the exclusively-milk-diet period of life. is reported to be a common member of the infant fecal microbiota. However, is composed of three subspecies, two of which are represented in the bowel microbiota ( subsp. ; subsp. ). subspecies are not differentiated in many studies, so that their prevalence and relative abundances are not accurately known. This may largely be due to difficulty in assigning subspecies identity using DNA sequences of or genes that are commonly used in bacterial taxonomy. We developed a qPCR method targeting the sialidase gene (subsp. ) and sugar kinase gene (subsp. ) to differentiate the subspecies using specific primers and probes. Specificity of the primers/probes was tested by pangenomic search, and using DNA from standard cultures of bifidobacterial species. The utility of the method was further examined using DNA from feces that had been collected from infants inhabiting various geographical regions. A pangenomic search of the NCBI genomic database showed that the PCR primers/probes targeted only the respective genes of the two subspecies. The primers/probes showed total specificity when tested against DNA extracted from the gold standard strains (type cultures) of bifidobacterial species detected in infant feces. Use of the qPCR method with DNA extracted from the feces of infants of different ages, delivery method and nutrition, showed that subsp. was detectable (0-32.4% prevalence) in the feces of Australian (  = 90), South-East Asian (  = 24), and Chinese babies (  = 91), but in all cases at low abundance (<0.01-4.6%) compared to subsp. (0.1-33.7% abundance; 21.4-100% prevalence). Our qPCR method differentiates subspecies and using characteristic functional genes. It can be used as an identification aid for isolates of bifidobacteria, as well as in determining prevalence and abundance of the subspecies in feces. The method should thus be useful in ecological studies of the infant gut microbiota during early life where an understanding of the ecology of bifidobacterial species may be important in developing interventions to promote infant health.

Background. Members of the genus Bifidobacterium are abundant in the feces of babies during the exclusively-milk-diet period of life. Bifidobacterium longum is reported to be a common member of the infant fecal microbiota. However, B. longum is composed of three subspecies, two of which are represented in the bowel microbiota (B. longum subsp. longum; B. longum subsp. infantis). B. longum subspecies are not differentiated in many studies, so that their prevalence and relative abundances are not accurately known. This may largely be due to difficulty in assigning subspecies identity using DNA sequences of 16S rRNA or tuf genes that are commonly used in bacterial taxonomy. Methods. We developed a qPCR method targeting the sialidase gene (subsp. infantis) and sugar kinase gene (subsp. longum) to differentiate the subspecies using specific primers and probes. Specificity of the primers/probes was tested by in silico, pangenomic search, and using DNA from standard cultures of bifidobacterial species. The utility of the method was further examined using DNA from feces that had been collected from infants inhabiting various geographical regions. Results. A pangenomic search of the NCBI genomic database showed that the PCR primers/probes targeted only the respective genes of the two subspecies. The primers/probes showed total specificity when tested against DNA extracted from the gold standard strains (type cultures) of bifidobacterial species detected in infant feces. Use of the qPCR method with DNA extracted from the feces of infants of different ages, delivery method and nutrition, showed that subsp. infantis was detectable (0-32.4% prevalence) in the feces of Australian (n = 90), South-East Asian (n = 24), and Chinese babies (n = 91), but in all cases at low abundance (<0.01-4.6%) compared to subsp. longum (0.1-33.7% abundance; 21.4-100% prevalence). Discussion. Our qPCR method differentiates B. longum subspecies longum and infantis using characteristic functional genes. It can be used as an identification aid for isolates of bifidobacteria, as well as in determining prevalence and abundance of the subspecies in feces. The method should thus be useful in ecological studies of the infant gut microbiota during early life where an understanding of the ecology of bifidobacterial species may be important in developing interventions to promote infant health.

. Academic disciplines evolve and regional science is no exception. Physics, French or economics changes over time but at the end of the day (or decade), they remain physics, French or economics. But regional science is different; it can take on the perspectives of geography, economics, planning, or other social sciences. At its best, perhaps regional science is a composite of these; many therefore think that the inevitable tension between these content areas and scientific and non‐scientific orientations is not only healthy but is also essential. Balancing perspectives and managing tensions in a discipline where both basic and applied research is appropariate is challenging. Combine this with the fact of rapid change and increased competition for limited resources in academic institutions with regional science programmes. From this starting point it seems worthwhile to revisit how we manage regional science and position it within our universities and within our graduates' job markets. We propose a model sensitive to both the supply side and the demand side, which indicates that we proactively cultivate markets within and outside educational institutions. We discuss the need for introductory regional science courses at the undergraduate level and for programmes at the masters and Ph.D. levels that transfer existing knowledge and prepare the next generation for intellectual and technical leadership in the field of regional science.

As regional scientists we are preoccupied with our scientific work, and this is as it should be. But from time to time it is worthwhile to step back and think about the business of regional science-the organizations that hold us together, the publications that help us build a body of knowledge, and the meetings that give us a sense of community. When these topics come up, the conversation usually focuses on concerns about new and innovated research strategies, about research quality, and about scientific rigor. The idea, of course, is that if we are good scientists the rest will take care of itself. This is a noble idea and a naive one. In the competitive environment that we operate in we cannot, I think, operate as a boutique field indefinitely. If we do not get bigger, we run the risk of getting lost in the shuffle. I am convinced that size really does matter.

Regional Science is alive and well. If we wish to maintain our position we need to explore ways to expand our numbers and the constituencies that we serve. Expanding undergraduate and graduate teaching programs, fostering more discussion of client-driven work at our meetings and in our journals, and actively encouraging participation by non-university based researchers and even regional development practitioners are all ways to promote multiple-constituency regional science. If one of these options is to be emphasized in the short term, I would suggest encouraging participation by non-university based researchers and more discussion of client-driven research. These strategies are often at least partially in place now, they benefit from the rigorous scientific work that is our core business, and they will help assure the institutionalization of \"full service\" regional science.[PUBLICATION ABSTRACT]

An analysis based on a study of three real communities is presented. The resulting report demonstrates the amount of useful information that can be gained from a careful community economic base analysis, and how this information can be applied to economic development practice.