Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p<0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p<0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

Deciphering the role of phosphorus management under conservation agriculture based wheat production system

Phosphorus (P) is a vital element required by all living organism (plants, animals and microbes etc.). Its application in agriculture, whether in conventional or conservation agriculture, requires careful attention due to its low use efficiency, which typically does not exceed 20%. With the increasing acceptance of conservation agriculture (CA), it is crucial to develop protocols for P management to ensure sustainable wheat production. Therefore, a field trial was conducted from 2016–2017 to 2017–2018 in the India's semiarid eco-region to study the role of P on wheat productivity, quality, and resource use efficiency under CA-based production system. We assessed the impact of tillage operations and P management practices on wheat productivity, quality, and resource use efficiency. Three tillage and residue management options such as CT-R (conventional tillage without residue); NT-R (no tillage without maize residue) and NT + R (no tillage with maize residue @ 2.5 Mg ha−1) were laid-out in main plot and five P management options subplots viz. P1 (nitrogen and potash according to recommended but not P); P2 (17.2 kg P ha−1); P3 (17.2 kg of P ha−1 + microbial fertilizer); P4 (17.2 kg P ha−1 + compost inoculant culture) and P5 (34.4 kg P ha−1) in split plot design with three replicates. The results indicates that the combination of no-tillage with residue retention (maize residue @ 2.5 Mg ha−1) (NT + R) and the application of 34.4 kg P ha−1 (P5) significantly improved grain yield by ~43.2% compared to the control treatment (conventional tillage with no residue, CT – R, and no phosphorus application). NT + R also resulted in significantly better amino acid (~22.7%) and net protein yield (~21.2%) compared to CT – R. Regarding the P management strategy, the highest amino acid (49.1%) and protein yield (12.5%) were observed under the P5 treatment compared to the no-phosphorus treatment. Conjoint use of NT – R, along with the application of 17.2 kg P ha−1 and PSB (Phosphorus Solubilizing Bacteria), resulted in a significant increase in energy use efficiency of ~58% over other treatments combination. Furthermore, the NT + R plot that received 17.2 kg P ha−1 + PSB demonstrated higher P agronomic efficiency (~43%) and recovery efficiency (~53%) over control. The study's findings underscore the significance of adopting efficient P management strategies in CA to ensure the sustainable production of wheat

Enjoy! Assertive Language and Consumer Compliance in (Non)Hedonic Contexts

This paper is concerned with the tension between consumer persuasion and freedom of choice. We study how assertive language (as in the slogan Just do it!) affects consumer compliance in hedonic vs. utilitarian contexts. Previous literature consistently claimed that forceful language would cause reactance and decreased compliance. However, we find in four studies that assertive persuasion is effective in contexts involving hedonic goods and hedonically framed utilitarian goods. Our hypotheses emerge from sociolinguistic research and confirm the relevance of linguistic research in consumer behavior

Chiari malformation: Has the dilemma ended?

Chiari malformation as a clinical entity has been described more than hundred years ago. The concepts regarding pathogenesis, clinical features and management options have not yet conclusively evolved. Considering that a variety of treatment methods are being adopted to treat Chiari malformation is suggestive of the fact that confusion still reigns supreme in the minds of treating clinicians. Over the years, the understanding of Chiari malformation has changed from a disease process to a natural protective phenomenon and the treatment from decompression to fixation