Adrenal function recovery after durable oral corticosteroid sparing with benralizumab in the PONENTE study

Background Oral corticosteroid (OCS) dependence among patients with severe eosinophilic asthma can cause adverse outcomes, including adrenal insufficiency. PONENTE's OCS reduction phase showed that, following benralizumab initiation, 91.5% of patients eliminated corticosteroids or achieved a final dosage ≤5 mg·day-1 (median (range) 0.0 (0.0-40.0) mg). Methods The maintenance phase assessed the durability of corticosteroid reduction and further adrenal function recovery. For ~6 months, patients continued benralizumab 30 mg every 8 weeks without corticosteroids or with the final dosage achieved during the reduction phase. Investigators could prescribe corticosteroids for asthma exacerbations or increase daily dosages for asthma control deteriorations. Outcomes included changes in daily OCS dosage, Asthma Control Questionnaire (ACQ)-6 and St George's Respiratory Questionnaire (SGRQ), as well as adrenal status, asthma exacerbations and adverse events. Results 598 patients entered PONENTE; 563 (94.1%) completed the reduction phase and entered the maintenance phase. From the end of reduction to the end of maintenance, the median (range) OCS dosage was unchanged (0.0 (0.0-40.0) mg), 3.2% (n=18/563) of patients experienced daily dosage increases, the mean ACQ-6 score decreased from 1.26 to 1.18 and 84.5% (n=476/563) of patients were exacerbation free. The mean SGRQ improvement (-19.65 points) from baseline to the end of maintenance indicated substantial quality-of-life improvements. Of patients entering the maintenance phase with adrenal insufficiency, 32.4% (n=104/321) demonstrated an improvement in adrenal function. Adverse events were consistent with previous reports. Conclusions Most patients successfully maintained maximal OCS reduction while achieving improved asthma control with few exacerbations and maintaining or recovering adrenal function

Climate and colonialism

Recent years have seen a growth in scholarship on the intertwined histories of climate, science and European imperialism. Scholarship has focused both on how the material realities of climate shaped colonial enterprises, and on how ideas about climate informed imperial ideologies. Historians have shown how European expansion was justified by its protagonists with theories of racial superiority, which were often closely tied to ideas of climatic determinism. Meanwhile, the colonial spaces established by European powers offered novel ‘laboratories’ where ideas about acclimatisation and climatic improvement could be tested on the ground. While historical scholarship has focused on how powerful ideas of climate informed imperial projects, emerging scholarship in environmental history, history of science and historical geography focuses instead on the material and cognitive practices by which the climates of colonial spaces were made known and dealt with in fields such as forestry, agriculture and human health. These heretofore rather disparate areas of historical research carry great contemporary relevance of studies of how climates and their changes have been understood, debated and adapted to in the past

RISK6, a 6-gene transcriptomic signature of TB disease risk, diagnosis and treatment response

Improved tuberculosis diagnostics and tools for monitoring treatment response are urgently needed. We developed a robust and simple, PCR-based host-blood transcriptomic signature, RISK6, for multiple applications: identifying individuals at risk of incident disease, as a screening test for subclinical or clinical tuberculosis, and for monitoring tuberculosis treatment. RISK6 utility was validated by blind prediction using quantitative real-time (qRT) PCR in seven independent cohorts. Prognostic performance significantly exceeded that of previous signatures discovered in the same cohort. Performance for diagnosing subclinical and clinical disease in HIV-uninfected and HIV-infected persons, assessed by area under the receiver-operating characteristic curve, exceeded 85%. As a screening test for tuberculosis, the sensitivity at 90% specificity met or approached the benchmarks set out in World Health Organization target product profiles for non-sputum-based tests. RISK6 scores correlated with lung immunopathology activity, measured by positron emission tomography, and tracked treatment response, demonstrating utility as treatment response biomarker, while predicting treatment failure prior to treatment initiation. Performance of the test in capillary blood samples collected by finger-prick was noninferior to venous blood collected in PAXgene tubes. These results support incorporation of RISK6 into rapid, capillary blood-based point-of-care PCR devices for prospective assessment in field studies

Epistemic geographies of climate change: science, space and politics

Anthropogenic climate change has been presented as the archetypal global problem, identified by the slow work of assembling a global knowledge infrastructure, and demanding a concertedly global political response. But this ‘global’ knowledge has distinctive geographies, shaped by histories of exploration and colonialism, by diverse epistemic and material cultures of knowledge-making, and by the often messy processes of linking scientific knowledge to decision-making within different polities. We suggest that understanding of the knowledge politics of climate change may benefit from engagement with literature on the geographies of science. We review work from across the social sciences which resonates with geographers’ interests in the spatialities of scientific knowledge, to build a picture of what we call the epistemic geographies of climate change. Moving from the field site and the computer model to the conference room and international political negotiations, we examine the spatialities of the interactional co-production of knowledge and social order. In so doing, we aim to proffer a new approach to the intersections of space, knowledge and power which can enrich geography’s engagements with the politics of a changing climate