The cost of treating severe refractory asthma in the UK: an economic analysis from the British Thoracic Society Difficult Asthma Registry

Severe refractory asthma poses a substantial burden in terms of healthcare costs but relatively little is known about the factors which drive these costs. This study uses data from the British Thoracic Society Difficult Asthma Registry (n=596) to estimate direct healthcare treatment costs from an National Health Service perspective and examines factors that explain variations in costs. Annual mean treatment costs among severe refractory asthma patients were £2912 (SD £2212) to £4217 (SD £2449). Significant predictors of costs were FEV1% predicted, location of care, maintenance oral corticosteroid treatment and body mass index. Treating individuals with severe refractory asthma presents a substantial cost to the health service.

Holding Shareholders to Account: British Banking Stability and Contingent Capital

This chapter seeks to explain the relative stability of the British banking system in terms of its capital structure. From 1826 joint-stock banking was allowed, but shareholder liability was jointly and severally unlimited. Limited liability banks were allowed from 1857–8, but these banks issued partly paid shares with an obligation on shareholders to subscribe for uncalled capital. Contingent capital meant that shareholders and managers would suffer losses in the event of failure and this discouraged risk shifting at the expense of note-holders and depositors. Although individual banks collapsed, the failure rate of banks (in terms of number or capital) did not reach a critical level—10 per cent—beyond which the payments system might have been threatened. This chapter argues that agency problems and systemic risk rose after the abolition of contingent share capital in 1958 and the deregulation of the banking sector in the 1970s.

'When I Land in Islamabad I Feel Home and When I Land in Heathrow I Feel Home': Gendered Belonging and Diasporic Identities of South Asian British Citizens in London, in Leicester and in North England

According to Deleuze and Guattari (1987) ‘de-territorialization’ is followed by a moment of re-territorialization. This moment, however, has to be regarded as a continuing educational process that becomes a different spatial site of social practices. It is argued in this chapter that regional, local as well as global identification override national and mono-ethno cultural identities, while shaping particular notions of gendered belonging and creating specific diasporic practices. Based on a sample of interviews with professional and academic South Asian British citizens in London, in Leicester, and in a number of Northern English cities gendered and generational patterns in terms of local diasporic identities are explored. Apart from multiple cultural belonging, foremost, territorial bonds and notions of group loyalty collapse at a point where temporary migration and settlement alternate in individual biographies.

Utopia Incomplete: British New Towns and Craigavon

The New towns initiative in the UK and Northern Ireland, enshrined in the Act of 1946, was derived out of a stream of philosophical thought that was a reaction to modernity, paritcularly Victorian industrialisation. This was developed through the writings of Ruskin and Morris and crystalised by Ebenezer Howard in his book Garden Cities of Tomorrow, which culminated with the design of Letchworth by Parker and Unwin (completed 1914). Letchworth however, was a more than just a physical and spatial entity: it was actually a policyscape, a novel economic and social policy landscape that regulated development in a modern and scientific way.

These themes of the scientification of urban design, and the regulation of urban development through policy, run through the whole New Town movement, right up to the development of the eco-towns of today. New Towns, in fact, can be seen as an embodiment of modernity, as well as a reaction to it .

Homogenization and analysis of an expanded long-term monthly rainfall network for the Island of Ireland (1850–2010)

Long-term precipitation series are critical for understanding emerging changes to the hydrological cycle. To this end we construct a homogenized Island of Ireland Precipitation (IIP) network comprising 25 stations and a composite series covering the period 1850–2010, providing the second-longest regional precipitation archive in the British-Irish Isles. We expand the existing catalogue of long-term precipitation records for the island by recovering archived data for an additional eight stations. Following bridging and updating of stations HOMogenisation softwarE in R (HOMER) homogenization software is used to detect breaks using pairwise and joint detection. A total of 25 breakpoints are detected across 14 stations, and the majority (20) are corroborated by metadata. Assessment of variability and change in homogenized and extended precipitation records reveal positive (winter) and negative (summer) trends. Trends in records covering the typical period of digitization (1941 onwards) are not always representative of longer records. Furthermore, trends in post-homogenization series change magnitude and even direction at some stations. While cautionary flags are raised for some series, confidence in the derived network is high given attention paid to metadata, coherence of behaviour across the network and consistency of findings with other long-term climatic series such as England and Wales precipitation. As far as we are aware, this work represents the first application of HOMER to a long-term precipitation network and bodes well for use in other regions. It is expected that the homogenized IIP network will find wider utility in benchmarking and supporting climate services across the Island of Ireland, a sentinel location in the North Atlantic.

Writing the History of the British Stage, 1660-1900

A monograph on British theatre historiography from its emergence in the Restoration to its foundation as an academic discipline in the early 20th century.

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Objective: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.
Design: Cross-sectional observational study.Setting The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.
Participants: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)—severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).
Main outcome measures: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.
Results: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.

Conclusions: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.