Drug therapies in severe asthma - the era of stratified medicine

Difficult-to-treat asthma affects up to 20% of patients with asthma and is associated with significant healthcare cost. It is an umbrella term that defines a heterogeneous clinical problem including incorrect diagnosis, comorbid conditions and treatment non-adherence; when these are effectively addressed, good symptom control is frequently achieved. However, in 3–5% of adults with difficult-to-treat asthma, the problem is severe disease that is unresponsive to currently available treatments. Current treatment guidelines advise the ‘stepwise’ increase of corticosteroids, but it is now recognised that many aspects of asthma are not corticosteroid responsive, and that this ‘one size fits all’ approach does not deliver clinical benefit in many patients and can also lead to side effects. The future of management of severe asthma will involve optimisation with currently available treatments, particularly corticosteroids, including addressing non-adherence and defining an ‘optimised’ corticosteroid dose, allied with the use of ‘add-on’ target-specific novel treatments. This review examines the current status of novel treatments and research efforts to identify novel targets in the era of stratified medicines in severe asthma.

The thinking doctor: clinical decision making in contemporary medicine

Diagnostic errors are responsible for a significant number of adverse events. Logical reasoning and good decision-making skills are key factors in reducing such errors, but little emphasis has traditionally been placed on how these thought processes occur, and how errors could be minimised. In this article, we explore key cognitive ideas that underpin clinical decision making and suggest that by employing some simple strategies, physicians might be better able to understand how they make decisions and how the process might be optimised.

'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.

Can we characterise ‘openness’ in the Holocene palaeoenvironmental record? Modern analogue studies of insect faunas and pollen spectra from Dunham Massey deer park and Epping Forest, England

This paper examines the degree to which tree-associated Coleoptera (beetles) and pollen could be used to predict the degree of ‘openness’ in woodland. The results from two modern insect and pollen analogue studies from ponds at Dunham Massey, Cheshire and Epping Forest, Greater London are presented. We explore the reliability of modern pollen rain and sub-fossil beetle assemblages to represent varying degrees of canopy cover for up to 1000m from a sampling site. Modern woodland canopy structure around the study sites has been assessed using GIS-based mapping at increasing radial distances as an independent check on the modern insect and pollen data sets. These preliminary results suggest that it is possible to use tree-associated Coleoptera to assess the degree of local vegetation openness. Additionally, it appears that insect remains may indicate the relative intensity of land use by grazing animals. Our results also suggest most insects are collected from within a 100m to 200m radius of the sampling site. The pollen results suggest that local vegetation and density of woodland in the immediate area of the sampling site can have a strong role in determining the pollen signal.

Ant-lore in Anglo-Saxon England

Two Old English versions of a sunshine prognostication survive in the mid-eleventh century Cambridge, Corpus Christi College 391, p. 713, and in a twelfth-century addition to Oxford, Bodleian Library, Hatton 115, 149v–150r. Among standard predictions promising joy, peace, blossom, abundance of milk and fruit, and a great baptism sent by God, one encounters an enigmatic prophecy which involves camels stealing gold from the ants. These gold-digging ants have a long pedigree, one which links Old English with much earlier literature and indicates the extent to which Anglo-Saxon culture had assimilated traditions of European learning. It remains difficult to say what is being prophesied, however, or to explain the presence of the passage among conventional predictions. Whether the prediction was merely a literary exercise or carried a symbolic implication, it must have originated in an ecclesiastical context. Its mixture of classical learning and vernacular tradition, Greek and Latin, folklore and Christian, implies an author with some knowledge of literary and scholarly traditions.

Weather Prognostics in Anglo-Saxon England

Prognostics concerning the day of the week on which kalendae ianuariae and Christmas Day fall, commonly known as the Revelatio Esdrae , purport to be a set of prophecies by the Biblical Esdras. They make predictions about the weather and other natural phenomena for the year to come, and they then extend their predictions to the field of human affairs. A remarkable number of copies of the Revelatio appear in English manuscripts from the tenth to the twelfth centuries. Some of these versions have been attributed to Bede and Abbo of Fleury as part of their computus works.

Both R. M. Liuzza and L. S. Chardonnens point out the frequent occurrence of the Revelatio in religious and scientific manuscripts and therefore reject the label of folklore, stressing instead the probable monastic origin of this prognostication. This study will provide the first complete collation and analysis of the surviving exemplars, to give as full an idea as possible of their circumstances of composition, their transmission, and their relationship to one another. It will consider how the Revelatio Esdrae was copied and used in Anglo-Saxon England, the audience to which it was addressed, and whether any conclusion can be drawn from its appearance in particular manuscripts, alongside certain other texts.

The regular occurrence of the Revelatio along with computistical material supports the case for its monastic origin and learned nature. Such a text would have been a helpful handbook to be used by monks and priests, and was among the standard holdings of continental and Anglo-Saxon monasteries and scriptoria, giving further proof of the monks’ intellectual eclecticism and their knowledge of the kinds of continental literature from which this text derives.

Children’s perceptions of primary science assessment in England and Wales

This study builds on and contributes to work on assessment of children in primary school, particularly in science. Previous research has examined primary science assessment from different standpoints, but no studies have speci?cally addressed children’s perspectives. This article provides additional insight into issues surrounding children’s assessment in primary school and how the assessment of science might develop in England after the science SATs (Standard Assessment Tests) were abolished in 2009. Some research suggests that primary science assessment via SATs is a major reason for the observed decline in children’s engagement with science in upper primary and lower secondary school. The analytic focus on engaging children as coresearchers to assist in the process of gathering informed views and interpreting ?ndings from a large sample of children’s views enables another contribution. The study, based on a survey of 1000 children in primary and secondary schools in England and Wales, reveals that despite being assessed under two different regimes (high-stakes national tests in England and moderated teacher assessment in Wales), children’s views of science assessment are remarkably consistent. Most appreciate the usefulness of science assessment and value frequent, non-SATs testing for monitoring/improving science progress. There was a largely negative impact, however, of science
assessment on children’s well-being, particularly due to stress. The paper demonstrates that children provide an important perspective on assessment and that including their views can improve policy-making in relation to primary science assessment.

The Determinants of Brownfields Redevelopment in England

This paper uses discrete choice models, supported by GIS data, to analyse the National Land Use Database, a register of more than 21,000 English brownfields - previously used sites with or without contamination that are currently unused or underused. Using spatial discrete choice models, including the first application of a spatial probit latent class model with class-specific neighbourhood effects, we find evidence of large local differences in the determinants of brownfields redevelopment in England and that the reuse decisions of adjacent sites affect the reuse of a site. We also find that sites with a history of industrial activities, large sites, and sites that are located in the poorest and bleakest areas of cities and regions of England are more difficult to redevelop. In particular, we find that the probability of reusing a brownfield increases by up to 8.5% for a site privately owned compared to a site publicly owned and between 15% - 30% if a site is located in London compared to the North West of England. We suggest that local tailored policies are more suitable than regional or national policies to boost the reuse of brownfield sites.

Re-Reading the Riots: Counter-Conduct in London 2011

The riots that took place in England in August 2011 have widely been described as destructive, senseless and without purpose. This article, taking inspiration from Michel Foucault’s later work on revolt as counter-conduct, argues for a new understanding of how to read political expression and thereby calls for the riots to be thought differently, as a form of counter-conduct. This demands a new appreciation for the possibilities of revolt where spontaneous, impulsive, mundane and non-spectacular events like riots can be construed as political rather than purely criminal. It also opens up possibilities for how we might understand the ethos of the ‘revolting subject’.