Estimating the incidence, prevalence and true cost of asthma in the UK: Secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales-a study protocol

Introduction Asthma is now one of the most common long-term conditions in the UK. It is therefore important to develop a comprehensive appreciation of the healthcare and societal costs in order to inform decisions on care provision and planning. We plan to build on our earlier estimates of national prevalence and costs from asthma by filling the data gaps previously identified in relation to healthcare and broadening the field of enquiry to include societal costs. This work will provide the first UK-wide estimates of the costs of asthma. In the context of asthma for the UK and its member countries (ie, England, Northern Ireland, Scotland and Wales), we seek to: (1) produce a detailed overview of estimates of incidence, prevalence and healthcare utilisation; (2) estimate health and societal costs; (3) identify any remaining information gaps and explore the feasibility of filling these and (4) provide insights into future research that has the potential to inform changes in policy leading to the provision of more cost-effective care.

Methods and analysis Secondary analyses of data from national health surveys, primary care, prescribing, emergency care, hospital, mortality and administrative data sources will be undertaken to estimate prevalence, healthcare utilisation and outcomes from asthma. Data linkages and economic modelling will be undertaken in an attempt to populate data gaps and estimate costs. Separate prevalence and cost estimates will be calculated for each of the UK-member countries and these will then be aggregated to generate UK-wide estimates.

Ethics and dissemination Approvals have been obtained from the NHS Scotland Information Services Division's Privacy Advisory Committee, the Secure Anonymised Information Linkage Collaboration Review System, the NHS South-East Scotland Research Ethics Service and The University of Edinburgh's Centre for Population Health Sciences Research Ethics Committee. We will produce a report for Asthma-UK, submit papers to peer-reviewed journals and construct an interactive map.

Intra and Interorganizational Learning Networks and the Implementation of Quality Improvement Initiatives: The Case of a Portuguese Teaching Hospital

Learning has an important position in the development of employees and their expertise. This article focuses on the role and utilization of intra and interorganizational formal and informal learning within different types of learning networks. Specifically, we investigate different types of networks (inter- or intraorganizational) and different types of learning (formal or informal) that can occur within such networks. Our qualitative case study is based on 46 expert interviews involving 49 interviewees, through which we explore how formal and informal learning was used in the development and implementation of quality improvement initiatives at a large public teaching hospital in Portugal. Our analysis suggests that formal and informal learning can take place within different types of learning networks that draw on internal resources as well as on the collaboration with external entities. The article argues that it is important for HRD managers, seeking to support organizational learning, to understand how different types of learning take place, and which features of learning networks support these processes.

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.

Economic optimization of wind farms in function of the cost of energy produced

Esta tese apresenta um estudo sobre otimização económica de parques eólicos, com o objetivo de obter um algoritmo para otimização económica de parques eólicos através do custo da energia produzida. No estudo utilizou-se uma abordagem multidisciplinar. Inicialmente, apresentam-se as principais tecnologias e diferentes arquiteturas utilizadas nos parques eólicos. Bem como esquemas de funcionamento e gestão dos parques. São identificadas variáveis necessárias e apresenta-se um modelo dimensionamento para cálculo dos custos da energia produzida, tendo-se dado ênfase às instalações onshore e ligados a rede elétrica de distribuição. É feita uma análise rigorosa das características das topologias dos aerogeradores disponíveis no mercado, e simula-se o funcionamento de um parque eólico para testar a validade dos modelos desenvolvidos. Também é implementado um algoritmo para a obtenção de uma resposta otimizada para o ciclo de vida económico do parque eólico em estudo. A abordagem proposta envolve algoritmos para otimização do custo de produção com multiplas funções objetivas com base na descrição matemática da produção de eletricidade. Foram desenvolvidos modelos de otimização linear, que estabelece a ligação entre o custo económico e a produção de eletricidade, tendo em conta ainda as emissões de CO2 em instrumentos de política energética para energia eólica. São propostas expressões para o cálculo do custo de energia com variáveis não convencionais, nomeadamente, para a produção variável do parque eólico, fator de funcionamento e coeficiente de eficiência geral do sistema. Para as duas últimas, também é analisado o impacto da distribuição do vento predominante no sistema de conversão de energia eólica. Verifica-se que os resultados obtidos pelos algoritmos propostos são similares às obtidas por demais métodos numéricos já publicados na comunidade científica, e que o algoritmo de otimização económica sofre influência significativa dos valores obtidos dos coeficientes em questão. Finalmente, é demonstrado que o algoritmo proposto (LCOEwso) é útil para o dimensionamento e cálculo dos custos de capital e O&M dos parques eólicos com informação incompleta ou em fase de projeto. Nesse sentido, o contributo desta tese vem ser desenvolver uma ferramenta de apoio à tomada de decisão de um gestor, investidor ou ainda agente público em fomentar a implantação de um parque eólico.

Evaluation of enzymatic and metabolic parameters of quality in sole eggs (Solea Senegalensis, Kaup, 1858)=Avaliação dos parâmetros enzimáticos e metabólicos de qualidade em ovos de linguado (Solea senegalensis, Kaup, 1858)

Dissertação de mest., Biologia Marinha, Faculdade de Ciências do Mar e Ambiente, Univ. do Algarve, 2008

Nutrition and farming practices as modulators of quality in gilthead seabream (Sparus aurata)

Gilthead seabream is the most important farmed species in the Mediterranean, and knowledge on how common farming practices impact its quality is limited. As such, this Thesis aimed to evaluate how gilthead seabream flesh quality is affected by some of these practices. In Chapter 2, the influence of nutritional factors was evaluated, specifically the high replacement of traditional marine-derived ingredients, both fishmeal and fish oil, with vegetable sources. We have seen that the vegetable-based diets tested did not greatly impact seabream flesh quality, although some alterations were seen in the fatty acid profile of the muscle. However, and despite having caused no alterations in flesh texture, vegetable ingredients reduced the amount of sulphated glycosaminoglycans in the extracellular matrix, affected muscle pH and reduced the activity of proteolytic enzymes. Throughout this Thesis, we measured for the first time the activity of proteolytic enzymes in seabream muscle, and cathepsin B was found to play a pivotal role in post-mortem muscle degradation. In Chapter 3, we evaluated the effect of harvesting and slaughter stress on seabream quality, and contrary to what is seen in most farmed species, our results show that gilthead seabream muscle structure is highly resistant to changes caused by stressful events. Nonetheless, considering that welfare is an increasingly important quality criterion, the use of a zero-withdrawal anaesthetic as a rested harvest technique or even slaughter method could prove valuable to the industry. In Chapter 4, we used maslinic acid as a dietary supplement, to modulate the muscle’s energetic status pre-mortem. As a finishing strategy, maslinic acid failed to increase levels of glycogen and ATP in the muscle. However, supplementation resulted in higher muscle fibre diameter and lower cathepsin B activity, and maslinic acid is likely to be useful to promote growth in this species. In general our Thesis has generated new knowledge to a major challenge facing the aquaculture industry, which is to find a compromise between the trends towards intensive rearing and consumer demand for healthy, high quality seafood being ethically acceptable and having a low impact on the environment.

Engendering a culture of quality enhancement in teaching and learning: lessons learned

Enhancing the quality of learning and teaching in higher education has been on the English national agenda for more than a decade. The Government and funding organisations have enabled universities to focus on creating a culture of excellence in learning and teaching and continuing academic and professional development. This paper describes some of the strategies that have promoted a culture of quality teaching in higher education in England and how one organisation, the University of Westminster has implemented those strategies to engender a culture of quality enhancement and continuing professional development.

The importance of quality in the consolidation of textile in Minho

The textile industry has a long tradition in Portugal and it is one of the most important sectors, despite the current economic crisis. It has always assumed a prominent role in terms of employment and a relevant position within the Portuguese economy. The lack of quality and the lower prices that other countries offer causes the loss of clients. Quality is a main tool to survive nowadays in the textile sector. To undertake our analysis, we made use of an existing database where 55 firms belonged to the textile industry, namely to the manufacturing sector. A new survey was created based on the original survey and was sent to 5 firms. Besides the survey, we also sent a few questions to the firms in order to retract more information about the actually situation in our country, concerning the textile industry. Several tables, graphs and pie charts were made to help shed light on our findings. This research was conducted in order to determine the importance of quality in the consolidation of textile firms in the north of Portugal. Most firms in our sample feel that quality improvement, business benefits, mobilizing employees’ knowledge and business image were important and that competition is very intense and is mainly by price and not by differentiation of product or service. The quality program has contributed to improve their competitive position and the improvement of their overall performance. The majority of the firms in our sample undertake TQM measures for quality purposes to meet customer expectations and prevent errors. Of all firms surveyed, the quality is certainly very important for its survival.

A generic model for integration of Quality, Environment and Safety Management Systems

Purpose – The purpose of this paper is to propose a generic model of Integrated Management System of Quality, Environment and Safety (IMS-QES) that can be adapted and progressively to assimilate various Management Systems, of which highlights: ISO 9001 for Quality; ISO 14001 for Environment; OHSAS 18001 for Occupational Health and Safety. Design/methodology/approach – The model was designed in the real environment of a Portuguese Organization and 160 employees were surveyed. The rate response was equal to 86 percent. The conceived model was implemented in a first phase for the integration of Quality, Environment and Safety Management Systems. Findings – Among the main findings of the survey the paper highlights: the elimination of conflicts between individual systems with resources optimization; creation of added value to the business by eliminating several types of wastes; the integrated management of sustainability components in a global market; the improvement of partnerships with suppliers of goods and services; reducing the number of internal and external audits. Originality/value – This case study is one of the first Portuguese empirical researches about IMS-QES and the paper believes that it can be useful in the creation of a Portuguese guideline for integration, namely the Quality Management Systems; Environmental Management Systems and Occupational Health and Safety Management Systems among others.

Families of the traumatically brian-injured : a case study approach to perceptions of quality of service, degree of satisfaction, and family needs /

The purpose of this qualitative research study was to foster an understanding of the rehabilitation counselling practice offamilies of the brain-injured. Specifically, the study explores the perceptions of stakeholders in regards to the degree of satisfaction with the quality of service received. Questionnaires were administered, and semi-structured, openended interviews were conducted, with six participating families (n=8). Preliminary data were collected via two instruments: (i) the Family Participant Questionnaire, consisting of participants' sample characteristics, information pertaining to the history of the family, details of the injury, and information relating to the type, use, and need offamily services utilized; and (ii) the Community Integration Questionnaire, a measurement of the degree of social displacementllevel of community integration of the injured family member. Utilizing the procedural steps outlined by Colaizzi's (1978) method of protocol analysis, recommendations for a future program based on related and current family needs are discussed in detail. Substantiating and supporting information are offered to rehabilitation practitioners, educational planners, and policymakers alike, concerning the degree of satisfaction with rehabilitative service, and the means of improving upon the overall quality of health care to families of the brain-injured. Implications for clinical practice and research are also raised for discussion.

The Effectiveness of Learning Portfolios: A Study of Quality Assurance Programs of Selected Health Regulatory Colleges in Ontario

Health regulatory colleges promote quality practice and continued competence through Quality Assurance (QA) programs. For many colleges, a QA program includes the use of portfolios that incorporate self-directed learning. The purpose of this study was to determine some of the issues surrounding the effectiveness of QA portfolio programs. The literature review revealed that portfolios are valuable tools, but gaps in knowledge include a comparative analysis of QA programs and the perspective of regulatory college administrators. Data were collected through interviews with 6 administrators and a review of 14 portfolio models described on college websites. The results from the two data sources were applied to Robert Stake's responsive evaluation framework to identify issues related to the portfolio's effectiveness (Stake, 1967). The learning components of portfolios were analyzed through the humanist and constructivist lenses. All 14 portfolio models were found to have 3 main components: self-diagnosis, learning plan and activities, and self-evaluation. However, differences were uncovered in learners' autonomy in selecting learning activities, methods of portfolio evaluation, and the relationship between the portfolio and other QA components. The results revealed a dual philosophy of learning in portfolio models and an apparent contradiction between the needs of the individual learner and the organization. Paths for future research include the tenuous relationship between competence and learning, and the impact of technical approaches on selfdirected learning initiatives. A key recommendation is to acknowledge the unique identity of each profession so that health regulatory colleges can address legislative demands and learner needs.