Obesity associated severe asthma represents a distinct clinical phenotype - Analysis of the British Thoracic Society Difficult Asthma Registry patient cohort according to body mass index

BACKGROUND: Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airways inflammation. However, the role of obesity in severe asthma remains unclear. OBJECTIVE: To explore the association between obesity (defined by BMI) and severe asthma. METHODS: Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics and healthcare utilisation between three body mass index (BMI) categories (normal weight: 18.5 -24.99, overweight: 25 -29.99, obese: =30) in a well characterised group of severe asthmatic adults. RESULTS: The study population consisted of 666 severe asthmatics with a median BMI of 29.8 (interquartile range 22.5 -34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% versus 40.4% and 34.5% in the overweight and normal weight groups, respectively), steroid burst therapy and short-acting ß2-agonist (SABA) use per day. Significant differences were seen with gastro-oesophageal reflux disease (GORD) (53.9% versus 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor (PPI) use. Bone density scores were higher in the obese group, whilst pulmonary function testing revealed a reduced FVC and raised Kco. Serum IgE levels decreased with increasing BMI and the obese group were more likely to report eczema, but less likely to have a history of nasal polyps. CONCLUSIONS: Severe asthmatics display particular characteristics according to BMI that support the view that obesity associated severe asthma may represent a distinct clinical phenotype.1Royal Brompton Hospital, London, UK;2Department of Computing, Imperial College, UK3Airways Disease, National Heart & Lung Institute, Imperial College, UK;4Centre for infection and immunity, Queen's University of Belfast, UK;5University of Leicester, UK;6The University of Manchester and University Hospital of South Manchester, UK;7Birmingham Heartlands Hospital, University of Birmingham, UK;8Gartnavel General Hospital, University of Glasgow, UK;9Glasgow Royal Infirmary, Glasgow, UKCorrespondence: Dr Andrew N. Menzies-Gow, Royal Brompton Hospital, Fulham Road, London SW3 6HP.

Zeros and Os:Silence, Absence and Erasure in an Intercultural O-thello

The performative function of sound and music has received little attention in performance theory and criticism and certainly much less so in studies of intercultural theatre. Such an absence is noteworthy particularly since interculturalism is an appropriative Western theatrical form that absorbs Eastern sources to re-create the targeted Western mise en scene. Consequently, a careful consideration of the employment of sound and music are imperative for sound and music form the vertebrae of Asian traditional performance practices. In acoustemological and ethnomusicological studies, sound and music demarcate cultural boundaries and locate cultures by an auditory (dis)recognition. In the light of this need for a more considered understanding of the performative function of sound and music in intercultural performance, this paper seeks to examine the soundscapes of an intercultural production of Shakespeare’s Othello – Desdemona. Directed by Singaporean Ong Keng Sen, Desdemona was a re-scripting of Shakespeare’s text and a self-conscious performance an identity politics. Staged with a multi-ethnic, multi-national cast, Desdemona employed various Asian performance traditions such as Sanskrit Kutiyattam, Myanmarese puppetry, and Korean p’ansori to create the intercultural spectacle. The spectacle was not only a visual aesthetic but an aural one as well. By examining the soundscapes of fractured silences and eruptive cultural sounds the paper hopes to establish the ways in which Desdemona performs absences and erasures of ‘Asia’ in a simultaneous act of performing an Asian Shakespeare.

A Document in Madness:Ophelia's Music of Insanity

This paper considers the musicological aspects of the songs performed by Ophelia in Shakespeare's Hamlet. It proposes a reconsideration of the concept of madness and insanity by an attentive, attuned and learned listening to the songs sung by Ophelia and the ways in which they are performed and received.

Impact damage and repair of composite structures

This paper gives an overview of the work carried out in a GARTEUR (Group for Aeronautical Research and Technology in Europe) program, under the chairmanship of the author, to develop and validate analytical and numerical methods to characterise real impact damage in composite structures, particularly those designed to sustain load in a postbuckled state, and to study the durability of bonded repairs. GARTEUR is an inter-governmental agreement between the seven European countries with the largest direct employment in the Aerospace industry, to mobilise scientific and technical knowledge between the member countries. A number of Action Groups have been launched, since GARTEUR’s inception in the early 1970s, to address specific technical issues of interest to the participating members. The research presented in this paper was performed under Action Group 28 with partners from ONERA, EADS-CCR (France), DLR, AIRBUS-Deutschland, EADS-M (Germany), CIRA (Italy), INTA (Spain), SICOMP, Saab, (Sweden), NLR (The Netherlands), QinetiQ, BAE Systems, Imperial College London and the University of Sheffield (United Kingdom). The Action Group tasks were divided into four Work Elements (WEs): WE1-Prediction and characterisation of impact damage, WE2- Postbuckling with delamination, WE3-Repair and WE4-Fatigue. This paper outlines the main developments and achievements within each Work Element.

Present orientation, future orientation and alcohol use in Northern Irish adolescents

Earlier initiation into more problematic drinking behaviour has been found to be associated with more problematic drinking later in life. Research has suggested that a lower future time perspective (and higher present time perspective) is associated with health-compromising behaviours such as problematic alcohol use in college student, University undergraduate and general population samples. This study used a cross-sectional design to examine whether consideration of future consequences (CFC), assessed by the Consideration of Future Consequences Scale, was significantly related to drinking behaviour in a large sample (n=707) of Northern Irish adolescents. Alcohol use was self-reported by means of a composite measure of drinking behaviour. Demographic data were also gathered. After controlling for year in school (proxy for age), sex and for clustering at school level, lower future orientation and higher present orientation were found to be significantly associated with more problematic self-reported drinking behaviour. These results extend recent findings of a significant relationship between a foreshortened future time perspective and more problematic self-reported drinking behaviour in a UK sample of University undergraduates, to a large UK sample of adolescents. Given the relationship between early-onset drinking and more problematic use in later life, health promotion interventions might explore using the CFC construct in targeting adolescent drinkers.

Buckling and Postbuckling Structures: Experimental, Analytical and Numerical Studies

This book provides an in-depth treatment of the study of the stability of engineering structures. Contributions from internationally recognized leaders in the field ensure a wide coverage of engineering disciplines in which structural stability is of importance, in particular the analytical and numerical modelling of structural stability applied to aeronautical, civil, marine and offshore structures. The results from a number of comprehensive experimental test programs are also presented, thus enhancing our understanding of stability phenomena as well as validating the analytical and computational solution schemes presented. A variety of structural materials are investigated with special emphasis on carbon-fibre composites, which are being increasingly utilized in weight-critical structures. Instabilities at the meso- and micro-scales are also discussed. This book will be particularly relevant to professional engineers, graduate students and researchers interested in structural stability.