The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases

Background: There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma. 

Methods: We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010-11, and routine administrative, health and social care datasets for 2011-12; 2011-12 costs were estimated in pounds sterling using economic modelling. 

Results: The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7-31.3; n = 18.5 million (m) people) and 15.6 % (14.3-16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9-10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7-5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths. 

Conclusions: Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs.

Design and Implementation of a Low Cost Virtual Rugby Decision Making Interactive

The paper describes the design and implementation of a novel low cost virtual rugby decision making interactive for use in a visitor centre. Original laboratory-based experimental work in decision making in rugby, using a virtual reality headset [1] is adapted for use in a public visitor centre, with consideration given to usability, costs, practicality and health and safety. Movement of professional rugby players was captured and animated within a virtually recreated stadium. Users then interact with these virtual representations via use of a lowcost sensor (Microsoft Kinect) to attempt to block them. Retaining the principles of perception and action, egocentric viewpoint, immersion, sense of presence, representative design and game design the system delivers an engaging and effective interactive to illustrate the underlying scientific principles of deceptive movement. User testing highlighted the need for usability, system robustness, fair and accurate scoring, appropriate level of difficulty and enjoyment.

Management of public water supply to reduce energy cost and improve wind power uptake

This paper presents a study on the implementation of Real-Time Pricing (RTP) based Demand Side Management (DSM) of water pumping at a clean water pumping station in Northern Ireland, with the intention of minimising electricity costs and maximising the usage of electricity from wind generation. A Genetic Algorithm (GA) was used to create pumping schedules based on system constraints and electricity tariff scenarios. Implementation of this method would allow the water network operator to make significant savings on electricity costs while also helping to mitigate the variability of wind generation.

Management of public water supply to reduce energy cost and improve wind power uptake

This paper presents a study on the implementation of Real-Time Pricing (RTP) based Demand Side Management (DSM) of water pumping at a clean water pumping station in Northern Ireland, with the intention of minimising electricity costs and maximising the usage of electricity from wind generation. A Genetic Algorithm (GA) was used to create pumping schedules based on system constraints and electricity tariff scenarios. Implementation of this method would allow the water network operator to make significant savings on electricity costs while also helping to mitigate the variability of wind generation.

Design and development of a diagonal-airflow batch dryer for spatial drying homogeneity

Das Verfahren der Lebensmitteltrocknung wird häufig angewendet, um ein Produkt für längere Zeit haltbar zu machen. Obst und Gemüse sind aufgrund ihres hohen Wassergehalts leicht verderblich durch biochemische Vorgänge innerhalb des Produktes, nicht sachgemäße Lagerung und unzureichende Transportmöglichkeiten. Um solche Verluste zu vermeiden wird die direkte Trocknung eingesetzt, welche die älteste Methode zum langfristigen haltbarmachen ist. Diese Methode ist jedoch veraltet und kann den heutigen Herausforderungen nicht gerecht werden. In der vorliegenden Arbeit wurde ein neuer Chargentrockner, mit diagonalem Luftstömungskanal entlang der Länge des Trocknungsraumes und ohne Leitbleche entwickelt. Neben dem unbestreitbaren Nutzen der Verwendung von Leitblechen, erhöhen diese jedoch die Konstruktionskosten und führen auch zu einer Erhöhung des Druckverlustes. Dadurch wird im Trocknungsprozess mehr Energie verbraucht. Um eine räumlich gleichmäßige Trocknung ohne Leitbleche zu erreichen, wurden die Lebensmittelbehälter diagonal entlang der Länge des Trockners platziert. Das vorrangige Ziel des diagonalen Kanals war, die einströmende, warme Luft gleichmäßig auf das gesamte Produkt auszurichten. Die Simulation des Luftstroms wurde mit ANSYS-Fluent in der ANSYS Workbench Plattform durchgeführt. Zwei verschiedene Geometrien der Trocknungskammer, diagonal und nicht diagonal, wurden modelliert und die Ergebnisse für eine gleichmäßige Luftverteilung aus dem diagonalen Luftströmungsdesign erhalten. Es wurde eine Reihe von Experimenten durchgeführt, um das Design zu bewerten. Kartoffelscheiben dienten als Trocknungsgut. Die statistischen Ergebnisse zeigen einen guten Korrelationskoeffizienten für die Luftstromverteilung (87,09%) zwischen dem durchschnittlich vorhergesagten und der durchschnittlichen gemessenen Strömungsgeschwindigkeit. Um den Effekt der gleichmäßigen Luftverteilung auf die Veränderung der Qualität zu bewerten, wurde die Farbe des Produktes, entlang der gesamten Länge der Trocknungskammer kontaktfrei im on-line-Verfahren bestimmt. Zu diesem Zweck wurde eine Imaging-Box, bestehend aus Kamera und Beleuchtung entwickelt. Räumliche Unterschiede dieses Qualitätsparameters wurden als Kriterium gewählt, um die gleichmäßige Trocknungsqualität in der Trocknungskammer zu bewerten. Entscheidend beim Lebensmittel-Chargentrockner ist sein Energieverbrauch. Dafür wurden thermodynamische Analysen des Trockners durchgeführt. Die Energieeffizienz des Systems wurde unter den gewählten Trocknungsbedingungen mit 50,16% kalkuliert. Die durchschnittlich genutzten Energie in Form von Elektrizität zur Herstellung von 1kg getrockneter Kartoffeln wurde mit weniger als 16,24 MJ/kg und weniger als 4,78 MJ/kg Wasser zum verdampfen bei einer sehr hohen Temperatur von jeweils 65°C und Scheibendicken von 5mm kalkuliert. Die Energie- und Exergieanalysen für diagonale Chargentrockner wurden zudem mit denen anderer Chargentrockner verglichen. Die Auswahl von Trocknungstemperatur, Massenflussrate der Trocknungsluft, Trocknerkapazität und Heiztyp sind die wichtigen Parameter zur Bewertung der genutzten Energie von Chargentrocknern. Die Entwicklung des diagonalen Chargentrockners ist eine nützliche und effektive Möglichkeit um dei Trocknungshomogenität zu erhöhen. Das Design erlaubt es, das gesamte Produkt in der Trocknungskammer gleichmäßigen Luftverhältnissen auszusetzen, statt die Luft von einer Horde zur nächsten zu leiten.

“Refugee Voices,” New Social Media and Politics of Representation: Young Congolese in the Diaspora and Beyond

This article examines the role of new social media in the articulation and representation of the refugee and diasporic “voice.” The article problematizes the individualist, de-politicized, de-contextualized, and aestheticized representation of refugee/diasporic voices. It argues that new social media enable refugees and diaspora members to exercise agency in managing the creation, production, and dissemination of their voices and to engage in hybrid (on- and offline) activism. These new territories for self-representation challenge our conventional understanding of refugee/diaspora voices. The article is based on research with young Congolese living in the diaspora, and it describes the Geno-cost project created by the Congolese Action Youth Platform (CAYP) and JJ Bola’s spoken-word piece, “Refuge.” The first shows agency in the creation of analytical and activist voices that promote counter-hegemonic narratives of violence in the eastern Democratic Republic of Congo, while the second is an example of aesthetic expressions performed online and offline that reveal agency through authorship and ownership of one’s voice. The examples highlight the role that new social media play in challenging mainstream politics of representation of refugee/diaspora voices.

Early stage memory loss interventions: utilization, impact, and the experience of living alone.

Thesis (Ph.D.)--University of Washington, 2016-08

Phobos: The design and implementation of embedded software for a low cost radar warning receiver

This portfolio thesis describes work undertaken by the author under the Engineering Doctorate program of the Institute for System Level Integration. It was carried out in conjunction with the sponsor company Teledyne Defence Limited. A radar warning receiver is a device used to detect and identify the emissions of radars. They were originally developed during the Second World War and are found today on a variety of military platforms as part of the platform’s defensive systems. Teledyne Defence has designed and built components and electronic subsystems for the defence industry since the 1970s. This thesis documents part of the work carried out to create Phobos, Teledyne Defence’s first complete radar warning receiver. Phobos was designed to be the first low cost radar warning receiver. This was made possible by the reuse of existing Teledyne Defence products, commercial off the shelf hardware and advanced UK government algorithms. The challenges of this integration are described and discussed, with detail given of the software architecture and the development of the embedded application. Performance of the embedded system as a whole is described and qualified within the context of a low cost system.

Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

"Am I Korean American?": beliefs and practices of parents and children living in two languages and two cultures

The purpose of this study is to explore attitudes and practices regarding their heritage language and the dominant English language among Korean American immigrant families. Using the framework of Language Ideology (Silverstein, 1979), I had three research questions: a) why do parents send their children to a Korean language school, b) what attitudes do immigrant parents and their children show toward Korean and English, and c) how are the parents and children involved in the practices of these two languages? I conducted a survey of parents whose children attended a Korean language school in Urbana-Champaign, Illinois, where the number of Korean sojourners (temporary residents) exceeds that of Korean immigrants. Forty participant parents provided demographic information. They described their children's language-use patterns depending on interlocutors as well as their language proficiency in both Korean and English. The reasons for sending their children to the Korean language school were significantly different depending on the respondents' residential status. In comparison to the sojourners, immigrants tended to give more priority to their children's oral language development and Korean identity construction. I also conducted case studies of three Korean immigrant families with 3- to 5-year-old children, using interviews, observations, and photographs of children's work. The collected data were analyzed according to themes such as daily life, parental beliefs about two languages, practices in two languages, children's attitudes toward two languages, and challenges and needs. Despite individual families' different immigration histories, the three families faced some common challenges. Because of their busy daily routines and different lifestyles, the immigrant families had limited interactions with other Koreans. The parents wanted their children to benefit from two communities and build a combined ethnic identity as Korean Americans. I argue that a Korean language school should expand its role as a comfort zone for all Koreans and Korean Americans. This study explores the heterogeneity among Korean sojourner and immigrant families and their language use and identity construction.

Cost-effectiveness analysis of apixaban compared to low-molecular-weight heparins and vitamin k antagonists for treatment and secondary prevention of venous thromboembolism

Objective: Cost-effectiveness analysis of a 6-month treatment of apixaban (10 mg/12h, first 7 days; 5 mg/12h afterwards) for the treatment of the first event of venous thromboembolism (VTE) and prevention of recurrences, versus low-molecular-weight heparins/vitamin K antagonists treatment (LMWH/VKA). Material and methods: A lifetime Markov model with 13 health states was used for describing the course of the disease. Efficacy and safety data were obtained from AMPLIFY and AMPLIFY-EXT clinical trials; health outcomes were measured as life years gained (LYG) and quality-adjusted life years (QALY). The chosen perspective of this analysis has been the Spanish National Health System (NHS). Drugs, management of VTE and complications costs were obtained from several Spanish data sources (€, 2014). A 3% discount rate was applied to health outcomes and costs. Univariate and probabilistic sensitivity analyses (SA) were performed in order to assess the robustness of the results. Results: Apixaban was the most effective therapy with 7.182 LYG and 5.865 QALY, versus 7.160 LYG and 5.838 QALYs with LMWH/VKA. Furthermore, apixaban had a lower total cost (€13,374.70 vs €13,738.30). Probabilistic SA confirmed dominance of apixaban (led to better health outcomes with less associated costs) in 89% of the simulations. Conclusions: Apixaban 5 mg/12h versus LMWH/VKA was an efficient therapeutic strategy for the treatment and prevention of recurrences of VTE from the NHS perspective.

Massachusetts College of Art and Design y Universidad de Cuenca. Acuerdo de Intercambio Estudiantil. Memorándum de Acuerdo entre Massachusetts College of Art and Design (Massart), Boston, Massachusetts, U:S:A. y la Universidad de Cuenca, Ecuador

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