Assessing Asthma control in UK primary care: Use of routinely collected prospective observational consultation data to determine appropriateness of a variety of control assessment models

Background: Assessing asthma control using standardised questionnaires is recommended as good clinical practice but there is little evidence validating their use within primary care. There is however, strong empirical evidence to indicate that age, weight, gender, smoking, symptom pattern, medication use, health service resource use, geographical location, deprivation, and organisational issues, are factors strongly associated with asthma control. A good control measure is therefore one whose variation is most explained by these factors. Method: Eight binary (Yes = poor control, No = good control) models of asthma control were constructed from a large UK primary care dataset: the Royal College of Physicians 3-Questions (RCP-3Qs); the Jones Morbidity Index; three composite measures; three single component models. Accounting for practice clustering of patients, we investigated the effects of each model for assessing control. The binary models were assessed for goodness-of-fit statistics using Pseudo R-squared and Akaikes Information Criteria (AIC), and for performance using Area Under the Receiver Operator Characteristic (AUROC). In addition, an expanded RCP-3Q control scale (0-9) was derived and assessed with linear modelling. The analysis identified which model was best explained by the independent variables and thus could be considered a good model of control assessment. Results: 1,205 practices provided information on 64,929 patients aged 13+ years. The RCP-3Q model provided the best fit statistically, with a Pseudo R-squared of 18%, and an AUROC of 0.79. By contrast, the composite model based on the GINA definition of controlled asthma had a higher AIC, an AUROC of 0.72, and only 10% variability explained. In addition, although the Peak Expiratory Flow Rate (PEFR) model had the lowest AIC, it had an AUROC of 71% and only 6% of variability explained. However, compared with the RCP-3Qs binary model, the linear RCP-3Q Total Score Model (Scale 0-9), was found to be a more robust 'tool' for assessing asthma control with a lower AIC (28,6163) and an R-squared of 33%. Conclusion: In the absence of a gold standard for assessing asthma control in primary care, the results indicate that the RCP-3Qs is an effective control assessment tool but, for maximum effect, the expanded scoring model should be used

Modeling and Experimental Demonstration of a Hopfield Network Analog-to-Digital Converter with Hybrid CMOS/Memristor Circuits

The purpose of this work was to demonstrate the feasibility of building recurrent artificial neural networks with hybrid complementary metal oxide semiconductor (CMOS)/memristor circuits. To do so, we modeled a Hopfield network implementing an analog-to-digital converter (ADC) with up to 8 bits of precision. Major shortcomings affecting the ADC's precision, such as the non-ideal behavior of CMOS circuitry and the specific limitations of memristors, were investigated and an effective solution was proposed, capitalizing on the in-field programmability of memristors. The theoretical work was validated experimentally by demonstrating the successful operation of a 4-bit ADC circuit implemented with discrete Pt/TiO2−x/Pt memristors and CMOS integrated circuit components.National Science Foundation CCF-1028378Air Force Office of Scientific Research FA9550-12-1-0038Ministerio de Economía y Competitividad TEC2012-37868-C04-0

The relationship between wind power, electricity demand and winter weather patterns in Great Britain

Wind power generation in Great Britain has increased markedly in recent years. However due to its intermittency its ability to provide power during periods of high electricity demand has been questioned. Here we characterise the winter relationship between electricity demand and the availability of wind power. Although a wide range of wind power capacity factors is seen for a given demand, the average capacity factor reduces by a third between low and high demand. However, during the highest demand average wind power increases again, due to strengthening easterly winds. The nature of the weather patterns affecting Great Britain are responsible for this relationship. High demand is driven by a range of high pressure weather types, each giving cold conditions, but variable wind power availability. Offshore wind power is sustained at higher levels and offers a more secure supply compared to that onshore. However, during high demand periods in Great Britain neighbouring countries may struggle to provide additional capacity due to concurrent low temperatures and low wind power availability

Goal-setting intervention in patients with active asthma: Protocol for a pilot cluster-randomised controlled trial

Background: Supporting self-management behaviours is recommended guidance for people with asthma. Preliminary work suggests that a brief, intensive, patient-centred intervention may be successful in supporting people with asthma to participate in life roles and activities they value. We seek to assess the feasibility of undertaking a cluster-randomised controlled trial (cRCT) of a brief, goal-setting intervention delivered in the context of an asthma review consultation. Methods/design: A two armed, single-blinded, multi-centre, cluster-randomised controlled feasibility trial will be conducted in UK primary care. Randomisation will take place at the practice level. We aim to recruit a total of 80 primary care patients with active asthma from at least eight practices across two health boards in Scotland (10 patients per practice resulting in ~40 in each arm). Patients in the intervention arm will be asked to complete a novel goal-setting tool immediately prior to an asthma review consultation. This will be used to underpin a focussed discussion about their goals during the asthma review. A tailored management plan will then be negotiated to facilitate achieving their prioritised goals. Patients in the control arm will receive a usual care guideline-based review of asthma. Data on quality of life, asthma control and patient confidence will be collected from both arms at baseline and 3 and 6 months post-intervention. Data on health services resource use will be collected from all patient records 6 months pre- and post-intervention. Semi-structured interviews will be carried out with healthcare staff and a purposive sample of patients to elicit their views and experiences of the trial. The outcomes of interest in this feasibility trial are the ability to recruit patients and healthcare staff, the optimal method of delivering the intervention within routine clinical practice, and acceptability and perceived utility of the intervention among patients and staff

High-Precision Tuning of State for Memristive Devices by Adaptable Variation-Tolerant Algorithm

Using memristive properties common for the titanium dioxide thin film devices, we designed a simple write algorithm to tune device conductance at a specific bias point to 1% relative accuracy (which is roughly equivalent to 7-bit precision) within its dynamic range even in the presence of large variations in switching behavior. The high precision state is nonvolatile and the results are likely to be sustained for nanoscale memristive devices because of the inherent filamentary nature of the resistive switching. The proposed functionality of memristive devices is especially attractive for analog computing with low precision data. As one representative example we demonstrate hybrid circuitry consisting of CMOS summing amplifier and two memristive devices to perform analog multiply and accumulate computation, which is a typical bottleneck operation in information processing.Comment: 20 pages, 6 figure

Expression in Aneuploid Drosophila S2 Cells

Analysis of the relationship between gene copy number and gene expression in aneuploid male Drosophila cells reveals a global compensation mechanism in addition to X chromosome-specific dosage compensation