Interactive digital interventions to promote self-management in adults with asthma : systematic review and meta-analysis

This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number (RP-PG- 1211–20001).Background: To identify, summarise and synthesise the evidence for using interactive digital interventions to support patient self-management of asthma, and determine their impact. Methods: Systematic review with meta-analysis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The selection criteria requirement was studies of adults (16 years and over) with asthma, interventions that were interactive digital interventions and the comparator was usual care. Outcomes were change in clinical outcomes, cost effectiveness and patient-reported measures of wellbeing or quality of life. Only Randomised Controlled Trials published in peer-reviewed journals in English were eligible. Potential studies were screened and study characteristics and outcomes were extracted from eligible papers independently by two researchers. Where data allowed, meta-analysis was performed using a random effects model. Results: Eight papers describing 5 trials with 593 participants were included, but only three studies were eligible for inclusion for meta-analysis. Of these, two aimed to improve asthma control and the third aimed to reduce the total dose of oral prednisolone without worsening control. Analyses with data from all three studies showed no significant differences and extremely high heterogeneity for both Asthma Quality of Life (AQLQ) (Standardised Mean Difference (SMD) 0.05; 95 % Confidence Interval (CI) 0.32 to -0.22: I2 96.8) and asthma control (SMD 0.21; 95 % CI -0.05 to .42; I2 = 87.4). The removal of the third study reduced heterogeneity and indicated significant improvement for both AQLQ (SMD 0.45; 95 % CI 0.13 to 0.77: I2 = 0.34) and asthma control (SMD 0.54; 95 % CI 0.22 to 0.86: I2 = 0.11). No evidence of harm was identified. Conclusion: Digital self-management interventions for adults with asthma show promise, with some evidence of small beneficial effects on asthma control. Overall, the evidence base remains weak due to the lack of large, robust trials.Publisher PDFPeer reviewe

Speaking vocabulary of first grade children

Thesis (Ed.M.)--Boston Universit

Robust SARS-CoV-2-specific and heterologous immune responses in vaccine-naïve residents of long-term care facilities who survive natural infection

We studied humoral and cellular immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 152 long-term care facility staff and 124 residents over a prospective 4-month period shortly after the first wave of infection in England. We show that residents of long-term care facilities developed high and stable levels of antibodies against spike protein and receptor-binding domain. Nucleocapsid-specific responses were also elevated but waned over time. Antibodies showed stable and equivalent levels of functional inhibition against spike-angiotensin-converting enzyme 2 binding in all age groups with comparable activity against viral variants of concern. SARS-CoV-2 seropositive donors showed high levels of antibodies to other beta-coronaviruses but serostatus did not impact humoral immunity to influenza or other respiratory syncytial viruses. SARS-CoV-2-specific cellular responses were similar across all ages but virus-specific populations showed elevated levels of activation in older donors. Thus, survivors of SARS-CoV-2 infection show a robust and stable immunity against the virus that does not negatively impact responses to other seasonal viruses

The life and material culture of Hertha Marks Ayrton (1854–1923): suffragette, physicist, mathematician and inventor

Suffragette, physicist, mathematician and inventor: in the late nineteenth and early twentieth century when few women had access to opportunities in science, technology, engineering and mathematics (STEM), Englishwoman Hertha Marks Ayrton held all these roles and was a strong advocate for social justice, especially suffrage for women. Using material from the Science Museum archives, this paper explores the material culture of Ayrton’s career and work and provides an insight into issues and intersections of gender, science, and technology in the late nineteenth and early twentieth centuries. The article engages with the material culture of Ayrton’s work across multiple fields in STEM. Firstly, it discusses the line-divider, a mathematical tool and engineering drawing instrument Ayrton developed while still an undergraduate at Cambridge and later patented. This was the first of twenty-six patents Ayrton was granted during her lifetime. Next, the paper turns to the electric arc. Ayrton made notable contributions to the understanding of this early and powerful form of electric lighting, and quite literally published the textbook on it. Thirdly, the paper looks at the ‘Ayrton anti-gas fan’, which was distributed in thousands and used to dissipate gas in the trenches on the Western Front during the First World War. Lastly, this paper will explore the impact of gender on Ayrton’s achievements and recognition. Ayrton was elected the first female member of the Institution of Electrical Engineers (IEE), the premier British institution of electrical and electronic engineering, in 1899. However, her nomination as a Fellow of the Royal Society (FRS) in 1902 was declined because of her gender

Work-life balance and the workforce reforms

Work-life balance is a relatively unexplored topic in the educational field, yet it was a significant element of the National Agreement (2003) which sought to enable teachers, including head teachers, to achieve a reasonable work-life balance. Subsequently the workforce reforms were introduced into schools in a phased manner in order to implement the Agreement’s principles. This study seeks to establish the meaning of work-life balance and goes on to examine the effectiveness of the workforce reforms in achieving their goal to support teachers in achieving such a balance. This is a qualitative study using multiple case study methodology. Data was gathered via semi-structured interviews with twelve teachers and six leaders from three secondary schools in the same locality. The differing perspectives of teachers and leaders in the schools are highlighted in order to identify the key factors which affect the ability of an individual to achieve a work-life balance. Following an analysis of the findings it is suggested that the workforce reforms had not been effective in this respect. Further, it is proposed that personal capacity and personal control are pivotal in enabling staff in secondary schools to manage the work and non-work aspects of their lives in order to achieve an acceptable balance

Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

Background: patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management.Methods: a qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae.Results: participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house.Conclusions: these participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this stud