A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

Background: Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients. Objectives: To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head. Methods: The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness. Results: There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for ‘light’ to 5.33 (1.48) for ‘moderate’, 8.28 (1.89) for ‘severe’, and 8.73 (3.03) for ‘very severe’ PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories. Conclusions: Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice

Optimum strength distribution for seismic design of tall buildings

This paper examines the effects of strength distribution pattern on seismic response of tall buildings. It is shown that in general for an MDOF structure there exists a specific pattern for height-wise distribution of strength and stiffness that results in a better seismic performance in comparison with all other feasible patterns. This paper presents a new optimization technique for optimum seismic design of structures. In this approach, the structural properties are modified so that inefficient material is gradually shifted from strong to weak areas of a structure. This process is continued until a state of uniform deformation is achieved. It is shown that the seismic performance of such a structure is optimal, and behaves generally better than those designed by conventional methods. The optimization algorithm is then conducted on shear building models with various dynamic characteristics subjected to a group of severe earthquakes. Based on the results, a new load pattern is proposed for seismic design of tall buildings that is a function of fundamental period of the structure and the target ductility demand. The optimization method presented in this paper could be useful in the conceptual design phase and in improving basic understanding of seismic behavior of tall buildings

Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care

Acknowledgements We thank Robin Taylor for his informative thinking and publications on FeNO, which have helped to influence and direct the thinking of the authors. Funding Extraction of the real-life dataset was funded by Research in Real Life Limited, the analysis of the dataset and the writing of this manuscript were co-funded (50:50) by Research in Real Life Limited and Aerocrine.Peer reviewedPublisher PD

Anxiety and depression following cumulative low-level exposure to organophosphate pesticides

Previous research suggests that individuals with a prior history of pesticide poisoning are at increased risk of psychiatric disorder (Freire and Koifman, 2013), but findings regarding the impact of cumulative low-level exposure are inconsistent. The aim of the current study was to investigate whether sheep farmers with a history of low-level exposure to organophosphate pesticides (1) report a higher level of psychological distress on subjective symptom questionnaires, compared to unexposed controls (2) also meet internationally agreed diagnostic criteria for a psychiatric disorder more often than unexposed controls. 127 sheep farmers were evaluated and compared to 78 unexposed controls, matched in terms of gender, education, level of intelligence, working status and area of residence. Both self-report measures and structured clinical interviews were used to assess mental health. The exposed cohort reported significantly higher rates of anxiety and depression when self-report questionnaires were used to evaluate mood, even when stressful life events, demographic and physical health factors were taken into account. However, when diagnostic interviews were used to assess mood, this pattern only held true for anxiety

Using the ecology model to describe the impact of asthma on patterns of health care

BACKGROUND: Asthma changes both the volume and patterns of healthcare of affected people. Most studies of asthma health care utilization have been done in selected insured populations or in a single site such as the emergency department. Asthma is an ambulatory sensitive care condition making it important to understand the relationship between care in all sites across the health service spectrum. Asthma is also more common in people with fewer economic resources making it important to include people across all types of insurance and no insurance categories. The ecology of medical care model may provide a useful framework to describe the use of health services in people with asthma compared to those without asthma and identify subgroups with apparent gaps in care. METHODS: This is a case-control study using the 1999 U.S. Medical Expenditure Panel Survey. Cases are school-aged children (6 to 17 years) and young adults (18 to 44 years) with self-reported asthma. Controls are from the same age groups who have no self-reported asthma. Descriptive analyses and risk ratios are placed within the ecology of medical care model and used to describe and compare the healthcare contact of cases and controls across multiple settings. RESULTS: In 1999, the presence of asthma significantly increased the likelihood of an ambulatory care visit by 20 to 30% and more than doubled the likelihood of making one or more visits to the emergency department (ED). Yet, 18.8% of children and 14.5% of adults with asthma (over a million Americans) had no ambulatory care visits for asthma. About one in 20 to 35 people with asthma (5.2% of children and 3.6% of adults) were seen in the ED or hospital but had no prior or follow-up ambulatory care visits. These Americans were more likely to be uninsured, have no usual source of care and live in metropolitan areas. CONCLUSION: The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services

“Not in their front yard” The opportunities and challenges of introducing perennial urban meadows: A local authority stakeholder perspective

© 2017 The Authors The growing evidence base for the benefits for people and wildlife of nature-based solutions to managing urban green infrastructure lacks research investigating land manager perspectives on their implementation. To address this gap, we explored UK local authority manager perceptions of the challenges and opportunities of introducing perennial urban meadows to prioritise biodiversity and aesthetics. This was co-produced as an experiment in urban greenspaces with Luton Parks Service and Bedford Borough Council 2013–15. We conducted semi-structured interviews with the eight stakeholder managers involved to identify key factors impacting on the perceived feasibility of future urban meadow establishment in other areas. All managers identified three dominant factors (aesthetics and public reaction, locational context, and human resources and economic sustainability). Additional factors (local politics, communication, biodiversity and existing habitat and physical factors) varied in importance according to personal values and managerial role. Support for future meadow introduction and a desire to overcome the economic challenge of the disposal of meadow arisings were related to manager biocentricity. Managers were aware of changing public values leading to increasing acceptance of a messier urban aesthetic. They perceived perennial meadows as a realistic alternative to amenity mown grass that in specific contexts could increase local biodiversity and enhance aesthetics if implemented in consultation with the public and local councillors. Our findings have relevance for the wider implementation of such nature-based solutions to urban GI management: Changes in management practice such as the introduction of perennial meadows have significant political, strategic, economic and practical implications and cannot be viewed purely as a technical challenge

Understanding teaching assistant self-efficacy in role and in training: its susceptibility to influence

There has been a noted growth in the number of teaching assistants (TAs) in mainstream schools (DfE, 2013a). Research is inconclusive about their efficacy at changing outcomes for children (Alborz et al 2009; Blatchford et al, 2009) and has proposed more training for TAs (Russell et al, 2005). Generic training models have suggested that enhancing self-efficacy in turn improves performance. This exploratory study investigated factors that may influence TAs’ sense of self-efficacy and its susceptibility to influence in training. Following two modes of mode of school-based training by Educational Psychologists (EPs) data were collected from 14 mainstream secondary school TAs using focus groups. A thematic analysis noted themes regarding self-efficacy, aligned with Bandura’s (1977) sources of information, outcome expectations and whole school support and norms. Review of the data is likely to be able to guide potential trainers to coach consult strategies which are self-efficacy supportive and which address contextual factors including the perceived status of TAs in schools

Organisational accreditation, workforce training and perceptions of performance

The paper examines if the 'Investors in People' (IiP) organisational accreditation scheme promoted worker training and organisational performance in Britain using a panel of organisations. DID matching estimators relating to both employee and employer assessed training outcomes revealed that IiP status promoted workforce training, but only for private sector organisations. Conversely, losing the status was not found to have a significant training link. On organisational performance, the estimates revealed that gaining (losing) the status had a significant positive (negative) link with managers' perceptions of organisational performance in both sectors. Public sector organisations are reported to have a relative strength in workforce training, which appears to explain the lack of significant training link. The sector may thus require a different scheme to promote workforce training further