The performance of Mini Wright peak flow meters after prolonged use

AbstractThe accuracy of 84 new and 35 old Mini Wright peak flow meters were tested using a servo-controlled pump system. The 95% confidence limits for flow measurement across the range of the new meters was between ± 151 min−1 at the lower end of the range and ± 281 min−1 at the top of the range. The readings for 22 (63%) of the old meters (age range 1–13 yr) were within these 95% confidence limits. For the remaining 13 old meters (age range 1–13 yr) whose readings were not within these limits, there were 11 meters with readings falling below and two meters with readings above these limits. Twelve of these old meters were washed and retested and there was no significant change in their readings. Twenty of the new meters were retested after 1 yr of continuous use and their readings were significantly higher with a median value of 51 min−1 across the range, although only two of these 20 meters had readings outside the 95% confidence limits set from the 84 new meters. It is concluded that whilst Mini Wright meters aged up to 14 yr can give readings which are as good as new meters, some meters demonstrate significant changes in readings after only 1 yr and washing did not correct this change. It is recommended that clinicians prescribing peak expiratory flow (PEF) meters should be responsible for checking the patient's meter as well as their PEF readings at clinic visits

Defining and investigating difficult asthma: Developing quality indicators

SummaryBackgroundThere is no agreed definition of ‘difficult asthma’ or what investigations should be available to investigate these patients. Patients with difficult asthma remain symptomatic on high levels of treatment and are high users of medical resources.AimTo develop a set of quality indicators for the definition and investigation of difficult asthma.MethodModified RAND Appropriateness Method was used. An expert panel composed of nine hospital asthma specialists who run ‘difficult’ asthma clinics and were identified from a shortlist of key workers in the field. Indicators were rated as necessary to define and investigate difficult asthma.ResultsDifficult asthma was defined as ‘symptoms persisting beyond therapy consistent with step 4 of the British Thoracic Society (BTS) guidelines’ (high dose inhaled corticosteroids and long acting β2-agonists). Eighty-three indicators were identified (40 relating to definition and 43 relating to investigations). Of these 32 (39%) were rated as necessary: 7 out of 40 (18%) for defining difficult asthma and 23 out of 43 (53%) for investigations. Indicators of high medical resource usage were characteristic of the ‘difficult’ nature of the management of patient with difficult asthma. A framework for the investigation of these patients was created.ConclusionThe listed performance indicators identify a range of requirements that are necessary to define difficult asthma. Targeting of real needs in this group of patients will lead to better patient care and reduction of ‘waste’ in provision of healthcare

Microlaser-based contractility sensing in single cardiomyocytes and whole hearts

Microscopic whispering gallery mode lasers detect minute changes in cellular refractive index inside individual cardiac cells and in live zebrafish. We show that these signals encode cardiac contractility that can be used for intravital sensing.Postprin

Driving pro-environmental change in tourist destinations: encouraging sustainable travel in National Parks via partnership project creation and implementation

© 2016 Taylor & Francis. This paper explores a key challenge in introducing more sustainable transport practices at destinations: achieving modal shift in visitor travel from cars to physically active or public transport to reduce tourism's environmental impacts. It centres on using partnership led projects bringing together the many public and private sector organisations involved, to drive destination change and development. To date, research has centred on pro-environmental change for individuals and individual organisations: little is known about the mechanisms of pro-environmental change via complex multi-partner organisations. The paper reports research into the processes involved in successful projects to provide alternatives to car travel in three UK National Parks by using partnerships to obtain funding and implement change. Based on case studies informed by in-depth interviews with key stakeholders involved in pro-environmental change implementation, narratives are analysed to explain the change process, and mapped against existing literature and theories of change. Conclusions show the role of inspired individuals, supportive senior management, strong governance, better visitor experiences and, most significantly, communication and communication of the benefits of change to stakeholders. The research suggests why and how change occurs in partnerships, contributes to better theories of change and offers guidance on understanding and implementing change processes worldwide

Talented suppliers? Strategic change and innovation in the UK aerospace industry

The 1990s marked the start of extensive re-structuring in the aerospace industry throughout the world. While the ensuing consolidation among prime contractors has been widely researched, the changes affecting the aerospace supply chain have received less attention. This study focuses on the re-structuring taking place within the supply chain of the UK aerospace industry. The findings point to extensive re-structuring. Unlike most earlier studies the lean supply model was found to be a powerful influence, with suppliers moving away from subcontractor status and instead taking on the mantle of ‘talented’ suppliers. While some of the implications of lean supply, in terms of the dynamics of innovation, were not apparent, there were modest signs of increased process innovation on the part of some suppliers

Observation of Orbitally Excited B_s Mesons

We report the first observation of two narrow resonances consistent with states of orbitally excited (L=1) B_s mesons using 1 fb^{-1} of ppbar collisions at sqrt{s} = 1.96 TeV collected with the CDF II detector at the Fermilab Tevatron. We use two-body decays into K^- and B^+ mesons reconstructed as B^+ \to J/\psi K^+, J/\psi \to \mu^+ \mu^- or B^+ \to \bar{D}^0 \pi^+, \bar{D}^0 \to K^+ \pi^-. We deduce the masses of the two states to be m(B_{s1}) = 5829.4 +- 0.7 MeV/c^2 and m(B_{s2}^*) = 5839.7 +- 0.7 MeV/c^2.Comment: Version accepted and published by Phys. Rev. Let

Simplicity in Visual Representation: A Semiotic Approach

Simplicity, as an ideal in the design of visual representations, has not received systematic attention. High-level guidelines are too general, and low-level guidelines too ad hoc, too numerous, and too often incompatible, to serve in a particular design situation. This paper reviews notions of visual simplicity in the literature within the analytical framework provided by Charles Morris' communication model, specifically, his trichotomy of communication levels—the syntactic, the semantic, and the pragmatic. Simplicity is ultimate ly shown to entail the adjudication of incompatibilities both within, and between, levels.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68281/2/10.1177_105065198700100103.pd

Whiteness and diasporic Irishness: nation, gender and class

Whiteness is often detached from the notion of diaspora in the recent flurry of interest in the phenomenon, yet it is a key feature of some of the largest and oldest displacements. This paper explores the specific contexts of white racial belonging and status over two centuries in two main destinations of the Irish diaspora, the USA and Britain. Its major contribution is a tracing of the untold story of ‘How the Irish became white in Britain’ to parallel and contrast with the much more fully developed narrative in the USA. It argues that, contrary to popular belief, the racialisation of the Irish in England did not fade away at the end of the nineteenth century but became transmuted in new forms which have continued to place the ‘white’ Irish outside the boundaries of the English nation. These have been strangely ignored by social scientists, who conflate Irishness and working-class identities in England without acknowledging the distinctive contribution of Irish backgrounds to constructions of class difference. Gender locates Irish women and men differently in relation to these class positions, for example allowing mothers to be blamed for the perpetuation of the underclass. Class and gender are also largely unrecognised dimensions of Irish ethnicity in the USA, where the presence of ‘poor white’ neighbourhoods continues to challenge the iconic story of Irish upward mobility. Irishness thus remains central to the construction of mainstream ‘white’ identities in both the USA and Britain into the twenty-first century