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Cr-Si based-alloys are promising candidates due to their high melting point and good oxidation resistance. They are designed for working temperatures beyond Ni-base superalloys. The major drawbacks of Cr- based alloys are the embrittlement by Cr2N formation and high ductile to brittle transition temperatures (DBTT). This work investigates the effect of alloying Cr-Si-alloys with the elements Fe and Ni and targets the microstructure and precipitation of A15 phase. Varied compositions are manufactured by arc-melting and heat treatment at 1200°C, which enables controlled precipitation hardening by the Cr3Si-A15 phase.Ni can cause the effect of solution softening in Cr and increases the low-temperature ductility as a result. For Fe it is shown, that it stabilizes the two-phase structure consisting of nitration resistant A15 phase and Crss. Oxidation exposures at 1200°C in synthetic air indicate that Fe additions up to 5 at.% increase also the nitridation resistance of Crss.

With the fast growth of renewable energy sources (RES), more and more uncertainties are involved and influencing the stable operation of power systems. Controlled islanding is the last measure to prevent power system blackouts, thus this paper aims to propose a novel model of system separation based on Online Coherency Identification and Adjustable Robust Optimization Programming (OCI-AROP) for minimizing load shedding considering the uncertainties of RES. First, Fuzzy C-Means (FCM) clustering method with F -statistics is utilized to identify the coherent generator groups with the frequency data measured by Phasor Measurement Units (PMUs). Then, the OCI-AROP model considering coherent group constraints, connectivity constraints and robustness constraints about RES are presented. Finally, the case studies on IEEE-39 bus system and WECC-179 bus system are employed to demonstrate the effectiveness of the proposed OCI-AROP model, and comparisons among the OCI-AROP model and the other models are also given to show its superiority.

The Parkinson's disease (PD) risk gene GTP cyclohydrolase 1 (GCH1) catalyzes the rate-limiting step in tetrahydrobiopterin (BH4) synthesis, an essential cofactor in the synthesis of monoaminergic neurotransmitters. To investigate the mechanisms by which GCH1 deficiency may contribute to PD, we generated a loss of function zebrafishgch1mutant (gch1–/–), using CRISPR/Cas technology.gch1–/–zebrafish develop marked monoaminergic neurotransmitter deficiencies by 5 d postfertilization (dpf), movement deficits by 8 dpf and lethality by 12 dpf. Tyrosine hydroxylase (Th) protein levels were markedly reduced without loss of ascending dopaminergic (DAergic) neurons. L-DOPA treatment ofgch1–/–larvae improved survival without ameliorating the motor phenotype. RNAseq ofgch1–/–larval brain tissue identified highly upregulated transcripts involved in innate immune response. Subsequent experiments provided morphologic and functional evidence of microglial activation ingch1–/–. The results of our study suggest that GCH1 deficiency may unmask early, subclinical parkinsonism and only indirectly contribute to neuronal cell death via immune-mediated mechanisms. Our work highlights the importance of functional validation for genome-wide association studies (GWAS) risk factors and further emphasizes the important role of inflammation in the pathogenesis of PD.SIGNIFICANCE STATEMENTGenome-wide association studies have now identified at least 90 genetic risk factors for sporadic Parkinson's disease (PD). Zebrafish are an ideal tool to determine the mechanistic role of genome-wide association studies (GWAS) risk genes in a vertebrate animal model. The discovery of GTP cyclohydrolase 1 (GCH1) as a genetic risk factor for PD was counterintuitive, GCH1 is the rate-limiting enzyme in the synthesis of dopamine (DA), mutations had previously been described in the non-neurodegenerative movement disorder dopa-responsive dystonia (DRD). Rather than causing DAergic cell death (as previously hypothesized by others), we now demonstrate that GCH1 impairs tyrosine hydroxylase (Th) homeostasis and activates innate immune mechanisms in the brain and provide evidence of microglial activation and phagocytic activity.

Among other tests, Barts Health NHS Trust clinical transplantation laboratory conducts two important gene-detection tests: human leucocyte antigen (HLA)-B*27 (‘B27’, associated with the diagnosis of ankylosing spondylitis) and HLA-B*57:01 (‘B57’, associated with prediction of abacavir hypersensitivity disorder). The turnaround time (TaT) from sample receipt to return of results is important to clinicians and their patients but was not monitored. Furthermore, we anticipated an imminent increase in demand from a forthcoming pathology service merger, together with long-term increases with the rise of personalised genetic medicine.In this quality improvement project, we identified current TaT performance and sources of delay. Over three plan-do-study-act (PDSA) cycles, we tested three change ideas, two involving using IT to remove manual administrative steps and alert us to samples needing progressing; both were retained. The other change involved separating out the targeted tests; we judged this not worthwhile with current demand levels, although something to be re-examined when volumes increase. During the project, we reduced mean TaT from 3.8 to 3.3 days and increased the proportion within our 5-day target from 78% to 100%. These have been sustained (at 3.4 days and 97%) for the 3 months following our PDSA cycles and illustrate that reducing variation can be as impactful as reducing the mean.We conducted this project during the COVID-19 disruption, which reduced demand substantially. We took advantage of this to allow staff to spend time on these improvement activities. Another interesting feature of the work is that during the project, we compared changes in performance on our targeted B27/B57 tests with that on another comparable test as a control, to consider the impact of the general increased attention (the Hawthorne effect). We found that performance on this control also increased comparably, but then fell away after our project finished, while it did not for B27/B57.

Purpose Idiopathic intracranial hypertension is a significant cause of preventable blindness. Patients suffer from debilitating headaches, pulsatile tinnitus, nausea, vomiting, photophobia and radicular pain. At this rate, treatment cost will increase to 462.7 million pounds sterling annually by 2030. Weight loss is the only proven disease-modifying therapy for reversal of idiopathic intracranial hypertension. Bariatric surgery leads to superlative weight loss and reversal of related comorbidities. The case series and literature review aim to raise awareness of bariatric surgery as a safe and effective treatment modality for idiopathic intracranial hypertension. Material and Methods The literature review comprises three systematic analysis and one randomised control trial which were identified after a PubMed search. In the case series, we have included four patients with a preoperative diagnosis of long-standing idiopathic intracranial hypertension. They were referred to our department for bariatric surgery by the neuro-ophthalmologist between January and December 2018. They were followed up for 2 years after bariatric surgery. Results All four patients were women with a mean age of 34 years. Mean body mass index reduced from 47.3 kg/m2 before surgery to 30 kg/m2 at the end of 2 years after surgery. They showed significant improvement or resolution in their symptoms related to idiopathic intracranial hypertension, and none of them required further cerebrospinal fluid pressure reducing procedures. Conclusion Bariatric surgery is a safe and effective method of treating idiopathic intracranial hypertension. It is superior compared to medical management and cerebrospinal fluid pressure reducing procedures which have high rates of recurrence.

Purpose: With the increasing burden of chronic pain and opioid use, provider shortages in Eastern Kentucky and West Virginia have experienced many challenges related to chronic pain management. This study tested a practice facilitator model in both academic and community clinics that selected and implemented best practice processes to better assist patients with chronic pain and increase the use of interdisciplinary health care services. Methods: Using a quasi-experimental design, a practice facilitator was assigned to each state’s clinics and trained clinic teams in quality improvement methods to implement chronic pain tool(s) and workflow processes. Charts for 695 patients with chronic pain using opioids, from 8 randomly selected clinics in eastern Appalachia, were reviewed to assess for changes in clinic processes. Results: Statistically significant improvements were found in 10 out of 16 chronic pain best practice process measures. These included improved workflow implementation (P < 0.001), increased urine drug screen test orders (P = 0.001) and increased utilization of controlled medication agreements (P = 0.004). In total, 7 of 8 clinics significantly improved in at least one, if not all, selected and implemented process measures. Conclusions: Our findings indicate that practice facilitation, standardization of workflows and formation of structured clinical teams can improve processes of care in chronic pain management and facilitate the use of interdisciplinary services. Future studies are needed to assess long-term patient-centered outcomes that may result from improved processes of chronic pain care.

Purpose. This study investigates the virulence and antimicrobial resistance in association with common clonal complexes (CCs) of enteroaggregative Escherichia coli (EAEC) isolated from Bangladesh. The aim was to determine whether specific CCs were more likely to be associated with putative virulence genes and/or antimicrobial resistance. Methodology. The presence of 15 virulence genes (by PCR) and susceptibility to 18 antibiotics were determined for 151 EAEC isolated from cases and controls during an intestinal infectious disease study carried out between 2007–2011 in the rural setting of Mirzapur, Bangladesh (Kotloff KL, Blackwelder WC, Nasrin D, Nataro JP, Farag TH et al. Clin Infect Dis 2012;55:S232–S245). These data were then analysed in the context of previously determined serotypes and clonal complexes defined by multi-locus sequence typing. Results. Overall there was no association between the presence of virulence or antimicrobial resistance genes in isolates of EAEC from cases versus controls. However, when stratified by clonal complex (CC) one CC associated with cases harboured more virulence factors (CC40) and one CC harboured more resistance genes (CC38) than the average. There was no direct link between the virulence gene content and antibiotic resistance. Strains within a single CC had variable virulence and resistance gene content indicating independent and multiple gene acquisitions over time. Conclusion. In Bangladesh, there are multiple clonal complexes of EAEC harbouring a variety of virulence and resistance genes. The emergence of two of the most successful clones appeared to be linked to either increased virulence (CC40) or antimicrobial resistance (CC38), but increased resistance and virulence were not found in the same clonal complexes.

Groundwater is the world's largest freshwater resource and due to overextraction, levels have declined in many regions causing extensive social and environmental impacts. Groundwater management seeks to balance and mitigate the detrimental impacts of development, with plans commonly used to outline management pathways. Thus, plan efficiency is crucial, but seldom are plans systematically and quantitatively assessed for effectiveness. This study frames groundwater management as a system control problem in order to develop a novel testability assessment rubric to determine if plans meet the requirements of a control loop, and subsequently, whether they can be quantitatively tested. Seven components of a management plan equivalent to basic components of a control loop were determined, and requirements of each component necessary to enable testability were defined. Each component was weighted based upon proposed relative importance, then segmented into rated categories depending on the degree the requirements were met. Component importance varied but, a defined objective or acceptable impact was necessary for plans to be testable. The rubric was developed within the context of the Australian groundwater management industry, and while use of the rubric is not limited to Australia, it was applied to 15 Australian groundwater management plans and approximately 47% were found to be testable. Considering the importance of effective groundwater management, and the central role of plans, our lack of ability to test many plans is concerning.

Objective Obesity is associated with a high incidence of obstructive sleep apnoea (OSA). Bariatric surgery is postulated to lead to OSA resolution, but there is inconclusive evidence on its efficacy. We used objective measurements to determine the rate of resolution or improvement of OSA in patients who had bariatric procedures in our unit. Results Data was analysed on all patients with OSA who underwent bariatric procedures [laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG)] between June 2012 and September 2016 in our unit. 47 patients (26.7%) were diagnosed with OSA. Mean age was 48.5 years. 63.8% were female. 43 required nocturnal continuous positive airway pressure (CPAP) support. Procedures were LRYGB (n = 26) and LSG (n = 21). Mean excess weight loss was 56.1%. Mean start apnoea-hypopnoea index (AHI) on CPAP was 6.4 events/hr and end AHI was 1.4 events/h. 14 patients (32.6%) had complete OSA resolution and 12 (27.9%) showed improvement in pressure support requirements. We demonstrated that 55.3% of patients had resolution or improvement in OSA following bariatric surgery. However, there was a high rate of non-attendance of follow-up appointments. Future efforts will involve analysis of the reasons for this to ensure more robust monitoring.

ObjectivesThe effective exploitation of what are often called big data is increasingly important. They provide the evidence in evidence-based health care and underpin scientific progress in many domains including social/economic policy. Typically, an optimal analysis involves working directly with microdata; i.e. the detailed data relating to each individual in the dataset. But there are many ethico-legal and other governance restrictions on physically sharing microdata. Furthermore, researchers or institutions may have an extensive intellectual property investment in complex microdata and although keen for other researchers to analyse their data they may not wish to give them a physical copy. These restrictions can discourage the use of optimum approaches to analysing pivotal data and slow scientific progress. Data science groups across the world are exploring privacy-protected approaches to analysing microdata without having to physically share the data. ApproachA two day international workshop was arranged focussing on privacy protected approaches to data analysis – particularly federated analysis where raw data remain at their original site of collection. The workshop considered the range of approaches that exist, and those that are currently being developed. It explored the strengths, weaknesses, opportunities and challenges associated with these methods and identified situations where specific approaches have a particularly important role. The workshop included a number of practical sessions where potential users could watch demonstrations of the various approaches in action and run analyses themselves. ResultsThe Data Analysis with Privacy Protection for Epidemiological Research (DAPPER) workshop was held 22-23rd August 2016, Bristol. We report back to the broader community on the outcomes of this workshop that focussed on exploring current approaches, tools and technical solutions that facilitate sensitive data to be shared and analysed. ConclusionsThe workshop has helped map out key opportunities and challenges and assisted potential users, developers and other stakeholders (e.g. funders/journals) to recognise the strengths and weaknesses of different privacy protected analytic approaches. The workshop will encourage further methodological work in this field and better informed application of existing methods.

Numerical groundwater modelling to support mining decisions is often challenging and time consuming. Simulation of open pit mining for model calibration or prediction requires models that include unsaturated flow, large magnitude hydraulic gradients and often require transient simulations with time varying material properties and boundary conditions. This combination of factors typically results in models with long simulation times and/or some level of numerical instability. In modelling practice, long run times and instability can result in reduced effort for predictive uncertainty analysis, and ultimately decrease the value of the decision-support modelling. This study presents an early application of the Iterative Ensemble Smoother (IES) method of calibration-constrained uncertainty analysis to a mining groundwater flow model. The challenges of mining models and uncertainty quantification were addressed using the IES method and facilitated by highly parallelized cloud computing. The project was an open pit mine in South Australia that required predictions of pit water levels and inflow rates to guide the design of a proposed pumped hydro energy storage system. The IES calibration successfully produced 150 model parameter realizations that acceptably reproduced groundwater observations. The flexibility of the IES method allowed for the inclusion of 1493 adjustable parameters and geostatistical realizations of hydraulic conductivity fields to be included in the analysis. Through the geostatistical realizations and IES analysis, alternative conceptual models of fractured rock aquifer orientation and connections could be conditioned to observation data and used for predictive uncertainty analysis. Importantly, the IES method out-performed finite difference methods when model simulations contained small magnitude numerical instabilities.

In this article we report on data analysed from a student project about attitudes to school and student perception of engagement and disengagement. The data were collected by students in an Australian study that employed the Young People as Researchers model. Middle year students devised and administered a questionnaire to students in grade 8, 9 and 10 at a secondary school in Australia. A total of 239 students completed the questionnaire. The students completed the initial analysis, which was followed by a more detailed analysis by the authors of this article. The findings support the work of American, British and Australian researchers about the factors that influence engagement and disengagement from schooling. The reported outcomes from the student work and the secondary analysis indicate that students do have the capacity to undertake valid and meaningful research and can make informed contributions to school improvement and student engagement.

Moralization is the process whereby preferences are converted to values (Rozin, 1999). Two studies used an embodied metaphor approach, in which moral metaphors are grounded in one’s sense of physical cleanliness, to investigate whether restrained eating practices are moralized among women. Specifically, we predicted that the regulation of food intake by women is embodied in their feelings of physical cleanliness. Study 1 found that failures of restrained eating (i.e., overeating) increased accessibility of physical cleanliness-related words for women, but not men. Study 2 found that increased negative moral emotions fully mediated the effect of overeating on a desire for physical cleanliness. Overall, the studies argue for the importance of morality in restrained eating and in the central role of emotions in the embodiment of cognitive metaphors. Postprint

I was lucky to have a PhD supervisor whose mentorship transformed my academic experience, says Emma Kathryn White. I was lucky to have a PhD supervisor whose mentorship transformed my academic experience, says Emma Kathryn White.

Introduction The aim of this study was to determine the diagnostic accuracy of REIMS for dysplasia in human adenomas and early colorectal cancer and to determine changes in mucosal lipid chemistry during cancer initiation. Moreover, we attempted to develop a proof of concept first in man study of a novel REIMS-based endoscope for in-vivo chemical phenotyping of adenomas based on the real time analysis of phosphatidic acid (PA) and phosphatidylethanolamine (PE) metabolism. Experimental procedure A prospective, observational cross-sectional cohort study was performed in patients undergoing elective resection for colorectal cancer or colonoscopy at Imperial College London NHS Trust. Two tissue types were obtained - early colorectal cancer (defined as T1 or T2 according to TNMv6 criteria) and adenomatous polyps. Patients with familial adenomatous polyposis, inflammatory bowel disease or hereditary non-polyposis colon cancer were excluded. Specimens were analyzed ex-vivo using a modified electro-surgical hand piece with the aerosol aspirated into a Xevo G2-S QTof mass spectrometer (Waters Corporation). Multivariate analyses were used to create models which underwent cross-validation using SIMCA (V14, Umetrics, Sweden). Characteristic lipid species were identified using univariate statistics in R Studio (V1.0.44) and Metlin. An endoscopic set up was created using a standard endoscope for proof of concept. Summary of data 19 patients (12:7 F:M) were included with a median age of 74 (range 50-92). Six patients had T1/2 adenocarcinoma and 13 had adenomatous polyps. REIMS was able to accurately distinguish the presence of low grade dysplasia (LGD) vs high grade dysplasia (HGD) in adenomatous polyps (sensitivity 95.0%, specificity 100%). Phosphatidic acids (PA) 38:2 and 38:1 were more abundant in high vs low grade dysplasia (p=0.003). REIMS was also able to identify adenomatous polyps from early cancer (sensitivity 100%, specificity 96.3%). Phosphatidylethanolamine (PE) 36:1, phosphatidic acid (PA) 38:1, glucosylceramide (Glc-Cer) 30:1 and ceramide phosphoethanolamines (PE-Cer) d16:1(4E)/20:0 and d14:1(4E)/22:0 were associated with early cancer formation rather than adenomas (p Conclusion Dysplastic adenomas exhibit mucosal lipid chemistry that is discrete from early colorectal cancer. PA, PE and Glc-Cer have potential use as diagnostic biomarkers. First in man studies of the endoscopic application of REIMS suggest it could serve as a real-time tool for early cancer detection based on in vivo analysis of the mucosal lipidome. Citation Format: Petra Paizs, Eftychios Manoli, Sam E. Mason, James L. Alexander, Zsolt Bodai, Emma White, Afeez Adebesin, Jonathan Hoare, Robert Goldin, Ara W. Darzi, James M. Kinross, Zoltan Takats. Rapid evaporative ionization mass spectrometry (REIMS) analysis of the mucosal lipidome has a high diagnostic accuracy for adenomas and early colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4536.

The rate of cardiovascular diseases (CVD) mortality has decreased over the last few years. However, in rural areas, this reduction is less substantial compared to urban areas despite the effort to ...

Objective: To compare the incidence and severity of local side effects of urinary-derived gonadotropins administered SC and IM. Design: Prospective randomized study of women undergoing IVF treatment. Setting: Tertiary referral center for assisted reproduction. Patient(s): A total of 71 patients were randomized to receive gonadotropins by the SC (n = 41) or IM (n = 30) route. Intervention(s): One cycle of IVF with gonadotropins administered either SC or IM for ovarian stimulation. Main Outcome Measure(s): Incidence and severity of local side effects, such as redness, itching, swelling, pain, and bruising. Result(s): Pain was the most common side effect, with 55.3% and 70.1% of IM and SC injections, respectively, resulting in pain. There were no statistically significant differences in the incidence of itching or bruising after IM and SC injections. Although there was a higher incidence of redness and swelling in the SC group compared with the IM group, most cases were classified as mild. Conclusion(s): There was a significantly higher incidence of some local side effects after SC gonadotropin administration but most of these were mild and well tolerated by patients.

Receiver domains control intracellular responses triggered by signal transduction in bacterial two-component systems. Here, we report the solution nuclear magnetic resonance structure and dynamics of Sma0114 from the bacterium Sinorhizobium meliloti, the first such characterization of a receiver domain from the HWE-kinase family of two-component systems. The structure of Sma0114 adopts a prototypical α(5)/β(5) Rossman fold but has features that set it apart from other receiver domains. The fourth β-strand of Sma0114 houses a PFxFATGY sequence motif, common to many HWE-kinase-associated receiver domains. This sequence motif in Sma0114 may substitute for the conserved Y-T coupling mechanism, which propagates conformational transitions in the 455 (α4-β5-α5) faces of receiver domains, to prime them for binding downstream effectors once they become activated by phosphorylation. In addition, the fourth α-helix of the consensus 455 face in Sma0114 is replaced with a segment that shows high flexibility on the pico- to nanosecond time scale by (15)N relaxation data. Secondary structure prediction analysis suggests that the absence of helix α4 may be a conserved property of the HWE-kinase-associated family of receiver domains to which Sma0114 belongs. In spite of these differences, Sma0114 has a conserved active site, binds divalent metal ions such as Mg(2+) and Ca(2+) that are required for phosphorylation, and exhibits micro- to millisecond active-site dynamics similar to those of other receiver domains. Taken together, our results suggest that Sma0114 has a conserved active site but differs from typical receiver domains in the structure of the 455 face that is used to effect signal transduction following activation.

Members of the orderHalobacterialesare obligate extreme halophiles that belong to the domainArchaea. The classification of theHalobacterialescurrently relies on a polyphasic approach, which integrates phenotypic, genotypic and chemotaxonomic characterization. However, the most utilized genetic marker for phylogeny, the 16S rRNA gene, has multiple drawbacks for use with theHalobacteriales: the species of many genera exhibit large intragenic differences between multiple ribosomal RNA operons, the gene is too conserved to discriminate reliably at the species level and it appears to be the most frequently recombined gene between closely related species. Moreover, theHalobacterialesis a rapidly expanding group due to recent successes at cultivating novel strains from a diverse set of hypersaline environments; a fast, reliable, inexpensive, portable molecular method for discriminating species is required for their investigation. Recently, multilocus sequence analysis (MLSA) has been shown to be an effective tool for strain identification and taxonomic designation, even for those taxa that experience frequent lateral gene transfer and homologous recombination. In this study, MLSA was utilized for evolutionary and taxonomic investigation of theHalobacteriales. Efficacy of the MLSA approach was tested across a hierarchical gradient using 52 halobacterial strains, representing 33 species (including names without standing in nomenclature) and 14 genera. A subset of 21 strains from the genusHaloarculawas analysed separately to test the sensitivity and relevance of the MLSA approach among closely related strains and species. The results demonstrated that MLSA differentiated individual strains, reliably grouped strains into species and species into genera and identified potential novel species and also family-like relationships. This study demonstrates that MLSA is a rapid and informative molecular method that will probably accommodate strain analysis at any taxonomic level within theHalobacteriales.

This is a pre-copy-editing, author-produced PDF of an article accepted for publication in ICES Journal of Marine Science following peer review. The definitive publisher-authenticated version “White, E., Minto, C., Nolan, C. P., King, E., Mullins, E., and Clarke, M. 2011. First estimates of age, growth, and maturity of boarfish (Capros aper): a species newly exploited in the Northeast Atlantic. – ICES Journal of Marine Science, 68: 61–66” is available online at: http://icesjms.oxfordjournals.org/content/68/1/61, peer-reviewed, Boarfish in the Northeast Atlantic have recently been exploited commercially for fishmeal. It is a sexually dimorphic species with an estimated maximum age of 26 years, late age at maturity (A50 = 5.25 years), relatively fast rate of growth (K = 0.186 year−1), and a small asymptotic length (L∞ = 128.9 mm).

The migration of doctors and nurses from low- to high-income countries has left many countries relying on mid-level cadres as the mainstay of their health delivery system, Malawi being an example. Although an extremely important resource, little attention has been paid to the management and further development of these cadres. In this paper we use the concept of organisational justice – fairness of treatment, procedures and communication on the part of managers – to explore through a questionnaire how mid-level cadres in jobs traditionally done by higher-level cadres self-assessed their level of job satisfaction. All mid-level health workers present on the day of data collection in 34 health facilities in three health districts of Malawi, one district each from the three geographical regions, were invited to participate; 126 agreed. Perceptions of justice correlated strongly with level of job satisfaction, and in particular perceptions of how well they were treated by their managers and the extent to which they were informed about decisions and changes. Pay was not the only important element in job satisfaction; promotion opportunities and satisfaction with current work assignments were also significant. These findings highlight the important role that managers can play in the motivation, career development and performance of mid-level health workers.

INTRODUCTION: In April 2004 British General Practitioners started to work under a “new contract”, known as GMS2. This encouraged more formal review of many conditions including asthma. AIMS & OBJECTIVES: The questionnaires would enable us to identify patients willing to have telephone reviews of their asthma, those well controlled, and those with poor control. The questionnaires have allowed us to audit our asthma care over a 10 month period. SUBJECT & METHODS: The patients were identified using our clinical software, and were those who had not attended asthma review in the preceding 12 months. The questionnaires asked about smoking status, telephone reviews, and asthma control. The first cohort was posted in February 2005, and in October 2005 we sent out the same questionnaires to another cohort of “non-attenders”. RESULTS: 199 questionnaires received in February, 120 in October. Overall asthma control was good. From the first set of questionnaires (n= 199, all figure relate to 3 or more times per week), 7.5% were woken; 8.5% had their normal activities disturbed; 28% had their normal asthma symptoms; 22% used their reliever inhaler; 84% were non smokers. October 2005 n= 120, these figures were similar, again all figures relate to >3 times in the previous week; woken at night 7.5%; activities disturbed 10%; asthma symptoms 25%; use of blue inhaler 24%; 80% were non smokers. CONCLUSIONS: The questionnaires provided a snapshot of asthma control in the practice population and were easy and inexpensive to perform. It is rewarding that we have less people who have not had a review, but overall asthma control has not changed. In the future those with poor control should probably be chased more actively, perhaps by their doctor, rather than simply by the administrative staff. Conflict of interest and funding No conflict of interest was declared. Postage for the first (February 2005) questionnaires was kindly supported by AstraZeneca.