Sex differences in quality of life in stroke survivors. Data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)

Introduction: Female sex is predictive of poor functional outcome in stroke, even after correction for prognostic factors. Poor quality of life (QoL) is observed in stroke survivors, with lower scores seen in the most disabled patients. We used data from the TAIST trial to assess the relationship between sex and QoL after ischaemic stroke. Methods: TAIST was a randomised controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1,484 patients with acute ischaemic stroke. QoL was measured at 180 days post randomisation using the short-form 36 health survey which assesses QoL across eight domains. The relationship between sex and each domain was assessed using ordinal regression, both unadjusted and adjusted for key prognostics factors. Results: Of the 1,484 patients randomised into TAIST, 216 had died at 180 days post randomisation. 1,268 survivors were included in this analysis, 694 males (55%), 574 females (45%). Females tended to score lower than males across all QoL domains (apart from general health); statistically significant lower scores were seen for physical functioning (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.47-0.72), vitality (OR 0.79, 95% CI 0.64-0.98) and mental health (OR 0.75, 95% CI 0.61-0.93). The results for physical functioning and mental health remained significant after adjustment for prognostic variables (OR 0.73, 95% CI 0.58-0.92; OR 0.76, 95% CI 0.60-0.95 respectively). Conclusions: QoL, in particular physical function and mental health domains, is lower in female patients after stroke. This difference persists even after correction for known prognostic factors such as age and stroke severity.

'An Indirect Genetic Algorithm for Set Covering Problems'

This paper presents a new type of genetic algorithm for the set covering problem. It differs from previous evolutionary approaches first because it is an indirect algorithm, i.e. the actual solutions are found by an external decoder function. The genetic algorithm itself provides this decoder with permutations of the solution variables and other parameters. Second, it will be shown that results can be further improved by adding another indirect optimisation layer. The decoder will not directly seek out low cost solutions but instead aims for good exploitable solutions. These are then post optimised by another hill-climbing algorithm. Although seemingly more complicated, we will show that this three-stage approach has advantages in terms of solution quality, speed and adaptability to new types of problems over more direct approaches. Extensive computational results are presented and compared to the latest evolutionary and other heuristic approaches to the same data instances.

Unfinished Turns in French: How Context Matters

On occasions, speakers do not complete their turns in conversation. Such syntactically-incomplete turns are not treated with repair or misunderstanding. The responses that they receive display a clear understanding of the actions that the unfinished turns embodied. In this article, using conversation analysis (CA), I describe the systematic occurrence of unfinished turns in French conversation. I show that context is necessary to the understanding of this type of turn and I describe the nature of that context. Data analysis reveals that unfinished turns are understandable primarily by reference to their sequential position. I conclude that unfinished turns are a locally- managed resource fitted to the particulars of the talk in progress and built upon the context that the sequences that house them have so far provided.

Moderate monism, persistence and sortal concepts

Coincidence (e.g., of a statue and the piece of bronze which constitutes it) comes in two varieties – permanent and temporary. Moderate monism (about coincidence) is the position that permanent coincidence, but not temporary coincidence, entails identity. Extreme monism (also known as the stage theory) is the position that even temporary coincidence entails identity. Pluralists are opponents of monism tout court. The intuitively obvious, commonsensical position (= my own position) is moderate monism. It is therefore important to see if it can be sustained.

The Motif Tracking Algorithm

The search for patterns or motifs in data represents a problem area of key interest to finance and economic researchers. In this paper we introduce the Motif Tracking Algorithm, a novel immune inspired pattern identification tool that is able to identify unknown motifs of a non specified length which repeat within time series data. The power of the algorithm comes from the fact that it uses a small number of parameters with minimal assumptions regarding the data being examined or the underlying motifs. Our interest lies in applying the algorithm to financial time series data to identify unknown patterns that exist. The algorithm is tested using three separate data sets. Particular suitability to financial data is shown by applying it to oil price data. In all cases the algorithm identifies the presence of a motif population in a fast and efficient manner due to the utilisation of an intuitive symbolic representation. The resulting population of motifs is shown to have considerable potential value for other applications such as forecasting and algorithm seeding.

Adaptive regulation or governmentality: patient safety and the changing regulation of medicine

Studies from across the world have shown that clinical mistakes are a major threat to the safety of patient care (World Health Organisation 2004). For the National Health Service (NHS) of England and Wales it is estimated that one in ten hospital patients experience some form of error, and each year these cost the service over £2billion in remedial care (Department of Health 2000). Unsurprisingly, ‘patient safety’ is now a major international health policy priority, questioning the efficacy of existing regulatory practices and proposing a new ethos of learning. Within England and Wales, the National Patient Safety Agency (NPSA) has been created to lead policy development and champion service-wide learning, whilst throughout the NHS the National Reporting and Learning System (NRLS) has been introduced to enable this learning (NPSA 2003). This paper investigates the extent to which, in seeking to better manage the threats to patient safety, this policy agenda represents a transition in medical regulation.

Doctors' thinking about the system as a threat to patient safety

‘Systems thinking’ is an important feature of the emerging ‘patient safety’ agenda. As a key component of a ‘safety culture’, it encourages clinicians to look past individual error to recognise the latent factors that threaten safety. This paper investigates whether current medical thinking is commensurate with the idea of ‘systems thinking’ together with its implications for policy. The findings are based on qualitative semistructured interviews with specialist physicians working within one NHS District General Hospital in the English Midlands. It is shown that, rather then favouring a 'person-centred’ perspective, doctors readily identify ‘the system’ as a threat to patient safety. This is not necessarily a reflection of the prevailing safety discourse or knowledge of policy, but reflects a tacit understanding of how services are (dis)organised. This line of thinking serves to mitigate individual wrong-doing and protect professional credibility by encouraging doctors to accept and accommodate the shortcomings of the system, rather than participate in new forms of organisational learning.

Safety and complexity: the inter-departmental threats to patient safety in the operating department

Purpose: Current thinking about ‘patient safety’ emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of Normal Accidents to extend this analysis and better understand the ‘organisational factors’ that threaten safety. Methods: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. Results: The work of the operating department is determined by inter-dependant, ‘tightly coupled’ organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as ‘breakdowns’ within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. Conclusion: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured ‘real world’ situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.

Beyond Blame: cultural barriers to medical reporting

The paper explores the attitudes of medical physicians towards adverse incident reporting in health care, with particular focus on the inhibiting factors or barriers to participation. It is recognised that there are major barriers to medical reporting, such as the ‘culture of blame’. There are, however, few detailed qualitative accounts of medical culture as it relates to incident reporting. Drawing on a 2-year qualitative case study in the UK, this paper presents data gathered from 28 semi-structured interviews with specialist physicians. The findings suggest that blame certainly inhibits medical reporting, but other cultural issues were also significant. It was commonly accepted by doctors that errors are an ‘inevitable’ and potentially unmanageable feature of medical work and incident reporting was therefore ‘pointless’. It was also found that reporting was discouraged by an anti-bureaucratic sentiment and rejection of excessive administrative duties. Doctors were also apprehensive about the increased potential for managers and non-physicians to engage in the regulation of medical quality through the use of incident data. The paper argues that the promotion of incident reporting must engage with more than the ubiquitous ‘culture of blame’ and instead address the ‘culture of medicine’, especially as it relates to the collegial and professional control of quality.

Inclusion, Participation and the Emergence of British Chinese Websites

Previous work has drawn attention to the relative absence of British Chinese voices in public culture. No one is more aware of this invisibility than British-born Chinese people themselves. Since 2000 the emergence of Internet discussion sites produced by British Chinese young people has provided an important forum for many of them to grapple with questions concerning their identities, experiences and status in Britain. In this paper we explore the ways in which Internet usage by British-born Chinese people has facilitated forms of self-expression, collective identity production and social and political action. This examination of British Chinese websites raises important questions about inclusion and exclusion, citizenship, participation and the development of a sense of belonging in Britain, issues which are usually overlooked in relation to a group which appears to be well integrated and successful in higher education.

European Cosmopolitanism and Civil Society

The discussion of European cosmopolitanism and civil society has failed to take questions of culture seriously enough. While remaining sympathetic to liberal forms of cosmopolitanism, this article considers the view that such proposals fail to make space for the 'Other'. In the context of histories of nationalist violence, masculinism and consumerism this article discusses the charge that ideas of European civilization need to be reconsidered. In the final part of the article, I discuss the view that cultural feminism and certain versions of multiculturalism have much to contribute towards the European project. However, at this point, I seek to distance myself from essentialist arguments in respect of identity. A generative European cosmopolitanism would do well to take questions of cultural domination seriously without reducing the complexity of modern identities.

European Cosmopolitan Solidarity

The idea of a cosmopolitan Europe continues to be central to contemporary debates within post-national citizenship. However, much of the writing in this area remains disconnected from the need to reinvent European social democracy that questions the centrality of work and racist nationalism. This article argues that a revived European Left would need to move beyond specifically liberal concerns with procedure to articulate a view of European futures that both deconstructed neo-liberalism and embraced more convivial collective futures. This would entail the combination of a post-material politics that sought to critique the centrality of employment while granting citizens a basic income or forms of civic labour and a more concerted attempt to break with a racialized politics based upon the fear of the ‘Other’. In conclusion, it is argued that the urgent political task of the future is to reinvent a sense of Europeaness that has both a substantive content, but that does not become mobilized by an exclusive cultural politics.