Risk adjustment for hospital use using social security data: cross sectional small area analysis

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Studies on acyl pyrrolidine inhibitors of HCV RNA-dependent RNA polymerase to identify a molecule with replicon antiviral activity

The SAR development is described for a series of N-acyl pyrrolidine inhibitors of the Hepatitis C virus RNA-dependent RNA polymerase, NS5B, from tractable Delta 21 enzyme inhibitors to an example with antiviral activity in a cellular assay (HCV replicon). (c) 2007 Elsevier Ltd. All rights reserved.

Action research and reflective practice: towards a holistic view

Two concepts that have captured the imagination of the educational community in the last 60 years have been those of ‘reflective practice’ and ‘action research’. Both, in their various forms, are considered to be critical dimensions of the professional development of teachers. However, whilst both were receiving academic attention during the 1930s and 1940s (Lewin, 1934, cited in Adelman, 1993; Lewin, 1946; Dewey, 1933), it was not until Stenhouse’s (1975) notion of the teacher-as-researcher that the two came most compellingly into relationship and educational action research as a process, which held at its centre different kinds of reflection, began to be reformulated in Britain (Carr, 1993). This article considers the important part played in teachers’ development by different kinds of action research. Its central thesis is that, although action research has a critical role to play not least as a means of building the capacity of teachers as researchers of their own practice, there has been insufficient attention given to both the nature of reflection in the action research process, and its relationship to the purposes, processes and outcomes. The article challenges the rational, cognitive models of reflection that are implicit in much of the action research literature. It suggests that more attention needs to be given to the importance of the role of emotion in understanding and developing the capacities for reflection which facilitates personal, professional and ultimately system change.