Decision making in childhood asthma exacerbation – a clinical judgement analysis

Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors on the basis of their knowledge and experience. These include administration of systemic corticosteroids (CS), oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making. Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 â??paperâ?? patients. Results:When compared by specialty, paediatriciansâ?? models for decision 1 were more likely to include as a cue level of alertness (54% v. 16%); for decision 2 presence of crepitations (49% v. 16%), and less likely to include inhaled CS (8% v. 40%), respiratory rate (0% v. 24%), and air entry (70% v. 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% v. 6%). Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.

Variation in shell morphology of Calliostoma zizyphinum (Gastropoda : Trochidae)

Differences in shell morphology in the intertidal prosobranch mollusc Calliostoma zizyphinum were studied from a number of sites within four geographical reo ions of the British Isles with varying exposures to wave action and crab predation. Mean values of damage scarring were highest in shells sampled from Strangford Lough, Northern Ireland, and lowe;t in individuals from the Atlantic Coast. Shells collected front the Isle of Man were smaller than those from either the Atlantic coast of Ireland or Strangford Lough. Shells front Strangford Lough had taller shells (higher aspect ratio) than shells from the County Down and Atlantic Coast and shells from the County Down coast were more squat (lower aspect ratio) than those from all other areas. Shells from Strangford Lough were significantly thinner than shells from all other geographical areas. The relationships between shell damage scarring and shell size and tallness were not consistent among areas. Shells from Strangford Lough are notable in showing a steep, positive relationship between shell size and scarring and a steep, negative relationship between scarring and tallness. The unusual shell phenotypes observed in shells from Strangford 1,Lough may be explained by rapid shell growth, which would not only allow Calliostoma to attain a size refuge from crab predators but also to recover successfully from repeated crab attacks on the shell lip. Such a strategy would result in larger, thinner shells with a high number of damage scars.

Protest practice and (tree) cultures of conflict: understanding the spaces of ‘tree maiming’ in eighteenth- and early nineteenth-century England

Developing understandings of protest and cultures of resistance has been a central theme of the 'new' cultural geography of the 1990s and 2000s. But whilst geographers of the here and now have been highly sensitive to the importance of acts of protest which occur outside of the context of broader social movements, geographers concerned with past protests have tended to focus overwhelmingly upon either understanding the development of social movements or highly specific place-based studies. Through a focus upon the hitherto ignored practice of 'tree maiming', this paper demonstrates not only the value of examining specific protest practices in helping to better understand the complexity of conflict, but also how in periods of acute socio-economic change the evolving relationship between humans and the non-human – in this case trees – is a central discourse to the protest practices of the poor. Such attacks often involved complex cultural understandings about the ways in which trees should – and should not – be socially enrolled.

Cut down by some cowardly miscreants’: Plant maiming, or the Malicious Cutting of Plants as an Act of Protest in Eighteenth and Nineteenth Century Rural England

Since the publication of Hobsbawm and Rudé's Captain Swing our understanding of the role(s) of covert protests in Hanoverian rural England has advanced considerably. Whilst we now know much about the dramatic practices of incendiarism and animal maiming and the voices of resistance in seemingly straightforward acquisitive acts, one major gap remains. Despite the fact that almost thirty years have passed since E. P. Thompson brought to our attention that under the notorious ‘Black Act’ the malicious cutting of trees was a capital offence, no subsequent research has been published. This paper seeks to address this major lacuna by systematically analysing the practices and patterns of malicious attacks on plants (‘plant maiming’) in the context of late eighteenth- and early nineteenth-century southern England. It is shown that not only did plant maiming take many different forms, attacking every conceivable type of flora, but also that it was universally understood and practised. In some communities plant maiming was the protestors' weapon of choice. As a social practice it therefore embodied wider community beliefs regarding the defence of plebeian livelihoods and identities.

The police officer's terrorist dilemma: Trust resilience following fatal errors

Suicide attacks have raised the stakes for officers deciding whether or not to shoot a suspect ('Police Officer's Terrorist Dilemma'). Despite high-profile errors we know little about how trust in the police is affected by their response to the terrorist threat. Building on a conceptualisation of lay observers as intuitive signal detection theorists, a general population sample (N= 1153) were presented with scenarios manipulated in terms of suspect status (Armed/Unarmed), officer decision (Shoot/Not Shoot) and outcome severity (e.g. suspect armed with Bomb/Knife; police shoot suspect/ suspect plus child bystander). Supporting predictions, people showed higher trust in officers who made correct decisions. reflecting good discrimination ability and who decided to shoot, reflecting an 'appropriate' response bias given the relative costs and benefits. This latter effect was moderated by (a) outcome severity, suggesting it did not simply reflect a preference for a particular type of action, and (b) preferences for a tough stance towards terrorism indexed by Right-Wing Authoritarianism (RWA). Despite loss of civilian life, failure to prevent minor terror attacks resulted in no loss of trust amongst people low in RWA. whereas among people high in RWA trust was positive when police erroneously shot all unarmed suspect. Relations to alternative definitions of trust and procedural justice research are discussed. Copyright (C),. 2007 John Wiley & Sons, Ltd.

Sleeping site selection by the golden-handed tamarin Saguinus midas midas: The role of predation risk, proximity to feeding sites, and territorial defence

Tamarin monkeys, of the genus Saguinus, spend over half their lives at arboreal sleeping sites. The decision as to which site to use is likely to have considerable fitness consequences. These decisions about sleeping sites by three troops of golden-handed tamarin Saguinus midas midas were examined over a 9-mo period at a rainforest site in French Guiana. Data are presented on the physical nature of sleeping sites, their number, position within home ranges, and pattern of use and reuse, aspects of behaviour at retirement and egress, and predation attempts on the study troops. Cumulative plot analysis indicated that a tamarin troop used 30-40 sleeping sites in a 100-day period, approximately half of which were used very infrequently, so that consecutive reuse was never greater than three nights. Sleeping trees were superior in architectural parameters and liana weight to non-sleeping trees. There were no more sleeping sites than expected within the home range boundary region of the tamarins or in areas of overlap with the home ranges of neighbouring troops. Tamarins selected sleeping sites nearest to the last feeding site of the day on 25% of occasions. The study troops engaged in a number of activities that may reduce predation risk; raptor attacks on the study troops over 9 mo were frequent but unsuccessful. Tamarins often visited a sleeping site several hours before arrival, and were more likely to visit a site before use if they had not used it recently. The decision to select a sleeping site therefore involved knowledge of the previous frequency of use of that site.

Bluestocking Feminism Revisited: The Satirical Figure of the Bluestocking

Recent debates about the Bluestockings have focused on the lives, writings and political opinions of the Bluestockings themselves. This article argues that the significance of the Bluestockings, however, lies in the ways in which they were figured in public representations. It examines the tradition of satires of the Bluestockings, showing how this tradition both continued earlier traditions of satire against the learned lady and invented the comic figure of the literary hostess. The satires’ crude attacks on intellectual women ultimately raised the profile of the learned lady, a figure whose incipient feminism bore no necessary relation to the historical Bluestockings themselves.

An investigation into the behaviour of concrete containing seawater-neutralised bauxite refinery residues in silage effluent

The farm production of silage as a winter-feed supplement is widespread. However, the bins in which silage is produced are subject to acidic and microbial attacks. Both these types of attack can lead to a weakening and failure of the concretes, especially on the outer lip of the open side of the silage pit. Consequently, the development of an acid-resistant concrete that can extend the life span of silage bins on farms could lead to considerable cost savings for farmers and, hence, can improve farm productivity. This paper reports on test results of an investigation into the behaviour of concrete containing seawater-neutralised bauxite refinery residues (Bauxsol™) exposed to sulphuric acid environments in the laboratory and to silage effluents. The concrete manufactured had a fixed water–cement ratio of 0.55 and natural sand was replaced with the Bauxsol™ at 0%, 5%, 10%, 15% and 20% by cement mass. Results indicated that the use of Bauxsol™ as a sand replacement material improved the behaviour of concrete both in sulphuric acid in the laboratory as well as in the silage effluent. Consequently, it is concluded that the Bauxsol™ can be used to replace 10% of natural sand to produce concrete that is resistant to silage effluents, providing an extended service life over conventional concretes used in silage pits.

Low-cost digital signature architecture suitable for radio frequency identification tags

Continuing achievements in hardware technology are bringing ubiquitous computing closer to reality. The notion of a connected, interactive and autonomous environment is common to all sensor networks, biosystems and radio frequency identification (RFID) devices, and the emergence of significant deployments and sophisticated applications can be expected. However, as more information is collected and transmitted, security issues will become vital for such a fully connected environment. In this study the authors consider adding security features to low-cost devices such as RFID tags. In particular, the authors consider the implementation of a digital signature architecture that can be used for device authentication, to prevent tag cloning, and for data authentication to prevent transmission forgery. The scheme is built around the signature variant of the cryptoGPS identification scheme and the SHA-1 hash function. When implemented on 130 nm CMOS the full design uses 7494 gates and consumes 4.72 mu W of power, making it smaller and more power efficient than previous low-cost digital signature designs. The study also presents a low-cost SHA-1 hardware architecture which is the smallest standardised hash function design to date.

Watermarking for Multimedia Security using Complex Wavelets

This paper investigates the application of complex wavelet transforms to the field of digital data hiding. Complex wavelets offer improved directional selectivity and shift invariance over their discretely sampled counterparts allowing for better adaptation of watermark distortions to the host media. Two methods of deriving visual models for the watermarking system are adapted to the complex wavelet transforms and their performances are compared. To produce improved capacity a spread transform embedding algorithm is devised, this combines the robustness of spread spectrum methods with the high capacity of quantization based methods. Using established information theoretic methods, limits of watermark capacity are derived that demonstrate the superiority of complex wavelets over discretely sampled wavelets. Finally results for the algorithm against commonly used attacks demonstrate its robustness and the improved performance offered by complex wavelet transforms.

The Future of Preventive Wars: The Case of Iraq

Eight years have past since the devastating September 11 attacks, and the USA has engaged in two wars in the name of uprooting global ‘terrorism’ and providing security to American citizens. The Bush administration bequeathed a legacy of two ongoing wars and growing threats emerging from ‘terrorist’ acts. This article analyses the future of the preventive war doctrine, formulated by the Bush administration, under international law. The article thus explores whether the preventive war doctrine has the potential to set a customary precedence, or whether it merely constitutes a breach of international law.

Robustness in scale-free networks: Comparing directed and undirected networks

In this paper, scale-free networks and their functional robustness with respect to structural perturbations of the network are studied. Two types of perturbations are distinguished: random perturbations and attacks. The robustness of directed and undirected scale-free networks is studied numerically for two different measures and the obtained results are compared. For random perturbations, the results indicate that the strength of the perturbation plays a crucial role. In general, directed scale-free networks are more robust than undirected scale-free networks.

Evaluation of Random Delay Insertion against DPA on FPGAs

Side-channel attacks (SCA) threaten electronic cryptographic devices and can be carried out by monitoring the physical characteristics of security circuits. Differential Power Analysis (DPA) is one the most widely studied side-channel attacks. Numerous countermeasure techniques, such as Random Delay Insertion (RDI), have been proposed to reduce the risk of DPA attacks against cryptographic devices. The RDI technique was first proposed for microprocessors but it was shown to be unsuccessful when implemented on smartcards as it was vulnerable to a variant of the DPA attack known as the Sliding-Window DPA attack.Previous research by the authors investigated the use of the RDI countermeasure for Field Programmable Gate Array (FPGA) based cryptographic devices. A split-RDI technique wasproposed to improve the security of the RDI countermeasure. A set of critical parameters wasalso proposed that could be utilized in the design stage to optimize a security algorithm designwith RDI in terms of area, speed and power. The authors also showed that RDI is an efficientcountermeasure technique on FPGA in comparison to other countermeasures.In this article, a new RDI logic design is proposed that can be used to cost-efficiently implementRDI on FPGA devices. Sliding-Window DPA and realignment attacks, which were shown to beeffective against RDI implemented on smartcard devices, are performed on the improved RDIFPGA implementation. We demonstrate that these attacks are unsuccessful and we also proposea realignment technique that can be used to demonstrate the weakness of RDI implementations.

Resilience and Vulnerability in the Midst of Socio-Political Violence in Northern Ireland: One Family’s Experience of a Paramilitary Style Assault.

This article focuses on the experience of one particular family living amidst the socio-political violence in Northern Ireland to illustrate the impact of a particular traumatic event – a paramilitary assault due to mistaken identity. These attacks are often colloquially referred to as a ‘punishment shootings’ or ‘beatings’. The therapeutic process is described in narrative terms, providing a framework for; understanding the systemic effect on family relationships of the initial problematic ‘storying’ of the event, and the process of ‘re-storying’ a new more coherent narrative that integrates the trauma experience. Thus, temporary family vulnerability becomes transformed into increased family resilience. This process has general applicability in work with traumatized families.

Forward to the Past? Loyalist Paramilitarianism in Northern Ireland since 1994

This article considers in detail loyalist paramilitary activity in Northern Ireland since the paramilitary cease-fires of 1994. The continuing nature of contemporary loyalist violence is documented with reference to sectarian attacks against members of the “Other”/Catholic community and associated symbols of that community, violence directed at other loyalists, and the potential for future violence given constitutional uncertainty regarding Northern Ireland's position within the United Kingdom. The article also challenges assumptions within the broader literature of an inability within loyalist paramilitary groups to move beyond violence in the post-cease-fire period with particular reference to their conflict transformation efforts.