Interobserver Reliability of Radiologists' Interpretations of Mobile Chest Radiographs for Nursing Home-Acquired Pneumonia

Objectives: To determine the interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia. Design: A cross-sectional reliability study. Setting: Nursing homes and an acute care hospital. Participants: Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections. Measurements: Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model. Results: On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI -0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76). Conclusion: In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be "fair." Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone. © 2006 American Medical Directors Association.

'Dark Interpretations': Romanticism's Ambiguous Legacy in India

This essay argues that Romanticism’s legacy in modern Indian literature has been constructed under the shadow of its colonial heritage. Although the Romantic period witnessed the enthusiastic “discovery” of classical Indian literature by British Orientalists, Romantic imperialism (which went hand-in-hand with Romantic orientalism) played a darker role in instituting a colonial educational system in India which denigrated Indian languages and literatures. Modern Indian literature represented by popular fictional writers from R.K. Narayan to Arundhati Roy registers this complex colonial inheritance by its qualified and often ironic celebration of British Romantic literature along with its associated ideologies of freedom, truth, and beauty.

The Scottish Reformations and the Origin of Religious and Civil Liberty in Britain and Ireland: Presbyterian Interpretations, c.1800-60

This article examines Presbyterian interpretations in Scotland and Ireland of the Scottish Reformations of 1560 and 1638–43. It begins with a discussion of the work of two important Presbyterian historians of the early nineteenth century, the Scotsman, Thomas McCrie, and the Irishman, James Seaton Reid. In their various publications, both laid the template for the nineteenth-century Presbyterian understanding of the Scottish Reformations by emphasizing the historical links between the Scottish and Irish churches in the early-modern period and their common theology and commitment to civil and religious liberty against the ecclesiastical and political tyranny of the Stuarts. The article also examines the commemorations of the National Covenant in 1838, the Solemn League and Covenant in 1843, and the Scottish Reformation in 1860. By doing so, it uncovers important religious and ideological linkages across the North Channel, including Presbyterian evangelicalism, missionary activity, church–state relationships, religious reform and revival, and anti-Catholicism

Interpretations of national identity in post-conflict Northern Ireland: A comparison of different school settings

It is generally accepted that education has a significant role to play in anysociety transitioning from conflict to a more peaceful dispensation. Indeed,some have argued that the education system potentially represents the singlemost effective agent of social change with the capacity to bridge ethnicdivision in conflict affected countries. Despite the potential, educationalpolicy-makers grapple with the dilemma as to precisely how school systemscan best facilitate this agenda. This paper thus attempts to shed lightupon the dilemma by exploring pupil identity and associated intergroupattitudes across various school types in Northern Ireland. Five schools wereselected for the study with each one representing a particular sector withinthe Northern Irish education system (maintained grammar, maintainedsecondary, controlled grammar, controlled secondary, integrated). This led toa total sample size of 265 pupils. The main findings show that children acrossseparate Catholic, separate Protestant and mixed Catholic and Protestanteducational contexts construct and interpret identity differently. At thesame time, our data suggest that no one school setting has supremacy inpromoting social cohesion. The implications of these findings are discussed.

Gazing at Ground Zero: Tourism, Voyeurism and Spectacle

This essay uses the temporary viewing platform at the site of the former World Trade Center to explore our fascination with violence, conflict and disaster. It illustrates how discourses of voyeurism and authenticity promote a desire for sites of horror, and examines how that desire both disrupts and reinforces our prevailing interpretations of global politics. The viewing platform at Ground Zero was initially constructed to manage the thousands of people who traveled to New York in response to the shocking media images of 11 September. However, their desire to escape mediation and touch "the real" had the opposite effect - it transformed Ground Zero into a tourist attraction. Using Ground Zero as a starting point, this essay theorizes discourses of voyeurism and authenticity through the work of Baudrillard, Debord and Bauman in an effort to position the tourist as a significant political subject.

'Chocolate makes you autism': impairment, disability and childhood identities

This paper discusses perceptions and experiences of impairment and disability from the perspectives of learning disabled children, their parents and their social workers. The author reports on findings from her doctoral study that adults often fail to take into account the views and experiences of learning disabled chidren. As a result, these children developed their own interpretations of impairment and disability based on their experiences and interactions with others. Whilst this indicates that they are active social interpreters, it also suggests that adults should make greater efforts to inform and consult learning disabled children. The author concludes by reflecting on the relevance of these findings to contemporary theories of disability and childhood.

Cities of God? Medieval urban forms and their Christian Symbolism

Situated in the context of recent geographical engagements with 'landscape', this paper combines 'morphological' and 'iconographic' landscape interpretations to examine how urban forms were perceived in late medieval Europe. To date, morphological studies have mapped the medieval city either by classifying urban layouts according to particular types, or by analysing plan forms of particular towns and cities to reveal their spatial evolution. This paper outlines a third way, an 'iconographic' approach, which shows how urban forms in the Middle Ages conveyed Christian symbolism. Three such 'mappings' explore this thesis: the first uses textual and visual representations which show that the city was understood as a scaled-down world â?? a microcosm â?? linking city and cosmos in the medieval mind; the second 'mapping' develops this theme further and suggests that urban landscapes were inscribed with symbolic form through their layout on the ground; while the third looks at how Christian symbolism of urban forms was performed through the urban landscape in perennial religious processions. Each of these 'mappings' points to the symbolic, mystical significance urban form had in the Middle Ages, based on religious faith, and they thus offer a deepened appreciation of how urban landscapes were represented, constructed and experienced at the time.

Evaluating the social effects of the EU URBAN Community Initiative Programme

This article explores alternative interpretations of the meaning and method of urban policy evaluation within the European Union (EU) Structural Funds. Using the EU URBAN Community Initiative Programme 1994-1999 it draws a distinction between 'instrumental' techniques that are primarily concerned with performance and efficiency measures and 'interpretative' approaches that stress the need to explore power relationships in the development and delivery of spending programmes. Empirically, it reflects on the interpretation of EU guidance and the MEANS (Means for Evaluating Actions of a Structural Nature) Collection to evaluate the Derry/Londonderry (UK) URBAN Sub-programme 1994-1999. The analysis concludes by emphasizing the need to ensure that urban policy evaluation is consistent with the broader social turn in the scope and content of regeneration programmes.

Testing the timing of radiocarbon-dated events between proxy archives

For interpreting past changes on a regional or global scale, the timings of proxy-inferred events are usually aligned with data from other locations. However, too often chronological uncertainties are ignored in proxy diagrams and multisite comparisons, making it possible for researchers to fall into the trap of sucking separate events into one illusionary event (or vice versa). Here we largely solve this "suck in and smear syndrome" for radiocarbon (14C) dated sequences. In a Bayesian framework, millions of plausible age-models are constructed to quantify the chronological uncertainties within and between proxy archives. We test the technique on replicated high-resolution 14C-dated peat cores deposited during the "Little Ice Age" (c. AD 1400-1900), a period characterized by abrupt climate changes and severe 14C calibration problems. Owing to internal variability in proxy data and uncertainties in age-models, these (and possibly many more) archives are not consistent in recording decadal climate change. Through explicit statistical tests of palaeoenvironmental hypotheses, we can move forward to systematic interpretations of proxy data. However, chronological uncertainties of non-annually resolved palaeoclimate records are too large for answering decadal timescale questions.

Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study

Objective : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting : Acute district hospital, Northern Ireland. Participants : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in `real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305—312 Key Words: do not attempt resuscitation (DNAR) • end stage illness • inter-professional • policy • resuscitation decisions

The investigation of mechanisms in environmental catalysis using time-resolved methods

The formation of nitrogen oxides (NOx) during a combustion process is difficult to avoid because of the large exotherm and the consequent problem of avoiding local high-temperature spikes. Consequently, for many applications, such as for automotive power generation, there will be a continuing need to use catalytic after-treatment to reduce harmful emissions. The investigation of the mechanisms of the key catalytic reactions in environmental catalysis can provide an insight into the action of the catalyst, and time-resolved methods offer a powerful means to study these processes under realistic conditions. The use of Temporal Analysis of Products (TAP) and Steady State Isotopic Transient Kinetic Analysis (SSITKA) methods to investigate the reduction of NOx under various experimental conditions is described. From a detailed analysis of the SSITKA profiles, it is shown that at low temperatures the mechanism for the formation of N-2 and N2O from NO may differ from the conventional high-temperature mechanism. This is supported by density functional theory calculations, which show that the barrier to the formation of N2O from the reaction of N(ads) and NO(ads) may be too high to allow this process to occur at low temperatures. The alternative reaction of NO(ads) + NO(ads) = N2O(g) + O(ads) is shown to be much more favorable and is consistent with the SSITKA analysis. The remarkable effect of hydrogen as a reductant at low temperatures is described, and alternative interpretations of the role of hydrogen are discussed.