The influence of patient and doctor gender on diagnosing coronary heart disease

Using novel methods, this paper explores sources of uncertainty and gender bias in primary care doctors' diagnostic decision-making about coronary heart disease (CHD). Claims about gendered consultation styles and quality of care are re-examined, along with the adequacy of CHD models for women. Randomly selected doctors in the UK and the US (n=112, 56 per country, stratified by gender) were shown standardised videotaped vignettes of actors portraying patients with CHD. Patients' age, gender, ethnicity and social class were varied systematically. During interviews, doctors gave free-recall accounts of their decision-making, which were analysed to determine patient and doctor gender effects. We found differences in male and female doctors' responses to different types of patient information. Female doctors recall more patient cues overall, particularly about history presentation, and particularly amongst women. Male doctors appear less affected by patient gender but both male and especially female doctors take more account of male patients' age, and consider more age-related disease possibilities for men than women. Findings highlight the need for better integration of knowledge about female presentations within accepted CHD risk models, and do not support the contention that women receive better-quality care from female doctors.

White working-class neighbourhoods:common themes and policy suggestions

What does it mean to be white and working class in modern Britain? The Joseph Rowntree Foundation’s studies of traditionally white estates in Bradford, London, Coventry and Birmingham are part of a growing body of research into ‘white identities’. This paper: • identifies common findings from JRF research into traditionally white estates, in the context of other similar work; • suggests how issues of white identity can be better understood and makes recommendations for policy and practice. Key points: • Profound economic and social change has increased isolation and fear in traditionally white estates. Residents often claim that things were better in the past. • ‘Estatism’ refers to specific social dynamics associated with council estates and prejudice towards residents based on where they live. This can result in lowered self-esteem and reluctance to participate in community campaigns. • People on traditionally white estates often feel they are not listened to by outside agencies. Consultations can raise hopes but ultimately reinforce disengagement. Initiatives to ensure equality have become associated with political correctness (‘PC’). • White working-class people feel they are bound by values of hard work, reciprocity and support. They are frustrated by the closure and lack of access to community facilities. The social class system simultaneously disadvantages the working class while giving advantage to other classes. • There is a strong desire for allocation of resources to be fair, with a widespread perception that minorities are given preference. Blaming incomers for decline is common, with the target of blame differing between sites. Participants did not want to be considered racist and felt that labelling ideas as racist prevents discussion. Similarly, the term ‘PC’ can also be used to shut down debate. • Recommendations include community-twinning, new ways of accessing local authorities, involvement from the private sector in disadvantaged areas and local panels to define and develop the ‘Big Society’. Initiatives aimed solely at white working-class people are unlikely to be successful.

Measuring social identity in interfunctional research in marketing

Management of social identities is important for optimizing intergroup relations in organizations, and for overall organizational performance. Research on marketing’s intergroup relations employs different social identity constructs. This leaves managers and academics confused as to what impact different social identity constructs have on organizational outcomes. We therefore tested the impact of competing social identity constructs (i.e., functional identity [FI], organizational identity [OI]) on important outcomes. We find different combinations of social identity constructs result in different levels of relationship quality and departmental performance, and that FI and OI measures provide more useful information than the accepted relative functional identity or OI measures in isolation. Academic and practical implications are advanced.

Authorship profiling in a forensic context

There are several unresolved problems in forensic authorship profiling, including a lack of research focusing on the types of texts that are typically analysed in forensic linguistics (e.g. threatening letters, ransom demands) and a general disregard for the effect of register variation when testing linguistic variables for use in profiling. The aim of this dissertation is therefore to make a first step towards filling these gaps by testing whether established patterns of sociolinguistic variation appear in malicious forensic texts that are controlled for register. This dissertation begins with a literature review that highlights a series of correlations between language use and various social factors, including gender, age, level of education and social class. This dissertation then presents the primary data set used in this study, which consists of a corpus of 287 fabricated malicious texts from 3 different registers produced by 96 authors stratified across the 4 social factors listed above. Since this data set is fabricated, its validity was also tested through a comparison with another corpus consisting of 104 naturally occurring malicious texts, which showed that no important differences exist between the language of the fabricated malicious texts and the authentic malicious texts. The dissertation then reports the findings of the analysis of the corpus of fabricated malicious texts, which shows that the major patterns of sociolinguistic variation identified in previous research are valid for forensic malicious texts and that controlling register variation greatly improves the performance of profiling. In addition, it is shown that through regression analysis it is possible to use these patterns of linguistic variation to profile the demographic background of authors across the four social factors with an average accuracy of 70%. Overall, the present study therefore makes a first step towards developing a principled model of forensic authorship profiling.

The political shaping of energy technology:combined heat and power in Britain

There has been negligible adoption of combined heat and power (CHP) for district heating (DH) in Britain, despite continued advocacy. This thesis constructs an account of the treatment of the option, and devises a framework for explanation. Analysis of technological development and adoption, it is argued, should be similar to that of other social processes, and be subject to the same requirements and criticisms. They will, however, show features peculiar to the institutions developing and selecting technologies, their relation to different social groups, and the forms of knowledge in and about technology. Conventional approaches - organisation and interorganisation theories, and analyses of policy-making - give useful insights but have common limitations. Elements of an analytical framework situating detailed issues and outcomes in a structured historical context are derived from convergent radical critiques. Thus activity on CHP/DH is essentially shaped by the development and relations of energy sector institutions: central and local government, nationalised industries and particularly the electricity industry. Analysis of them is related to the specific character of the British state. A few CHP and DH installations were tried before 1940. During postwar reconstruction, extensive plans for several cities were abandoned or curtailed. In the 1960s and 70s, many small non-CHP DH schemes were installed on housing estates. From the mid-70s, the national potential of CHP/DH has been reappraised, with widespread support and favourable evaluations, but little practical progress. Significant CHP/DH adoption is shown to have been systematically excluded ultimately by the structure of energy provision; centralised production interests dominate and co-ordination is weak. Marginal economics and political commitment have allowed limited development in exceptional circumstances. Periods of upheaval provided greater opportunity and incentive for CHP/DH but restructuring eventually obstructed it. Explanation of these outcomes is shown to require analysis at several levels, from broad context to detailed action.

Anticholinergic medication use and cognitive impairment in the older population:the Medical Research Council cognitive function and ageing study

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. DESIGN: A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. SETTING: Community-dwelling and institutionalized participants. PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14–0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics. CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.

A moral economy of whiteness:behaviours, belonging and Britishness

This article outlines the complex stories through which national belonging is made, and some ways in which class mediates the racialisation process. It is based on fieldwork on the ways in which white UK people in provincial cities construct identities based on positioning vis-a`-vis other groups, communities and the nation. I argue that this relational identity work revolves around fixing a moral-ethical location against which the behaviour and culture of Others is measured, and that this has a temporal and spatial specificity. First, attitudinal trends by social class emerge in our work as being to do with emphasis and life experience rather than constituting absolute distinctions in attitudes. Second, in an era supposedly marked by the hegemony of ‘new’ or ‘cultural’ racism, bloodlines and phenotypes are still frequently utilised in race-making discursive work. Third, in provincial urban England, there is a marked ambivalence towards Britishness (as compromised by Others) and an openness to Englishness as a more authentic source of identification.

Language and identity in englishes

Key features include: • Discussion of language in relation to various aspects of identity, such as those connected with nation and region, as well as in relation to social aspects such as social class and race. • A chapter on undertaking research that will equip students with appropriate research methods for their own projects. • An analysis of language and identity within the context of written as well as spoken texts. Language and Identity in Englishes examines the core issues and debates surrounding the relationship between English, language and identity. Drawing on a range of international examples from the UK, US, China and India, Clark uses both cutting-edge fieldwork and her own original research to give a comprehensive account of the study of language and identity. With its accessible structure, international scope and the inclusion of leading research in the area, this book is ideal for any student taking modules in language and identity or sociolinguistics.

The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of 'knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

A copa do mundo FIFA na África do Sul/2010:como foi a experiência e o que podemos aprender com ela?

Neste ensaio pretendemos problematizar algumas lógicas sociais não explícitas que se articulam ao domínio de realização da Copa do Mundo FIFA. Para tanto, privilegiamos como recorte analítico a edição de 2010 deste evento, de modo a desvelarmos algumas das retóricas e ações estratégicas que permearam o contexto de sua realização na África do Sul. Com base em dados obtidos na literatura acadêmica e mídia, buscamos apresentar que as motivações para o evento se baseavam em discursos desenvolvimentistas por parte tanto da FIFA quanto das elites locais sul-africanas visando o convencimento e apoio por parte de diferentes grupos sociais. Entretanto, as consequências não foram necessariamente aquelas prometidas, sendo essas instituições as reais beneficiadas em seus interesses econômicos e políticos. Nesse ponto, argumentamos que a sociedade brasileira pode e deve aprender com essa experiência para avaliar de forma crítica os motivos menos aparentes de sediar eventos desse porte. In this essay, we intend to discuss some social logics not explicit that articulate the domain of the FIFA World Cup. Therefore, the 2010 edition of this event is used as analytical approach to reveal some of the rhetoric and strategic actions that permeated the context of its realization. Based on data obtained in the academic literature and media, we present that the motivations for the event were based on developmental discourses by both FIFA as well as local elites South African aiming to convince different social groups and conquer their support. However, the consequences are not necessarily those promised, and these institutions were the real beneficiaries in their economic and political mutual interests. At this point, we argue that Brazilian society can and should learn from the experience of South Africa to assess critically the motives less apparent to host such events.

Institutions matter: essays on the determinants and consequences of socio-political institutions

ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY WITH PRIOR ARRANGEMENT This thesis seeks to contribute to the socio-political literature. It comprises of three individual chapters examining the determinants and consequences of different social-political institutional factors. Specifically, the first study combines game theoretical and empirical techniques to examine how bureaucrats favour other agents within their social group and the effects this will have on the level of corruption in the economy. To this end, I develop a simple model of allocation of time between economic activities and leisure (time spent building social network ties), to illustrate the underlying causal mechanism between social network and corruption. It shows that large social networks and low levels of economic activities provides the condition for high levels of corruption. However, the ability of the government to punish corruption through well-established laws and property rights enforcement acts as a deterrent to corruption. he second work also combines game theoretical and empirical techniques. It aims to clarify the relationship between the degree of competition and political influence of firms, paying particular attention to the level of government regulations that exist in the countries in which the firms operates. The interplay between economic and political institutions is vital to any analysis on understanding the workings of political influence. The third study is purely empirical. It examines the role of two types of business network, namely, political connections and business group affiliations on a firm’s performance. Evidence was provided on Chinese firms’ performance during the 2008 financial crisis.