A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

A discussion of ethnographic research methods and their relevance for the translation process

In recent years, technologically advanced methodologies such as Translog have gained a lot of ground in translation process research. However, in this paper it will be argued that quantitative research methods can be supplemented by ethnographic qualitative ones so as to enhance our understanding of what underlies the translation process. Although translation studies scholars have sometimes applied an ethnographic approach to the study of translation, this paper offers a different perspective and considers the potential of ethnographic research methods for tapping cognitive and behavioural aspects of the translation process. A number of ethnographic principles are discussed and it is argued that process researchers aiming to understand translators’ perspectives and intentions, how these shape their behaviours, as well as how translators reflect on the situations they face and how they see themselves, would undoubtedly benefit from adopting an ethnographic framework for their studies on translation processes.

The experiences and perceptions of fathers attending the birth and immediate care of their baby

Fathers in the United Kingdom (UK) usually attend the birth and immediate care of their baby. They also have an increasing presence during complicated and preterm childbirth, newborn resuscitation and early neonatal unit(NNU) care. However, there is limited evidence about the effect of these experiences on them. The aim of this study was to gain an understanding of the experiences of fathers encountering these situations. The study consisted of three phases and was undertaken in one National Health Service trust in the UK. Qualitative semi-structured interviews using a phenomenological approach were undertaken with 20 first-time fathers present at the delivery, resuscitation and/or admission of their baby to the NNU. Direct observations were made of 22 normal and complicated deliveries and initial newborn care and qualitative semi-structured interviews using the critical incident approach were undertaken with 37 health care professionals (HCPs). The study generated qualitative and quantitative data that were analysed accordingly. The findings show that most fathers were involved for at least some of the time and often spontaneously initiated their involvement. Their most important need was for information. They were usually more concerned about their partner, irrespective of the baby?s need for resuscitation and NNU care. To facilitate their involvement, fathers needed guidance and support from HCPs, particularly delivery suite midwives. Most HCPs recognised the needs of fathers and ways in which they could be helped to connect with their experience. However, these needs were not always met, usually because of inadequate staffing levels, a lack of resources or a mother-centred philosophy of care. The findings suggest the service often determines the extent to which fathers are involved. It is anticipated that these findings will inform HCP education and training and the development of both policy and health education thereby enhancing the quality of care provision for fathers.

The role and relevance of non-government aid:a case study of Kenya

How effective are non-government organisations (NG0s) in their response to Third World poverty? That is the question which this thesis examines. The thesis begins with an overview of the problems facing Third World communities, and notes the way in which people in Britain have responded through NG0s. A second part of the thesis sets out the issues on which the analysis of NGOs has been made. These are: - the ways in which NGOs analyse the process of development; - the use of 'improving nutrition' and 'promoting self-reliance' as special objectives by NG0s; and - the nature of rural change, and the implications for NGOs as agents of rural development. Kenya is taken as a case study. Firstly the political and economic structure of the country is studied, and the natures of development, nutritional problems and self-reliance in the Kenyan context are noted. The study then focusses attention onto Kitui District, an area of Kenya which at the time of the study was suffering from drought. However, it is argued that the problems of Kitui District and the constraints to change there are as much a consequence of Kenya's structural underdevelopment as of reduced rainfall. Against this background the programmes of some British NGOs in the country are examined, and it is concluded that much of their work has little relevance to the principal problems which have been identified. A final part of the thesis takes a wider look at the policies and practices of NG0s. Issues such as the choice of countries in which NGOs work, how they are represented overseas, and their educational role in Britain are considered. It is concluded that while all NGOs have a concern for the conditions in which the poorest communities of the Third World live, many NGOs take a quite narrow view of development problems, giving only little recognition to the international and intranational political and economic systems which contribute to Third World poverty.

Modelling the underlying principles of human aesthetic preference in evolutionary art

Our understanding of creativity is limited, yet there is substantial research trying to mimic human creativity in artificial systems and in particular to produce systems that automatically evolve art appreciated by humans. We propose here to study human visual preference through observation of nearly 500 user sessions with a simple evolutionary art system. The progress of a set of aesthetic measures throughout each interactive user session is monitored and subsequently mimicked by automatic evolution in an attempt to produce an image to the liking of the human user.

The effect of care solutions on the bulk and surface properties of soft contact lenses

Purpose: Soft contact lenses for continuous wear require the use of cleaning regimes which utilise hydrogen peroxide systems or multipurpose cleaning solutions (MPS). The compositions of MPS are becoming increasingly complex and often include disinfectants, cleaning agents, preservatives, wetting agents, demulcents, chelating and buffering agents. Recent research on solution–lens interactions has focused on specific ocular parameters such as corneal staining. However the effect of a solution on the lens, particularly silicone hydrogel lenses, itself has received less attention. The purpose of this work was to establish and understand the effects that care solutions have on selected bulk and surface material properties. Methods: Selected bulk and surface properties of each material (etafilcon A, vifilcon A, balafilcon A, senofilcon A, lotrafilcon A and lotrafilcon B, galyfilcon A) were measured after a 24 h soak in a variety of care solutions. Additionally the lenses were soaked for 24 h in hyperosmolar (680 mOsm L-1) and hyposmolar (170 mOsm L-1) PBS. A bulk property parameter the total diameter (TD) was measured using an Optimec contact lens analyser. The surface property related CoF of soaked lenses was measured on a nano-tribometer with conditions of load 30 mN, at a distance of 20 mm and speed 30 mm/min. Results: In terms of bulk properties, change is related to the EWC of the lens, the higher the EWC of the lens the greater the TD changes. Silicone hydrogel lenses have EWCs of <47% and little or no TD changes were observed; lotrafilcon A exhibited no change irrespective of the cleaning solution. Conventional contact lenses have higher EWCs (58% for etafilcon A and 55% for vifilcon A) and the TD was seen to change to a greater extent, for example the etafilcon A material in ReNu MPS had an increase to 14.45± 0.07 mm from the cited 14.2 mm. Other lenses increased or decreased in TD depending on the solution used. The osmolarity of the solution although important is not the only factor governing change in the TD, for example soaking senofilcon A in hyperosmolar PBS (680 mOsm L-1) for 24 h increased the TD of the lens (+0.25 ± 0.07 mm), however when the same lens type was soaked for 24 h in a MPS with a lower osmolarity there was a similar effect. Biotribology measurements demonstrated that some solution–lens combinations can reduce the CoF by 55%, when compared with biotribology with the native packing solution. An increase in the CoF was observed for other solution–lens combinations. Conclusions: There is a dramatic difference in bulk and surface performance of specific lens materials with particular care solutions. Individual components of the care solutions have effects on the bulk and surface properties of contact lenses. The affects are not as great with the silicone hydrogel as compared with conventional hydrogels.

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

The continuing relevance of Germany's engine for CEE andthe EU

The article looks first into the nature of the relations between Germany and the CEE countries a decade since the accession of the CEE countries to the EU. The relations are characterized as normalised and intensive with diverse levels of closeness and co-operation reflecting of the conceptual and ideological compatibility/differences. Next, the article focuses on the German attitude to the euro zone crisis. Germany has become a hegemon in the rescue effort aimed at stabilisation and economic invigoration of the euro zone. However, German hegemony has developed by default, not by design: her leading position is linked with considerable political and financial costs. Germany moved central stage and took the position of a reluctant hegemon. However, German role is contested internationally (it has not the support of the French government in key areas) as well as internally (particularly by the Federal Constitutional Court and the Bundesbank).The article argues that the new situation makes the German-CEE relations increasingly relevant for both sides. The German leadership of the EU increasing split along the north-south divide requires backing by the Northern group countries to which the CEE in general belongs. Given a number of reasons the CEE countries implement three distinctive strategies of co-operation with Germany in European politics. Also military co-operation, which remained rather limited so far, may receive new impulses, given the financial austerity. © 2013 The Regents of the University of California.

Is Bologna working? Employer and graduate reflections of the quality, value and relevance of business and management education in four European Union countries

This article focuses on the relevance of undergraduate business and management higher education from the perspectives of recent graduates and graduate employers in four European countries. Drawing upon the findings of an empirical qualitative study in which data was collated and analysed using grounded theory research techniques, the paper draws attention to graduates' and employers' perceptions of the value of higher education in equipping students with discipline-specific skills and knowledge as well as softer 'generic' skills. It also highlights the importance of formal 'work-based' learning within undergraduate curricula in providing students with the skills and experiences required by employers operating within a global workplace. © 2014 John Wiley & Sons Ltd.

Relevance of microstructural influences in the short crack regime to overall fatigue resistance

The behaviour of short fatigue cracks is shown to be relevant only to a limited number of engineering situations. Within these situations, further restrictions on the extent to which metallurgical control can be exerted to improve fatigue crack growth behaviour are identified. The degree of control remaining is discussed in terms of two separate regimes which are described as intrinsic and extrinsic crack growth resistance. These separate effects are highlighted by comparisons both within and between a wide range of alloy systems. The implications of such an analysis are discussed in terms of aerospace applications.

Assessing the value relevance of accounting data after the introduction of IFRS in Europe

Since 2005, European-listed companies have been required to prepare their consolidated financial statements in accordance with the International Financial Reporting Standards (IFRS). We examine whether value relevance increased following the introduction of IFRS, using a sample of 3,721 companies listed on five European stock exchanges: Frankfurt, Madrid, Paris, London, and Milan. We find mixed evidence of an increase in value relevance. However, the influence of earnings on share price increased following the introduction of IFRS in Germany, France, and the United Kingdom, while the influence of book value of equity decreased (except for the United Kingdom). © 2010 Blackwell Publishing Ltd.

Evidence for the early clinical relevance of hallucinatory-delusional states in the general population

OBJECTIVE: To analyze, in a general population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters. METHOD: General population-based household surveys of randomly selected adults between 18 and 65 years of age were carried out. SETTING: 52 countries participating in the World Health Organization's World Health Survey were included. PARTICIPANTS: 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated. RESULTS: Compared with isolated delusions and hallucinations, co-occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92-0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0-3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5-14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3-22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9-12.4). Co-occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8-2.3). CONCLUSION: The results suggest that the co-occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state.

Who speaks up for Inés Fonseca? Representing violence against vulnerable subjects and the ethics of care in fictional narrative about Alzheimer’s disease:Ahora tocad música de baile (2004) by Andrés Barba

This paper studies the Spanish fictional novel by Andrés Barba, Ahora tocad música de baile (2004), one of the first cultural texts dealing entirely with Alzheimer’s disease (AD) to appear in Spain. It argues that the significance of Barba’s fictional novel rests on two important issues: the ethics of representation of violence against vulnerable subjects and the ethics of care. The paper analyses how these two issues allow Barba to create a story in which the verbal and physical abuse to which the person living with Alzheimer’s disease is subjected places the reader, on the one hand, as voyeur/witness of the abuse; and, on the other, as interpreter, and ultimately judge, of the fine line that separates euthanasia, assisted suicide, and murder. The open ending of the novel defers all ethical and moral judgment to the reader. It examines how the novel offers a monolithic perspective about AD, in which care is presented as a burden. In fact, this study shows that the novel’s multi-layered structure and polyphonic nature places the emphasis on stigmas, stereotypes and negative metaphors around AD, as found in contemporary social discourses.

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label “care pathways”, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.