Correlates of spontaneous reporting of adverse drug reactions within primary care: the paradox of low prescribers who are high reporters

AIM(S) To examine Primary Care Trust (PCT) demographics influencing general practitioner (GP) involvement in pharmacovigilance. METHODS PCT adverse drug reaction (ADR) reports to the Yellow Card scheme between April 2004 and March 2006 were obtained for the UK West Midlands region. Reports were analysed by all drugs, and most commonly reported drugs (‘top drugs’). PCT data, adjusted for population size, were aggregated. Prescribing statistics and other characteristics were obtained for each PCT, and associations between these characteristics and ADR reporting rates were examined. RESULTS During 2004–06, 1175 reports were received from PCTs. Two hundred and eighty (24%) of these reports were for 14 ‘top drugs’. The mean rate of reporting for PCTs was 213 reports per million population. A total of 153 million items were prescribed during 2004–06, of which 33% were ‘top drugs’. Reports for all drugs and ‘top drugs’ were inversely correlated with the number of prescriptions issued per thousand population (rs = -0.413, 95% CI -0.673, -0.062, P < 0.05, and r = -0.420, 95% CI -0.678, -0.071, P < 0.05, respectively). Reporting was significantly negatively correlated with the percentages of male GPs within a PCT, GPs over 55 years of age, single-handed GPs within a PCT, the average list size of a GP within a PCT, the overall deprivation scores and average QOF total points. ADR reports did not correlate significantly with the proportion of the population over 65 years old. CONCLUSIONS Some PCT characteristics appear to be associated with low levels of ADR reporting. The association of low prescribing areas with high ADR reporting rates replicates previous findings.

'It's a double-edged thing':the paradox of civil partnership and why some couples are choosing not to have one

Since their introduction in 2005, thousands of same-sex couples in the UK have had a civil partnership. However, many other couples have chosen not to have one. This qualitative study explores why some same-sex couples are choosing not to have a civil partnership. Seven semi-structured interviews were conducted with 12 people (five couples and two individuals) who identified as lesbian, gay or bisexual, and analysed using discourse analysis. Participants' accounts were characterised by ambivalence about civil partnership, and three main paradoxes were identified: the 'good but not good enough' paradox, the 'unwanted prize' paradox and the 'legal rights v. social oppression paradox. A major source of ambivalence was support for rights but resistance to assimilation into dominant heteronormative cultural frameworks. Participants negotiated this ambivalence in a variety of ways, including considering how to have a civil partnership that is different from 'marriage', and adopting a pragmatic position. The analysis highlights the importance of social recognition and support for a range of relationship forms and identities, as well as for an ongoing critical debate about civil partnerships and same-sex marriage. © The Author(s) 2011.

The paradox of social resilience:how cognitive strategies and coping mechanisms attenuate and accentuate resilience

This paper examines two concepts, social vulnerability and social resilience, often used to describe people and their relationship to a disaster. Social vulnerability is the exposure to harm resulting from demographic and socioeconomic factors that heighten the exposure to disaster. Social resilience is the ability to avoid disaster, cope with change and recover from disaster. Vulnerability to a space and social resilience through society is explored through a focus on the elderly, a group sometimes regarded as having low resilience while being particularly vulnerable. Our findings explore the degree to which an elderly group exposed to coastal flood risk exhibits social resilience through both cognitive strategies, such as risk perception and self-perception, as well as through coping mechanisms, such as accepting change and self-organisation. These attenuate and accentuate the resilience of individuals through their own preparations as well as their communities' preparations and also contribute to the delusion of resilience which leads individuals to act as if they are more resilient than they are in reality, which we call negative resilience. Thus, we draw attention to three main areas: the degree to which social vulnerability can disguise its social resilience; the role played by cognitive strategies and coping mechanisms on an individual's social resilience; and the high risk aspects of social resilience. © 2014 Elsevier Ltd. All rights reserved.

Paradox lost? Exploring the role of alpha oscillations during externally vs. internally directed attention and the implications for idling and inhibition hypotheses

Although slow waves of the electroencephalogram (EEG) have been associated with attentional processes, the functional significance of the alpha component in the EEG (8.1–12 Hz) remains uncertain. Conventionally, synchronisation in the alpha frequency range is taken to be a marker of cognitive inactivity, i.e. ‘cortical idling’. However, it has been suggested that alpha may index the active inhibition of sensory information during internally directed attentional tasks such as mental imagery. More recently, this idea has been amended to encompass the notion of alpha synchronisation as a means of inhibition of non-task relevant cortical areas irrespective of the direction of attention. Here we test the adequacy of the one idling and two inhibition hypotheses about alpha. In two experiments we investigated the relation between alpha and internally vs. externally directed attention using mental imagery vs. sensory-intake paradigms. Results from both experiments showed a clear relationship between alpha and both attentional factors and increased task demands. At various scalp sites alpha amplitudes were greater during internally directed attention and during increased load, results incompatible with alpha reflecting cortical idling and more in keeping with suggestions of active inhibition necessary for internally driven mental operations.

The social media paradox:an intersection with freedom of expression and the criminal law

This article begins by setting out the human rights provisions that apply to social media expression. It then provides insight into the part social media plays within our society by analysing the social media landscape and how it facilitates a ‘purer’ form of expression. The social media paradox is explored through the lens of current societal issues and concerns regarding the use of social media and how these have manifested into litigation. It concludes by analysing the tension that the application of an array of criminal legislation and jurisprudence has created with freedom of expression, and whether this can successfully mitigated by the Director of Public Prosecution’s Interim Guidelines.

The involvement/exclusion paradox of spontaneous volunteering:new lessons from winter flood episodes in England

This article focuses on the involvement and management of spontaneous volunteers (SVs). It develops a new theory—which we call the “involvement/exclusion” paradox—about a situation which is frequently manifested when SVs converge in times of disaster. After reviewing research and policy guidance relating to spontaneous volunteering, we present findings from a study of responses to winter flood episodes in England. Taking together the empirical findings and the literature, the article analyzes elements inherent in the involvement/exclusion paradox and develops a conceptual model to illustrate and explain the paradox. Implications for managers and future research are discussed.

The paradox of German power. By Hans Kundnani

Book review: The paradox of German power. By Hans Kundnani. London: Hurst. 2014. 147pp. £17.90. isbn 978 1 84904 415 8.

Climate change and knowledge politics

This paper addresses the paradox that although the Intergovernmental Panel on Climate Change has reached a broad consensus, various governments pursue different, if not opposing policies. This puzzle not only challenges the traditional belief that scientific knowledge is objective and can be more or less directly translated into political action, but also calls for a better understanding of the relation between science and public policy in modern society. Based on the conceptual framework of knowledge politics the use of expert knowledge in public discourse and in political decisions will be analysed. This will be carried out through a country comparison between the United States and Germany. The main finding is that the press in both countries relies on different sources of scientific expertise when reporting on global warming. In a similar way, governments in both countries use these different sources for legitimising their contrasting policies.

A room with a view:window images and 'open immanence' in the writings of adolphe retté and G.K. chesterton

Adolphe Retté and G.K. Chesterton often use the image of a window, a paradox given the widespread view that Catholic writers are usually closed minded. This article asks whether Charles Taylor's philosophy of the individual could explain this paradox more satisfactorily. Chesterton's windows express a realist epistemology, while Retté's windows express the illumination of faith. The themacity of the subject in their writings, however, shows that their windows give expression to Taylor's 'open immanence', rather than Taylorian 'porosity'. Their reactionary character can be interpreted as a kind of Taylorian 'buffering' which is necessary for believing writers resisting secularity. © 2011 The Author. Published by Oxford University Press 2011; all rights reserved.

L'association négative:depuis la syntaxe jusqu'à l'interprétation

This book untangles the old grammatical paradox allowing for several negations within the same negative clause through his work of the scope of negations. The scope of each negation over the same predicate is what allows for concordant values. The frequent co-occurrence of negative items, cases of double negation and the expletive negative, as compared to constituent negation, help to demonstrate this. Analysis of these phenomena is based on a large body of data of different varieties of French considered in the light of historical, typological, and psycholinguistic tendencies. While extensive reference is made to current analysis, independence is maintained from any particular model. Starting from syntactic generalisations, the work provides an innovative solution to a classic interpretative issue.

The impact of procurement-driven technological change on U.S. manufacturing productivity growth

As we enter the 21st Century, technologies originally developed for defense purposes such as computers and satellite communications appear to have become a driving force behind economic growth in the United States. Paradoxically, almost all previous econometric models suggest that the largely defense-oriented federal industrial R&D funding that helped create these technologies had no discernible effect on U.S. industrial productivity growth. This paper addresses this paradox by stressing that defense procurement as well as federal R&D expenditures were targeted to a few narrowly defined manufacturing sub-sectors that produced high tech weaponry. Analysis employing data from the NBER Manufacturing Productivity Database and the BEA' s Input Output tables then demonstrates that defense procurement policies did have significant effects on the productivity performance of disaggregated manufacturing industries because of a process of procurement-driven technological change.

Inter-organisational knowledge transfer strategies

Inter-organisational knowledge transfer is very important for SMEs. However, compared to knowledge transfer within an organisation, its ‘boundary paradox’ makes its process more complicated and difficult to understand. In order to solve the ‘paradox’, inter-organisational knowledge transfer strategies need to be developed for SMEs. Through a review of the literature on knowledge transfer, this paper proposes an inter-organisational knowledge transfer process model that contains four stages (initiation, selection, interaction and conversion). It classifies three situations in which an SME exchanges knowledge with a customer (whether a larger company or an SME). It then applies a coordinating mechanism to analyse knowledge transfer strategies for the SME when it is a knowledgegiving firm and knowledge-receiving firm respectively, in the different stages of each situation.