Financial consequences of one-stop dispensing at Birmingham Children's Hospital

Poster session - Costs for one stop dispensing and the use of patients’ own drugs (PODs) were compared with traditional dispensing costs - It was found that operating a one-stop dispensing scheme, with the use of PODs where applicable, could save an average of £4.35 per patient per day on ward A and £5.19 per patient per day on ward B - These saving would equate to annual savings of £24,000 on ward A and £34,000 on ward B - Additional savings can be made to the secondary care budget as no in-patient drugs would be wasted upon patient discharge - These additional savings are an average £25.19 per patient on ward A and £13.42 per patient on ward B

Analysis of single and multiple, non-permanent, tunable, birefringent spectral holes in a fibre-Bragg grating stop-band produced via uniaxial pressure

We present an experimental and numerical study of transversely loaded uniform fibre-Bragg gratings. A novel loading configuration is described, producing pressure-induced spectral holes in an initially strong uniform grating. The birefringence properties of these gratings are analysed. It is shown that the frequency splitting of the two spectral holes, corresponding to two orthogonal polarisation states, can be adjusted precisely using this loading configuration. We finally demonstrate a new and simple scheme to induce multiple spectral holes in the stop-band. © 2003 Elsevier Science B.V. All rights reserved.

The Pronunciation of the Aspirated Consonants P, T, and K in English by Native Speakers of Spanish and French

This study examines whether explicit phonetic instruction helps Spanish and French speakers more closely approximate native pronunciation of the aspirated variants of the English consonants p, t, and k. The study results indicate that phonetic instruction clearly benefited the subjects, and the findings warrant further investigation.

L-R: Bob Kunst and Dr. Alan Rockway as part of the "Stop Anita Bryant Comm[ission] Leaders from Dade County, Florida

General note: Title and date provided by Bettye Lane.

Please Stop Rubbing Your Relationship In My Face(book): An Investigation of Online Romantic Social Comparison

It is well-documented that social networking sites such as Facebook set the stage for social comparison. Such comparison has been linked to a number of negative outcomes including envy, negative moods, and lower self-esteem. The present research aims to extend current understanding of online social comparison by investigating how it pertains to romantic relationships. I hypothesized that for individuals high in attachment anxiety (compared to those low in this construct), online romantic social comparison might be related to negative consequences—which, in the current project, was operationalized as lower mood/affect and state self-esteem. Further, I hypothesized that there would be an interaction between attachment anxiety and relationship insecurities on these negative outcomes, such that the expected difference of attachment anxiety would be more pronounced under conditions priming relationship insecurities, relative to a control condition. Two experiments were conducted, one of which focused on single individuals, and the second focusing on individuals who were themselves in dating relationships. The paradigms of each entailed experimental manipulation of a key relationship-related variable (for single individuals, pessimism for future relationships; for dating individuals, the presence or absence of rejection threat), subsequent exposure to romantic content from Facebook, and finally, measures of affect and state self-esteem. I discovered partial support for the hypothesis that some single individuals—particularly those with higher, rather than lower, attachment anxiety—do indeed report feeling more negative moods and lower state self-esteem following exposure to romantic online content, in contrast to single individuals who had instead viewed neutral online content. The association between attachment anxiety and negative outcome was especially pertinent if individuals had been primed to believe that their own future romantic prospects were grim, or if attention had been drawn to their singleness. Among dating individuals, less support for hypotheses was found; however, exploratory post-hoc analyses revealed a promising (albeit weak) trend indicating that reinvestigation of the current hypotheses would be prudent.

The roles of EFN-1 and seam cell V2 in the transmission of a stop cue for the posterior lateral microtubule in Caenorhabditis elegans

A functional nervous system requires the precise arrangement of all nerve cells and their neurites. To achieve this correct assembly, a myriad of molecular guidance cues works together to direct the outgrowth of neurites to their correct positions. The small nematode C. elegans provides the ideal model system to study the complex mechanisms of neurite guidance due to its relatively simple nervous system, composed of 302 neurons. I used two mechanosensory neurons, called the posterior lateral microtubule (PLM), to investigate the role of the ephrin and Eph receptor protein family in neurite termination in C. elegans. Activation of the C. elegans Eph receptor VAB-1 on the PLM growth cone is sufficient to cause PLM termination, but the identity and location of the activating ligand has not been established. In my thesis I investigated the ability of the ephrin ligand EFN-1 to activate VAB-1 to cause PLM termination when expressed on the same cell (in cis) and on opposing cells (in trans) to the receptor. I showed that EFN-1 is able to activate VAB-1 in cis and in trans to cause PLM termination. I also assessed the hypodermal seam cells as the source of the ephrin stop cue using fluorescently labelled and seam cell mutant transgenic worms. I found that although the PLM shows consistent termination on the seam cell V2 in wild type worms independent of PLM length, this process is not significantly disrupted in seam cell mutants. With this information I have created a new hypothesis that the PLM neurite is able the provide a positional cue for the developing seam cells, and have created a new transgenic strain which can be used to assess the impact of PLM and ALM cell ablation on seam cell position. My research is the first to demonstrate the ability of an ephrin ligand to activate its ephrin receptor in cis, and further research can investigate if this finding has in vivo applications.

How the World Learned to Stop Worrying and Love Failure: Big Data, Resilience and Emergent Causality

In modernity, failure was the discourse of critique, today, it is increasingly the discourse of power: failure has changed its allegiances. Over the last two decades, failure has been enfolded into discourses of power, facilitating the development of new policy approaches. Foremost among governing approaches that seek to include and to govern through failure is that of resilience. This article seeks to reflect upon how the understanding of failure has become transformed in this process, particularly linking this transformation to the radical appreciation of contingency and of the limits to instrumental cause-and-effect approaches to rule. Whereas modernity was shaped by a contestation over failure as an epistemological boundary, under conditions of contingency and complexity there appears to be a new consensus on failure as an ontological necessity. This problematic ‘ontological turn’ is illustrated using examples of changing approaches to risks, especially anthropogenic understandings of environmental threats, formerly seen as ‘natural’.

Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study

AIMS: Prevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention.

METHODS AND RESULTS: This is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8 years, interquartile range (IQR) 57.8:72.4, with 4.3 years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50 pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was €9683 (sensitivity range -€843 to €20 210), whereas the cost per MACE prevented was €3471 (sensitivity range -€302 to €7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was €1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of €30 000.

CONCLUSION: Among patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective.

TRIAL REGISTRATION: NCT00921960.

Natriuretic peptide-based screening and collaborative care for heart failure:the STOP-HF randomized trial

IMPORTANCE: Prevention strategies for heart failure are needed.

OBJECTIVE: To determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in an at-risk population in reducing newly diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction.

DESIGN, SETTING, AND PARTICIPANTS: The St Vincent's Screening to Prevent Heart Failure Study, a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors (mean age, 64.8 [SD, 10.2] years) recruited from 39 primary care practices in Ireland between January 2005 and December 2009 and followed up until December 2011 (mean follow-up, 4.2 [SD, 1.2] years).

INTERVENTION: Patients were randomly assigned to receive usual primary care (control condition; n=677) or screening with BNP testing (n=697). Intervention-group participants with BNP levels of 50 pg/mL or higher underwent echocardiography and collaborative care between their primary care physician and specialist cardiovascular service.

MAIN OUTCOMES AND MEASURES: The primary end point was prevalence of asymptomatic LV dysfunction with or without newly diagnosed heart failure. Secondary end points included emergency hospitalization for arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure.

RESULTS: A total of 263 patients (41.6%) in the intervention group had at least 1 BNP reading of 50 pg/mL or higher. The intervention group underwent more cardiovascular investigations (control, 496 per 1000 patient-years vs intervention, 850 per 1000 patient-years; incidence rate ratio, 1.71; 95% CI, 1.61-1.83; P<.001) and received more renin-angiotensin-aldosterone system-based therapy at follow-up (control, 49.6%; intervention, 56.5%; P=.01). The primary end point of LV dysfunction with or without heart failure was met in 59 (8.7%) of 677 in the control group and 37 (5.3%) of 697 in the intervention group (odds ratio [OR], 0.55; 95% CI, 0.37-0.82; P = .003). Asymptomatic LV dysfunction was found in 45 (6.6%) of 677 control-group patients and 30 (4.3%) of 697 intervention-group patients (OR, 0.57; 95% CI, 0.37-0.88; P = .01). Heart failure occurred in 14 (2.1%) of 677 control-group patients and 7 (1.0%) of 697 intervention-group patients (OR, 0.48; 95% CI, 0.20-1.20; P = .12). The incidence rates of emergency hospitalization for major cardiovascular events were 40.4 per 1000 patient-years in the control group vs 22.3 per 1000 patient-years in the intervention group (incidence rate ratio, 0.60; 95% CI, 0.45-0.81; P = .002).

CONCLUSION AND RELEVANCE: Among patients at risk of heart failure, BNP-based screening and collaborative care reduced the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00921960.

Progression of left atrial volume index in a population at risk for heart failure:a substudy of the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) trial

AIMS: Limited data are available concerning the evolution of the left atrial volume index (LAVI) in pre-heart failure (HF) patients. The aim of this study was to investigate clinical characteristics and serological biomarkers in a cohort with risk factors for HF and evidence of serial atrial dilatation.

METHODS AND RESULTS: This was a prospective substudy within the framework of the STOP-HF cohort (NCT00921960) involving 518 patients with risk factors for HF electively undergoing serial clinical, echocardiographic, and natriuretic peptide assessment. Mean follow-up time between assessments was 15 ± 6 months. 'Progressors' (n = 39) were defined as those with serial LAVI change ≥3.5 mL/m(2) (and baseline LAVI between 20 and 34 mL/m(2)). This cut-off was derived from a calculated reference change value above the biological, analytical, and observer variability of serial LAVI measurement. Multivariate analysis identified significant baseline clinical associates of LAVI progression as increased age, beta-blocker usage, and left ventricular mass index (all P < 0.05). Serological biomarkers were measured in a randomly selected subcohort of 30 'Progressors' matched to 30 'Non-progressors'. For 'Progressors', relative changes in matrix metalloproteinase 9 (MMP9), tissue inhibitor of metalloproteinase 1 (TIMP1), and the TIMP1/MMP9 ratio, markers of interstitial remodelling, tracked with changes in LAVI over time (all P < 0.05).

CONCLUSION: Accelerated LAVI increase was found to occur in up to 14% of all pre-HF patients undergoing serial echocardiograms over a relatively short follow-up period. In a randomly selected subcohort of 'Progressors', changes in LAVI were closely linked with alterations in MMP9, TIMP1, and the ratio of these enzymes, a potential aid in highlighting this at-risk group.

Failure to Stop for School Bus Convictions by County of Occurrence 2009-2014, May 8, 2015

Failure to stop for school bus convictions by county from 2009-2014.

'Don't stop': re-thinking the function of endings in narrative television

This thesis argues that the study of narrative television has been limited by an adherence to accepted and commonplace conceptions of endings as derived from literary theory, particularly a preoccupation with the terminus of the text as the ultimate site of cohesion, structure, and meaning. Such common conceptions of endings, this thesis argues, are largely incompatible with the realities of television’s production and reception, and as a result the study of endings in television needs to be re-thought to pay attention to the specificities of the medium. In this regard, this thesis proposes a model of intra-narrative endings, islands of cohesion, structure, and meaning located within television texts, as a possible solution to the problem of endings in television. These intra-narrative endings maintain the functionality of traditional endings, whilst also allowing for the specificities of television as a narrative medium. The first two chapters set out the theoretical groundwork, first by exploring the essential characteristics of narrative television (serialisation, fragmentation, duration, repetition, and accumulation), then by exploring the unique relationship between narrative television and the forces of contingency. These chapters also introduce the concept of intra-narrative endings as a possible solution to the problems of television’s narrative structure, and the medium’s relationship to contingency. Following on from this my three case studies examine forms of television which have either been traditionally defined as particularly resistant to closure (soap opera and the US sitcom) or which have received little analysis in terms of their narrative structure (sports coverage). Each of these case studies provides contextual material on these televisual forms, situating them in terms of their narrative structure, before moving on to analyse them in terms of my concept of intra-narrative endings. In the case of soap opera, the chapter focusses on the death of the long running character Pat Butcher in the British soap EastEnders (BBC, 1985-), while my chapter on the US sitcom focusses on the varying levels of closure that can be located within the US sitcom, using Friends (NBC, 1993-2004) as a particular example. Finally, my chapter on sports coverage analyses the BBC’s coverage of the 2012 London Olympics, and focusses on the narratives surrounding cyclists Chris Hoy and Victoria Pendleton. Each of these case studies identifies their chosen events as intra-narrative endings within larger, ongoing texts, and analyses the various ways in which they operate within those wider texts. This thesis is intended to make a contribution to the emerging field of endings studies within television by shifting the understanding of endings away from a dominant literary model which overwhelmingly focusses on the terminus of the text, to a more televisually specific model which pays attention to the particular contexts of the medium’s production and reception.

"You have ruined this entire experiment…shall we stop talking now?" Orientations to the experimental setting as an interactional resource

One limitation widely noted in sociolinguistics is the tension presented by the ‘observer’s paradox’ (Labov, 1972), i.e. the notion that everyday language is ‘susceptible to contamination by observation’ (Stubbs, 1983: 224). The observer’s paradox has been perceived to present significant challenges to traditional sociolinguistic researchers seeking to explore the processes at work during ordinary interaction. More recently, scholars have begun to argue that in fact the presence of a recording device, rather than being a mere constraint on spoken interaction, is in itself an interactional resource explicitly oriented to by participants (Speer & Hutchby 2003; Gordon 2012). Drawing on a collection of transcripts collected in experimental conditions as part of a wider project exploring the relationship between language and identity, this paper seeks to explore how these orientations manifest themselves in the context of Instant Messaging (IM) conversations. We show different orientations to the experimental setting, and different understandings of the role of the researcher – represented in this case by the IM chat archive – as both a topic of discussion and as a participant themselves.