[Implementation of a routine gradual psycho-diagnostic programme in somatic rehabilitation centres - results of a pilot study]

STUDY AIM: A pilot study was conducted to implement and evaluate a routine gradual psycho-diagnostic programme to improve diagnostics and treatment of mental disorders in somatic rehabilitation centres. First of all, implementation strategies were acquired in trainings together with psychologists and physicians. The psycho-diagnostic programme consists of a screening instrument (PHQ-9) designed to permit time-effective detection of comorbid mental disorders. Besides evaluation of the training, the aim of the study was to analyze the extent to which it is possible to implement the routine gradual psycho-diagnostic programme in practice. Additionally, it was intended to identify beneficial and obstructive conditions for implementation. METHODOLOGY: The pilot study was conducted in two orthopaedic and one cardiological rehabilitation centre. The training was evaluated directly after its completion using a questionnaire. Three months after its implementation, the introduction of the psycho-diagnostic programme was evaluated using interviews with n=11 physicians and psychologists. RESULTS: The training was rated positively by the participants . Implementation of the entire gradual psycho-diagnostic programme was possible in one centre and to some degree in the other two. Beneficial for implementation were a frank organisational climate, sufficient time resources, and physicians' biopsychosocial understanding of disease. A dismissive attitude towards psycho-diagnostics, little communication between staff members, little perceived advantage for one's own work and fear to stigmatise patients by psychiatric diagnoses were obstructive. CONCLUSION: Essential for a successful implementation are sufficient time and personal resources, a motivation for change in staff and centre management, and a positive attitude regarding psycho-diagnostics in clinic staff. Furthermore, flexibility in implementation strategies and the opportunity to participate in the implementation process are important.

La arquitectura residencial en El Real Sitio de El Pardo (1885 - 1965): Orígenes, tipos y configuración del trazado urbano

Tras la denominación de Real Sitio a mediados del siglo XVIII, bajo el reinado de Fernando VI, su sucesor Carlos III procedió a la incorporación a su Patrimonio de todos los Montes y Bosques de El Pardo. Comenzó entonces el proceso de planeamiento urbano y de construcción arquitectónica que finalizó en torno al año 1800. En lo sucesivo, no sólo se mantiene el curso de la conservación y consolidación de los edificios principales, sino que se realiza obra nueva de índole civil. Algunos edificios cambiaron de propiedad y de uso hasta que tras la Guerra Civil se procedió a la mayor transformación vivida por el Real Sitio. El intervalo que aquí se trata (1885 a 1965), no ha suscitado, en los estudios sobre El Pardo, atención suficiente al no acontecer obra nueva de carácter patrimonial ni ha sido objeto de análisis el trazado y la fisonomía del centro urbano residencial del pueblo que Carlos III configuró. Sin embargo se estima relevante analizar los cambios en la actividad residencial; en primer lugar porque coexiste con la arquitectura oficial y, por tanto, se entiende necesario un análisis global del conjunto y en segundo lugar porque facilita la comprensión sobre la imagen original de carácter histórico del conjunto de finales del siglo XVIII. Este marco temporal determina tres partes principales de estudio que estructuran la presente tesis, cuyas fechas establecen los intervalos históricos clave: Actuaciones sobre el núcleo urbano consolidado (1885-1931). Cese de la actividad constructiva (1931-1939). Propuestas regeneradoras y crecimiento acelerado (1939-1965). Dentro de ellos se establecen, a su vez, dos subcapítulos diferenciados con la finalidad de explicar los sucesos que pautaron los cambios trascendentales en la historia de El Pardo. En el estudio del estado de la cuestión se observa que en El Pardo, al igual que sucede en otros Reales Sitios, se investigan los edificios destacados como el Palacio, la Casita del Príncipe, la Casa de Oficios y la Casa de Infantes desde el punto de vista de su historia pero no desde la arquitectura ni de cómo esta afecta al desarrollo del trazado y por tanto al contexto urbano. Se manifiestan determinadas carencias de tratamiento gráfico que facilitarían la comprensión histórica mediante el análisis de la forma y cómo esta ha ido variando sustancialmente. El concepto de escala y orientación reordena el estudio, no sólo de estos edificios protagonistas sino de los que se entretejen a su alrededor y componen el conjunto histórico, lo cual aporta nuevas conclusiones al estado de la cuestión que aquí compete. El principal objetivo de la tesis es, por tanto, contribuir a la dimensión patrimonial mediante el estudio de la arquitectura residencial del pueblo de El Pardo y en cómo esta ha ido conformando y consolidando el entramado urbano original en torno a edificios de la realeza y corte. Analizar aquellos edificios que perduran, los que fueron reconstruidos, rehabilitados, y apuntar acontecimientos históricos que formularon la actual fisonomía. Sistematizar y reordenar sobre la traza actual los edificios que desaparecieron, nos da las pistas sobre las modificaciones en concepto de escala arquitectónica y urbana. El estudio de las fuentes y establecer una metodología de conexión de estas, ayuda a detectar dónde no se han dirigido aún los focos de interés así como las lagunas que han quedado por explorar con el fin de responder a nuevas hipótesis, conceder conclusiones y abrir otras líneas de investigación. Como conclusiones generales, la tesis aporta documentación nueva sobre el objeto de estudio, no solicitada, digitalizada o publicada con anterioridad. En ella se analizan los procesos de configuración, consolidación y transformación en el Real Sitio mediante la sistematización de estados comparativos. Con respecto al estudio de los diferentes contextos natural y urbano la tesis analiza cómo los accidentes naturales, el desarrollo de infraestructuras y el impulso de la agronomía afectaron a El Pardo a partir del siglo XIX, y estudia los procesos de configuración, consolidación y transformación en el Real Sitio mediante la sistematización de la documentación encontrada de manera gráfica y escrita. En relación al marco patrimonial arquitectónico, la tesis analiza los procesos edificatorios históricos. Se estudian, a su vez, cambios de ocupación o uso que derivaron en reformas, ampliaciones, obras de nueva planta e incluso en derribos, así como los proyectos no materializados o que se llevaron a cabo de manera parcial. Con respecto al análisis del momento histórico, la tesis analiza las posibles afectaciones, políticas, sociales y económicas en las etapas de Monarquía, Segunda República, Guerra Civil y Posguerra. Por último, la tesis abre cuatro vías de investigación (que ya se han tratado y avanzado en parte pero que escapan a los límites de este trabajo) que pueden plantear nuevas hipótesis, reportando así respuestas sobre objetos de estudio complementarios y paralelos al presente. Estas refieren a análisis más concretos sobre El Palacio Real de El Pardo y la Casa de Oficios, el Camino Real de Madrid a El Pardo desde la Puerta de Hierro, los cuarteles, puertas y portilleras del Monte de El Pardo y los proyectos desarrollados por el arquitecto Diego Méndez en los Reales Sitios para el Patrimonio Nacional. ABSTRACT Following the Royal Site denomination being granted in the mid-18th Century, during the reign of Ferdinand VI, his successor Charles III proceeded to include all the Forests and Woodlands of El Pardo in his heritage. That then gave rise to the process of town planning and architectural construction that was completed around 1800. Thereafter, not only the process of conservation and consolidation of the main buildings has been maintained, but new civil engineering works have also been carried out. Some buildings changed ownership and use until, after the Civil War, the greatest transformation experienced by the Royal Site was undertaken. The time frame this paper concerns (1885 to 1965), has not attracted sufficient attention in studies of El Pardo due to there having been no new works with heritage status, nor has there been an analysis of the layout and external appearance of the residential centre in the town once conceived by Charles III. However, it is considered relevant to analyse the changes in residential activity, firstly, because it coexists with the official architecture and, thus, it is considered necessary to perform a global analysis of the complex and, secondly, because it facilitates a historical understanding of the original appearance of the complex at the end of the 18th Century. This time framework defines three main parts of the study that provide the structure of this thesis, the dates of which establish the key historical time frames: Actions in the consolidated town centre (1885-1931). Cessation of construction works (1931-1939). Proposals of regeneration and accelerated growth (1939-1965). Two distinct sub-chapters are also established within these, in order to explain the events that marked the transcendental changes in the history of El Pardo. When studying the subject matter, it is noted that in El Pardo, as is the case in other Royal Sites, outstanding buildings such as the Palace, the Prince's Cottage, the Trades House and the Infantes House are usually researched strictly from the point of view of their history, but not from an architectural perspective, nor analysing how that affects the development of the site layout and thus the urban area. Specific shortcomings are evident in the graphic treatment that would have otherwise facilitated a historical understanding through the analysis of the shape and the way it has gradually undergone substantial variation. The concept of scale and orientation reorganises the study, not only of these key buildings, but also of those that are woven around them and make up the historic complex, allowing entirely new conclusions concerning the subject matter analysed herein. Therefore, the main purpose of this thesis is to outline our heritage through the study of the residential architecture of the town of El Pardo and the analysis of the way the original town has been built up and consolidated around the buildings erected by royalty and the court; to analyse the buildings that still remain, those that were rebuilt, refurbished, and to note historic events that shaped its current appearance. To this end, a systematic classification and reorganisation on the current urban layout of the buildings that have disappeared will give us the key to understand changes in the concept of architectural and urban scale. Studying the sources and establishing a methodology to connect them will help us detect those areas where the focus of interest has not concentrated yet, and will also reveal the gaps that remain unexplored, in order to respond to new hypotheses, reach new conclusions and open up new lines of research. As general conclusions, this thesis provides new documentation on the subject matter that had not been requested, digitized or published before. There we find an analysis of the processes of configuration, consolidation and transformation of the Royal Site through a systematic classification of comparative states. With regard to the study of the multiple natural and urban environments, this thesis analyses the way natural features, development of infrastructures and agricultural driving forces affected El Pardo as of the 19th Century, and it studies the processes of configuration, consolidation and transformation of the Royal Site by systematically classifying the documentation found in graphic and written documents. In relation to the architectural heritage framework, this thesis analyses historical building processes. Likewise, a study is also performed on the changes in land occupation or use that led to reforms, extensions, new buildings and even to demolitions, as well as on unrealized projects, or even on those that were partially implemented. As for the analysis of the historical time period, this thesis assesses the potential political, social and economic effects of the Monarchy, Second Republic, Civil War and Post-War Periods. Finally, this thesis opens up four lines of investigation (that have already been discussed and partially advanced, but which fall beyond the scope of this work) that could pose new hypotheses, thus giving answer to other subject matters parallel and complementary to the one assessed herein. These refer to more specific analyses of El Palacio Real de El Pardo (Royal Palace of El Pardo) and the Casa de Oficios (Trades House), the Royal Highway from Madrid to El Pardo from Puerta de Hierro, the barracks, gates and entrances to estates in the Woodlands of El Pardo and the projects developed on the Royal Sites by the architect Diego Méndez for the National Heritage.

Casas de la oligarquía castellana en la Granada del siglo XVI : tipologías, adaptación y contexto urbano, fundamentos para su recuperación

El tema de estudio de esta tesis es el análisis morfológico y cronológico de diez ejemplares emblemáticos de la arquitectura doméstica señorial de la Granada del siglo XVI, analizados en comparación con otros casos de referencia construidos en el mismo período en la propia ciudad, conservados y desaparecidos. También se han tenido en cuenta las principales manifestaciones arquitectónicas de los mayores focos urbanos contemporáneos en el reino de Castilla. El trabajo se ha desarrollado partiendo de la realización de una planimetría precisa y completa de las diez casas documentadas, uniendo al trabajo in situ sobre los datos materiales el estudio de las fuentes de archivo y de la bibliografía especializada existente sobre la materia. El análisis formal de las unidades domésticas ha sido enfocado al estudio tipológico de lo construido, haciendo especial hincapié en las pervivencias andalusíes sobre las cuales los nuevos moradores edificaron o adaptaron sus casas solariegas. En apoyo a las hipótesis presentadas se aporta la documentación arqueológica derivada de las excavaciones realizadas en los solares de las viviendas objeto de análisis, además de los planos de los estados previos a las recientes reformas sufridas por muchos de estos edificios. El análisis comparativo con algunos edificios contemporáneos en los que se ha documentado y estudiado cronológicamente su evolución histórica, ha permitido afianzar las hipótesis de datación y de reconstrucción de la distribución espacial de las fábricas originarias de la época tratada. Los objetivos de la investigación han sido orientados a poner de manifiesto la delicada y compleja transición de la medina nazarí a la ciudad cristiana, tratando también ciertas características multiculturales propias de las técnicas constructivas y de sociedad de la época. Los resultados de este estudio multidisciplinar se han registrado en un mapa de datos creado con el Sistema de Información Geográfico, en el que se han incluido tanto los datos cronológicos como formales, individualizando los ambientes que constituyen las pervivencias medievales y los que se han construido después, aportando sus distintas dataciones. Se ha querido dar respuesta a varios interrogativos: ¿Cómo se adapta la arquitectura castellana al tejido urbano andalusí? ¿Reaprovecha las preexistencias o las elimina en cada momento? ¿De qué modo la ciudad ha ido modificándose hasta configurarse como una ciudad moderna? ¿Cuánto se ha mantenido este patrimonio de casas? ¿Cómo se debería conservar? Se ha tratado de resolver estas cuestiones formulando síntesis gráficas en las que se puede comprender la evolución histórica de las viviendas acontecida a lo largo del siglo XVI, junto con sus transformaciones recientes provocadas por las intervenciones contemporáneas. Asimismo se aporta el estudio de las principales características de las intervenciones acometidas sobre este patrimonio único de viviendas, que por su propia naturaleza es altamente perecedero y necesita que se formulen criterios eficaces y correctos para su mayor conservación. El punto de partida de este trabajo no ha sido solamente el análisis de campo sino también la recopilación y ordenación de los datos procedentes de la bibliografía existente para formular discursos coherentes y precisos sobre la evolución de este tipo de viviendas históricas, cuyos valores son tan expuestos a graves deterioros que su catalogación, documentación y valoración se hacen imprescindibles. Pese a que las diez viviendas incluidas en los capítulos de estudio detallado estén catalogadas en los Planes Especiales de Protección (Albaicín, 1990 y Centro, 2002), sus caracteres formales y sus elementos estructurales y decorativos de valor histórico han sufrido un evidente proceso de expolio o destrucción, hecho grave que esta Tesis quiere reflejar de cara a la deseable futura puesta en valor real de estos edificios así como, indirectamente, de sus ámbitos urbanísticos de pertenencia. ABSTRACT The purpose of this thesis is to study the morphological and chronological characteristics of ten emblematic mansions belonging to the architectural period of the 16th Century in Granada, Spain. These houses are compared with other similar outstanding constructions of the same period that are located in the city, which have either been preserved or disappeared. Also, this study has taken into account the main architectural expressions of greater contemporary urban areas of the Kingdom of Castile. The work carried out began, first of all, by drawing a precise and thorough planimetry of the ten surveyed houses, together with in situ tasks based on physical data, a study of archival data, and the specialized existing bibliography on the subject. The formal analysis of the home units is focused as a typological study of erected buildings, with a special attention on Al Andalus remains over which the new householders constructed or adapted their mansions. The hypotheses brought forward have been supported by the archaeological documentation that had been elaborated during the excavation works of the houses concerned in this study. Moreover, the drawings of the states of the sites, previously to the most recent renovation works many of these buildings have undergone, have been presented. The comparative analysis made with some contemporary buildings, which have been chronologically documented and studied in their historical evolution, has confirmed the dating hypotheses, and that of the reconstruction of the spatial distribution of the original factories the period discussed. The aims of this research have been oriented to bring to light the delicate and complex transition of the town, from the Nasrid period to Christian times. The research has also dealt with some special multicultural characteristics of the constructive techniques, as well as of the society of that period. The results of this multidisciplinary study have been registered on a data map created with the Geographical Information System, which includes both the chronological and formal data. The Medieval settings, and those of later constructions, have been individualised and dated. Several questions have been answered: how the Castilian architecture adapts to the Al Andalus urban design? Have the pre-existing structures been reused or eliminated at each stage? How has the town evolved until becoming a modern city? To which degree this heritage of houses has remained? How should it been preserved? These questions have been approached by means of graphical syntheses in an attempt to bring an understanding of the historical evolution of the houses throughout the 16th Century. But also, this work shows the more recent transformations these structures suffered over the contemporary period. Moreover, there is a study of the main characteristics of interventions over this unique patrimony of housing which by nature is perishable and needs a formulation of correct and efficient criteria for better conservation. The starting point of this work has not only been that of field analysis, but also the gathering and ordering of the existing bibliographical data, in order to formulate coherent and precise statements on the evolution of this type of historical housing. Its treasures are so exposed to severe deterioration that their cataloguing, documentation and appreciation are becoming crucial. Despite the fact that the ten houses considered in the chapters of this detailed study are listed in the special protection plans (Planes Especiales de Protección, Albaicín plan of 1990 and the town centre plan of 2002) their formal characteristics, as well as structural and decorative historical value, have suffered gradual plunders or destruction. This thesis tries to reflect how serious is that matter and the need in the future to give this heritage and the surrounding urban environment, a real value.

Applicazione dell’Indice di Funzionalità Fluviale (I.F.F.) al fiume Segura nella provincia di Alicante

L’obiettivo di questo studio è la valultazione della funzionalità ecologica del fiume Segura nella provincia di Alicante (Spagna) mediante l’applicazione dell’IFF (Indice di Funzionalità Fluviale). La motivazione di questa scelta è stata la volontà di partecipare all’introduzione di questo indice in Spagna, paese in cui non è abitualmente utilizzato. Sono stati valutati 24006 m di corso d’acqua suddivisi in 24 tratti di varie lunghezze, partendo dall’uscita del centro urbano di Orihuela fi no al centro abitato di Guardamar del Segura. Il giudizio della funzionalità del fiume complessivamente rientra nell’intervallo dei livelli da V a III-IV, con una percentuale maggiore dell’80% di livello IV sia per la sponda destra che per la sinistra. L’applicazione dell’Indice ha permesso non solo di valutare la funzionalità dei 24 tratti, ma anche di individuare i parametri più degradati del corso d’acqua e i parametri più «forti», dall’osservazione dei quali è possibile far partire un lavoro di ripristino ambientale e rinaturalizzazione del fiume.

Transformación urbana, espacio público y su percepción social. El río Segura a su paso por Orihuela y Rojales

El río Segura en su tramo final, la Vega Baja en la provincia de Alicante, atraviesa las ciudades de Orihuela y Rojales, que se caracterizan por ser las dos únicas de esta zona en las que el cauce recorre su casco urbano. Se parte de las obras de remodelación del cauce con el Plan de Defensa contra Avenidas en la Cuenca del Río Segura, concluido en 1994, en el que la solución adoptada para el encauzamiento en los tramos urbanos es similar en ambos municipios. Esta investigación expone en qué medida dichas actuaciones han tenido un refl ejo directo en la imagen de la ciudad, en las actividades en el espacio público urbano y en la manera que es percibido por los ciudadanos. Finalmente, se ponen en evidencia resultados coincidentes y divergentes, pese a la similitud del contexto de las actuaciones.

Att marknadsföra en stadskärna : En kvalitativ studie om hur Sandvikens stadskärna kan marknadsföras och ses som mötesplats

This study takes its basis in preliminary talks with stakeholders active in the development of the city center in Sandviken. Sandviken is a small town that like many other cities has experienced both economic and demographic stagnation. This is due to the great extent of external retail which affects the economics of city core negative. This study was developed through the complex of problems that show that Town Centre Managements has visions to increase the attractiveness of the city center, but lack a clear strategy of how the vision will be achieved. The study therefore aims to examine how a city center can be marketed and examine ways and beliefs that exist around the production of the city center as a meeting place. The importance of the city center to take a new role as a meeting place is demonstrated in this study's analysis where this approach proved to be a winning concept, in which important values can take place, to in turn help to satisfy the needs of today's urban centers. As a conclusion, and also presented in the discussion how marketing can go to and which actors are responsible and how a community can be created.

Makt och motstånd i köpcentrumet

This article focuses how power and resistance are exercised in one of Stockholm’s biggest shopping centres. Power and resistance are key words in Cultural Studies. However, the tradition is dominated by studies where 'ordinary/common’ people and their everyday resistance against economical, political and symbolic power is analysed. Critics of Cultural Studies have pointed out that this domination in some cases has led to a romanticized view on common people s resistance and an unproblematic, simplified concept of power. This article works in the tradition of Cultural Studies, but takes this critique seriously by distinguishing three arenas where economic, political and symbolical forms of power intersect and clash with other interests. These are located in the tension between three sets of relations: a) the shopping centre versus the local municipality, b) the centre management versus the individual businesses that run shops in the centre, and c) the shopping centre as a whole (comprising the owners, the shops and the space itself) versus the visitors (who are predominantly women). The empirical material consists of observations and field-notes, branch statistics, interviews with customers, shop employees and centre managers, photographic documentation, advertisements and other public sources from 1998 to 2002.

Architecture and Construction Management at Queens University Belfast:Regional Cultural Centre

The Regional Cultural Centre in Letterkenny is a new 2000sqm arts center containing theatre, galleries, workshops and ancillary offices. The site is set back from the street, on high ground with good views. The form and envelope of the building was derived from geometrically connecting the site with the town’s two other main public buildings, the Cathedral (1901) and new Civic Offices (2002, also designed by MacGabhann Architects). This geometrical connection or vectors informed the geometry and shape of the building. This urban matrix of geometrically connecting three corner stones of society, namely the ecclesiastical headquarters, the administrative head quarters and the art centre helps to improve the town planning and urban design of the disparate and chaotic development that Letterkenny has become.
The large cantilever, which houses a 300sqm gallery, is aligned towards the Civic Offices, marks the entrance, and signifies a change of direction of the pedestrian route past the building, like a modern day obelisk.
The circulation routes and stairs internally provide views towards the civic offices and cathedral, thus reinforcing the connection between the three buildings and helps visitors make some sense of Letterkenny as an urban center. The main stairs and vertical circulation are contained behind the large glazed foyer, which is framed to be viewed externally like a proscenium stage, with visitors to the building passively acting their routes through the building.

Wound Management Innovation Cooperative Research Centre - a new model for inter-disciplinary wound research

Wound research is a complex multidimensional activity most effectively conducted by inter-disciplinary teams that connect studies in basic wound biology, devices and biomaterials with clinical practice. These complexities have been recognised in a new initiative through the establishment of an inter-disciplinary wound research centre in Australia; the Wound Management Innovation Cooperative Research Centre (WMI CRC). The centre is funded by the Australian Government's Cooperative Research Centre Program and a consortium of 22 participants and has a resource of US$108 million over 8 years...

Surveillance Town: Social inclusion-exclusion through surveillance, ‘the dignity of work’ and income management

This paper discusses the situation of welfare claimants, constructed as faulty citizens and flawed welfare subjects at the receiving end of complex and multi-layered, private and public, forms of monitoring and surveillance aimed at securing socially responsible, consuming and compliant behaviours. In Australia as in many other western countries, the rise of neoliberal economic regimes with their harsh and often repressive treatment of welfare claimants operates in tandem with a growing arsenal of CCTV and assorted urban governance measures (Monahan 2008, Maki 2011). The capacity for all forms of surveillance to intensify social inequalities through the lens of CCTV and other modes and methods of electronic monitoring is amply demonstrated in the surveillance studies literature, raising fundamental questions around issues of social justice, equity and the expenditure of societal resources (Norris and Armstrong 1999, Lyon 1994, 2001, Loader 1996).

Perioperative medication management: expanding the role of the preadmission clinic pharmacist in a single centre, randomised controlled trial of collaborative prescribing

Objectives Current evidence to support non-medical prescribing is predominantly qualitative, with little evaluation of accuracy, safety and appropriateness. Our aim was to evaluate a new model of service for the Australia healthcare system, of inpatient medication prescribing by a pharmacist in an elective surgery preadmission clinic (PAC) against usual care, using an endorsed performance framework. Design Single centre, randomised controlled, two-arm trial. Setting Elective surgery PAC in a Brisbane-based tertiary hospital. Participants 400 adults scheduled for elective surgery were randomised to intervention or control. Intervention A pharmacist generated the inpatient medication chart to reflect the patient's regular medication, made a plan for medication perioperatively and prescribed venous thromboembolism (VTE) prophylaxis. In the control arm, the medication chart was generated by the Resident Medical Officers. Outcome measures Primary outcome was frequency of omissions and prescribing errors when compared against the medication history. The clinical significance of omissions was also analysed. Secondary outcome was appropriateness of VTE prophylaxis prescribing. Results There were significantly less unintended omissions of medications: 11 of 887 (1.2%) intervention orders compared with 383 of 1217 (31.5%) control (p<0.001). There were significantly less prescribing errors involving selection of drug, dose or frequency: 2 in 857 (0.2%) intervention orders compared with 51 in 807 (6.3%) control (p<0.001). Orders with at least one component of the prescription missing, incorrect or unclear occurred in 208 of 904 (23%) intervention orders and 445 of 1034 (43%) controls (p<0.001). VTE prophylaxis on admission to the ward was appropriate in 93% of intervention patients and 90% controls (p=0.29). Conclusions Medication charts in the intervention arm contained fewer clinically significant omissions, and prescribing errors, when compared with controls. There was no difference in appropriateness of VTE prophylaxis on admission between the two groups.

Management based on exhaled nitric oxidelevels adjusted for atopy reduces asthma exacerbations in children : A dual centre randomised controlled trial

While several randomised control trials (RCTs) have evaluated the use of fractional exhaled nitric oxide (FeNO) to improve asthma outcomes, none used FeNO cut-offs adjusted for atopy, a determinant of FeNO levels. In a dual centre RCT, we assessed whether a treatment strategy based on FeNO levels, adjusted for atopy, reduces asthma exacerbations compared with the symptoms-based management (controls). Children with asthma from hospital clinics of two hospitals were randomly allocated to receive an a-priori determined treatment hierarchy based on symptoms or FeNO levels. There was a 2-week run-in period and they were then reviewed ten times over 12-months. The primary outcome was the number of children with exacerbations over 12-months. Sixty-three children were randomised (FeNO=31, controls=32); 55 (86%) completed the study. Although we did achieve our planned sample size, significantly fewer children in the FeNO group (6 of 27) had an asthma exacerbation compared to controls (15 of 28), p=0.021; number to treat for benefit=4 (95%CI 3-24). There was no difference between groups for any secondary outcomes (quality of life, symptoms, FEV1). The final daily inhaled corticosteroids (ICS) dose was significantly (p=0.037) higher in the FeNO group (median 400µg, IQR 250-600) compared to the controls (200, IQR100-400). Taking atopy into account when using FeNO to tailor asthma medications is likely beneficial in reducing the number of children with severe exacerbations at the expense of increased ICS use. However, the strategy is unlikely beneficial for improving asthma control. A larger study is required to confirm or refute our findings.

Human resource management of Indian call centre representatives

This study examines how call centres adopt different types of human resource practices (involvement and control oriented) to manage frontline employees in Indian call centres. Data were collected from 250 call centre representatives to test the research hypotheses. The research model was analyzed using Mplus software. Findings showed that involvement and control oriented human resource practices resulted in more employee exhaustion and disengagement. Involvement oriented HRM had a positive impact on job satisfaction as well as, a positive relationship between employee exhaustion and disengagement. The findings suggest that, while involvement oriented HRM enhances job satisfaction, its implementation comes with a cost, that is, an increase in employee exhaustion and disengagement at work.