Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions.

BACKGROUND: Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD) may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR) rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. METHODS: We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine) on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR < 30 to ≥ 30 mL/min/1.73m(2)) of their recommended referrals based on their use of creatinine versus eGFR. RESULTS: Primary care physicians recommended subspecialty referrals later (CKD more advanced) when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m(2), p < 0.001]. Forty percent of primary care physicians significantly improved the timing of their referrals when basing their recommendations on eGFR. Improved timing occurred more frequently among primary care physicians practicing in academic (versus non-academic) practices or presented with White (versus African American) hypothetical patients [adjusted percentage(95% CI): 70% (45-87) versus 37% (reference) and 57% (39-73) versus 25% (reference), respectively, both p ≤ 0.01). CONCLUSIONS: Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine) to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead to more timely subspecialty care and improved clinical outcomes for patients with CKD.

The varieties of student experience - an open research question and some ways to answer it

Based on meetings of the Society for Research into Higher Education’s Student Experience Network over the past three years, the genuinely open research question is posed whether there is one or more undergraduate student experience within English higher education. Answering this question depends on whether what is taught or what is learnt is examined. If the latter, then a unitary student experience can be said to exist only in the narrowest of normative senses. What undergraduates actually learn – defined in the widest sense – is the $64,000 question of research on the student experience. Various ways to answer this question are proposed, including using students to research students. Conceptual tools to apply to findings can be developed from youth studies and cognate disciplines, particularly in relation to student identities and aspirations. Lastly, these proposals are placed in the wider context of comparative models of the varieties of student experience, including those emerging in the UK’s national regions.

‘Nothing will prevent me from doing a good job’. The professionalisation of part-time teaching staff in further and adult education

Approximately 85,000 part-time teaching staff working in further education (FE) and adult and community learning (ACL) are often seen as ‘a problem’. The intrinsic ‘part-timeness’ of these staff tends to marginalise them: they remain under-recognised and largely unsupported. Yet this picture is over-simplified. This article examines how part-time staff make creative use of professional autonomy and agency to mitigate problematic ‘casual employment’ conditions, reporting on results from Learning and Skills Development Agency-sponsored research (2002–2006) with 700 part-time staff in the learning and skills sector. The question of agency was reported as a key factor in part-time employment. Change is necessary for the professional agency of part-timers to be harnessed as the sector responds to ambitious sectoral ‘improvement’ agendas following the Foster Report and FE White Paper. Enhanced professionalisation for part-time staff needs greater recognition and inclusion in change agendas.

Super-villains of the "real world": the political use of the characterization of villains in Chistopher Nolan's "Dark Knight Trilogy"

It is almost a tradition that celluloid (or digital) villains are represented with some characteristics that remind us the real political enemies of the producer country of the film, or even enemies within the country according to the particular ideology that sustains the film. The case of Christopher Nolan The Dark Knight trilogy, analyzed here, is representative of this trend for two reasons. First, because it gets marked by political radicalization conducted by the US government after the attack of September 11, 2001. Secondly, because it offers a profuse gallery of villains who are outside the circle of friends as the new doctrine “either with us or against us” opened by George Bush for the XXI century. This gallery includes from the very terrorists who justify the War on Terror (Ra's al Ghul, the Joker), to the “radical left” (Bane, Talia al Ghul) including liberal politicians (Harvey Dent), and corrupt that take advantage of the softness of the law to commit crimes with impunity (Dr. Crane, the Scarecrow).

Playback Theatre: the art of being oneself. A tool for empowerment and real change for individuals and communities

This article presents the application of a theatrical technique—Playback Theatre, which was developed in the United States during the 1970s—to social intervention, as a narrative and listening space that confers value and dignity upon the person and the unique and distinct individual experiences that facilitate their social and relational integration. This art of being oneself, as the author states, uses the oral tradition and spontaneous and creative communication of psychodrama and combines them with theatrical expression. This technique has been shown to be pertinent to both community social work and support groups for persons in problematic situations. The aim of this is to celebrate some specific moment of their lives, as individuals or as a community, and to define strategies for improving living conditions or resolving or alleviating conflicts. It is also used to assess the achievements of the proposed objectives, to strengthen the motivation to change and to transform existing relationships into collaborative ones. This is possible not only owing to the participation of persons, but also to the assumption of different roles that can permit the overcoming of certain traumatic events.In addition to support groups, it is used for the training and supervision of social work professionals. The theatrical technique in question allows them to assume roles as diverse as narrator, audience or actor, whether simultaneously or successively. Taking the role of «performer» or guide to the theatrical action requires prior preparation in order for the group of participants to be able to pool their individualities and their emotions and reflect on them. The participatory methodology that Playback Theatre proposes is important in community social work and is posed in a new and transformative key.

The “re-socialization” of Gypsy women in the literacy courses aimed to the recipients of the Social Integration Revenue Policy of the Region of Madrid

This article studies the gender values that are promoted both in the literacy courses for gypsy women beneficiaries of the Social Integration Revenue Policy of the Region of Madrid and in the events that are organized for this group by public institutions and NGOs. The process of “socialization” that occurs in the educative groups for Gypsy women is focused on constructing an image of what it is to be a “Gypsy modern woman”. Through multiple mechanisms and discursive techniques a specific conception of gender equality is transmitted in these educative spaces. In addition to this, Gypsy women are continually urged to assume certain values and social practices (of gender identity, of "citizenship", of parenting, etc..), while an archetype of "Gypsy Woman" which condenses powerful stereotypes and prejudices about the "Gypsy culture" and the gender relations characteristics of this group is constructed.

The sector of olive-oil cooperatives and the use of ICT: A comparative study regarding othe legal forms

The current global environment and the general increase in the spread and use of Information Technology and Communication (ICT) by companies and consumers, make the use of these technologies as essential to confront the growing competition in the market. Focused on this sector, in this research we analyze the use of electronic commerce, as through websites as through electronic markets, and the use of social networking tools as enablers of business. For this aim, we conducted a comparative analysis between the Andalusian olive oil cooperatives and other legal forms which are present in the sector.

From the "pólis" to the modern state: an approach to the problem of politics in Heidegger

This paper starts off asking whether a strictly political approach may be deduced based on Martin Heidegger’ ontological analyses of modernity. His interpretation of the Greek phenomenon of the polis is discussed along with the distinction established therein between this form of community and the modern state, founded according to Heidegger on the metaphysical essence of modernity. To clarify this question regard is had to the proclamation of values observed by Heidegger in the different forms of state organization arising in the age of technical consummation of metaphysics. In this connection, his vision of nihilism is studied and a hypothesis is finally offered as to the form of state that would be consistent with a renunciation of the values required, in his view, by the manifestation of the entity in modernity as a wholly producible object.

A Profile of Adolescent Cocaine Use in Northern Ireland.

Background: The image of cocaine as a 'party' drug used by more affluent members of society has begun to change as the levels of use of the drug rise amongst school aged young people. Methods: Cocaine use patterns amongst young people aged 13-16 years who were participating in the Belfast Youth Development Study, a longitudinal study of adolescent drug use was explored. Data was collected through an annual datasweep in participating schools. This paper includes data collected in years 3, 4 and 5 of the study. Results: The results show higher levels of cocaine use amongst this age group than reported in much of the existing harm reduction literature. Lifetime use was 3.8% at age 13-14 years, rising to 7.5% at 15-16 years. The profile indicated that adolescent cocaine users were more likely to be female, live in disrupted families and experience social deprivation which is similar to existing adolescent drug use profiles. There was also some evidence of experimental cocaine use amongst the sample. Conclusions: These findings provide further evidence for the development of age appropriate school focused harm reduction initiatives and continued monitoring of contemporary trends of use of cocaine amongst school aged young people.

Light-color and body-mass. The subjectivity of the Argentinean nation, according to the painting of Pío Collivadino

Pío Collivadino was a highly recognized painter in life, occupying the most important charges in the artistic field and receiving awards in his country and abroad, which turned him into an inescapable reference of young Argentinean artists who earned recognition throughout the twentieth century. Why, then, with the time, his work began to fall to the wayside? In response to this question, the present article, based on the analysis of the work of that artist, proposes to problematize the notion of subjectivity, both in its individual dimension and its national character, underlining the role that the figure of the artist meets for its formation. Developing the concepts of light-color and body-mass, from Collivadino painting, this article will attempt to explain the relation between the emergence of an Argentinean subjectivity, at the beginning of 20th century, and the art, not only at the level of the issues addressed, but, especially, taking into consideration its formal characteristics.

The redemption of the gaze: the crisis of observation in the "fin de siècle" and the advent of cinema

The intention of this article is not to affirm, but rather to question wether it is possible to speak of a loss of the ability to gaze in the context of the nineteenth century and especially in the context of the fin de siècle, in the bosom of the epistemological crisis that beset the Turn of the Century. And very especially, this article tries to question about the impact this crisis had, perhaps, in the birth of cinema. Is in this context that arises the work of Marey and the advent of the cinematograph of the Lumière brothers in the fin de siècle Europe, both of them showing a deep faith in a mechanical apparatus that would allow the redemption of a battered gaze. And it seems to be a dream that continues over time through the tradition of shooting the everyday life.

The use of ICT in the course “Photography” in university education. First results of a teaching innovation project at the University of Murcia

The new pedagogical framework arisen since the Bologna Declaration,the Prague Communiquéand the introduction of the European Higher Education Area (EHEA), encourages, significantly, the use of new Communication and Information Technology to evolve teaching methodologies. The different ways teachers relate to learners have undergone a staggering change from which educational initiatives have emerged. Many of them are based on contents’ democratization through the use of ICT. The current article is intended to show the results obtained until the 2012/2013 academic course, since the implementation of the teaching innovation project entitled “The use of ICT for the students’ autonomous learning in the university education of the course Photography. Elaboration of a virtual classroom and results’ analysis related to the acquisition of skills and competencies” that has been developed in the course called Draw with light: Photography, belonging to the Fine Arts Degree at the University of Murcia.

The use of cues for attention in ancient Greek art: aspects that influence concentration in the work of art and its elements

The goal of this study is to identify cues for the cognitive process of attention in ancient Greek art, aiming to find confirmation of its possible use by ancient Greek audiences and artists. Evidence of cues that trigger attention’s psychological dispositions was searched through content analysis of image reproductions of ancient Greek sculpture and fine vase painting from the archaic to the Hellenistic period - ca. 7th -1st cent. BC. Through this analysis, it was possible to observe the presence of cues that trigger orientation to the work of art (i.e. amplification, contrast, emotional salience, simplification, symmetry), of a cue that triggers a disseminate attention to the parts of the work (i.e. distribution of elements) and of cues that activate selective attention to specific elements in the work of art (i.e. contrast of elements, salient color, central positioning of elements, composition regarding the flow of elements and significant objects). Results support the universality of those dispositions, probably connected with basic competencies that are hard-wired in the nervous system and in the cognitive processes.

A “very limited” effect or a “seismic” impact? A study of the impact of the Human Rights Act 1998 on the Courts of Northern Ireland

This article focuses on the question of what impact the Human Rights Act 1998 has had in practice on the courts of Northern Ireland. How frequently are human rights arguments made in the course of cases in this jurisdiction, and to what extent do such arguments affect outcomes of cases? In order to assess the impact of the Act, the use of the European Convention on Human Rights in the Northern Irish courts during four periods of time is examined. These are, firstly, prior to the passing of the Act in November 1998; secondly, between the Act’s passing and its coming into force in October 2000; thirdly, the first three years after the coming into force of the Act (October 2000 until October 2003); and fourthly, the three years between October 2006 and October 2009.

The role of visual landmarks in the avian familiar area map - Commentary

The question of whether homing pigeons use visual landmarks for orientation from distant, familiar sites is an unresolved issue in the field of avian navigation. Where evidence has been found, the question still remains as to whether the landmarks are used independent of the map and compass mechanism for orientation that is so important to birds. Recent research has challenged the extent to which experiments that do not directly manipulate the visual sense can be used as evidence for compass-independent orientation. However, it is proposed that extending a new technique for research on vision in homing to include manipulation of the compasses used by birds might be able to resolve this issue. The effect of the structure of the visual sense of the homing pigeon on its use of visual landmarks is also considered.