Development and validaton of an indicator to compare antibiotic usage in secondary care in England

The use of antibiotics was investigated in twelve acute hospitals in England. Data was collected electronically and by questionnaire for the financial years 2001/2, 2002/3 and 2003/4. Hospitals were selected on the basis of their Medicines Management Self-Assessment Scores (MMAS) and included a cohort of three hospitals with integrated electronic prescribing systems. The total sample size was 6.65% of English NHS activity for 2001/2 based on Finished Consultant Episode (FCE) numbers. Data collected included all antibiotics dispensed (ATC category J01), hospital activity FCE's and beddays, Medicines Management Self-assessment scores, Antibiotic Medicines Management scores (AMS), Primary Care Trust (PCT) of origin of referral populations, PCT antibiotic prescribing rates, Index of Multiple Deprivation for each PCT. The DDD/FCE (Defined Daily Dose/FCE) was found to correlate with the DDD 100beddays (r = 0.74 pindicating this is a useful additional indicator for identifying hospitals that require further study. Antibiotic use increased from a mean 4.16 DDD/FCE in 2001/2 to 4.35 DDD/FCE in 2003/4. Antibiotic use in the electronic prescribing cohort was found to be lower, than the sample mean at 3.48 DDD/FCE in 2001/2 and 3.34 DDD/FCE in 2003/4. The MMAS and AMS were found to correlate (r = 0.74 ping the use of the MMAS as an indication of control of antibiotic use. No correlation was found between the MMAS and a range of qualitative indicators of antibiotic use. A number of indicators are proposed as triggers for further investigation including a proportion of 0.24 for the ratio of third generation to first/second generation cephalosporin use, and five percent as the limit for parenteral quinolone DOD of total quinolone DOD usage. It was possible to demonstrate a correlation between the IMD 2000 and primary care antibiotic prescribing rates but not between primary and secondary care antibiotic prescribing rates for the same referral population or between the weighted mean IMD 2000 for each hospital's referral population and the hospital antibiotic prescribing rate.

An introduction to Point-Counterpoint articles

Editorial

Ballots for Equality: An Approach to the Radical Tradition in U.S. Electoral Politics

Posing radical challenges to structural inequality is the defining quality of the Left. What role electoral politics might play in such processes is a dilemma of radical politics, the contours of which vary by historical and national contexts. For the U.S. Left there is a distinctive aspect of the dilemma directly related to the failure of a "Left" party of even the most moderate social democratic type to take root, creating a seemingly never ending debate over the value if any of "third party" progressive organizing. This debate is current, as illustrated by three divergent approaches; independent left electoral politics (Socialist Alternative), organizing within the less conservative of the dominant parties (Progressive Democrats of America), and a social movement focus outside the electoral process (Occupy Movement). The present day examples of alternative Left strategies noted here in passing are but three of many such specific organizational options for progressive politics. This article does not seek to advocate for any one of these options to the exclusion of the others but rather seeks to provide historical perspective.

Randomized controlled trial of an intervention to change cardiac misconceptions in myocardial infarction patients

There is converging evidence that changing beliefs about an illness leads to positive recovery outcomes. However, cardiac misconceptions interventions have been investigated mainly in Angina or Coronary Heart Disease patients, and less in patients following Myocardial Infarction (MI). In these patients, cardiac misconceptions may play a role in the adjustment or lifestyle changes. This article reports a randomized controlled trial of an intervention designed to reduce the strength of misconceptions in patients after a first MI. The primary outcome was the degree of change in misconceptions and the secondary outcomes were: exercise, smoking status, return to work and mood (anxiety and depression). Patients in the intervention condition (n = 60) were compared with a control group (n = 67) receiving usual care. Both groups were evaluated at baseline and 4, 8 and 12 months after hospital discharge. There was a significant time-by-group interaction for the total score of cardiac misconceptions. Patients in the intervention group significantly decreased their total score of cardiac misconceptions at 4 months compared with the control group and this difference was sustained over time. Patients in the intervention group were also more likely to exercise at the follow-up period after MI than the control group. This intervention was effective in reducing the strength of cardiac misconceptions in MI patients and had a positive impact on health behaviour outcomes. These results support the importance of misconceptions in health behaviours and the utility of belief change interventions in promoting health in patients with Myocardial Infarction.

Estrutura, personagens e enganos: introdução à leitura de As Báquides de Plauto /// Structure, characters and deceptions: an introduction to the study of Plautus’ Bacchides

Esta publicação apresenta um estudo sobre as As Báquides de Plauto, no qual se analisam o contexto e as características da peça, a estrutura e as personagens, e ainda o problema da originalidade plautina na conceptualização do ‘terceiro engano’.

Research in Tourism Course Presentation

Research in Tourism is an optional course that is taught during the second semester of the fourth year of the Undergraduate Degree in Sociology. It is directly linked to Sociology of Tourism. It is held in English.

Development and application of magnetoencephalographic methods in the investigation of the human visual system

This thesis is an exploration of the organisation and functioning of the human visual system using the non-invasive functional imaging modality magnetoencephalography (MEG). Chapters one and two provide an introduction to the ‘human visual system and magnetoencephalographic methodologies. These chapters subsequently describe the methods by which MEG can be used to measure neuronal activity from the visual cortex. Chapter three describes the development and implementation of novel analytical tools; including beamforming based analyses, spectrographic movies and an optimisation of group imaging methods. Chapter four focuses on the use of established and contemporary analytical tools in the investigation of visual function. This is initiated with an investigation of visually evoked and induced responses; covering visual evoked potentials (VEPs) and event related synchronisation/desynchronisation (ERS/ERD). Chapter five describes the employment of novel methods in the investigation of cortical contrast response and demonstrates distinct contrast response functions in striate and extra-striate regions of visual cortex. Chapter six use synthetic aperture magnetometry (SAM) to investigate the phenomena of visual cortical gamma oscillations in response to various visual stimuli; concluding that pattern is central to its generation and that it increases in amplitude linearly as a function of stimulus contrast, consistent with results from invasive electrode studies in the macaque monkey. Chapter seven describes the use of driven visual stimuli and tuned SAM methods in a pilot study of retinotopic mapping using MEG; finding that activity in the primary visual cortex can be distinguished in four quadrants and two eccentricities of the visual field. Chapter eight is a novel implementation of the SAM beamforming method in the investigation of a subject with migraine visual aura; the method reveals desynchronisation of the alpha and gamma frequency bands in occipital and temporal regions contralateral to observed visual abnormalities. The final chapter is a summary of main conclusions and suggested further work.

Putting theory to work: the use of theory in construction research

Attention to epistemology, theory use and citation practices are all issues which distinguish academic disciplines from other ways of knowing. Examples from construction research are used to outline and reflect on these issues. In doing so, the discussion provides an introduction to some key issues in social research as well as a reflection on the current state of construction research as a field. More specifically, differences between positivist and interpretivist epistemologies, the role of theory in each and their use by construction researchers are discussed. Philosophical differences are illustrated by appeal to two published construction research articles by Reichstein et al. and Harty on innovation (Reichstein, Salter and Gann, 2005; Harty, 2008). An analysis of citations for each highlights different cumulativity strategies. The potential contribution of mixed research programmes, combining positivist and interpretivist research, is evaluated. The paper should be of interest to early researchers and to scholars concerned with the ongoing development of construction research as an academic field.