Medication incidents in primary care medicine: protocol of a study by the Swiss Federal Sentinel Reporting System.

BACKGROUND/RATIONALE: Patient safety is a major concern in healthcare systems worldwide. Although most safety research has been conducted in the inpatient setting, evidence indicates that medical errors and adverse events are a threat to patients in the primary care setting as well. Since information about the frequency and outcomes of safety incidents in primary care is required, the goals of this study are to describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. Label="METHODS AND ANALYSIS" ="METHODS"/> <AbstractText STUDY DESIGN AND SETTING: We will conduct a prospective surveillance study to identify cases of medication incidents among primary care patients in Switzerland over the course of the year 2015. PARTICIPANTS: Patients undergoing drug treatment by 167 general practitioners or paediatricians reporting to the Swiss Federal Sentinel Reporting System. INCLUSION CRITERIA: Any erroneous event, as defined by the physician, related to the medication process and interfering with normal treatment course. EXCLUSION CRITERIA: Lack of treatment effect, adverse drug reactions or drug-drug or drug-disease interactions without detectable treatment error. PRIMARY OUTCOME: Medication incidents. RISK FACTORS: Age, gender, polymedication, morbidity, care dependency, hospitalisation. STATISTICAL ANALYSIS: Descriptive statistics to assess type, frequency, seasonal and regional distribution of medication incidents and logistic regression to assess their association with potential risk factors. Estimated sample size: 500 medication incidents. LIMITATIONS: We will take into account under-reporting and selective reporting among others as potential sources of bias or imprecision when interpreting the results. ETHICS AND DISSEMINATION: No formal request was necessary because of fully anonymised data. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT0229537.

More than Words? An Analysis on the Language and Structure of General Election Manifestos of the British Labour Party 1983-2005

The topic of this study is the language of the educational policies of the British Labour party in the General Election manifestos between the years 1983-2005. The twenty-year period studied has been a period of significant changes in world politics, and in British politics, especially for the Labour party. The emergence educational policy as a vote-winner of the manifestos of the nineties has been noteworthy. The aim of the thesis is two-fold: to look at the structure of the political manifesto as an example of genre writing and to analyze the content utilizing the approach of critical discourse analysis. Furthermore, the aim of this study is not to pinpoint policy positions but to look at what is the image that the Labour Party creates of itself through these manifestos. The analysis of the content is done by a method of close-reading. Based on the findings, the methodology for the analysis of the content was created. This study utilized methodological triangulation which means that the material is analyzed from several methodological aspects. The aspects used in this study are ones of lexical features (collocation, coordination, euphemisms, metaphors and naming), grammatical features (thematic roles, tense, aspect, voice and modal auxiliaries) and rhetoric (Burke, Toulmin and Perelman). From the analysis of the content a generic description is built. By looking at the lexical, grammatical and rhetorical features a clear change in language of the Labour Party can be detected. This change is foreshadowed already in the 1992 manifesto but culminates in the 1997 manifesto which would lead Labour to a landslide victory in the General Election. During this twenty-year period Labour has moved away from the old commitments and into the new sphere of “something for everybody”. The pervasiveness of promotional language and market inspired vocabulary into the sphere of manifesto writing is clear. The use of the metaphors seemed to be the tool for the creation of the image of the party represented through the manifestos. A limited generic description can be constructed from the findings based on the content and structure of the manifestos: especially more generic findings such as the use of the exclusive we, the lack of certain anatomical parts of argument structure, the use of the future tense and the present progressive aspect can shed light to the description of the genre of manifesto writing. While this study is only the beginning, it proves that the combination of looking at the lexical, grammatical and rhetorical features in the study of manifestos is a promising one.

The present state of aragonese

How much Aragonese is still spoken remains largely an unknown quantity. Naturally, establishing the number of speakers of any variety begs the question of what speaking a language actually means, and the picture is often clouded by the political interests of particular groups, as is the case in Aragon. The strong claim to the continued widespread use of Aragonese made by such associations as the Consello d"a Fabla in Huesca is counterbalanced by that of the more reactionary, sceptical academics at the University of Saragossa, who maintain that Aragonese varieties, ignoring the Catalan of Aragon spoken right down La Franja, the transition area between Aragon and Catalonia, now only survive in certain pockets of resistance across the north of Huesca. This paper will attempt to provide a summary of the available facts and report on some of the author"s own findings during his more recent trips to Aragon. Keywords Spanish dialectology, Aragonese, standardization of Aragonese, vitality of Aragonese

Literature report : a review of policy learning in five strands of political science research

This paper reviews the policy learning literature in political science. In recent years, the number of publications on learning in the political realm increased dramatically. Researchers have focused on how policymakers and administrators adapt policies based on learning processes or experiences. Thereby, learning has been discussed in very different ways. Authors have referred to learning in the context of ideas, understood as deeply held beliefs, and, as change and adaptation of policy instruments. Two other strands of literature have taken into consideration learning, namely the diffusion literature and research on transfer, which put forward learning to understand who learns from whom and what. Opposed to these views, political learning emphasizes the adaptation of new strategies by policymakers over the transfer of knowledge or broad ideas. In this approach, learning occurs due to the failure of existing policies, increasing problem pressure, scientific innovations, or a combination of these elements.

Braving the Storm: How Are Global Biofuel Policies Sustained Despite Being Contested? An Analysis of the Biofuel Discourses of the EU, Brazil and Mozambique

Considered as a remedy to multiple problems that our world is facing, biofuels are nowadays promoted on a global scale. Despite this globalised approach, however, biofuels are heavily contested. Not only the social implications of biofuels are disputed and uncertain, particularly in countries of the global South, but also their environmental and economic rationales. Given these huge controversies, policies promoting biofuels would seem difficult to maintain. Yet, support for them has been surprisingly well established on the political agendas. With the aim of understanding this puzzle, this study asks how the dominant approach to biofuels has been sustained on a global level. In order to answer this question, the meanings and assumptions in biofuel discourses are explored through the lens of Maarten Hajer’s “argumentative” discourse analysis. Based on the existence of a “partnership for sustainable bioenergy” between the EU, Brazil and Mozambique, the study takes these three locations as case studies. The analysis reveals that various discursive strategies, including a particular problem construction and the use of two main story-lines, have played an important role in ensuring the permanence of the global approach to biofuels. Moreover, while the discourse of critics against biofuels demonstrates that there is room for contestation, the analysis finds that the opponents’ discourse largely fails to target the most salient justification for biofuels. A more effective strategy for critics would therefore be to also question the problem constructions underpinning this main justification in the global discourse.

Pattern of injury with a graded excitotoxic insult and ensuing chronic medial septal damage in the rat brain

Brain damage caused by an acute injury depends on the initial severity of the injury and the time elapsed after the injury. To determine whether these two variables activate common mechanisms, we compared the response of the rat medial septum to insult with a graded series of concentrations of a-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) with the time-course effects of a low dose of AMPA. For this purpose we conducted a dose-response study at concentrations of AMPA between 0.27 and 10.8 nmol to measure atrophy of the septal area, losses of cholinergic and GABAergic neurons, astroglial and microglial reactions, and calcification. Cholinergic neurons, whose loss paralleled the degree of septal atrophy produced by AMPA, are more sensitive than GABAergic neurons to the injury produced by AMPA. At doses of AMPA above 2.7 nmol, calcification and the degree of microglial reaction increased only in the GABAergic region of the septal area, whereas atrophy and neuronal loss reached a plateau. We chose the 2.7-nmol dose of AMPA to determine how these parameters were modified between 4 days and 6 months after injection. We found that atrophy and neuronal loss increased progressively through the 6-month study period, whereas astrogliosis ceased to be observed after 1 month, and calcium precipitates were never detected. We conclude that septal damage does not increase with the intensity of an excitotoxic insult. Rather, it progresses continuously after the insult. Because these two situations involve different mechanisms, short-term paradigms are inappropriate for interpreting the pathogenic mechanisms responsible for long-term neurodegenerative processes.

Indirect comparison meta-analysis of two enoxaparin regimens in patients undergoing major orthopaedic surgery. Impact on the interpretation of thromboprophylactic effects of new anticoagulant drugs.

Two enoxaparin dosage regimens are used as comparators to evaluate new anticoagulants for thromboprophylaxis in patients undergoing major orthopaedic surgery, but so far no satisfactory direct comparison between them has been published. Our objective was to compare the efficacy and safety of enoxaparin 3,000 anti-Xa IU twice daily and enoxaparin 4,000 anti-Xa IU once daily in this clinical setting by indirect comparison meta-analysis, using Bucher's method. We selected randomised controlled trials comparing another anticoagulant, placebo (or no treatment) with either enoxaparin regimen for venous thromboembolism prophylaxis after hip or knee replacement or hip fracture surgery, provided that the second regimen was assessed elsewhere versus the same comparator. Two authors independently evaluated study eligibility, extracted the data, and assessed the risk of bias. The primary efficacy outcome was the incidence of venous thomboembolism. The main safety outcome was the incidence of major bleeding. Overall, 44 randomised comparisons in 56,423 patients were selected, 35 being double-blind (54,117 patients). Compared with enoxaparin 4,000 anti-Xa IU once daily, enoxaparin 3,000 anti-Xa IU twice daily was associated with a reduced risk of venous thromboembolism (relative risk [RR]: 0.53, 95% confidence interval [CI]: 0.40 to 0.69), but an increased risk of major bleeding (RR: 2.01, 95% CI: 1.23 to 3.29). In conclusion, when interpreting the benefit-risk ratio of new anticoagulant drugs versus enoxaparin for thromboprophylaxis after major orthopaedic surgery, the apparently greater efficacy but higher bleeding risk of the twice-daily 3,000 anti-Xa IU enoxaparin regimen compared to the once-daily 4,000 anti-Xa IU regimen should be taken into account.

Epilepsy priorities in Europe: A report of the ILAE-IBE Epilepsy Advocacy Europe Task Force.

The European Forum on Epilepsy Research (ERF2013), which took place in Dublin, Ireland, on May 26-29, 2013, was designed to appraise epilepsy research priorities in Europe through consultation with clinical and basic scientists as well as representatives of lay organizations and health care providers. The ultimate goal was to provide a platform to improve the lives of persons with epilepsy by influencing the political agenda of the EU. The Forum highlighted the epidemiologic, medical, and social importance of epilepsy in Europe, and addressed three separate but closely related concepts. First, possibilities were explored as to how the stigma and social burden associated with epilepsy could be reduced through targeted initiatives at EU national and regional levels. Second, ways to ensure optimal standards of care throughout Europe were specifically discussed. Finally, a need for further funding in epilepsy research within the European Horizon 2020 funding programme was communicated to politicians and policymakers participating to the forum. Research topics discussed specifically included (1) epilepsy in the developing brain; (2) novel targets for innovative diagnostics and treatment of epilepsy; (3) what is required for prevention and cure of epilepsy; and (4) epilepsy and comorbidities, with a special focus on aging and mental health. This report provides a summary of recommendations that emerged at ERF2013 about how to (1) strengthen epilepsy research, (2) reduce the treatment gap, and (3) reduce the burden and stigma associated with epilepsy. Half of the 6 million European citizens with epilepsy feel stigmatized and experience social exclusion, stressing the need for funding trans-European awareness campaigns and monitoring their impact on stigma, in line with the global commitment of the European Commission and with the recommendations made in the 2011 Written Declaration on Epilepsy. Epilepsy care has high rates of misdiagnosis and considerable variability in organization and quality across European countries, translating into huge societal cost (0.2% GDP) and stressing the need for cost-effective programs of harmonization and optimization of epilepsy care throughout Europe. There is currently no cure or prevention for epilepsy, and 30% of affected persons are not controlled by current treatments, stressing the need for pursuing research efforts in the field within Horizon 2020. Priorities should include (1) development of innovative biomarkers and therapeutic targets and strategies, from gene and cell-based therapies to technologically advanced surgical treatment; (2) addressing issues raised by pediatric and aging populations, as well as by specific etiologies and comorbidities such as traumatic brain injury (TBI) and cognitive dysfunction, toward more personalized medicine and prevention; and (3) translational studies and clinical trials built upon well-established European consortia.

The transatlantic business community faced with US direct investment in Western Europe, 1958-1968

This article examines the position of US and European business in the debate about American direct investment in Western Europe in a historical perspective, from the establishment of the Common Market to the introduction of US regulation of foreign direct investment (FDI) a decade later. Based on abundant and diverse archival documents, it sheds new light on the process of Americanisation and contributes to existing research on transnational networks, by revealing the active role industrial leaders on both sides of the Atlantic played in shaping the political responses to problems raised by the American firms' massive presence in the Common Market.

A Pragmatic Intellectual: Dutch Fabians, Boekman, and Cultural Policy in the Netherlands, 1890-1940

Around 1900, the notion of community art (gemeenschapskunst) served to crystallize Dutch social democratic thinking about the role of the arts in society. Drawing on the pragmatism of leading social democrats like Wibaut, and drawing on his formal education in economics and statistics, the self‐made social democrat Emanuel Boekman redressed the utopian meaning of community art to signify the dissemination of "good" culture over all layers of society in his influential 1939 dissertation on the relation of the state to the arts. Being about facts rather than opinions, Boekman set the boundaries of his work to exclude a substantial discussion of the meaning of "good" culture. On the one hand, this pragmatism helped Boekman to gain support for government intervention for the arts over most of the political spectrum. On the other hand, Boekman thus pre‐empted discussions about the tension between "quality" and "accessibility" of the arts that haunts cultural policy in the Netherlands to this day.

Online and Offline Participation at the Local level: A Quantitative Analysis of the Catalan Municipalities

This article presents an analysis on local participatory experiences in Catalonia,both online and in-person. The analysis is based on a database set up by theauthors. The article carries out an explanatory analysis of local participatoryinitiatives (on- and offline) taking into account political variables (not usually con-sidered in this kind of analysis) and also classical socio-economic variables thatcharacterize municipalities. Hence, we add a quantitative analysis to the numerouscase studies on local e-participation experiences. We have chosen Catalonia becauseit is one of the European regions with more initiatives and a considerable localgovernment support for citizen participation initiatives since the 1980s. Thearticle offers a characterization of these experiences and an explanatory analysis,considering: (i) the institutional context in which these experiences are embedded,(ii) the citizen participation processes and mechanisms online and (iii) a set ofexplanatory variables composed of the population size and the province to whichthe municipality belongs, the political tendency of the mayor, the electoral absten-tion rate, age, income, level of education, broadband connection and users of theInternet in the municipality. The model that we present is explanatory for munici-palities with more than 20,000 inhabitants but it is not for fewer than 20,000inhabitants. Actually, the majority of these latter municipalities have not developedany participatory activities. Among all the variables, population size is the mostinfluential variable and affects the influence of other variables, such as the politicalparty of the mayor, the local abstention rate and the province.

Similar problems, different solutions: Comparing refuse collection in the Netherlands and Spain

Local public service provision can vary greatly because of differences in institutional arrangements, public service markets, and national traditions regarding government intervention. In this paper we compare the procedures adopted by the local governments of the Netherlands and Spain in arranging for the provision of solid waste collection. We find that Spain faces a consolidation problem, opting more frequently to implement policies of privatization and cooperation, at the expense of competition. By contrast, the Netherlands has, on average, larger municipalities, resorting somewhat less to privatization and cooperation, and more to competition. The two options - cooperation and competition - have their merits when striving to strike a balance between transaction costs and scale economies. The choices made in organizational reform seem to be related to several factors, among which the nature of the political system and the size of municipalities appear to be relevant.

Sexual foraging segregation in South American sea lions increases during the pre-breeding period in the La Plata River plume

Stable carbon and nitrogen isotopes in skin and bone of South American sea lions from Brazil and Uruguay were analysed to test the hypothesis that trophic overlap between the sexes is lower during the pre-breeding season than throughout the rest of the year. The isotopic values of skin and bone were used to infer the trophic relationships between the sexes during the pre-breeding period and year round, respectively. Prey species were also analysed to establish a baseline necessary for interpreting the stable isotope ratios of skin and bone. Standard ellipse areas, estimated using Bayesian inference in the SIBER routine of the SIAR package in R, suggested that males and females used a wide diversity of foraging strategies throughout the year and that no differences existed between the sexes. However, the diversity of foraging strategies was largely reduced during the pre-breeding period, with all the individuals of each sex adopting similar strategies, but with the two sexes differing considerably in stable isotope values and the ellipse areas of males and females not overlapping at all. Nevertheless, the results revealed a general increase in the consumption of pelagic prey by both sexes during the pre-breeding period. The progressive crowding of individuals in the areas surrounding the breeding rookeries during the pre-breeding period could lead to an increase in the local population density, which could explain the above reported changes.

Strike hard, strike sure - Operation Musketeer : British military planning during the Suez Crisis, 1956

Operation Musketeer, a combined joint Anglo-French operation aimed at regaining control of the Suez Canal in 1956, has received much attention from scholars. The most common approach to the crisis has been to examine the political dimension. The political events that led Prime Minister Anthony Eden’s cabinet to decide to use military force against the wishes of their superior American ally and in the face of American economic pressure and a Soviet threat to attack Paris and London with rockets have been analysed thoroughly. This is particularly the case because the ceasefire and eventual withdrawal were an indisputable defeat of British policy in the Middle East. The military operation not only ruined Prime Minister Eden’s career, but it also diminished the prestige of Britain. It was the beginning of the end, some claim. The British Empire would never be the same. As the consequences of using force are generally considered more important than the military operations themselves, very little attention has been paid to the military planning of Operation Musketeer. The difference between the number of publications on Operation Corporate of the Falklands War and Operation Musketeer is striking. Not only has there been little previous research on the military aspects of Musketeer, the conclusions drawn in the existing works have not reached a consensus. Some historians, such as Correlli Barnett, compare Musketeer to the utter failures of the Tudor landings and Gallipoli. Among significant politicians, Winston Churchill, who had retired from the prime ministership only a year before the Suez Crisis, described the operation as “the most ill-conceived and ill-executed imaginable”. Colin McInnes, a well-known author on British defence policy, represents the middle view when he describes the execution as “far from failure”. Finally, some, like Julian Thompson, the Commander of 3 Commando Brigade during the Falklands War, rate the military action itself as being successful. The interpretation of how successful the handling of the Suez Crisis was from the military point of view depends very much on the approach taken and the areas emphasised in the subject. Frequently, military operations are analysed in isolation from other events. The action of a country’s armed forces is separated from the wider context and evaluated without a solid point of comparison. Political consequences are often used as validated criteria, and complicated factors contributing to military performance are ignored. The lack of comprehensive research on the military action has left room for an analysis concentrating on the military side of the crisis.

Spatialization of climate, physical and socioeconomic factors that affect the dairy goat production in Brazil and their impact on animal breeding decisions

Brazil has high climate, soil and environmental diversity, as well as distinct socioeconomic and political realities, what results in differences among the political administrative regions of the country. The objective of this study was to determine spatial distribution of the physical, climatic and socioeconomic aspects that best characterize the production of dairy goats in Brazil. Production indices of milk per goat, goat production, milk production, as well as temperature range, mean temperature, precipitation, normalized difference vegetation index, relative humidity, altitude, agricultural farms; farms with native pasture, farms with good quality pasture, farms with water resources, farms that receive technical guidance, family farming properties, non-familiar farms and the human development index were evaluated. The multivariate analyses were carried out to spatialize climatic, physical and socioeconomic variables and so differenciate the Brazilian States and Regions. The highest yields of milk and goat production were observed in the Northeast. The Southeast Region had the second highest production of milk, followed by the South, Midwest and North. Multivariate analysis revealed distinctions between clusters of political-administrative regions of Brazil. The climatic variables were most important to discriminate between regions of Brazil. Therefore, it is necessary to implement animal breeding programs to meet the needs of each region.