Compression stockings and the prevention of symptomatic venous thromboembolism: data from the Tinzaparin in Acute Ischaemic Stroke Trial

Background: Venous thromboembolism (VTE) is a well recognised and preventable complication of acute stroke. While graduated compression stockings reduce the risk of VTE in surgical patients their benefit in acute stroke remains uncertain. Methods: The relationship between symptomatic VTE and use of stockings using observational data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’, which compared 10 days of treatment with tinzaparin (175 IU.kg-1 or 100 IU.kg-1) with, aspirin (300 mg od), was assessed using logistic regression adjusted for known VTE risk factors and treatment. Results: Symptomatic VTE occurred in 28 patients (1.9%, DVT 18, PE 13) within 15 days of enrolment in 1,479 patients. Patients wearing one or two stockings for any period of time during the first 10 days (n=803) had a non-significant increase (odds ratio, OR 2.45, 95% confidence interval, CI 0.95 - 6.32) in the risk of symptomatic VTE. In contrast, those wearing bilateral stockings for 10 days (n=374) had a non-significant reduction in the odds of symptomatic VTE as compared to those who wore no stockings or wore them for less than 10 days (OR 0.65, 95% CI 0.26-1.65). Mild stroke and treatment with tinzaparin were associated with a reduced risk of VTE. Conclusions: Bilateral graduated compression stockings may reduce the incidence of VTE by one-third in patients with acute ischaemic stroke. However, the uncertainty in this finding, low frequency of symptomatic VTE, potential for stockings to cause harm, and cost of stockings highlight the need for a large randomised-controlled trial to examine the safety and efficacy of stockings in acute stroke.

Diversity in intermediate care

This paper discusses the evolution of intermediate care and presents some interim observations from a survey of providers in England being conducted as part of a national evaluation of intermediate care. Telephone interviews covering various issues concerning the level of provision and style of delivery of intermediate care have been conducted with 70 services to date. Data from these are used to discuss the progress, range and nature of intermediate care in relation to clinician viewpoints and academic and official literature on the subject. Intermediate care ‘on the ground’ is a multiplicitous entity, with provision apparently evolving in accordance with the particularities of local need. Whilst protocols for medical involvement in intermediate care generally appear to be well established, there are some tensions concerning integration of services in a locality, care management processes and questions of flexibility and inclusiveness in relation to eligibility criteria. The definitive version is available at www.blackwell-synergy.com

Human motivation and professional practice: of knights, knaves and social workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self-interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy-makers have sought to effect such changes has been through the "new community care" of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide-ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self-interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client-centred ethos. The definitive version is available at www.blackwell-synergy.com

A bidomain threshold model of propagating calcium waves

We present a bidomain fire-diffuse-fire model that facilitates mathematical analysis of propagating waves of elevated intracellular calcium (Ca) in living cells. Modelling Ca release as a threshold process allows the explicit construction of travelling wave solutions to probe the dependence of Ca wave speed on physiologically important parameters such as the threshold for Ca release from the endoplasmic reticulum (ER) to the cytosol, the rate of Ca resequestration from the cytosol to the ER, and the total [Ca] (cytosolic plus ER). Interestingly, linear stability analysis of the bidomain fire-diffuse-fire model predicts the onset of dynamic wave instabilities leading to the emergence of Ca waves that propagate in a back-and-forth manner. Numerical simulations are used to confirm the presence of these so-called "tango waves" and the dependence of Ca wave speed on the total [Ca]. The original publication is available at www.springerlink.com (Journal of Mathematical Biology)

Narratives great and small: neighbourhood change, place and identity in Notting Hill

The area of Notting Hill in west London has been subject to much media coverage in recent years, which, along with substantial gentrification, has given rise to an image of the area as the epitome of fashionable London. This study investigates the views of those marginal to gentrification and mediated representation on their feelings about the local area, its image and their changing neighbourhoods. Many participants in the research resented some of the more recent changes in Notting Hill and the area's representation in the media. However, in contrast to expectations, most of the more working-class respondents involved in the research did not articulate much emotional attachment to the area. They were more concerned with what might be termed the material aspects of life in Notting Hill: convenience, facilities, safety and so on. In contrast, the more middle-class respondents frequently spoke of their regret of the changes to the area, such as the loss of independent shops, and the reduction in diversity. Paradoxically, the loss of working-class landscapes seems a relatively middle-class worry. The symbolically important landscapes described by working-class respondents were related to more immediate, material issues, in which gentrification was only a relatively minor concern. The definitive version is available at www.blackwell-synergy.com

Place, policy and practitioners: on rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the United Kingdom

A growing body of literature in geography and other social sciences considers the role of place in the provision of healthcare. Authors have focused on various aspects of place and care, with particular interests emerging around the role of the psychological, social and cultural aspects of place in care provision. As healthcare stretches increasingly beyond the traditional four walls of the hospital, so questions of the role of place in practices of care become ever more pertinent. In this paper, we examine the relationship between place and practice in the care and rehabilitation of older people across a range of settings, using qualitative material obtained from interviews and focus groups with nursing, care and rehabilitation staff working in hospitals, clients’ homes and other sites. By analysing their testimony on the characteristics of different settings, the aspects of place which facilitate or inhibit rehabilitation and the ways in which place mediates and is mediated by social interaction, we consider how various dimensions of place relate to the power-inscribed relationships between service users, informal carers and professionals as they negotiate the goals of the rehabilitation process. We seek to demonstrate how the physical, psychological and social meanings of place and the social processes engendered by the rehabilitation encounter interact to produce landscapes that are more or less therapeutic, considering in particular the structuring role of state policy and formal healthcare provision in this dynamic.

Review of order fulfilment models for Catalogue Mass Customization

Mass Customization (MC) is not a mature business strategy and hence it is not clear that a single or small group of operational models are dominating. Companies tend to approach MC from either a mass production or a customization origin and this in itself gives reason to believe that several operational models will be observable. This paper reviews actual and theoretical fulfilment systems that enterprises could apply when offering a pre-engineered catalogue of customizable products and options. Issues considered are: How product flows are structured in relation to processes, inventories and decoupling point(s); - Characteristics of the OF process that inhibit or facilitate fulfilment; - The logic of how products are allocated to customers; - Customer factors that influence OF process design and operation. Diversity in the order fulfilment structures is expected and is found in the literature. The review has identified four structural forms that have been used in a Catalogue MC context: - fulfilment from stock; - fulfilment from a single fixed decoupling point; - fulfilment from one of several fixed decoupling points; - fulfilment from several locations, with floating decoupling points. From the review it is apparent that producers are being imaginative in coping with the demands of high variety, high volume, customization and short lead times. These demands have encouraged the relationship between product, process and customer to be re-examined. Not only has this strengthened interest in commonality and postponement, but, as is reported in the paper, has led to the re-engineering of the order fulfilment process to create models with multiple fixed decoupling points and the floating decoupling point system

The organization, form and function of intermediate care services and systems in England: results from a national survey

This paper reports the results of a postal survey of intermediate care co-ordinators (ICCs) on the organization and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, ‘tick-box’ and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). We discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, we highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate our findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care and the evidence for and aims of the policy as part of NHS modernization, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.

National evaluation of NHS genetics service investments: emerging issues from the cancer genetics pilots

In seeking to fulfil the ambition of the 2003 genetics white paper, Our Inheritance, Our Future, to ‘mainstream’ genetic knowledge and practices, the Department of Health provided start-up funding for pilot services in various clinical areas, including seven cancer genetics projects. To help to understand the challenges encountered by such an attempt at reconfiguring the organization and delivery of services in this field, a programme-level evaluation of the genetics projects was commissioned to consider the organizational issues faced. Using a qualitative approach, this research has involved comparative case-study work in 11 of the pilot sites, including four of the seven cancer genetics pilots. In this paper, the researchers present early findings from their work, focusing in particular on the cancer genetics pilots. They consider some of the factors that have influenced how the pilots have sought to address pre-existing sector, organizational and professional boundaries to these new ways of working. The article examines the relationship between these factors and the extent to which pilots have succeeded in setting up boundary-spanning services, dealing with human-resource issues and creating sustainable, ‘mainstreamed’ provision which attracts ongoing funding in a volatile NHS commissioning environment where funding priorities do not always favour preventive, risk-assessment services.

Unfinished Turns in French: How Context Matters

On occasions, speakers do not complete their turns in conversation. Such syntactically-incomplete turns are not treated with repair or misunderstanding. The responses that they receive display a clear understanding of the actions that the unfinished turns embodied. In this article, using conversation analysis (CA), I describe the systematic occurrence of unfinished turns in French conversation. I show that context is necessary to the understanding of this type of turn and I describe the nature of that context. Data analysis reveals that unfinished turns are understandable primarily by reference to their sequential position. I conclude that unfinished turns are a locally- managed resource fitted to the particulars of the talk in progress and built upon the context that the sequences that house them have so far provided.

Libraries and open access: the implications of open-access publishing and dissemination for libraries in higher education institutions

This chapter discusses the consequences of open-access (OA) publishing and dissemination for libraries in higher education institutions (HEIs). Key questions (which are addressed in this chapter) include: 1. How might OA help information provision? 2. What changes to library services will arise from OA developments (particularly if OA becomes widespread)? 3. How do these changes fit in with wider changes affecting the future role of libraries? 4. How can libraries and librarians help to address key practical issues associated with the implementation of OA (particularly transition issues)? This chapter will look at OA from the perspective of HE libraries and will make four key points: 1. Open access has the potential to bring benefits to the research community in particular and society in general by improving information provision. 2. If there is widespread open access to research content, there will be less need for library-based activity at the institution level, and more need for information management activity at the supra-institutional or national level. 3. Institutional libraries will, however, continue to have an important role to play in areas such as managing purchased or licensed content, curating institutional digital assets, and providing support in the use of content for teaching and research. 4. Libraries are well-placed to work with stakeholders within their institutions and beyond to help resolve current challenges associated with the implementation of OA policies and practices.

O! She doth teach the torches to burn bright: How JULIET can help authors and repository advocates.

JULIET is a service provided by SHERPA. Its mission is to provide a brief summary of each funding agency’s policy on self-archiving of the published research they have funded. Each entry covers the requirements and details: -Whether archiving is mandatory or encouraged, -What should be deposited -Within what time frame this deposit should take place -Where articles should be deposited -Any conditions attached to this deposit. JULIET interacts with other services such as RoMEO, which listed publisher policies on self-archiving. JULIET is being developed to include funding agency’s policies on open access to data.

Release currents of IP₃ receptor channel clusters and concentration profiles

We simulate currents and concentration profiles generated by Ca2+ release from the endoplasmic reticulum (ER) to the cytosol through IP3 receptor channel clusters. Clusters are described as conducting pores in the lumenal membrane with a diameter from 6 nm to 36 nm. The endoplasmic reticulum is modeled as a disc with a radius of 1–12 mm and an inner height of 28 nm. We adapt the dependence of the currents on the trans Ca2+ concentration (intralumenal) measured in lipid bilayer experiments to the cellular geometry. Simulated currents are compared with signal mass measurements in Xenopus oocytes. We find that release currents depend linearly on the concentration of free Ca2+ in the lumen. The release current is approximately proportional to the square root of the number of open channels in a cluster. Cytosolic concentrations at the location of the cluster range from 25 μM to 170 μM. Concentration increase due to puffs in a distance of a few micrometers from the puff site is found to be in the nanomolar range. Release currents decay biexponentially with timescales of < 1 s and a few seconds. Concentration profiles decay with timescales of 0.125–0.250 s upon termination of release.

Can open access repositories and peer-reviewed journals coexist?

It is often assumed that open access repositories and peer-reviewed journals are in competition with each other and therefore will in the long term be unable to coexist. This paper takes a critical look at that assumption. It draws on the available evidence of actual practice which indicates that coexistence is possible at least in the medium term. It discusses possible future models of publication and dissemination which include open access, repositories, peer review and journals. The paper suggests that repositories and journals may coexist in the long term but that both may have to undergo significant changes. Important areas where changes need to occur include: widespread deployment of repository infrastructure, development of version identification standards, development of value-added features, new business models, new approaches to quality control and adoption of digital preservation as a repository function.

Open Access through the Depot

The mission of "the Depot" is to provide a service that enables all UK academics to share in the benefits of open access exposure for their post-print research outputs. It does this by providing a national intake and storage facility - the Depot - for use by any UK academic in Higher Education. This article describes the Depot and the service it provides.