A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: the DQIP study protocol.

Background: High-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents accounts for a significant proportion of hospital admissions due to preventable adverse drug events. The recently completed PINCER trial has demonstrated that a one-off pharmacist-led information technology (IT)-based intervention can significantly reduce high-risk prescribing in primary care, but there is evidence that effects decrease over time and employing additional pharmacists to facilitate change may not be sustainable.Methods/design: We will conduct a cluster randomised controlled with a stepped wedge design in 40 volunteer general practices in two Scottish health boards. Eligible practices are those that are using the INPS Vision clinical IT system, and have agreed to have relevant medication-related data to be automatically extracted from their electronic medical records. All practices (clusters) that agree to take part will receive the data-driven quality improvement in primary care (DQIP) intervention, but will be randomised to one of 10 start dates. The DQIP intervention has three components: a web-based informatics tool that provides weekly updated feedback of targeted prescribing at practice level, prompts the review of individual patients affected, and summarises each patient's relevant risk factors and prescribing; an outreach visit providing education on targeted prescribing and training in the use of the informatics tool; and a fixed payment of 350 GBP (560 USD; 403 EUR) up front and a small payment of 15 GBP (24 USD; 17 EUR) for each patient reviewed in the 12 months of the intervention. We hypothesise that the DQIP intervention will reduce a composite of nine previously validated measures of high-risk prescribing. Due to the nature of the intervention, it is not possible to blind practices, the core research team, or the data analyst. However, outcome assessment is entirely objective and automated. There will additionally be a process and economic evaluation alongside the main trial.Discussion: The DQIP intervention is an example of a potentially sustainable safety improvement intervention that builds on the existing National Health Service IT-infrastructure to facilitate systematic management of high-risk prescribing by existing practice staff. Although the focus in this trial is on Non-steroidal anti-inflammatory drugs and antiplatelets, we anticipate that the tested intervention would be generalisable to other types of prescribing if shown to be effective

Numerical simulations of effects of faults in a vertical axis wind turbine’s performance.

Renewable sources of energy are being developed globally to overcome the present excessive dependence on fossil fuels. Wind energy is one of the important sources of renewable energy. Considerable amount of research is being carried out on the innovative designs for optimal performance of wind turbines. Furthermore a lot of research is being carried out on maintenance and condition monitoring of such systems. Torque output is one of the most important parameters in analysing the performance of a turbine; which in turn depends on a number of factors including the structural health and the performance of each blade. Cracks in a wind turbine blade affect the aerodynamic profile of the blade and consequently flow field around it, and may cause vibration in the blade further affecting its performance. In this paper Computational Fluid Dynamics (CFD) based technique has been used to study the effect of the presence of cracks in the blades on the torque output of Vertical axis wind turbine (VAWT). For this purpose, different cracks configurations have been simulated and results analysed which indicate variations in the amplitude of the torque output of the turbine due to the presence of cracks

Altering a fixed identity: thinking through improvisation.

Replacing artist with player as if adopting an alias is a way of altering a fixed identity. And a changed identity is a principle of mobility, of going from one place to another¦ (Kaprow, Essays on the Blurring of Art and Life 125-6) This paper explores an experiment in improvisation in which the practices of music, the visual arts, philosophy, and anthropology come together. Calendar Variations (2010-11) draws different kinds of artists into creative experiences through the use of verbal scores. The score invites participation in a process in which the outcome is indeterminate. The experiment raises a question within the group of artists and participants about the nature of artistic practice itself and whether any single aesthetic approach is more appropriate than another. The experiment frames the following questions: Why do we have/institute improvisation in life? Can art particularly inform those situations in life in which the unscripted and contingent challenge us to rethink in situations in which we may be encountering failure either in what is around us or failure in ourselves to cope? Drawing in particular on Allan Kaprows articulation of Experimental Art (Essays), informed by Ingold and Hallams construct of improvisation as a metaphor for existence (Creativity and Cultural Improvisation), I propose that the radical questioning of certainty in experimental art practices offers a different insight into improvisation, one that deals with experiences of failure. The paper concludes that sustaining uncertainty about what the arts might be has given rise to two possible understandings of visual art, one based on contemplation, and the other on time and duration. Our creative imagination is challenged by the collisions and complementarities of these different understandings to sustain a perpetually mobile state of creativity, akin to adopting an alias as a way of altering a fixed identity (Kaprow, Essays)

Assessing the significance of ethnicity on VLCD induced weight loss and outcomes at 1 year follow up.

Introduction: Few studies have examined the relationship between ethnicity and longer-term outcomes following a very-low-calorie diet (VLCD)

Tourism network sector survey report 2011.

Members needs are at the heart of the work of the Aberdeen and Grampian Chamber of Commerce and, as a result, we have formed a range of sector-interest groups from within our membership of more than 1,200 organisations allowing us to target specific needs with increasingly tailored services and benefits. As part of these services, the Chamber are pleased to publish a series of surveys to provide sector specific research on businesses in North-east Scotland; the first being tourism. The aim of this survey is to assess the state of tourism within the North-east by comparing current performance against previous performance, identifying factors and issues affecting the industry, estimating the impact of policy and other public enablers on profitability and establishing the overall optimism of the industry on future growth and performance. Our conclusion is that overall, the prospects for the tourism sector in North-east Scotland appear to be bright. Businesses are optimistic about their future, opportunities exist for investment and new ventures, the local environment is regarded as very supportive and visitor numbers appear to be on the rise

Build Our Nation international project: an innovative educational model for systems thinking in design.

Ethical decision-making models grounded in ethical frameworks comprehend elements of systems thinking such as holistic language and value-guided systems. This paper proposes an innovative educational model for systems thinking in architectural design. Academic members, students, and future users work together as an international architectural design studio team to improve specific real-world living conditions. The model of Build Our Nation aims at reconsidering the whole design process by focusing on rethinking design and rethinking construction. In response to the current global crisis in designing and building, the paper argues that more than a responsible behaviour has become necessary. Starting from the educational stage an ethic of resilience should be pursued and that represents the core of the model proposed by Build Our Nation

Experiential knowledge and improvisation: variations on movement, motion, emotion.

Improvisation is a way of knowing that is experiential, pivotal to the body's movement and growth in the world. It allows us to manage constraint and freedom in a rich world of possibility. Within this article we trace a trajectory from improvisation in life to improvisation in art. By focusing on practitioners who work with improvisation in precise ways in the fields of anthropology, ecology, visual art and music, we explore how improvisation and experiential knowledge are profoundly interconnected. To achieve this, we use the four characteristics of improvisation developed by anthropologists Ingold and Hallam as a framework for the evaluation of art practices of improvisation including the authors' own project work. We expand the framework through Dewey's analysis of art as experience. The article concludes with an evaluation of how the techniques and processes of improvisation from the case examples may be useful ways to shed light on the workings of experiential knowledge

The Tunisian textile industry: local responses to internationalisation.

The continuing internationalisation of the textile industry has reduced the labour cost advantages of Tunisian clothing firms. These firms have a precarious position in the international value chain, often as subcontractors and only rarely contributing high value inputs. To remain viable in the hyper competition wrought by internationalisation, firms must cut costs further or adopt an entrepreneurial approach. We examined 103 small Tunisian textile firms to find how they have responded to international competitive pressures. Our conceptual framework is entrepreneurial orientation. Employing multiple correspondence analysis and typological analysis, we identify clusters of approaches. Our typology shows three distinctive types: innovators, potentially innovative, passive imitators and a further ambiguous group. Our results show that different small firms have responded in different ways to the threats and opportunities of globalisation. However, many Tunisian firms have improved their position in the international supply chain by innovation strategies, rather than simply focusing on cost reduction

Relational leadership in global multistakeholder groups.

This doctoral thesis explores relational leadership in global multistakeholder groups. As a complete participant observer, I used grounded theory to investigate relational processes through which leadership is constructed, sustained and deconstructed within a global multistakeholder group. By a global multistakeholder group I mean a group made up of multistakeholder categories from different parts of the world. The research setting is situated within the ISO 26000 Working Group on Social Responsibility (WGSR). The study thereby fills a gap in the leadership literature insofar as there is no substantial body of academic literature on leadership processes within a global multistakeholder setting. The majority of leadership studies have considered leadership from an entity perspective. This study examines leadership from a relational perspective. A relational perspective was more pertinent for such an informal setting with no rigid organisational structure and procedures. In the current thesis, leadership is recognised as a modified form of status (Uhl- Bien, 2006). From this perspective, relational processes are considered as leadership when the social influence that is generated contributes to the emergence of social order and new approaches, attitudes, and goals. The findings show that consensus-building, legitimacy and delegation to groups are significant organising acts and activities of leadership relational processes. Those acts contribute to the emergence, preservation and disbandment of leadership in a global multistakeholder group. The data also reveal the importance of consensus and delegation to groups in maintaining or destabilizing the social order within the setting. This research also offers a theory of delegation to groups in global multistakeholder settings which could be considered as a substantial contribution. The outcomes of this study are a reference point for research on relational leadership in global multistakeholder groups. It is also intended to be a catalyst for more consideration of relational perspectives in leadership. Furthermore, it will enhance greater concern for cultural and regional diversity in the constitution of similar groups in the future. The major challenge has been around identifying the extent that relational processesconstitute leadership. Moreover, studies about dynamic approaches such as relational perspectives are much harder to generalize from but possess greater potential for improving leadership theories and practices. CHAPTERS 5, 6, 7 AND 8 HAVE BEEN RESTRICTED FOR CONFIDENTIALITY REASONS

Policing rural crime.

Between 2000 and 2012, over 1,000 police stations were closed in the UK and many more have been placed on reduced opening hours. A similar situation is unfolding in Northern Ireland and Eire. This may be viewed as a strategic and operational withdrawal from the current concept of rural policing. This closure trend has significantly altered the landscape of rural policing in the UK. In the same period, the landscapes of rural crime and criminality have also changed, in that there has been a noticeable increase in the levels of the organisation of serious and organised crime groups - both indigenous and international - involved in committing rural crimes. In short, crime is becoming more entrepreneurial. The increase of rural crimes - such as the theft of farm machinery, tools and livestock, and unregulated butchery practices - evidences the danger that serious and organised crime groups pose to rural areas, as they expand their criminal activities in the current economic recession. It does appear that Eastern European organised crime groups are targeting the UK by stealing tractors and other items of heavy plant for resale in Europe and on the African subcontinent. There is evidence that British-based organised crime groups are also becoming more organised at exploiting criminal opportunities in rural areas