Reflexivity in Professional Practise and The Social Construction of Defensive Medicine: A Study of Discourses of Risk in Medical Practice.

Abstract: Viewed in the context of a so-called 'compensation crisis' in the United Kingdom, defensive medicine broadly refers to a response by doctors to the risk of being sued in an action for negligence. However, the interrelated risk discourses of a 'compensation crisis' and defensive medical practice are suffused with controversy and confusion. For example, influenced by the methods of positivism, narrowly constructed 'cause' and 'effect' studies of defensIve medicine have tended to heighten controversy and confusion around the phenomenon. Accordingly, whilst some researchers seem perplexed by the findings of their studies, others appear to have simply abandoned their projects. Thus, in contrast to simplistic 'cause' and 'effect' methods a key aim in this thesis is to adopt a social constructionist, and therefore a reflexive approach to the study of medical practice and discourses of risk. Underpinned by theories of risk and control, the discussion draws upon theoretical concepts that include contestation and therefore 'reflexivity' in knowledge, 'governmentality', trust, autonomy and discretion. In acknowledging in this thesis that risks associated in public discourse with defensive medicine might have some foundation in reality, unlike most studies informed by positivism, neither defensive medicine nor risk are understood as objective realities. Rather, risk is largely considered in relation to representations of the world as being anxious or in crisis of some kind. In sum, thi~/study suggests that 'reflexivity' in professional practice and medical discourses of risk may be viewed within a nexus of social, political, technological and cultural transformation, entailing for example, the organization of trust relations, indeterminacy, and the erosion of control. The thesis is structured around seven chapters. The initial chapters ground the later analysis of data generated via semi-structured interviews with hospital doctors in England and Wales

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Reflexivity in Professional Practise and The Social Construction of Defensive Medicine: A Study of Discourses of Risk in Medical Practice

Abstract: Viewed in the context of a so-called 'compensation crisis' in the United Kingdom, defensive medicine broadly refers to a response by doctors to the risk of being sued in an action for negligence. However, the interrelated risk discourses of a 'compensation crisis' and defensive medical practice are suffused with controversy and confusion. For example, influenced by the methods of positivism, narrowly constructed 'cause' and 'effect' studies of defensIve medicine have tended to heighten controversy and confusion around the phenomenon. Accordingly, whilst some researchers seem perplexed by the findings of their studies, others appear to have simply abandoned their projects. Thus, in contrast to simplistic 'cause' and 'effect' methods a key aim in this thesis is to adopt a social constructionist, and therefore a reflexive approach to the study of medical practice and discourses of risk. Underpinned by theories of risk and control, the discussion draws upon theoretical concepts that include contestation and therefore 'reflexivity' in knowledge, 'governmentality', trust, autonomy and discretion. In acknowledging in this thesis that risks associated in public discourse with defensive medicine might have some foundation in reality, unlike most studies informed by positivism, neither defensive medicine nor risk are understood as objective realities. Rather, risk is largely considered in relation to representations of the world as being anxious or in crisis of some kind. In sum, thi~/study suggests that 'reflexivity' in professional practice and medical discourses of risk may be viewed within a nexus of social, political, technological and cultural transformation, entailing for example, the organization of trust relations, indeterminacy, and the erosion of control. The thesis is structured around seven chapters. The initial chapters ground the later analysis of data generated via semi-structured interviews with hospital doctors in England and Wales.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Dye adsorption on layered graphite oxide

Graphite oxide (GO) was prepared by a modified Hummers−Offeman method and was tested as an adsorbent for the removal of dyes in aqueous solution. The structure of GO was characterized by N2 adsorption, X-ray diffraction (XRD), and Fourier transform infrared (FT-IR) spectroscopy. It is found that GO does not show a significant change in surface area, but the layered graphene structure was expanded, and several surface oxygen functional groups were formed, which play a significant role in adsorption. The amount of the dyes, methylene blue and malachite green, adsorbed on the GO was much higher than that on graphite, and the adsorption capacity based on the Langmuir isotherm is (351 and 248) mg·g−1, respectively, much higher than activated carbon. The adsorption mechanism was proposed as electrostatic attraction

ENT300 : Fundamental Of Entrepreneurship Wase's Homemade Burger Company Business Plan / Wynder Bradder Anak Hosen... [et.al]

We have decided to register our business under partnership. It is because our business is consisting of four members. So, our business is incorporated under the Business Registration Act 1956 (Amendment 1978). We are going to open business of which we have chooses homemade burger, French fries and drink as our product. All partners in our company are having their own roles such as general manager, administrative manager, marketing manager, operation manager and financial manager. So each partner in our company is entitled to actively participate in the management of the business. This can make sure that our business run smoothly based on our planning and also can help us in order to achieve our goal. The relationship between the entire partners also important to make sure that we can work together to achieve our vision and goal. In our company, there will be one of our partner holding two posts as general manager and administrative manager since he has experiences opening business before and good in both. Besides that, all partners also have their own right to make any decision in daily routine in our business and usually all the changes should be agreed by majority of members. This can help our company to increase our products and services according to the market demand to ensure we can achieve our target and goals effectively and efficiency