Answers to a Discussion Note: On the ‘Metaphor of the Metaphor’

Should a debate of the choice(s) between metaphorical investigation and epistemological realism in organizational research be prioritized as Willy McCourt called for in Organization Studies? (McCourt 1997) We argue here against doing any such thing — a ‘realism’ debate in organizational theory would merely be a ‘red herring’ (Hausman 1998). Theoretical investigation from Ricoeur to Derrida has liberated us from the need to re-visit the theme, but examination of Gareth Morgan's (and Gibson Burrell's) intellectual development, as begun by McCourt, is of interest because it reveals two very different ‘realisms’. What is of interest about ‘realism’ is not an eitherlor of either ‘realism’ or ‘constructivism’, but a polyphony of the many voices (‘selfs’) of research

Hypoxia activates IKK-NF-κB and the immune response in <em>Drosophila melanogaster</em>

Hypoxia, or low oxygen availability, is an important physiological and pathological stimulus for multicellular organisms. Molecularly, hypoxia activates a transcriptional programme directed at restoration of oxygen homoeostasis and cellular survival. In mammalian cells, hypoxia not only activates the HIF (hypoxia-inducible factor) family, but also additional transcription factors such as NF-κB (nuclear factor κB). Here we show that hypoxia activates the IKK–NF-κB [IκB (inhibitor of nuclear factor κB)–NF-κB] pathway and the immune response in Drosophila melanogaster. We show that NF-κB activation is required for organism survival in hypoxia. Finally, we identify a role for the tumour suppressor Cyld, as a negative regulator of NF-κB in response to hypoxia in Drosophila. The results indicate that hypoxia activation of the IKK–NF-κB pathway and the immune response is an important and evolutionary conserved response

Computerprogramma's voor de administratie van boomkwekerijen

Een overzicht wordt gegeven van het aanbod aan bedrijfsadministratieprogramma's voor de boomkwekerij. Ook wordt antwoord gegeven op de vraag wat verschillende programma's kunnen en waar de boomkweker of handelaar op moet letten bij de keuze van een programm

An 8-channel receive array for improved 31 P MRSI of the whole brain at 3T.

PURPOSE: To demonstrate a 1 H/31 P whole human brain volume coil configuration for 3 Tesla with separate 31 P transmit and receive components that maintains 1 H MRS performance and delivers optimal 31 P MRSI with 1 H decoupling. METHODS: We developed an 8-channel 31 P receive array coil covering the head to be used as an insert for a commercial double-tuned 1 H/31 P birdcage transmit-receive coil. This retains the possibility of using low-power rectangular pulses for 1 H-decoupled 3D 31 P MRSI (nominal resolution 17.6 cm3 ; acquisition duration 13 min) but increases the SNR with the receive sensitivity of 31 P surface coils. The performance of the combined coil setup was evaluated by measuring 1 H and 31 P SNR with and without the 31 P receive array and by assessing the effect of the receive array on the transmit efficiencies of the birdcage coil. RESULTS: Compared to the birdcage coil alone, the 31 P insert in combination with the birdcage achieved an average 31 P SNR gain of 1.4 ± 0.4 in a center partition of the brain. The insert did not cause losses in 1 H MRS performance and transmit efficiency, whereas for 31 P approximately 20% more power was needed to achieve the same γB1. CONCLUSION: The new coil configuration allows 1 H MRSI and optimal 1 H-decoupled 3D 31 P MRSI, with increased SNR of the human brain without patient repositioning, for clinical and research purposes at 3 Tesla.C. Rodgers is funded by the Wellcome Trust and the Royal Society (Grant Number 098436/Z/12/Z)

Religion as an Existential Resource: On Meaning-Making, Religious Coping and Rituals

In this paper, we make a contribution to the treatment of post-traumatic stress disorder. We show how religion can function as an existential resource. Religions enable people to perceive an underlying pattern of order and purpose below the surface of life’s incomprehensible inevitabilities such as death and suffering. Religion then works as a meaning-making system that can positively influence the individual’s mental health. Recently, the relations between religion and health have been studied particularly in the context of the ‘religious coping paradigm’. Religious coping is aiming at a ‘search for significance’. Religious coping will often occur where non-religious coping fails, especially in situations involving loss of life, health and relational embeddedness. Religious activities and acts can also enable religious coping. A crucial religious act is the ritual. What are the functions of ritual, and how can a ritual contribute to the mental health of an individual in crisis? What is, in this context, the role of myths and symbols? Several examples are given of how rituals can work as therapeutic tools in the treatment of traumatic disorders. We conclude by stating that religion, being a robust form of meaning-making, is not the sole system able to contribute to working through a trauma, and that its success is far from guaranteed. | Durch unseren Artikel möchten wir zur Behandlung der Folgen der posttraumatischen Belas- tungsstörung beitragen. Wir zeigen, wie die Religion als Kraftquelle der Existenz funktionieren kann. Die Religionen ermöglichen den Menschen, das Muster einer tieferen Ordnung und eines tieferen Sinnes in Bezug auf scheinbar unverständliche Beschaffenheiten des Lebens wie der Tod oder das Leiden, zu erblicken. Auf diese Weise funktioniert die Religion als ein Sinngebendes System, das die geistige Gesundheit positiv beeinflussen kann. Neulich wurden die Zusammenhänge zwischen Religion und Gesundheit im Rahmen des „religiösen Bewältigungsparadigmas“ geforscht. Das Ziel der religiösen Bewältigung ist die „Suche nach Bedeutung und Wichtigkeit“. Religiöse Bewältigung findet häufig dann statt, wenn die nicht-religiöse Bewältigung versagt, vor allem in Situationen, in denen Themen wie Verlust des Lebens, Gesundheit oder Beziehungen betroffen sind. Auch religiöse Taten und Handlungen können die religiöse Bewältigung ermöglichen. Eine der grundlegenden religiösen Handlungen ist das Ritual. Was sind die Funktionen des Rituals und wie kann das Ritual zur psychischen Gesundheit der in der Krise befindlichen Person beitragen? Welche Rolle spielen die Mythen und Symbole in diesem Zusammenhang? Wir zeigen zahlreiche Beispiele dafür, wie Rituale bei traumatischen Störungen zum therapeutischen Instrument werden können. Als Schlussfolgerung behaupten wir, dass die Religion – obwohl sie eine grundlegende Form der Sinngabe ist, aber doch nicht das einzige System, das zur Verarbeitung des Traumas beitragen kann und dessen Erfolg bei Weitem nicht sicher ist

A study of National Health Service management of chronic osteoarthritis and low back pain

AIM: To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective. BACKGROUND: Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care. METHOD: Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients’ records for three years from diagnosis (‘newly diagnosed’ patients) or for the most recent three years (‘established’ patients). FINDINGS: Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and ‘newly diagnosed’ patients were significantly more likely to visit their GP for pain management than ‘established’ patients. Although ‘newly diagnosed’ patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups. CONCLUSION: This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use

Supporting future scholars of engaged research

Researchers in the UK are taking on new roles and responsibilities to meet the requirements of an expanded agenda for generating and evidencing social and economic impacts from research. Within this wider context, culture change programmes have identified learning as an important driver of change. Here we outline a professional development programme designed to train postgraduate researchers studying environmental sciences in core engagement, influence and impact, governance and organization skills for research. We argue that training is an important step in further catalysing progressive culture change. However, our research- and experience-informed critical reflections in supporting researchers suggest that there is still significant work to be done: (1) to offer consistent messages to researchers at all grades about social impacts from research and (2) to ensure that engagement is seen as an aspirational activity, embedded within research

Out-of-hours care in western countries: assessment of different organizational models

Contains fulltext : 81655.pdf (publisher's version ) (Open Access)BACKGROUND: Internationally, different organizational models are used for providing out-of-hours care. The aim of this study was to assess prevailing models in order to identify their potential strengths and weaknesses. METHODS: An international web-based survey was done in 2007 in a sample of purposefully selected key informants from 25 western countries. The questions concerned prevailing organizational models for out-of-hours care, the most dominant model in each country, perceived weaknesses, and national plans for changes in out-of-hours care. RESULTS: A total of 71 key informants from 25 countries provided answers. In most countries several different models existed alongside each other. The Accident and Emergency department was the organizational model most frequently used. Perceived weaknesses of this model concerned the coordination and continuity of care, its efficiency and accessibility. In about a third of the countries, the rota group was the most dominant organizational model for out-of-hours care. A perceived weakness of this model was lowered job satisfaction of physicians. The GP cooperative existed in a majority of the participating countries; no weaknesses were mentioned with respect to this model. Most of the countries had plans to change the out-of-hours care, mainly toward large scale organizations. CONCLUSION: GP cooperatives combine size of scale advantages with organizational features of strong primary care, such as high accessibility, continuity and coordination of care. While specific patients require other organizational models, the co-existence of different organizational models for out-of-hours care in a country may be less efficient for health systems

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

<p>Abstract</p> <p>Background</p> <p>Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.</p> <p>Methods</p> <p>We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.</p> <p>Results</p> <p>One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).</p> <p>Conclusions</p> <p>One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.</p