887 research outputs found

    The Emergence Of The American Agriculture Movement, 1977-1979

    Get PDF
    Beginning in late 1977, the media, television in particular, portrayed as a unique cultural phenomenon an emerging American Agriculture Movement (AAM), a pending farm strike, and a depressed farm economy that had caused this mobilization. Much was indeed unique, especially to the individual farmers and the specific manner in which they were attempting to apply political pressures, but the American Agriculture Movement itself was similar to other organizational attempts that have taken place in rural America. In the following paper we chronicle the emergence of the American Agriculture Movement as a distinct entity, identify the common features in the emergence of new farm organizations, and examine the conditions of modern society and technology that affect group formation. AN ORGANIZATION DEVELOPS Despite impressions left from journal and media accounts that portrayed a grass roots insurgency, the emergence of AAM must be seen in terms of an active leadership directing organizing efforts to a relatively inactive constituency.1 These leaders encouraged activism through a concerted strategy of mobilization with an emphasis on the national issue of a farm strike, the reintroduction of a traditional farm movement ideology, and the skillful use of public relations.2 AAM began in mid-summer· 1977 in Campo, Colorado, as an outgrowth of those enduring cafe conversations typical in all farm communities. However, Bud Bitner, George Bitner, Alvin Jenkins, Darrel Schroeder, Gene Schroeder, Van Stafford, and a few regular listeners talked mostly about a new political spokesman for farm interests during this particular summer.3 They saw a gloomy farm economy beset by both low prices and high costs, by an unresponsive government, and by an array of farm interest groups who were out of touch with real farm needs. Their immediate reaction to the 1977 Farm Bill, a piece of legislation that confirmed incentives for large-scale production without high supports, intensified their frustrations about each of these conditions and precipitated a decision to protest. Encouraged by the reception their ideas found in their own community, these locally respected larger-scale farmers and farmrelated businessmen proceeded to develop an organization based on rallies and protests against the political system.4 They would prompt and assist farmers throughout the country to organize as local groups, much along the lines of Farm Bureau county chapters, but without Bureau-related emphasis on nonpolitical services. AAM locals would be pockets of farmer interaction and discussion that would inspire political activism instead of emphasizing individual income.5 The local organizations would Jom in statewide and, finally, national demonstrations of movement support. Farmers, the initial organizers believed, were widely concerned about their weakened economic status but politically lethargic because they lacked inspired leadership

    The effectiveness of providing peer benchmarked feedback to hip replacement surgeons based on patient-reported outcome measures—results from the PROFILE (Patient-Reported Outcomes: Feedback Interpretation and Learning Experiment) trial: a cluster randomised controlled study

    Get PDF
    Objective To test whether providing surgeons with peer benchmarked feedback about patient-reported outcomes is effective in improving patient outcomes.Design Cluster randomised controlled trial.Setting Secondary care—Ireland.Participants Surgeons were recruited through the Irish Institute of Trauma and Orthopaedic Surgery, and patients were recruited in hospitals prior to surgery. We randomly allocated 21 surgeons and 550 patients.Intervention Surgeons in the intervention group received peer benchmarked patient-reported outcome measures (PROMs) feedback and education.Main outcome variable Postoperative Oxford Hip Score (OHS).Results Primary outcome data were available for 11 intervention surgeons with responsibility for 230 patients and 10 control surgeons with responsibility for 228 patients. The mean postoperative OHS for the intervention group was 40.8 (95% CI 39.8 to 41.7) and for the control group was 41.9 (95% CI 41.1 to 42.7). The adjusted effect estimate was −1.1 (95% CI −2.4 to 0.2, p=0.09). Secondary outcomes were the Hip Osteoarthritis Outcome Score (HOOS), EQ-5D and the proportion of patients reporting a problem after surgery. The mean postoperative HOOS for the intervention group was 36.2 and for the control group was 37.1. The adjusted effect estimate was −1.1 (95% CI −2.4 to 0.3, p=0.1). The mean postoperative EQ-5D for the intervention group was 0.85 and for the control group was 0.87. The adjusted effect estimate was −0.02 (95% CI −0.05 to 0.008, p=0.2). 27% of intervention patients and 24% of control patients reported at least one complication after surgery (adjusted OR=1.2, 95% CI 0.6 to 2.3, p=0.6).Conclusions Outcomes for patients operated on by surgeons who had received peer benchmarked PROMs data were not statistically different from the outcomes of patients operated on by surgeons who did not receive feedback. PROMs information alone seems to be insufficient to identify opportunities for quality improvement.Trial registration number ISRCTN 69032522

    The drivers and impact of emergency care reconfiguration in Ireland: Results from a large mixed-methods research programme

    Get PDF
    Ireland, like many countries, has reconfigured emergency care in recent years towards a more centralised model. Although centralisation is presented as ‘evidence-based’, the relevance of this evidence is challenged by groups which hold values beyond those implicit in the literature. The Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks (SIREN) programme was funded to evaluate the development and performance of emergency and urgent care systems in Ireland. SIREN found that the drivers of reconfiguration in Ireland are based on safety and efficiency claims which are highly contestable. Reconfiguration was not associated with improvements in safety or efficiency and may have exacerbated the growing capacity challenges for acute hospitals. These findings are consistent with UK research. Our study adds to an emerging literature on the interaction between a narrow technocratic approach to health system planning and the perspectives of the public and patients

    GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research

    Get PDF
    Objective To synthesise the existing published literature on the perceptions of general practitioners (GPs) or their equivalent on the clinical management of multimorbidity and determine targets for future research that aims to improve clinical care in multimorbidity. Design Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore GPs’ experiences of clinical management of multimorbidity or multiple chronic diseases. Data sources EMBASE, MEDLINE, CINAHL, PsycInfo, Academic Search Complete, SocIndex, Social Science Full Text and digital theses/online libraries (database inception to September 2012) to identify literature using qualitative methods (focus groups or interviews). Review methods The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. Results Of 1805 articles identified, 37 were reviewed in detail and 10 were included, using a total of 275 GPs in 7 different countries. Four areas of difficulty specific to the management of multimorbidity emerged from these papers: disorganisation and fragmentation of healthcare; the inadequacy of guidelines and evidence-based medicine; challenges in delivering patient-centred care; and barriers to shared decision-making. A ‘line of argument’ was drawn which described GPs’ sense of isolation in decision-making for multimorbid patients. Conclusions This systematic review shows that the problem areas for GPs in the management of multimorbidity may be classified into four domains. There will be no ‘one size fits all’ intervention for multimorbidity but these domains may be useful targets to guide the development of interventions that will assist and improve the provision of care to multimorbid patients

    Fermi surface, possible unconventional fermions, and unusually robust resistive critical fields in the chiral-structured superconductor AuBe

    Get PDF
    The noncentrosymmetric superconductor (NCS) AuBe is investigated using a variety of thermodynamic and resistive probes in magnetic fields of up to 65~T and temperatures down to 0.3~K. Despite the polycrystalline nature of the samples, the observation of a complex series of de Haas-van Alphen (dHvA) oscillations has allowed the calculated bandstructure for AuBe to be validated. This permits a variety of BCS parameters describing the superconductivity to be estimated, despite the complexity of the measured Fermi surface. In addition, AuBe displays a nonstandard field dependence of the phase of dHvA oscillations associated with a band thought to host unconventional fermions in this chiral lattice. This result demonstrates the power of the dHvA effect to establish the properties of a single band despite the presence of other electronic bands with a larger density of states, even in polycrystalline samples. In common with several other NCSs, we find that the resistive upper critical field exceeds that measured by heat capacity and magnetization by a considerable factor. We suggest that our data exclude mechanisms for such an effect associated with disorder, implying that topologically protected superconducting surface states may be involved

    Computational prediction of the Crc regulon identifies genus-wide and species-specific targets of catabolite repression control in Pseudomonas bacteria

    Get PDF
    <p>Abstract</p> <p>Background</p> <p>Catabolite repression control (CRC) is an important global control system in <it>Pseudomonas </it>that fine tunes metabolism in order optimise growth and metabolism in a range of different environments. The mechanism of CRC in <it>Pseudomonas </it>spp. centres on the binding of a protein, Crc, to an A-rich motif on the 5' end of an mRNA resulting in translational down-regulation of target genes. Despite the identification of several Crc targets in <it>Pseudomonas </it>spp. the Crc regulon has remained largely unexplored.</p> <p>Results</p> <p>In order to predict direct targets of Crc, we used a bioinformatics approach based on detection of A-rich motifs near the initiation of translation of all protein-encoding genes in twelve fully sequenced <it>Pseudomonas </it>genomes. As expected, our data predict that genes related to the utilisation of less preferred nutrients, such as some carbohydrates, nitrogen sources and aromatic carbon compounds are targets of Crc. A general trend in this analysis is that the regulation of transporters is conserved across species whereas regulation of specific enzymatic steps or transcriptional activators are often conserved only within a species. Interestingly, some nucleoid associated proteins (NAPs) such as HU and IHF are predicted to be regulated by Crc. This finding indicates a possible role of Crc in indirect control over a subset of genes that depend on the DNA bending properties of NAPs for expression or repression. Finally, some virulence traits such as alginate and rhamnolipid production also appear to be regulated by Crc, which links nutritional status cues with the regulation of virulence traits.</p> <p>Conclusions</p> <p>Catabolite repression control regulates a broad spectrum of genes in <it>Pseudomonas</it>. Some targets are genus-wide and are typically related to central metabolism, whereas other targets are species-specific, or even unique to particular strains. Further study of these novel targets will enhance our understanding of how <it>Pseudomonas </it>bacteria integrate nutritional status cues with the regulation of traits that are of ecological, industrial and clinical importance.</p

    The Early Development Instrument: an evaluation of its five domains using Rasch analysis

    Get PDF
    Background: Early childhood development is a multifaceted construct encompassing physical, social, emotional and intellectual competencies. The Early Development Instrument (EDI) is a population-level measure of five domains of early childhood development on which extensive psychometric testing has been conducted using traditional methods. This study builds on previous psychometric analysis by providing the first large-scale Rasch analysis of the EDI. The aim of the study was to perform a definitive analysis of the psychometric properties of the EDI domains within the Rasch paradigm. Methods: Data from a large EDI study conducted in a major Irish urban centre were used for the analysis. The unidimensional Rasch model was used to examine whether the EDI scales met the measurement requirement of invariance, allowing responses to be summated across items. Differential item functioning for gender was also analysed. Results: Data were available for 1344 children. All scales apart from the Physical Health and Well-Being scale reliably discriminated between children of different levels of ability. However, all the scales also had some misfitting items and problems with measuring higher levels of ability. Differential item functioning for gender was particularly evident in the emotional maturity scale with almost one-third of items (9 out of 30) on this scale biased in favour of girls. Conclusion: The study points to a number of areas where the EDI could be improved

    An analysis of the Research Fellowship Scheme of the Royal College of Surgeons of England.

    No full text
    BACKGROUND: The Research Fellowship Scheme of the Royal College of Surgeons of England commenced in 1993 with the aim of exposing selected surgical trainees to research techniques and methodology, with the hope of having an impact on surgical research and increasing the cadre of young surgeons who might decide to pursue an academic career in surgery. Over 11 million pounds sterling (approximately US 20 million dollars) has been invested in 264 fellowships. The College wished to evaluate the impact of the Scheme on the careers of research fellows, surgical research, and patient care. As the 10th anniversary of the Scheme approached. STUDY DESIGN: Two-hundred and sixty research fellows whose current addresses were available were sent a questionnaire. Two-hundred and thirty-eight (91.5%) responded. RESULTS: Three-quarters of the research fellows conducted laboratory-based research, with most of the remainder conducting patient-based clinical research. One-third of the fellows who have reached consultant status have an academic component to their post. The total number of publications based on fellowship projects was 531, with a median impact factor of 3.5. Almost all fellows had been awarded a higher degree or were working toward this. Half of the fellows received subsequent funding for research, mostly awarded by national or international funding bodies. CONCLUSIONS: The Research Fellowship Scheme of the Royal College of Surgeons of England has successfully supported many trainee surgeons in the initial phase of their research career. It has helped surgical research by increasing the pool of surgeons willing to embark on an academic career. Indirectly, patient care has benefited by promoting an evidence-based culture among young surgeons. Such schemes are relevant to surgical training programs elsewhere if more young surgeons are to be attracted into academic surgery

    Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

    Get PDF
    BACKGROUND: It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. METHODS: A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses. RESULTS: The average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938 - €1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis. CONCLUSIONS: This study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision
    corecore