The need for core outcome sets in urological cancer research

Peer reviewedPublisher PD

Effectiveness of de-implementation strategies for low-value prescribing in secondary care : a systematic review

Peer reviewedPublisher PD

Account giving as a fundamental social practice and a central sociological concept: a theoretical and methodological reconceptualisation and a practical exploration in a critical case.

This PhD thesis argues that accounts are influenced by culture, are a fundamental form of social practice by which interaction is accomplished, and thus a central sociological concept. The focus of the thesis is that accounts of time and money are affected by religious belief. It examines and (re)conceptualises the concept of an account. Accounts are re-theorised as taking two forms: rational and rhetorical, with their mediation emphasised as the feature that makes them empirically different. Studies of accounting in religious institutions are critically examined and complemented using research from a neglected (in 'financial' accounting studies) branch of sociological research about accounts as ubiquitous social practices. Time and money are appropriate phenomena to research sociologically because they are relevant to sociological and financial conceptions of an account as numerically accountable phenomena that also have socially meaningful features. Ethnomethodology and institutional ethnography are deployed as two mutual methodological frameworks for researching the social accomplishment of accounts in small-scale interaction and ways in which a complex of wider ruling relations, through institutional discourses, are implicit in accounting interactions, especially in institutional settings. The thesis forwards a set of theoretically derived propositions to provide an explanation of accounts that explores their social embeddedness more closely than previous work. Briefly, these are that accounts generally, and particularly as applied to time and money, are a key means to make actions visible; are an attempt to promote a morally worthy self; are culturally relative; give information about the social norms of the social collective; always occur at moral and sometimes institutional interfaces; and are ubiquitous social practices. To provide and interrogate an applied example of these theoretically and methodologically derived propositions about accounts of time and money and how these are affected by culture and beliefs, I use observation, participant observation, analysis of community produced literature, and semi-structured interviews in a critical case study of the Findhorn Foundation. Therein time and money are rhetorically accountable; are indicative of the spiritually influenced moral code of the Findhorn Foundation; and the moral code provides for a vocabulary of motives that members use in order present morally worthy selves. The ideal moral self is culturally relative to the Findhorn Foundation and sets itself in opposition to an ideal type of capitalist production, consumption and generally dominant ways of knowing, being, and organising in industrialised western societies. Rhetorical accounts of time and money pervade rational ones at the organisational level and spiritual principles are blended with business acumen. However, although spiritual principles have epistemological and ontological differences (from dominant ways of doing business in the wider society), they need to be commensurable with the extra-locally produced discourses found within the wider society in order to remain legally viable. Furthermore, tensions around inefficient decision-making processes exist. Accounts are tied to multiple (at times competing) moral codes within Findhorn, and also operate within pragmatically set limits involving disposable resources. This thesis is argued to be a valuable contribution to sociological literature around social accounting in general, and in religious institutions in particular, and contributes to the literature concerning social actors' accounts of their social actions, regardless of the specific setting. That is, these findings are 'about social practices' in general. Succinctly, my thesis puts forward a strong case for seeing accounts as a central sociological concept

Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer

UCAN Cancer Charity (www.ucanhelp.org.uk) and MacMillan Cancer Charity (www.macmillan.org.uk) helped design and conduct the study.Peer reviewedPostprin

Interleukin (IL)–12 and IL-23 Are Key Cytokines for Immunity against Salmonella in Humans

Patients with inherited deficiency of the interleukin (IL)–12/IL-23–interferon (IFN)–g axis show increased susceptibility to invasive disease caused by the intramacrophage pathogens salmonellae and mycobacteria. We analyzed data on 154 patients with such deficiency. Significantly more patients with IL-12/IL-23–component deficiency had a history of salmonella disease than did those with IFN-g–component deficiency. Salmonella disease was typically severe, extraintestinal, and caused by nontyphoidal serovars. These findings strongly suggest that IL-12/IL-23 is a key cytokine for immunity against salmonella in humans and that IL-12/IL-23 mediates this protective effect partly through IFN-g–independent pathways. Investigation of the IL-12/IL-23–IFN-g axis should be considered in patients with invasive salmonella disease

“Vicarious thinking” is a key driver of score change in Delphi surveys for COS development and is facilitated by feedback of results

Acknowledgements: We would like to thank and acknowledge the participants in the Delphi surveys used here. We also thank individuals who contributed significantly to the wider COS development projects: Professor Andrew G. Renehan and Professor Caroline Sanders (CORMAC); Dr. Thomas B. L. Lam (COMPACTERS); Professor Iain A Bruce and Professor Jane M Blazeby (GASTROS). Funding: This work was supported by a National Institute for Health Research (NIHR) Senior Investigator Award (NF-SI_0513-10025). The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care.Peer reviewedPublisher PD

Words of Wisdom RE: Low adherence to guidelines in nonmuscle-invasive disease

Non peer reviewedPostprin

A randomised trial comparing three Delphi feedback strategies found no evidence of a difference in a setting with high initial agreement

Peer reviewedPostprintPostprintPostprintPostprintPostprintPostprintPostprintPostprintPostprintPostprintPostprin

Lymphocyte subsets in healthy Malawians: Implications for immunologic assessment of HIV infection in Africa

BackgroundCD4+T lymphocyte measurements are the most important indicator of mortality in HIV-infected individuals in resource-limited settings. There is currently a lack of comprehensive immunophenotyping data from African populations to guide the immunologic assessment of HIV infection.ObjectiveTo quantify variation in absolute and relative lymphocyte subsets with age in healthy Malawians.MethodsLymphocyte subsets in peripheral blood of 539 healthy HIV-uninfected Malawians stratified by age were enumerated by flow cytometry.ResultsB and T–lymphocyte and T-lymphocyte subset absolute concentrations peaked in early childhood then decreased to adult levels, whereas lymphocyte subset proportions demonstrated much less variation with age. Adult lymphocyte subsets were similar to those in developed countries. In contrast, high B-lymphocyte and CD8+T-lymphocyte levels among children under 2 years, relative to those in developed countries, resulted in low CD4+T-lymphocyte percentages that varied little between 0 and 5 years (35% to 39%). The CD4+T-lymphocyte percentages in 35% of healthy children under 1 year and 18% of children age 1 to 3 years were below the World Health Organization threshold defining immunodeficiency in HIV-infected children in resource-limited settings. Thirteen percent of healthy children under 18 months old had a CD4:CD8T-lymphocyte ratio <1.0, which is commonly associated with HIV infection. All immunologic parameters except absolute natural killer lymphocyte concentration varied significantly with age, and percentage and overall absolute CD4+T-lymphocyte counts were higher in females than males.ConclusionAlthough lymphocyte subsets in Malawian adults are similar to those from developed countries, CD4+T-lymphocyte percentages in young children are comparatively low. These findings need to be considered when assessing the severity of HIV-related immunodeficiency in African children under 3 years

Knowledge Transfer and Guidelines Implementation in Genitourinary Cancers

Peer reviewedPostprin