Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Background The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems. We have examined the implications for research of these different underlying philosophies. Methods Records of 40,183 children from 141 practices in DIN and 76,310 from 464 practices in GRPD who were followed to age 5 were used to compare the volume of recording of prescribing and diagnostic codes in the two databases. To assess the importance and additional value of the POMR within DIN, the appropriateness of diagnostic linking to skin emollient prescriptions was investigated. Results Variation between practices for both the number of days on which prescriptions were issued and diagnoses were recorded was marked in both databases. Mean number of "prescription days" during the first 5 years of life was similar in DIN (19.5) and in GPRD (19.8), but the average number of "diagnostic days" was lower in DIN (15.8) than in GPRD (22.9). Adjustment for linkage increased the average "diagnostic days" to 23.1 in DIN. 32.7% of emollient prescriptions in GPRD appeared with an eczema diagnosis on the same day compared to only 19.4% in DIN; however, 86.4% of prescriptions in DIN were linked to an earlier eczema diagnosis. More specifically 83% of emollient prescriptions appeared under a problem heading of eczema in the 121 practices that were using problem headings satisfactorily. Conclusion Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure. Period prevalence rates will be underestimated in DIN unless this structure is taken into account. The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue

Nano-porosity in GaSb induced by swift heavy ion irradiation

Nano-porous structures form in GaSb after ion irradiation with 185 MeV Au ions. The porous layer formation is governed by the dominant electronic energy loss at this energy regime. The porous layer morphology differs significantly from that previously reported for low-energy, ion-irradiated GaSb. Prior to the onset of porosity, positron annihilation lifetime spectroscopy indicates the formation of small vacancy clusters in single ion impacts, while transmission electron microscopy reveals fragmentation of the GaSb into nanocrystallites embedded in an amorphous matrix. Following this fragmentation process, macroscopic porosity forms, presumably within the amorphous phase.The authors thank the Australian Research Council for support and the staff at the ANU Heavy Ion Accelerator Facility for their continued technical assistance. R.C.E. acknowledges the support from the Office of Basic Energy Sciences of the U.S. DOE (Grant No. DE-FG02-97ER45656)

Factors influencing the inspirational effect of major sports events on audience sport participation behaviour

The purpose of this paper is to elucidate the factors that determine the extent to which spectators attending one-off sports events feel inspired to increase their own participation in sport. The research considers both the socio-demographic and sport participation profile of the audience as well as the characteristics of an event as predictors of inspiration. The methodological approach involved secondary analysis of data collected from audiences across 10 events held in England since 2010. The findings are based on an aggregate sample of 7458 respondents. The statistical method used to analyse the data was multinomial logistic regression. The results show that the majority of respondents were inspired by the event that they attended, but the strength of the inspiration effect varied significantly according to their age; place of residence; ethnic origin; sport participation profile; and whether or not they had been exposed to information about opportunities to undertake sport. Moreover, events featuring team sports, non-age restricted events and elite events incorporating a mass participation component were also found to be positively related to inspiration. Several policy implications are identified for event organizers and public funders of both elite and community sport

Planning and Leveraging Event Portfolios: Towards a Holistic Theory

This conceptual paper seeks to advance the discourse on the leveraging and legacies of events by examining the planning, management, and leveraging of event portfolios. This examination shifts the common focus from analyzing single events towards multiple events and purposes that can enable cross-leveraging among different events in pursuit of attainment and magnification of specific ends. The following frameworks are proposed: (1) event portfolio planning and leveraging, and (2) analyzing events networks and inter-organizational linkages. These frameworks are intended to provide, at this infancy stage of event portfolios research, a solid ground for building theory on the management of different types and scales of events within the context of a portfolio aimed to obtain, optimize and sustain tourism, as well as broader community benefits

Should we privilege sport for health? The comparative effectiveness of UK government investment in sport as a public health intervention

INTRODUCTION: Claimed links between sport and health are pervasive. This paper interrogates evidence for the UK government’s theory of change that sport can be used as a public health intervention to increase physical activity among the less and least active to deliver improvements in the physical health of the population. Regardless of efficacy evidence linking sport participation to improvements in physical health, effectiveness evidence to support the processes by which it is assumed that sport participation can be increased among the less and least active is unclear. METHOD: Two time-series analyses of current and historical national survey data explore evidence for the effectiveness of sport as a public health intervention for physical health. RESULTS & DISCUSSION: There is no top tier evidence from controlled designs to support, and some second tier evidence from time-series analyses to undermine, the effectiveness of sport as a public health intervention to increase physical activity among the less and least active. Despite sustained UK government investment, sport participation has stagnated or fallen from 1990, whilst since 1997 an additional 10% of the population have become physically active in ways that do not include sport. CONCLUSION: There is no evidence that sport is effective as a public health intervention to improve physical health. In comparison to the opportunity cost of not implementing potentially effective alternatives that promote wider physical activity choices that do not privilege sport, investment in sport as a public health intervention may cause net harm to the physical health of the UK population

Informing evidence-based policy for sport-related concussion: are the consensus statements of the concussion in sport group fit for this purpose?

This essay explores how evidence-based policy can be developed for sport-related concussion (SRC), focusing particularly on the role and influence of the Consensus Statements of the Concussion in Sport Group (CiSG). Three credible policy purposes are suggested: (i) to mitigate acute health impacts of concussion events in sport; (ii) to reduce or eliminate the identified causes of SRC (direct blows to the head, neck, or body); and (iii) to improve long-term brain health outcomes for athletes. Eight of ten systematic reviews commissioned for the most recent Consensus Statement, and ten of its thirteen headings, address the first purpose. The primary influence of the CiSG Consensus Statements has been to improve SRC acute response practice and protocols in professional/elite sport, which has always been their primary policy purpose, although evidence of improvement is more limited in child/adolescent and recreational sport. But a primary focus on mitigating acute health impacts has crowded out other credible policy purposes of concern to stakeholder groups with whom evidence-based policy for SRC must be co-produced. No recommendations are made to improve long-term brain outcomes for athletes because concerns about imperfections in evidence are cited to question the link between such outcomes and SRC. Modifications to reduce or eliminate purposive blows to the head, neck, or body that are permitted as a structural part of the way some sports are played are given very limited attention, even when discussing prevention, where they are just one approach considered alongside protective equipment, neuromuscular strengthening, and concussion management strategies. The essay concludes that the CiSG should shift the primary policy purpose of its Consensus Statements to address the identified causes of SRC: purposive blows to the head, neck, or body. Reducing or removing causes of SRC both better safeguards children/adolescents and renders debates about the link between SRC and long-term brain health outcomes superfluous

Modern ‘live’ football: moving from the panoptican gaze to the performative, virtual and carnivalesque

Drawing on Redhead's discussion of Baudrillard as a theorist of hyperreality, the paper considers the different ways in which the mediatized ‘live’ football spectacle is often modelled on the ‘live’ however eventually usurps the ‘live’ forms position in the cultural economy, thus beginning to replicate the mediatized ‘live’. The blurring of the ‘live’ and ‘real’ through an accelerated mediatization of football allows the formation of an imagined community mobilized by the working class whilst mediated through the sanitization, selling of ‘events’ and the middle classing of football, through the re-encoding of sporting spaces and strategic decision-making about broadcasting. A culture of pub supporting then allows potential for working-class supporters to remove themselves from the panoptican gazing systems of late modern hyperreal football stadia and into carnivalesque performative spaces, which in many cases are hyperreal and simulated themselves

Towards reviving post-Olympic Athens as a cultural destination

This paper examines the effects of global change on the status and qualities of the Greek national capital, Athens, focusing on how they affect the development of cultural tourism in the city. Although Athens constituted one of the most significant destinations for Greek tourism in the past, in recent years it started to weaken. Athens is characterised by a series of problems, among them are the degradation of its environment and quality of life and traffic congestion. However, in terms of tourism development, the Olympic Games helped in re-imaging the city and upgrading its infrastructure. This study based on semi-structured interviews with top officials reveals how global change has affected Athens’ socio-cultural/economic status, identity and image. Despite the tourism policy/planning responses to global changes, Athens’ tourism continues to decline leaving unexplored potential such as its rich cultural heritage, new multicultural identity and the New Acropolis Museum. The paper suggests that cultural elements of capital cities must be multidimensional including a variety of attractions and amenities. The use of cultural heritage assets needs to be in line with global developments in order for cities to effectively leverage heritage for cultural tourism

DEBATE: do interventions based on behavioral theory work in the real world?

Background: Behavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes. Discussion: Hagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the ‘real world’. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective behavioral interventions is needed, and behavioral scientists should engage in greater advocacy to persuade gatekeepers to invest in behavioral interventions. Weed argues there is no evidence to demonstrate behavioral theory interventions are genuinely effective in real world settings in populations that are offered them: they are merely efficacious for those that receive them. Despite behavioral volatility that is a normal part of maintaining steady-state population behavior levels creating the illusion of effectiveness, interventions fail in shifting the curve of population behaviors because they focus on individuals rather than populations. Hagger responds that behavioral interventions work in the ‘real world’ in spite of, not because of, flux in health behaviors, and that the contention that behavioral theory focuses solely on individual behavior change is inaccurate. Weed responds that the focus on extending the controls of efficacy trials into implementation is impractical, uneconomic and futile, and this has squandered opportunities to conduct genuine effectiveness trials in naturalistic settings. Summary: Hagger contends that interventions based on behavioral theory are effective in changing population-level behavior in ‘real world’ contexts, but more evidence on how best to implement them and how to engage policymakers and practitioners to provide sustained funding is needed. Weed argues for a paradigm shift, away from aggregative attempts to effect individual behavior change towards a focus on disrupting social practices, underpinned by understanding social and economic causation of the distribution and acceptance of behaviors in a population

Olympic legacy and cultural tourism: Exploring the facets of Athens' Olympic heritage

This study examines the effects of the Olympic Games on Athens’ cultural tourism and the city’s potential to leverage the Olympic legacy in synergy with its rich heritage in order to enhance its tourism product during the post-Games period. In doing so, a qualitative and interpretive approach was employed. This includes a literature review on Athens’ 2004 Olympics to identify the sport facilities and regeneration projects, which constitute the Olympic legacy and heritage. Based on that, an empirical analysis was undertaken, by collecting official documents about the 2004 Olympics, and conducting five semi-structured interviews with tourism/administrative officials. The findings indicate that the Olympiad contributed significantly to Athens’ built and human heritage, revealing the dimensions of new venues/facilities, infrastructure, transportation and aesthetic image of the city, and human capital enhancement. Hence, the Games affected to the multifaceted representation and reconstruction of the city’s identity and cultural heritage. However, the potential afforded from the post-Olympic Athens remains unrealised due to lack of strategic planning/management. The study concludes that there is a need to develop cross-leveraging synergies between the Olympic legacy and cultural tourism for the host city. Finally, a strategic planning framework for leveraging post-Games Olympic tourism is suggested in order to maximise the benefits of Olympic legacy and heritage in a host city’s tourism development