Losing Control Again? Power and the quality of working life

Talk of power and work seems passé, an unhelpful memory of battles that have long since been settled. This paper argues that far from having been superseded, we need a view of power to understand many prominent changes in work and working life. The imbalance of power remains a fact of life in the employment relationship in the 21st century, just as it was in the 19th and 20th. However, the responses society makes to it are radically different. For example, the solution to the power imbalance is no longer simply a matter of trade unions and collective bargaining, but is now seen as involving skills, individual employment rights, management practices that emphasise empowerment and autonomy, and, to a lesser extent, the implementation of technology in places of work. Our understanding of the circulations and exercise of power is more complex than it once was as a result

Diffraction studies of molecular crystals

SIGLEAvailable from British Library Document Supply Centre- DSC:D41735/82 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Intermediality and interventions: Applying intermediality frameworks to reality television and microblogs

This article explores the usefulness of ‘intermediality’ approaches for understanding contemporary reality television. Through a case study of Intervention, it is proposed that intermedial frameworks illuminate reality television’s function as a “dream of presence”. The article focuses particularly on intermedial manifestations of the television program on the microblogging platform, tumblr. Building on studies of intermediality within cinema and visual cultural studies, this article highlights the liminal, affective and processual elements that arise from the intermedial movement of content. It does this through an application of ideas from non-representational theory as a means for expanding intermediality beyond the cinematic. This article suggests that liminality, affect and process are, in turn, presented in Intervention, and emphasised in the intermedial presentation of Intervention ‘screencaps’ on fan-made tumblr microblogs.Peer Reviewe

Vascular Investigation and Management of Ischaemic Stroke

A variety of aetiological factors serve as targets for both treatment and prevention in ischaemic stroke. Research has shifted towards acute therapy and improving the risk / benefit ratio in secondary prevention. Current evidence based practice in ischaemic stroke is discussed in chapter one, and the background to subsequent chapters is introduced. The thesis is then divided into two broad areas that examine mechanisms by which vascular disease may cause ischaemic stroke, and the manner in which vascular risk may be modulated. Chapters two to four highlight controversies in investigation and management. Chapter two addresses a clinical dilemma - essentially whether a carotid lesion ipsilateral to a lacunar stroke should be considered symptomatic. Observational data comparing incidence of lacunar disease contralateral (group 1) or ipsilateral (group 2) to carotid artery disease, and stroke recurrence in patients in whom co-existent lacunar and carotid disease had been identified, were analysed. 32 patients had carotid disease contralateral to their lacunar stroke, compared to 61 patients with ipsilateral lacunar disease. Chi-squared testing indicated a positive association between unilateral lacunar stroke and ipsilateral carotid disease (p=0.003), and a just significant trend towards more severe carotid disease in group 2 (p=0.049). Recurrent ischaemic stroke occurred more commonly in group 2 than group 1, although this difference just failed to reach statistical significance (p=0.059). A positive association therefore exists between lacunar stroke and ipsilateral carotid disease that confers a poor prognosis. Cryptogenic stroke accounts for approximately 30% of ischaemic stroke. Inter-atrial septal abnormalities (patent foramen ovale (PFO) and atrial septal aneurysm) have been proposed as a cause of stroke. Chapter three details a meta-analysis of data examining the relationship between inter-atrial septal abnormalities and stroke. Comparing ischaemic stroke to controls, the odds ratio (OR) associated with PFO for all ages was 1.83 (95% C.I.=1.25-2.66). For atrial septal aneurysm it was 2.35 (1.46-3.77), and for both lesions in conjunction it was 4.96 (2.37-10.39). Homogeneous results were found within the group 55 years (1.27 (0.80-2.01), 3.43 (1.89-6.22) and 5.09 (1.25-20.74) respectively). Comparing cryptogenic stroke patients to patients with known stroke cause, heterogeneous results derived from total group examination (PFO 3.16 (2.30-4.35), atrial septal aneurysm 3.65 (1.34- 9.97), PFO and atrial septal aneurysm 23.26 (5.24-103.20)). In those 55, 3 studies produced heterogeneous results for PFO (2.26 (0.96-5.31)), while no data were available on atrial septal aneurysm prevalence. Meta-analysis therefore demonstrates significant association between both PFO and atrial septal aneurysm and ischaemic stroke in patients 55 years. The climate of uncertainty that surrounds the subject of 'PFO-associated stroke' has led to a wide spectrum of practice amongst specialists, which is examined in chapter four, using a questionnaire. 17% of respondents would investigate for PFO in all cryptogenic stroke patients, while 60% investigate only in those 55 years, and by 33% of respondents for those <55 years (p<0.01 for comparison of proportions). In a patient of any age with recurrent events, less than 5% of respondents would continue to use antiplatelet therapy alone. 45% would use warfarin, and 42% would refer the patient for a corrective procedure. For a patient with a large PFO, 57% (55 years) would refer (p=0.01), and for a patient with concomitant atrial septal aneurysm, 62% (55 years) would refer (p<0.01). A large PFO was felt to be the most important factor in decisions regarding lesion correction. Investigation practice varied considerably amongst specialists. Randomised trial design should reflect management practice in this area. The second part of the thesis reports clinical trials designed to examine the manner in which agents aimed at the modification of vascular risk may act in the acute and subacute phase of ischaemic stroke. The cholesterol- independent effects of statins may explain their efficacy in patients at high vascular risk. (Abstract shortened by ProQuest.)

Factors influencing multiple sclerosis disease-modifying treatment prescribing decisions in the United Kingdom: A qualitative interview study

Background The proportion of people with relapsing-remitting multiple sclerosis prescribed disease modifying treatments (DMTs) in the United Kingdom (UK) is considered low compared with other countries. There are differences in DMT prescription rates between UK nations (England, Wales, Scotland, Northern Ireland). Despite this, there has been little research into decision-making processes and prescribing practices. Objective To investigate views and experiences of neurologists prescribing DMTs and MS specialist nurses to identify factors influencing prescribing. Methods Semi-structured interviews with 18 consultant neurologists and 16 specialist nurses from diverse settings across the four UK nations. Data were analysed using thematic framework analysis. Results Prescribing practices are influenced by organisational prescribing “cultures”, informal “benchmarking” within peer networks, and prior experience with different DMTs. Health professionals differ in their perceptions of benefits and risks of DMTs and personal “thresholds” for discerning relapses and determining eligibility for DMTs. Prescribers in England felt most constrained by guidelines. Conclusion To achieve equity in access to DMTs for people with MS eligible for treatment, there is a need for public discussion acknowledging differences in health professionals’ interpretations of “relapses” and guidelines and perceptions of DMTs, variation in organisational prescribing “cultures”, and whether the prevailing culture sufficiently meets patients’ needs

Diagnosis and management of multiple sclerosis: MRI in clinical practice.

BACKGROUND: Recent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres. METHODS: MS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol. RESULTS: We identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated. CONCLUSIONS: The proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach

"Ain schone kunstliche underweisung": Modelling German lute tablature in MEI

Abstract: https://teimec2023.uni-paderborn.de/contributions/188.htm