756 research outputs found

    A secure seat at the academic high table? An exploratory study of the field of university-based teacher education for post-compulsory education and training in England: a Legitimation Code Theory analysis

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    As a specialised field of study in English universities, teacher education for the post-compulsory education and training sector (TE-PCET) is under-researched and under-theorised. By portraying the views and perspectives of teacher educators (TEds) about their knowledge context, practices and beliefs at a time of considerable flux for the PCET sector and for university provision of teacher education (TE) generally, the thesis makes a significant contribution to the empirical and theoretical literature for this field. Extensive interviews and programme documentation provided insight into its current state and security of tenure in the academy. Analysis and implications of the findings drew on Maton’s (2014) Legitimation Code Theory, an innovative analytic explanatory framework in which organising principles of knowledge practices were conceptualised. The findings suggest that TEds constructed their field as one of relative low autonomy with little collective agency to insulate itself from external sources of power and influence. It also lacked legitimacy and was marginalised in the academy. Absent a distinctive specialised pedagogy of TE-PCET to articulate an academic TEd identity, there was considerable ambivalence as to the focus and conduct of academic TE-PCET research. This influenced the field’s ability to develop a cohesive, distinctive community of scholars with implications for the framing of curricula and pedagogy. In sum, knowledge and knower specialisation were relatively weak in the intellectual and educational domains. In a circular way, this rendered TE-PCET as a specialism susceptible to extrinsic pressures. Analysis drew attention to the potential for TEds to raise the status of university-based TE-PCET; to strengthen its intellectual autonomy and the epistemic power of its knowledge base; and cultivation of a distinctly TEd disposition that would serve to enhance its cumulative knowledge-building potential. This could be achieved by a sustained focus on a distinctive ‘higher’ TE disciplinary discourse

    Riemann surfaces

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    Association between clinical presentations before myocardial infarction and coronary mortality: a prospective population-based study using linked electronic records.

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    BACKGROUND: Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influence post-AMI outcomes. No studies have evaluated prospectively collected information on ischaemia and its effect on short- and long-term coronary mortality. The objective of this study was to compare patients with and without prospectively measured ischaemic presentations before AMI in terms of infarct characteristics and coronary mortality. METHODS AND RESULTS: As part of the CALIBER programme, we linked data from primary care, hospital admissions, the national acute coronary syndrome registry and cause-specific mortality to identify patients with first AMI (n = 16,439). We analysed time from AMI to coronary mortality (n = 5283 deaths) using Cox regression (median 2.6 years follow-up), comparing patients with and without recent ischaemic presentations. Patients with ischaemic presentations in the 90 days before AMI experienced lower coronary mortality in the first 7 days after AMI compared with those with no prior ischaemic presentations, after adjusting for age, sex, smoking, diabetes, blood pressure and cardiovascular medications [HR: 0.64 (95% CI: 0.57-0.73) P < 0.001], but subsequent mortality was higher [HR: 1.42 (1.13-1.77) P = 0.001]. Patients with ischaemic presentations closer in time to AMI had the lowest seven day mortality (P-trend = 0.001). CONCLUSION: In the first large prospective study of ischaemic presentations prior to AMI, we have shown that those occurring closest to AMI are associated with lower short-term coronary mortality following AMI, which could represent a natural ischaemic preconditioning effect, observed in a clinical setting. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov identifier NCT01604486

    The effects of hourly differences in air pollution on the risk of myocardial infarction: case crossover analysis of the MINAP database.

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    OBJECTIVES: To investigate associations between air pollution levels and myocardial infarction (MI) on short timescales, with data at an hourly temporal resolution. DESIGN: Time stratified case crossover study linking clinical data from the Myocardial Ischaemia National Audit Project (MINAP) with PM(10), ozone, CO, NO(2), and SO(2) data from the UK National Air Quality Archive. Pollution effects were investigated with delays (lags) of 1-6, 7-12, 13-18, 19-24, and 25-72 hours in both single and multi-pollutant models, adjusted for ambient temperature, relative humidity, circulating levels of influenza and respiratory syncytial virus, day of week, holidays, and residual seasonality within calendar month strata. SETTING: Population based study in 15 conurbations in England and Wales. SUBJECTS: 79,288 diagnoses of myocardial infarction recorded over the period 2003-6. MAIN OUTCOME MEASURES: Excess risk of myocardial infarction per 10 µg/m(3) increase in pollutant level. RESULTS: In single pollutant models, PM(10) and NO(2) levels were associated with a very short term increase in risk of myocardial infarction 1-6 hours later (excess risks 1.2% (95% confidence interval 0.3 to 2.1) and 1.1% (0.3 to 1.8) respectively per 10 μg/m(3) increase); the effects persisted in multi-pollutant models, though with only weak evidence of an independent PM(10) effect (P = 0.05). The immediate risk increases were followed by reductions in risk at longer lags: we found no evidence of any net excess risk associated with the five pollutants studied over a 72 hour period after exposure. CONCLUSIONS: Higher levels of PM(10) and NO(2), which are typically markers of traffic related pollution, seem to be associated with transiently increased risk of myocardial infarction 1-6 hours after exposure, but later reductions in risk suggest that air pollution may be associated with bringing events forward in time ("short-term displacement") rather than increasing overall risk. The well established effect of air pollution on cardiorespiratory mortality may not be mediated through increasing the acute risk of myocardial infarction, but through another mechanism

    No association between exacerbation frequency and stroke in patients with COPD.

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    BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of stroke than the general population. Chronic inflammation associated with COPD is thought to contribute to this risk. Exacerbations of COPD are associated with a rise in inflammation, suggesting that there may be an association between exacerbation frequency and the risk of stroke. This study examined that association. METHODS: Using the UK Clinical Practice Research Datalink, COPD patients with a first stroke between January 2004 and December 2013 were identified as cases and matched on age, sex, and general practice to controls with COPD but without a stroke (6,441 cases and 19,323 controls). Frequent exacerbators (FEs) were defined as COPD patients with ≥2 exacerbations, and infrequent exacerbators (IEs) have ≤1 exacerbation in the year prior to their stroke. Conditional logistic regression was used to estimate the association between exacerbation frequency and stroke overall, and by stroke subtype (hemorrhagic, ischemic, or transient ischemic attack). Exacerbations were also categorized into 0, 1, 2, or ≥3 exacerbations in the year prior to stroke. RESULTS: There was no evidence that FE had an increased odds of stroke compared to IE (OR [odds ratio] =0.95, 95% CI [confidence interval] =0.89-1.01). There was strong evidence that the risk of stroke decreased with each exacerbation of COPD experienced per year (P trend =0.003). In the subgroup analysis investigating stroke subtype, FE had 33% lower odds of hemorrhagic stroke than IE (OR =0.67, 95% CI =0.51-0.88, P=0.003). No association was found within other stroke types. CONCLUSION: This study found no evidence of a difference in the odds of stroke between IE and FE, suggesting that exacerbation frequency is unlikely to be the reason for increased stroke risk among COPD patients. Further research is needed to explore the association through investigation of stroke risk and the severity, duration, treatment of exacerbations, and concurrent treatment of cardiovascular risk factors

    I. Quantitative Determination of Tannin in Grain Sorghum II. Paper Chromatography of Sorghum Tannin

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    Chemistr

    Myocardial infarction as the first manifestation of atherosclerotic disease

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    Aim: To examine the occurrence of cardiovascular disease risk factors, previously diagnosed atherosclerotic disease, new ischaemic events and prescriptions issued in the period prior to first myocardial infarction (MI) and their association with outcomes at the time of and after MI. Methods: This thesis describes studies using linked CALIBER data from four UK sources: the General Practice Research Database, Hospital Episode Statistics, the Myocardial Ischaemic National Audit Project and Office for National Statistics mortality data. Linkage of these sources created a large, rich longitudinal dataset, allowing reconstruction of the patient journey before and after first MI. Quality of MI recording across the four data sources was first assessed and three further studies examined atherosclerotic disease, risk factor and drug exposures in the period preceding MI. Results: Despite an increased rate of ischaemic coronary presentations in the 90 days prior to MI, over half of first MI patients were unheralded by atherosclerotic disease diagnoses (56.5% (55.6-57.4%)). However, the great majority of people with no prior diagnosed atherosclerotic disease had identifiable vascular disease risk factors or had recent presentations with chest pain. Survival analysis showed that patients with new ischaemic presentations shortly before MI - possible clinical correlates of ischaemic preconditioning - had less severe infarcts and improved survival in the first seven days after MI (Hazard Ratio for coronary heart disease mortality 0.64 (0.57-0.73), P<0.001) compared to patients without previously recorded ischaemia. However, in the longer term ischaemic presentations shortly before MI were associated with poorer survival. Prescription of aspirin for primary prevention in the pre-MI period was also marker for attenuated MI severity, but with no effect on mortality or infarct size. There was no association between statin use for primary prevention and outcomes at MI. Conclusions: The novel prospective data used in this thesis have provided the opportunity to obtain new insights into MI as the first manifestation of ischaemic heart disease

    Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000–2011: a population-based study using data from the UK Clinical Practice Research Datalink

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    Objectives: To determine the relative contribution of general practices (GPs) to the diagnosis of chlamydia and gonorrhoea in England and whether treatment complied with national guidelines. Design: Analysis of longitudinal electronic health records in the Clinical Practice Research Datalink (CPRD) and national sexually transmitted infection (STI) surveillance databases, England, 2000–2011. Setting: GPs, and community and specialist STI services. Participants: Patients diagnosed with chlamydia (n=1 386 169) and gonorrhoea (n=232 720) at CPRD GPs, and community and specialist STI Services from 2000–2011. Main outcome measures: Numbers and rates of chlamydia and gonorrhoea diagnoses; percentages of patients diagnosed by GPs relative to other services; percentage of GP patients treated and antimicrobials used; percentage of GP patients referred. Results: The diagnosis rate (95% CI) per 100 000 population of chlamydia in GP increased from 22.8 (22.4–23.2) in 2000 to 29.3 (28.8–29.7) in 2011 (p<0.001), while the proportion treated increased from 59.5% to 78.4% (p=0.001). Over 90% were prescribed a recommended antimicrobial. Over the same period, the diagnosis rate (95% CI) per 100 000 population of gonorrhoea in GP ranged between 3.2 (3–3.3) and 2.4 (2.2–2.5; p=0.607), and the proportion treated ranged between 32.7% and 53.6% (p=0.262). Despite being discontinued as a recommended therapy for gonorrhoea in 2005, ciprofloxacin accounted for 42% of prescriptions in 2007 and 20% in 2011. Over the study period, GPs diagnosed between 9% and 16% of chlamydia cases and between 6% and 9% of gonorrhoea cases in England. Conclusions: GP makes an important contribution to the diagnosis and treatment of bacterial STIs in England. While most patients diagnosed with chlamydia were managed appropriately, many of those treated for gonorrhoea received antimicrobials no longer recommended for use. Given the global threat of antimicrobial resistance, GPs should remain abreast of national treatment guidelines and alert to treatment failure in their patients

    Conservation in conversation: People's perspectives on a woodland with high conservation value-A qualitative study

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    Concepts such as ecosystem services and nature's contributions to people are frameworks for articulating the value of nature and biodiversity conservation. Yet it remains difficult to argue for the conservation of species and habitats where they are inconspicuous or 'non-charismatic'. This paper investigates the perceptions of a woodland area in rural western Scotland, designated for its high conservation value and characterised by habitats, rare species and species assemblages with limited appreciation by non-experts and no obvious 'utility' value. Based on interviews with residents and visitors as well as workshops with participants representing different types of local expertise, we show how people experience and perceive the benefits from such woodlands. Overall, our study participants emphasised values and ecosystem services that benefitted humans, strongly drawing on stories of cultural or historical land use to argue for more material opportunities to be created. For those participants without ecological expertise, the designated conservation value, albeit respected and accepted, remained vague and bland. Participants also articulated a strong underlying development logic, pushing in some way for 'more' to be made from the woodlands so that more people could receive benefits from the woodland either directly (e.g. mental restoration; increased use for recreation) or indirectly (e.g. through creating jobs in the local tourism industry). Our findings suggest that managing for conservation alone might cause challenges in acceptability, especially where the species and habitats conserved are of little obvious value to the non-specialist. At the same time, participants recognised that they valued the woodland being unique in some way, and that increasing the material use of the woods might harm the very essence of what made it special
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