Correlation between prescribing quality and pharmaceutical costs in English primary care: national cross-sectional analysis

Background Both pharmaceutical costs and quality-indicator performance vary substantially between general practices, but little is known about the relationship between prescribing costs and quality Aim To measure the association between prescribing quality and pharmaceutical costs among English general practices Design and setting Cross-sectional observational study using data from the Quality and Outcomes Framework and the Prescribing Analysis and Cost database from all 8409 general practices in England in 2005-2006 Method Correlation between practice achievement of 26 prescribing quality indicators in eight prescribing areas and related pharmaceutical costs was examined. Results There was no significant association between the overall achievement of quality indicators and related pharmaceutical costs (P= 0.399). Mean achievement of quality indicators across all eight prescribing areas was 79.0% (standard deviation 4.4%). There were small positive correlations in five prescribing areas: influenza vaccination, beta blockers, angiotensin converting enzyme inhibitors, lipid lowering, and antiplatelet treatment (all

Antero-posterior (AP) pelvis x-ray imaging on a trolley : impact of trolley design, mattress design and radiographer practice on image quality and radiation dose

Introduction: Physical and technical differences exist between imaging on an x-ray tabletop and imaging on a trolley. This study evaluates how trolley imaging impacts image quality and radiation dose for an antero-posterior (AP) pelvis projection whilst subsequently exploring means of optimising this imaging examination. Methods: An anthropomorphic pelvis phantom was imaged on a commercially available trolley under various conditions. Variables explored included two mattresses, two image receptor holder positions, three source to image distances (SIDs) and four mAs values. Image quality was evaluated using relative visual grading analysis with the reference image acquired on the x-ray tabletop. Contrast to noise ratio (CNR) was calculated. Effective dose was established using Monte Carlo simulation. Optimisation scores were derived as a figure of merit by dividing effective dose with visual image quality scores. Results: Visual image quality reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired on the trolley using identical acquisition parameters to the reference image. The trolley image with the highest optimisation score was acquired using 130 cm SID, 20 mAs, the standard mattress and platform not elevated. A difference of 12.8 mm was found between the image with the lowest and highest magnification factor (18%). Conclusion: The acquisition parameters used for AP pelvis on the x-ray tabletop are not transferable to trolley imaging and should be modified accordingly to compensate for the differences that exist. Exposure charts should be developed for trolley imaging to ensure optimal image quality at lowest possible dose

Telomere dysfunction accurately predicts clinical outcome in chronic lymphocytic leukaemia, even in patients with early stage disease

© 2014 John Wiley & Sons Ltd. Defining the prognosis of individual cancer sufferers remains a significant clinical challenge. Here we assessed the ability of high-resolution single telomere length analysis (STELA), combined with an experimentally derived definition of telomere dysfunction, to predict the clinical outcome of patients with chronic lymphocytic leukaemia (CLL). We defined the upper telomere length threshold at which telomere fusions occur and then used the mean of the telomere 'fusogenic' range as a prognostic tool. Patients with telomeres within the fusogenic range had a significantly shorter overall survival (P  <  0·0001; Hazard ratio [HR] = 13·2, 95% confidence interval [CI]  = 11·6-106·4) and this was preserved in early-stage disease patients (P  <  0·0001, HR=19·3, 95% CI = 17·8-802·5). Indeed, our assay allowed the accurate stratification of Binet stage A patients into those with indolent disease (91% survival at 10 years) and those with poor prognosis (13% survival at 10 years). Furthermore, patients with telomeres above the fusogenic mean showed superior prognosis regardless of their IGHV mutation status or cytogenetic risk group. In keeping with this finding, telomere dysfunction was the dominant variable in multivariate analysis. Taken together, this study provides compelling evidence for the use of high-resolution telomere length analysis coupled with a definition of telomere dysfunction in the prognostic assessment of CLL

Factors Influencing the Participation of Older People in Clinical Trials : Data Analysis from the MAVIS Trial

Peer reviewedPostprin

On pluralism, inclusion, and musical citizenship

In an age of international wealth insecurity, countries around the world are putting increasing pressure on public schools to prepare young people to compete in the new global marketplace. Using quantifiable measures as indictors of societal well-being, a kind of PISA panic has resulted, in which discourses of crisis have replaced long held beliefs about the purpose of education and public schooling. In this climate, we have forgotten the language we once used that linked education to values broader and richer than economic competitiveness alone. What if educators reconnected the idea of public schooling to citizenship and personal well-being? Music education is particularly well-suited to cultivate citizenship, defined in this article as a cooperative engagement between teachers and students, where sites of learning are communal, public-spirited, experimental, historically engaged, socially responsible, multicultural, and forward-looking. Using philosophical method to examine a notion of musical citizenship, the author shares a series of observations and analyses that link this call to conflicting facets of multicultural life in North America and Northern Europe. James Bank’s conception of multicultural education may serve as a guide to the difficult, painful, but mutually enriching process of reconnecting education, especially music education, to citizenship and the public good. Keywords: multicultural music education, citizenship, inclusion, democrac

Dissertation review: Johan Nyberg’s Music education as an adventure of knowledge.

Research note: Dissertation reviewHow does one generation of Swedish music teachers and students—inserted into this moment in time, and woven into the fabric of a particular context and its place—conceptualize the work they do? All research is animated by a hunch. And Nyberg’s hunch was that if we listened to teachers and students as they grapple with the problems of their day, we might be better poised to modify classroom spaces so that education may become a so-called ‘adventure of knowledge’. In three peer-reviewed studies, Nyberg asked a series of inter-related research questions, which I have paraphrase like this: (1) How do music students conceptualize music knowledge and learning? (2) Likewise, how do music teachers conceptualize music knowledge and learning? (3) How is the work of teaching and learning understood and experienced in an educational environment that is hostile to adventure and openness

On groups and initial segments in nonstandard models of Peano Arithmetic

This thesis concerns M-finite groups and a notion of discrete measure in models of Peano Arithmetic. First we look at a measure construction for arbitrary non-M-finite sets via suprema and infima of appropriate M-finite sets. The basic properties of the measures are covered, along with non-measurable sets and the use of end-extensions. Next we look at nonstandard finite permutations, introducing nonstandard symmetric and alternating groups. We show that the standard cut being strong is necessary and sufficient for coding of the cycle shape in the standard system to be equivalent to the cycle being contained within the external normal closure of the nonstandard symmetric group. Subsequently the normal subgroup structure of nonstandard symmetric and alternating groups is given as a result analogous to the result of Baer, Schreier and Ulam for infinite symmetric groups. The external structure of nonstandard cyclic groups of prime order is identified as that of infinite dimensional rational vector spaces and the normal subgroup structure of nonstandard projective special linear groups is given for models elementarily extending the standard model. Finally we discuss some applications of our measure to nonstandard finite groups