303 research outputs found
Rational and safe dosing of phenprocoumon during loading and maintenance phase
No full textPhenprocoumon is the second most commonly used oral anticoagulant worldwide
and the most common agent in many European countries including Switzerland.
Given its long half-life of about one week, an initial loading-dose is generally applied.
A high loading-dose is helpful to rapidly reach a therapeutic concentration but may be
associated with an increased risk of bleeding if the effect overshoots.
Phenprocoumon has a narrow therapeutic range, and individual dose requirements
are highly variable. In clinical practice the initial dose-finding process for
phenprocoumon is largely empiric and often delegated to inexperienced staff
members. Thus, both a prolonged loading phase and overshooting of anticoagulation
is commonly observed.
Question under study
The general aim of the thesis was to define one or more algorithms for the loading
phase of phenprocoumon-treatment. These algorithms should be easily applicable in
a clinical setting and help to improve the drug safety of phenprocoumon especially
during the initial dose-finding process.
Retrospective study
In a retrospective study, predictors of individual dosing needs for a target-INR of 2.0
to 3.0 in medical and orthopaedic inpatients were determined. Several significant
predictors of the loading dose could be identified. Using these predictors two simple
clinical algorithms for the initial dosing of phenprocoumon in medical and orthopedic
inpatients were developed. One algorithm contains clinical data and, additionally,
serum albumin; the second algorithm contains clinical data only.
Prospective study
The aim of the prospective, randomized interventional study was to validate the efficacy and
safety of the two previously proposed dosing algorithms for the initiation of oral
anticoagulation with phenprocoumon. Additionally, the predictive value of
pharmacogenetic markers was to be studied.
Both algorithms could be validated and were slightly optimized. They proved to be
very safe and effective in hospitalized patients with a high rate of comorbidity. The
algorithm using clinical data can be especially recommended due to its simplicity of
use
Prescribing errors in children
No full textPrescribing errors are a well-known safety concern in pediatric patients. The aim of this thesis was to
investigate factors related to patients, drugs, and the mode of prescription, that influenced the rate of
prescribing errors in a population of 1000 pediatric patients hospitalized on general medical and surgical
wards at the University Children's Hospital Zurich. The data were collected during two periods in 2018
and 2019. In total 5022 prescriptions were analyzed.
The prevalence of prescribing errors under different circumstances of prescribing (2299 pre-CPOE
prescriptions with semi-structured order forms or handwritten prescriptions versus 2723 post-CPOE
prescriptions as electronic prescriptions with limited clinical decision support (CDS)), was investigated
in different age groups and different types of drugs. Additionally, the types of errors that occurred and
the severity of harm potentially caused by these errors were revealed. Furthermore, associations of
errors withs specific drug types or patients were investigated, with a particular emphasis on unlicensed
drugs.
In the first study Prescribing errors in children – what is the influence of a computerized physician order
entry (CPOE)? the influence of the prescribing mode was investigated. The prescriptions of 500 patients
before (2018) and after (2019) introduction of a CPOE were analyzed and prescribing errors assessed.
It was found that the post-CPOE prescriptions overall contained significantly fewer prescribing errors
(25 errors / 100 prescriptions) than pre-CPOE prescriptions (78 errors / 100 prescriptions) (p < 0.001).
Errors that actually could have led to patient harm with a severity rated as “temporary harm possible” to
“death” (further referred to as potentially harmful errors: PHE), were also reduced from 18 errors / 100
prescriptions pre-CPOE to 11 errors / 100 prescriptions post-CPOE (p < 0.001). The errors that occurred
most frequently in the pre-CPOE period were errors due to missing information. These errors were of
minor severity and were strongly decreased post-CPOE, where dosing errors were the most frequent
type of error. A statistically significant increase in medication reconciliation errors was observed after
CPOE introduction due to remaining hybrid prescriptions in certain cases. Overall, the CPOE had a
positive impact on patient safety.
In Prescribing patterns in pediatric general wards and their association with prescribing errors, the
second study, a sub-analysis of the first study was conducted in which prescribing patterns in the post-
CPOE population were revealed. Newborns were excluded from the study due to small sample size,
leading to a remaining population of 489 patients with 2693 prescriptions. Drugs for the nervous system,
drugs for the alimentary system and anti-infective drugs were the most frequently prescribed drug
classes, with paracetamol, metamizole and ibuprofen being the most frequently prescribed active
substances. Patient characteristics like age and gender as well as drug use were associated with
prescribing errors. Children between 2 and 11 years experienced higher error rates than infants under
2 years of age: 12.2 potentially harmful errors (PHE) / 100 prescriptions, vs. 8.5 PHE / 100 prescriptions
(p = 0.026). A statistically significant difference was also found for female patients as compared to male
patients, with the female patients having higher rates of PHE than the male (25.6 errors or 12.1 PHE /
100 prescriptions vs. 24.7 errors or 9.3 PHE / 100 prescriptions) (p = 0.035 for PHE), even though there
was no difference in the overall error rates. This finding needs further investigation.
The third study, Use of unlicensed drugs in a Swiss Pediatric University Hospital and associated
prescribing error rates, another sub-analysis of the first study laid a focus on unlicensed drugs in the
population of 1000 patients (pre- and post-CPOE), which accounted for a proportion of 10.8% of all
prescriptions. 34% of patients were prescribed at least one unlicensed drug. Oral liquid forms were the
most frequently prescribed drug form in unlicensed drugs. In the post-CPOE population unlicensed
drugs were more prone to prescribing errors than licensed drugs (32 errors / 100 prescriptions vs.
24 errors / 100 prescriptions, p = 0.024). Particularly extemporaneously prepared drugs had high error
rates of 36.4 errors / 100 prescriptions. Therefore, licensed drugs are favorable in terms of medication
safety.
Overall, this thesis highlights various aspects of prescribing errors in children and illustrates, that
pediatric patients are still at a high risk of experiencing a prescribing error. Ongoing efforts are necessary
to improve medication safety. These include electronic solutions like CPOE and CDS, multifaceted
approaches on healthcare professional and organizational level as well as support from the
pharmaceutical industry by licensing more suitable formulations for pediatric patients
Il tempo perduto delle donne nei racconti di Adriana Bittel: Cum încărunţeste o blondă, Soi bun, Departe-n zare, spre Azuga
No full textIl contributo comprende la prima traduzione in italiano di tre racconti della scrittrice rumena Adriana Bittel, e un saggio sulle strategie narrative messe in atto da Bittel per descrivere lo spazio della socialità femminile nella Romania del periodo precedente al 1989The contribution consists of the translation into Italian of three short stories authored by the Romanian woman writer Adriana Bittel, entitled respectively, "How a Blond turns white", "Good Quality", “Far away in the horizon, towards Azuga”. Angela Tarantino, the author of the translation, adds to her work a presentation of Adriana Bittel and the narrative strategies used to describe the space of the women's sociality in Romania during the years previous to 198
Food and eating in fiction since 1950 with particular reference to the writing of Angela Carter, Doris Lessing, Michele Roberts and Alice Thomas Ellis.
No full textPhDEating is a fundamental activity. What people eat, how and with whom, what
they feel about food, what they do or do not want to eat and why - even who
they eat - are of crucial significance in any reading of human behaviour.
In this thesis, I consider the diverse and complex uses of food and eating
in fiction since 1950, especially that written by women. I argue both that food
and eating carry much of the meaning of a novel or story and that the acts of
cooking, feeding and eating depicted are inseparable from issues of power and
control: individually, interpersonally, culturally, politically.
My discussion centres on the writing of Angela Carter, Doris Lessing,
Michele Roberts and Alice Thomas Ellis. Drawing on psychoanalytic theory,
sociology, anthropology, Foucault, Bakhtin and others, the thesis aims to
construct an interdisciplinary perspective which both resists reductive
interpretations and emphasises the centrality, complexity and diversity of food
and eating in literature in our culture.
I begin with an examination of the ambiguities of maternal feeding and
nurturing, moving on to explore the links between appetite, eating and sexuality.
I explore cannibalism and vampirism as manifestations of oppression, but also as
indicating insatiable emptiness and transgressive appetite. The body itself is
crucial, and my argument considers the paradox of not eating as
control/enslavement, also tracing self-starvation as a positive route towards
wholeness and connection. The last part of my argument focuses on social
eating, examining conventions, rituals and food itself in connection with power
relations, and finally considers how we might truly speak of food and eating in
the context of society as a whole
Randomised trial of a clinical dosing algorithm to start anticoagulation with phenprocoumon
No full textProspective validation of two algorithms for the initiation of phenprocoumon treatment
American public journalism versus other international media models
No full textChapter 2 of 'International Journalism and Democracy' provides examples of what the author dubs "deliberative journalism". Following a definition of deliberative journalism in Chapter 1, the book's second chapter examines major models of deliberative journalism that are in operation around the world. These models include public journalism, citizen journalism, community and alternative media, development journalism and peace journalism. \ud
\ud
The author argues that when these new forms of journalism are practiced well, they extend people's ability to identify, express, understand and respond to politics and issues affecting their communities. However, the main models of deliberative journalism all have contentious elements. Many deliberative journalism practioners have been subjected to criticism for lack of objectivity and poor professional standards. Many of their activities have clearly been ill-conceived. The author also finds that neither professional nor citizen journalists have a strong understanding of what constitutes "good practice" in deliberative journalism. Furthermore, there is much debate as to whether the type of "citizen journalism" that is posted intermittently on Facebook, Twitter, blogs and other social media can even be defined as "journalism". The practice of deliberative journalism can potentially contribute to public deliberation, but it does not always do so in any immediate or obvious way. The author finds that even so, deliberative journalism indirectly strengthens the environments that support fertile deliberation and decision making. (See the Extended Abstract for further details.
How to be a woman. Models of masochism and sacrifice in young adult fiction
No full textBuffy, Bella, Veronica, Katniss, Clary, Tris and Saba : For two decades post-feminist heroines have faced life-threatening trials as part of their progress to womanhood. In this chapter I consider how young adult popular fictions operate as forms of pedagogy for young women by offering them particular models of maturity and womanhood. I explore the recurrence and reformulation of a persistent pattern of behaviour in which heroines engage in risky and/or masochistic behaviours for which they are emotionally rewarded.. These recurrences function as a form of vicarious experiential learning in which readers and viewers learn that emotional gratification and adult status are conferred through self-harm and self-sacrifice. Popular culture is not a monolithic form and young adult fictions are no exception. An analysis of fictional examples of this behaviour pattern challenges the idea that heroines today are empowered agents as a result of the legacy of feminism. At the same time, the analysis belies any notion that fictions are universally hegemonic and oppressive – fictions can and do disrupt and interrogate this pattern of emotional masochism. Scholars of public pedagogy have explored the complexities, contradictions and subtleties of the pedagogical process. Sandlin O’Malley and Burdick (2011) in their review of public pedagogy literature acknowledge that some scholarship has demonstrated how “the teaching and learning inherent within daily life can be both oppressive and resistant” (p. 144). Jubas and Knutson (2012) also see public pedagogy as an arena where contradictions and tensions are in play. They argue that we can see “New examples of dialectic or tensions … between the authority of the producer and the consumer; between traditional structures which ground identities and help people make sense of cultural texts, and personal agency which frees people to choose and invent identities and meanings” (p. 86). This analysis aims to contribute to understandings of the complexities of public pedagogy by showing how fictions aimed primarily at young women both resist and accommodate patriarchy
Use of unlicensed drugs in a Swiss Pediatric University Hospital and associated prescribing error rates – a retrospective observational study
No full textAIMS OF THE STUDY: Unlicensed drugs are frequently used in paediatric care. To what extent they are prescribed in hospital care in Switzerland is unclear. Because prescribing errors seem to occur more frequently with unlicensed drugs, we aimed to assess the prevalence of unlicensed drug prescriptions in two study periods (2018 and 2019) at the University Children’s Hospital Zurich, compare these periods and investigate whether unlicensed drugs were more prone to prescribing errors than licensed drugs.
METHODS: We conducted a sub-analysis of a retrospective single-centre observational study and analysed 5,022 prescriptions for a total of 1,000 patients from 2018 and 2019 in paediatric general wards. The rate of unlicensed drugs, consisting of imported or formula drugs, was investigated. The prescriptions from 2019 were further analysed on prescribing errors to see whether errors occurred more often in unlicensed or licensed drug use.
RESULTS: Of all prescriptions, 10.8% were unlicensed drugs, with around half each being imported and formula drugs. Among all patients, 34% were prescribed at least one unlicensed drug. Younger paediatric patients were prescribed more unlicensed drugs than older paediatric patients (newborns: 15.8% of prescriptions, infants: 13.4%, children: 10.6%, adolescents: 7.1%). Ibuprofen suppositories, midazolam oral solution and gentamicin i.v. solution were the most frequently prescribed imported drugs. Macrogol powder, lisinopril oral suspension and potassium chloride i.v. solution were the most frequently prescribed formula drugs. The most common drug forms in unlicensed use were oral liquid forms and i.v. solutions. Unlicensed drugs had a significantly higher rate of prescribing errors than licensed drugs (31.6 errors per 100 prescriptions [95% CI: 26.1–37.0] versus 24.3 errors per 100 prescriptions [95% CI: 22.3–26.2], p = 0.024). In particular, formula drugs carried a higher risk (36.4 errors per 100 prescriptions, p = 0.012).
CONCLUSIONS: Unlicensed drugs are frequently prescribed in this paediatric hospital setting in Switzerland. Around every tenth prescription is an unlicensed drug. Because unlicensed drugs showed a significantly higher rate of prescribing errors, licensed drugs are favourable in terms of medication safety and should be prescribed whenever possible. If no licensed drug is available, imported drugs should be favoured over formula drugs due to lower prescribing error rates. To increase medication safety in paediatrics in Switzerland, efforts are necessary to increase the number of suitable licensed drug formulations for paediatric patients, including developing new innovative drug formulations for children
Torque Vectoring Control on Ice for Electric Vehicles with Individually Actuated Wheels
No full textRecent studies on torque vectoring control for electric vehicles proposed various efficient solutions demonstrating improvement of vehicle stability for evasive manoeuvres. However, the torque vectoring on very low friction surfaces such as black ice or wet snow is rarely investigated, especially for the electric vehicles with off-road capability. The presented study contributes to this topic by laying the groundwork for further advanced torque vectoring designs. Within the framework of this paper, the target vehicle is a sport utility vehicle equipped with four on-board electric motors controlling each wheel separately. The functionality of the developed controllers is tested under hardware-in-the-loop simulations for icy road conditions. For this purpose, the tyre model has been parameterized and validated based on the experimental data conducted on a unique terramechanics test rig at Virginia Polytechnic Institute and State University. The test results confirm very good functionality of the developed controllers and demonstrate an improvement of the electric vehicle driving performance.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Intelligent Vehicle
The Uses of Cultural Studies
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The Uses of Cultural Studies
A Textbook
Angela McRobbie Goldsmiths College, University of London
© 2005 224 pages SAGE Publications Ltd
Lecturers
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Paperback ISBN: 9781412908450 £27.99
Hardcover ISBN: 9781412908443 £82.00
Ebook ISBN: 9781848605176
Other Titles in: Cultural Studies | Communication & Media Studies
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'What McRobbie manages to do so skilfully is to show how each [author], regardless of his or her particular disciplinary location, makes a significant contribution to the project of cultural studies. It should be essential reading for students studying culture' - THES
'I'll be recommending that students buy this text and teaching from it extensively over the course of the module. This is an excellent text by a concise, clear and important British scholar which will help introduce students to the opportuntities they have to study contemporary life meaningfully.' - Dr Stuart Robertson, University of Central England
'An inspirational take on cultural studies - past, present and future. It is both a student text and considerably more than that. It is written with admirable clarity, but so too with fire, passion and much good sense' - Bill Schwarz, Queen Mary, University of London
'This is an important book. It will be the first textbook in cultural studies that does what a truly useful textbook is supposed to do - in the very act of summarizing and representing the field, it recreates it anew and moves it further along' - Lawrence Grossberg, University of North Carolina at Chapel Hill
'This is one of the most useful textbooks in a long time' - Michele Barrett, Queen Mary, University of London
Students of cultural studies frequently struggle with the subject's primary texts. For example, the work of Hall, Bhabha and Butler can be complex. Having grappled with these texts however, the student is then confronted with having to apply these insights to their own areas of study.
The heart of this book comprises a series of extended critical chapters on six of the foundational theorists of cultural studies - Hall, Bhabha, Butler, Gilroy, Bourdieu and Jameson. By looking at the key themes and central dynamics of these writers work, Angela McRobbie introduces their work and their contribution.
Alongside these chapters, McRobbie has added six shorter essays which demonstrate how one might actually do cultural studies using insights from these six key theorists.
Aimed at students of cultural studies this book offers an introduction to both the theory and practice of cultural studies. It also provides readers with an opportunity to regard Angela McRobbie 'in dialogue' with six of today's leading cultural studies theorists. As such it will be eagerly welcomed by all students of media and cultural theory
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