Background. There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, ...adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Methods. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. Results. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of "noninterference' in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a "prescribing etiquette," which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. Conclusions. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.
The Oxford WebQ is an online 24-hour dietary questionnaire that is appropriate for repeated administration in large-scale prospective studies, including the UK Biobank study and the Million Women ...Study. We compared the performance of the Oxford WebQ and a traditional interviewer-administered multiple-pass 24-hour dietary recall against biomarkers for protein, potassium, and total sugar intake and total energy expenditure estimated by accelerometry. We recruited 160 participants in London, United Kingdom, between 2014 and 2016 and measured their biomarker levels at 3 nonconsecutive time points. The measurement error model simultaneously compared all 3 methods. Attenuation factors for protein, potassium, total sugar, and total energy intakes estimated as the mean of 2 applications of the Oxford WebQ were 0.37, 0.42, 0.45, and 0.31, respectively, with performance improving incrementally for the mean of more measures. Correlation between the mean value from 2 Oxford WebQs and estimated true intakes, reflecting attenuation when intake is categorized or ranked, was 0.47, 0.39, 0.40, and 0.38, respectively, also improving with repeated administration. These correlations were similar to those of the more administratively burdensome interviewer-based recall. Using objective biomarkers as the standard, the Oxford WebQ performs well across key nutrients in comparison with more administratively burdensome interviewer-based 24-hour recalls. Attenuation improves when the average value is taken over repeated administrations, reducing measurement error bias in assessment of diet-disease associations.
This book, Chiang Yee and His Circle: Chinese Artistic and Intellectual Life in Britain, 1930–1950, celebrates the life and work of Chiang Yee (1903–1977), a Chinese writer, poet, and painter who ...made his home in London, England during the 1930s and 1940s. It examines Chiang’s relationship with his circle of friends and colleagues in the English capital, and assesses the work he produced during his sojourn there. This edited volume, with contributions from eleven distinguished scholars, tells a story of a Chinese intellectual community in London that up to now has been largely overlooked. It portrays a dynamic picture of the London-based émigré life during the years that led up to the war and during the conflict that was the catalyst for many of them moving on. In addition, the book broadens our understanding of cultural interactions between China and the West in Hampstead, one of the most vibrant artistic communities in London.
Abstract E-waste generation has broadly increased worldwide and is called intense pressure on sustainable practice implementation firms by recycling and redesigning the products. Thus, e-waste ...operation management in developed countries like the UK has become the top priority and is subjected to multiple sustainable circular economies (CE) contributing factors, including social, technical, environmental, and governmental policies. The authorized decision-makers can benefit from a well-established systematic decision-making tool to assess and evaluate the e-waste operation management considering the potential CE contributing factors. An extensive literature overview is expanded to identify the most relevant and influential contributing factors to e-waste CE. The city of London Metropolitan has been selected as the case location. In this regard, it is necessary to utilize an advanced multi-criteria decision-making tool to explore the interdependency and causality of CE-relevant factors. The present study proposed an innovative decision-making approach to address the multiple contributing factors of causality, interdependency, data, and model uncertainty in practice. It uses the step-wise weighted influence nonlinear gauge system method integrated with Fermatean fuzzy linguistic sets. This study conducted a sensitivity analysis to evaluate the effectiveness of the proposed decision-making approach in e-waste operation management. The results are promising, clearly demonstrating the framework’s competence. The CE index, crucial in designing e-waste operation management strategies, was calculated to be 2.8036. Among the various factors analyzed, “ Environmental Management Systems ” emerged as the most significant driving factor. This underscores the critical need to improve environmental management systems within e-waste operations.
In much public discourse on immigrants in Western Europe, perceptions towards newcomers are discussed in relation to what white national majorities think. However, today, new migrants often move into ...places which are already settled by previous migrants. This article investigates the local experiences, perceptions, and attitudes towards newcomers among long‐established ethnic minorities in an area which they have made their home, and where they predominate not just in numbers but also by way of shops, religious sites, school population, and so on. Based on ethnographic fieldwork in East London (UK), it looks at long‐established ethnic minority residents’ attitudes towards newcomers from Eastern Europe, and how these are shaped by their own histories of exclusion. By bringing together theories on symbolic boundary making with the concept of “convivial labor,” it shows how experiences of stigmatization impact on perceptions of white newcomers, and how these perceptions are characterized by a combination of empathy and resentment.
Road traffic noise has been associated with hypertension but evidence for the long-term effects on hospital admissions and mortality is limited. We examined the effects of long-term exposure to road ...traffic noise on hospital admissions and mortality in the general population.
The study population consisted of 8.6 million inhabitants of London, one of Europe's largest cities. We assessed small-area-level associations of day- (7:00-22:59) and nighttime (23:00-06:59) road traffic noise with cardiovascular hospital admissions and all-cause and cardiovascular mortality in all adults (≥25 years) and elderly (≥75 years) through Poisson regression models. We adjusted models for age, sex, area-level socioeconomic deprivation, ethnicity, smoking, air pollution, and neighbourhood spatial structure. Median daytime exposure to road traffic noise was 55.6 dB. Daytime road traffic noise increased the risk of hospital admission for stroke with relative risk (RR) 1.05 95% confidence interval (CI): 1.02-1.09 in adults, and 1.09 (95% CI: 1.04-1.14) in the elderly in areas >60 vs. <55 dB. Nighttime noise was associated with stroke admissions only among the elderly. Daytime noise was significantly associated with all-cause mortality in adults RR 1.04 (95% CI: 1.00-1.07) in areas >60 vs. <55 dB. Positive but non-significant associations were seen with mortality for cardiovascular and ischaemic heart disease, and stroke. Results were similar for the elderly.
Long-term exposure to road traffic noise was associated with small increased risks of all-cause mortality and cardiovascular mortality and morbidity in the general population, particularly for stroke in the elderly.
A Good Death Cullen, Lesley; Young, Michael
1996, 20050628, 2005-06-28, 19960101
eBook
A Good Death is based on a survey in East London and provides a wide range of fascinating and helpful insights into all aspects of experiencing death and surviving grief. The voices in the book are ...those of people who have managed to cope despite being under the shadow of impending death. Their experience could be a comfort to anybody in a similar situation. A Good Death is intended for people who are dying, for their lay and professional carers and for student doctors, nurses and social workers.
Geology of London, UK Royse, Katherine R.; de Freitas, Mike; Burgess, William G. ...
Proceedings of the Geologists' Association,
January 2012, 2012-01-00, Letnik:
123, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The population of London is around 7 million. The infrastructure to support this makes London one of the most intensively investigated areas of upper crust. However construction work in London ...continues to reveal the presence of unexpected ground conditions. These have been discovered in isolation and often recorded with no further work to explain them. There is a scientific, industrial and commercial need to refine the geological framework for London and its surrounding area. This paper reviews the geological setting of London as it is understood at present, and outlines the issues that current research is attempting to resolve.
Tasks that demand externalized attention reliably suppress default network activity while activating the dorsal attention network. These networks have an intrinsic competitive relationship; ...activation of one suppresses activity of the other. Consequently, many assume that default network activity is suppressed during goal-directed cognition. We challenge this assumption in an fMRI study of planning. Recent studies link default network activity with internally focused cognition, such as imagining personal future events, suggesting a role in autobiographical planning. However, it is unclear how goal-directed cognition with an internal focus is mediated by these opposing networks. A third anatomically interposed ‘frontoparietal control network’ might mediate planning across domains, flexibly coupling with either the default or dorsal attention network in support of internally versus externally focused goal-directed cognition, respectively. We tested this hypothesis by analyzing brain activity during autobiographical versus visuospatial planning. Autobiographical planning engaged the default network, whereas visuospatial planning engaged the dorsal attention network, consistent with the anti-correlated domains of internalized and externalized cognition. Critically, both planning tasks engaged the frontoparietal control network. Task-related activation of these three networks was anatomically consistent with independently defined resting-state functional connectivity MRI maps. Task-related functional connectivity analyses demonstrate that the default network can be involved in goal-directed cognition when its activity is coupled with the frontoparietal control network. Additionally, the frontoparietal control network may flexibly couple with the default and dorsal attention networks according to task domain, serving as a cortical mediator linking the two networks in support of goal-directed cognitive processes.
►Spatiotemporal PLS and rsfcMRI analysis identified distributed brain networks.►The default mode network was engaged during goal-directed behavior.►Default activity was co-active, and coupled, with the frontoparietal control network.
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