'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

Impact of clinical history on fracture detection with radiography

The effect of knowledge of localizing symptoms and signs in the detection of fractures was studied. Forty radiographs of the extremities were examined twice by seven radiologists; the sessions were separated by 4 months. In 26 cases, a subtle fracture was present; 14 cases were normal. In half of the cases at each session, the precise location of pain, tenderness, or swelling was provided. The observer was asked to determine if the case was normal or abnormal (provide the exact location of the fracture) and to indicate the degree of confidence in the diagnosis. Responses were converted to a numeric scale for analysis. Analysis of receiver operator characteristic parameters indicates that clues regarding location of trauma facilitate detection of fractures. The improvement is based largely on an increased true-positive rate without an increased false-positive rate, regardless of the decision criteria of the radiologist (overall willingness to "overread" or "underread"). This has direct clinical applicability and reinforces the plea of radiologists for precise clinical information.     

Lymph node infarction – a rare complication associated with disseminated intra vascular coagulation in a case of dengue fever

Background  

Lymph node infarction is known to occur in association with many non-neoplastic and neoplastic conditions however its occurrence in association with DIC is not reported hitherto in the literature.     

Production of interleukin-1 and tumor necrosis factor by bone marrow-derived macrophages: effect of cisplatin and lipopolysaccharide

Mature macrophages derived in vitro from bone marrow progenitors under the influence of either L929 CM (a source of M-CSF) or GM-CSF have been shown to differ morphologically and functionally. Treatment of these bone marrow-derived macrophages with cisplatin or LPS resulted in the expression of enhanced tumoricidal activity and the production of significant amounts of extracellular and membrane-associated IL-1 and TNF. rGM-CSF-derived bone marrow macrophages produced higher amounts of TNF and IL-1 activity than L929CM-derived macrophages. Untreated bone marrow-derived macrophages showed little IL-1 and TNF activity. Bone marrow macrophages cultured with medium alone also did not respond to cisplatin or LPS for the production of IL-1 and TNF. Neutralization studies with anti-IL-1 and anti-TNF antibodies inhibited the IL-1 and TNF activity of bone marrow-derived macrophages. These results suggest that cisplatin or LPS treatment of murine bone marrow-derived macrophages results in increased expression of both released and membrane-associated IL-1 and TNF.     

Effect of TNF priming of murine peritoneal macrophages on their activation to a tumoricidal state

Murine peritoneal macrophages, on treatment with TNF (10 U/ml) for various durations, showed enhanced cyototoxicity against tumor target cells. The macrophage-mediated cytotoxicity was significantly enhanced when TNF-primed macrophages were treated with cisplatin, LPS, FK-565 or interferon-gamma for 24 h, compared to unprimed and treated macrophages. TNF-primed macrophages also showed enhanced expression of interleukin-1 and tumor necrosis factor activities on activation with different biological response modifiers.     

Acute coronary syndromes

The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or ‘primary’ percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.