Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study

Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. Design: Qualitative study using focus groups and indepth interviews. Setting: Primary care in Northern Ireland. Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. Main outcome measures: Participants' views about their own and colleagues' health. Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

Multi-state CDW approximation to electron capture during slow p-H collisions

The first complete multi-state CDW close coupling calculations which use a fully normalized basis set are performed. The results obtained at impact energies in the region of 10 keV for total and n = 2 capture cross sections are in reasonably good accord with experiment despite the fact that only the ground states of both species and the n = 2 states of the projectile are incorporated into the model. The theory has significant advantages over other atomic and molecular expansions which may require extensive bases to obtain similar accuracy.

A study of HPV 1, 2 and 4 antibody prevalence in patients presenting for treatment with cutaneous warts to general practitioners in N. Ireland

Three hundred and seventy-six patients attending their general practitioner with cutaneous warts at five health centres in Northern Ireland were screened for human papilloma virus (HPV) types 1 and 2 IgM antibody using an indirect immunofluorescence test. Eight-eight (23.4%) patients were positive for HPV type 1 IgM and 156 (41.5%) for HPV type 2 IgM. HPV 1 IgM antibody was significantly more likely to be associated with plantar warts than warts elsewhere (P less than 0.0001). HPV 2 IgM was present in 45 (34.1%) patients with plantar warts and 99 (45.6%) patients with warts at other sites (P = 0.1). Evidence of multiple infection by HPV types 1 and 2 was demonstrated by the finding of HPV 1 and 2 IgM antibodies in the sera of 16 (4.3%). HPV 4 was found in only 1 out of 30 biopsies and HPV 4 IgM was undetectable in 50 randomly chosen sera.

Respecting and fulfilling the right of post-primary pupils to consent to participate in trials and evaluative research: A discussion paper

This paper provides an introduction to issues surrounding the participation rights of young people in research and the implications of their growing involvement in research as well as providing a discourse on the ethical implications related to consent. The unique contribution of this paper is that it considers children’s rights in respect to the increasing opportunities for young people to take part in evaluation research. The aim of this paper, therefore, is to acknowledge the growing involvement for young people in research and the implications of ensuring that their rights of participation are respected. Secondly we will consider the children’s rights legislation and our obligations as researchers to implement this. Finally we will explore consent as an issue in its own right as well as the practicalities of accessing participants. This paper will postulate that any research about young people should involve and prioritise at all stages of the research process; including participation in decision-making. We conclude by identifying five key principles, which we believe can help to facilitate the fulfilment of post-primary pupils’ ability to consent to participate in trials and evaluative research.

Many ways to say 'no', different ways to say 'yes': Applying Q-Methodology to understand public acceptance of wind farm proposals

This paper explores the nature of public acceptance of wind farms by investigating the discourses of support and objection to a proposed offshore scheme. It reviews research into opposition to wind farms, noting previous criticisms that this has tended to provide descriptive rather than explanatory insights and as a result, has not effectively informed the policy debate. One explanation is that much of this research has been conceived within an unreflective positivist research frame, which is inadequate in dealing with the subjectivity and value-basis of public acceptance of wind farm development. The paper then takes a case study of an offshore wind farm proposal in Northern Ireland and applies Q-Methodology to identify the dominant discourse of support and objection. It is argued that this provides new insights into the nature of wind farm conflicts, points to a number or recommendations for policy functions of an example of how this methodology can act as a potential bridge between positivist and post-positivist approaches to policy analysis.

Introduction to Domain-Driven Data Mining Special Section

In the last decade, data mining has emerged as one of the most dynamic and lively areas in information technology. Although many algorithms and techniques for data mining have been proposed, they either focus on domain independent techniques or on very specific domain problems. A general requirement in bridging the gap between academia and business is to cater to general domain-related issues surrounding real-life applications, such as constraints, organizational factors, domain expert knowledge, domain adaption, and operational knowledge. Unfortunately, these either have not been addressed, or have not been sufficiently addressed, in current data mining research and development.Domain-Driven Data Mining (D3M) aims to develop general principles, methodologies, and techniques for modeling and merging comprehensive domain-related factors and synthesized ubiquitous intelligence surrounding problem domains with the data mining process, and discovering knowledge to support business decision-making. This paper aims to report original, cutting-edge, and state-of-the-art progress in D3M. It covers theoretical and applied contributions aiming to: 1) propose next-generation data mining frameworks and processes for actionable knowledge discovery, 2) investigate effective (automated, human and machine-centered and/or human-machined-co-operated) principles and approaches for acquiring, representing, modelling, and engaging ubiquitous intelligence in real-world data mining, and 3) develop workable and operational systems balancing technical significance and applications concerns, and converting and delivering actionable knowledge into operational applications rules to seamlessly engage application processes and systems.

Modelling the mechanical response of the reed-mouthpiece-lip system of a clarinet. Part II: A lumped model approximation

A non-linear lumped model of the reed-mouthpiece-lip system of a clarinet is formulated, in which the lumped parameters are derived from numerical experiments with a finite-difference simulation based on a distributed reed model. The effective stiffness per unit area is formulated as a function of the pressure signal driving the reed, in order to simulate the effects of the reed bending against the lay, and mass and damping terms are added as a first approximation to the dynamic behaviour of the reed. A discrete-time formulation is presented, and its response is compared to that of the distributed model. In addition, the lumped model is applied in the simulation of clarinet tones, enabling the analysis of the effects of using a pressure-dependent stiffness per unit area on sustained oscillations. The analysed effects and features are in qualitative agreement with players' experiences and experimental results obtained in prior studies.

Folate and vitamin B-12: friendly or enemy nutrients for the elderly

In the UK vitamin B-12, deficiency occurs in approximately 20% of adults aged >65 years. This incidence is significantly higher than that among the general population. The reported incidence invariably depends on the criteria of deficiency used, and in fact estimates rise to 24% and 46% among free-living and institutionalised elderly respectively when methylmalonic acid is used as a marker of vitamin B-12 status. The incidence of, and the criteria for diagnosis of, deficiency have drawn much attention recently in the wake of the implementation of folic acid fortification of flour in the USA. This fortification strategy has proved to be extremely successful in increasing folic acid intakes pre-conceptually and thereby reducing the incidence of neural-tube defects among babies born in the USA since 1998. However, in successfully delivering additional folic acid to pregnant women fortification also increases the consumption of folic acid of everyone who consumes products containing flour, including the elderly. It is argued that consuming additional folic acid (as 'synthetic' pteroylglutamic acid) from fortified foods increases the risk of 'masking' megaloblastic anaemia caused by vitamin B-12 deficiency. Thus, a number of issues arise for discussion. Are clinicians forced to rely on megaloblastic anaemia as the only sign of possible vitamin B-12 deficiency? Is serum vitamin B-12 alone adequate to confirm vitamin B-12 deficiency or should other diagnostic markers be used routinely in clinical practice? Is the level of intake of folic acid among the elderly (post-fortification) likely to be so high as to cure or 'mask' the anaemia associated with vitamin B-12 deficiency?.