The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective: We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method: This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures: The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results: Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions: Participants indicated a willingness to be?involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial

Objective: To explore the difficulties experienced by lay-workers, women and health professionals involved in a peer-mentoring programme for first-time mothers living in socially disadvantaged areas. Design: Qualitative study; semi-structured interviews with lay-worker peer-mentoring programme participants at two separate stages of the programme (antenatal and postnatal). Setting: Community based. Participants: 11 women receiving peer-mentoring support (from first hospital antenatal visit to one year postnatal); 11 lay-workers; 2 research midwives. Results: Lay-workers had difficulty initiating contact with women and failure to establish contact affected their morale adversely. They felt that women understood their intended role poorly and attempted to develop relationships with them by sharing personal experiences and offering friendship; women who participated in the programme appreciated this. Developing a peer-mentor relationship was difficult if women lacked interest in the programme or in continuing contact. External influences on peer-mentoring uptake and delivery included family and friends who could prevent or encourage women’s participation and cause difficulties for the lay-worker both in delivering support and arranging follow-up. Lay-workers providing support to women from a different ethnic background experienced difficulties relating to both language and culture: these were perceived to affect peer-mentor relationships adversely. Major personal difficulties for lay-workers related to time constraints in reconciling mentoring requirements with demands of family and other work. Informing midwives of these difficulties helped identify solutions through training and ongoing professional support for the lay-workers. Conclusions: Lay-worker peer support is appreciated by first time mothers but difficulties in initiating contact, developing peer-mentor relationships and external influences such as family, ethnicity and time constraints are relevant to poor uptake and high staff turnover. In developing peer support programmes, awareness of potential difficulties and of how professional support can help resolve these should improve uptake and thus optimise the evaluations of their effectiveness.

Laser-Driven Proton Beams: Acceleration Mechanism, Beam Optimization, and Radiographic Applications

This paper reviews recent experimental activity in the area of optimization, control, and application of laser accelerated proton beams, carried out at the Rutherford Appleton Laboratory and the Laboratoire pour l’Utilisation des Lasers Intenses 100 TW facility in France. In particular, experiments have investigated the role of the scale length at the rear of the plasma in reducing target-normal-sheath-acceleration acceleration efficiency. Results match with recent theoretical predictions and provide information in view of the feasibility of proton fast-ignition applications. Experiments aiming to control the divergence of the proton beams have investigated the use of a laser-triggered microlens, which employs laser-driven transient electric fields in cylindrical geometry, enabling to focus the emitted
protons and select monochromatic beam lets out of the broad spectrum beam. This approach could be advantageous in view
of a variety of applications. The use of laser-driven protons as a particle probe for transient field detection has been developed and
applied to a number of experimental conditions. Recent work in this area has focused on the detection of large-scale self-generated magnetic fields in laser-produced plasmas and the investigation of fields associated to the propagation of relativistic electron both on the surface and in the bulk of targets irradiated by high-power laser pulses.

2-D R-matrix propagation: A large scale electron scattering simulation dominated by the multiplication of dynamically changing matrices

We examine the computational aspects of propagating a global R-matrix, R, across sub-regions in a 2-D plane. This problem originates in the large scale simulation of electron collisions with atoms and ions at intermediate energies. The propagation is dominated by matrix multiplications which are complicated because of the dynamic nature of R, which changes the designations of its rows and columns and grows in size as the propagation proceeds. The use of PBLAS to solve this problem on distributed memory HPC machines is the main focus of the paper.

Comparison of Image Transform-Based Features for Visual Speech Recognition in Clean and Corrupted Videos

We present results of a study into the performance of a variety of different image transform-based feature types for speaker-independent visual speech recognition of isolated digits. This includes the first reported use of features extracted using a discrete curvelet transform. The study will show a comparison of some methods for selecting features of each feature type and show the relative benefits of both static and dynamic visual features. The performance of the features will be tested on both clean video data and also video data corrupted in a variety of ways to assess each feature type's robustness to potential real-world conditions. One of the test conditions involves a novel form of video corruption we call jitter which simulates camera and/or head movement during recording.