General practitioners’ management of the long-term sick role

In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees / patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons’s model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.

Awareness and knowledge of autism and autism interventions: A general population survey.

Recent figures show that Autism Spectrum Disorder (ASD) affects at least 1 in 88 of the population, yet for years, international public awareness of ASD was limited. Over the past 5-10 years intense efforts have been made to raise autism awareness in the general population in countries such as UK and US. In this paper we report data from a large-scale general population survey (n=1204) in which we assessed autism awareness, knowledge about autism, and perceptions about autism interventions in Northern Ireland. We found high levels of autism awareness, in fact over 80% of the sample were aware of ASD and over 60% of these respondents knew someone with ASD in their own family, circle of friends or work colleagues. Generally, knowledge of strengths and challenges faced by individuals with ASD was relatively accurate. However, perceptions of interventions and service provider responsibilities were vague and uncertain. Results show that local and international autism awareness campaigns have largely been successful and that the focus should shift towards disseminating accurate information regarding intervention and service provider responsibilities.

Lessons from 'The Wire': Epistemological Reflections on the Practice of Sociological Research

Recent debates and controversies have highlighted several issues surrounding sociological research, which relate to the general conditions under which it is undertaken and how this is changing. There is a pressing need to respond to these issues as a whole, in particular by examining what they tell us about research practices. This article argues that a consideration of themes raised by the American television drama The Wire is useful for facilitating such a response, since it may be read as a discussion of working conditions within neoliberal societies. The following themes are pertinent here: the need to reflect upon the terms by which research is framed by funders, to take adequate time to conduct and complete research, and to encourage critical debate within research. Whilst these relate to influential epistemological discussions by Pierre Bourdieu and Michael Burawoy, this reading of The Wire is particularly helpful for highlighting the practical and inter-relational situations in which sociological research is carried out but which tend not to receive the systematic attention they deserve.

Creating an Inclusive Society… How Close are We in Relation to Autism Spectrum Disorder? A General Population Survey

BackgroundChildren with autism spectrum disorder are increasingly educated in mainstream classrooms in the United Kingdom (Wilkinson & Twist, Autism and Educational Assessment: UK Policy and Practice. NFER, Slough, 2010), and some employers are now specifically seeking out staff on the autism spectrum. Does that mean that we are living in an inclusive society' [United Nations Department of Economic and Social Affairs (UNDESA), Creating an Inclusive Society: Practical Strategies to Promote Social Integration 2008], in the sense that inequalities are reduced and full economic, social and cultural participation is advanced for individuals with autism?

MethodsA general population survey was conducted to assess how close we, as a society, are to an inclusive society for individuals with autism in Northern Ireland. Public attitudes were examined to (i) visibility and social interaction, (ii) aetiology, needs and interventions, and (iii) rights and resources.

ResultsA stratified, representative sample of 1204 adults took part in the survey; of these, 989 were aware of autism and their attitudes and behavioural projections reflected a mix of acceptance and denunciation. The level of confusion with regard to interventions reflected the general uncertainty within UK policy regarding meeting the needs of individuals on the autism spectrum (International Journal of Disability, Development and Education 61, 134, 2014a).

ConclusionTherefore, it seems that inclusion is working to an extent, but more clarity is needed with regard to adequate education, intervention and support for individuals with autism.

Post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific survival: a nested case-control study in a breast cancer cohort from the UK Clinical Practice Research Datalink

INTRODUCTION: Recent observational studies indicate that post-diagnostic use of aspirin in breast cancer patients may protect against cancer progression perhaps by inhibiting cyclooxygenase-2 dependent mechanisms. Evidence also supports a crucial role for interactions between tumour cells and circulating platelets in cancer growth and dissemination, therefore, use of low-dose aspirin may reduce the risk of death from cancer in breast cancer patients.

METHODS: A cohort of newly diagnosed breast cancer patients (1998 to 2006) were identified in the UK Clinical Practice Research Datalink (and confirmed by cancer registry linkage). Cancer-specific deaths were identified up to 2011 from Office for National Statistics mortality data. A nested case-control analysis was conducted using conditional logistic regression to compare post-diagnostic aspirin exposure using General Practice prescription data in 1,435 cases (breast cancer deaths) with 5,697 controls (matched by age and year of diagnosis).

RESULTS: After breast cancer diagnosis, 18.3% of cancer-specific deaths and 18.5% of matched controls received at least one prescription for low-dose aspirin, corresponding to an odds ratio (OR) of 0.98 (95% CI 0.83, 1.15). Adjustment for potential confounders (including stage and grade) had little impact on this estimate. No dose response relationship was observed when the number of tablets was investigated and no associations were seen when analyses were stratified by receipt of prescriptions for aspirin in the pre-diagnostic period, by stage at diagnosis or by receipt of prescriptions for hormone therapy.

CONCLUSIONS: Overall, in this large population-based cohort of breast cancer patients, there was little evidence of an association between receipt of post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific death. However, information was not available on medication compliance or over-the-counter use of aspirin, which may have contributed to the null findings.

The distribution of COPD in UK general practice using the new GOLD classification

The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 document recommends a combined assessment of chronic obstructive pulmonary disease (COPD) based on current symptoms and future risk.

A large database of primary-care COPD patients across the UK was used to determine COPD distribution and characteristics according to the new GOLD classification. 80 general practices provided patients with a Read code diagnosis of COPD. Electronic and hand searches of patient medical records were undertaken, optimising data capture.

Data for 9219 COPD patients were collected. For the 6283 patients with both forced expiratory volume in 1 s (FEV1) and modified Medical Research Council scores (mean¡SD age 69.2¡10.6 years, body mass index 27.3¡6.2 kg?m-2), GOLD 2011 group distributions were: A (low risk and fewer symptoms) 36.1%, B (low risk and more symptoms) 19.1%, C (high risk and fewer symptoms) 19.6% and D (high risk and more symptoms) 25.3%. This is in contrast with GOLD 2007 stage classification: I (mild) 17.1%, II (moderate) 52.2%, III (severe) 25.5% and IV (very severe) 5.2%. 20% of patients with FEV1 o50% predicted had more than two exacerbations in the previous 12 months. 70% of patients with FEV1 ,50% pred had fewer than two exacerbations in the previous 12 months.

This database, representative of UK primary-care COPD patients, identified greater proportions of patients in the mildest and most severe categories upon comparing 2011 versus 2007 GOLD classifications. Discordance between airflow limitation severity and exacerbation risk was observed.

Up close and personal: A qualitative study exploring the lived experience of older carers. Mental Health and Learning Disabilities Research. 8 (1). Pp.15-29.

This study explored the experiences of informal carers who were aged 65 years and over. It has been estimated that 15 per cent of those aged 65 or over provide some form of informal care in England. Despite a growing literature on the involvement of older people in research, there is a paucity of literature on the involvement of older carers. In this study, older carers were identified via a General Practice (GP) register in one urban medical practice. Data was collected through a series of focus groups, which were transcribed and analysed using
thematic analysis. Every carer aged 55 or over and registered with the medical practice was invited to take part in the study. Four female carers and one male carer took part in the study (age range 65-83). Themes that emerged during data analysis included, 1) managing things in an emergency, 2) feeling valued because they took part in the research and 3) the day-to-day reality of living with social exclusion. GP registers provide a valuable tool for identifying older
carers who may otherwise be difficult to engage in research. However, persuading GPs to engage with qualitative research may be a challenge.

New SR drive with integrated charging capacity for plug-in hybrid electric vehicles (PHEVs)

Plug-in hybrid electric vehicles (PHEVs) provide much promise in reducing greenhouse gas emissions and, thus, are a focal point of research and development. Existing on-board charging capacity is effective but requires the use of several power conversion devices and power converters, which reduce reliability and cost efficiency. This paper presents a novel three-phase switched reluctance (SR) motor drive with integrated charging functions (including internal combustion engine and grid charging). The electrical energy flow within the drivetrain is controlled by a power electronic converter with less power switching devices and magnetic devices. It allows the desired energy conversion between the engine generator, the battery, and the SR motor under different operation modes. Battery-charging techniques are developed to operate under both motor-driving mode and standstill-charging mode. During the magnetization mode, the machine's phase windings are energized by the dc-link voltage. The power converter and the machine phase windings are controlled with a three-phase relay to enable the use of the ac-dc rectifier. The power converter can work as a buck-boost-type or a buck-type dc-dc converter for charging the battery. Simulation results in MATLAB/Simulink and experiments on a 3-kW SR motor validate the effectiveness of the proposed technologies, which may have significant economic implications and improve the PHEVs' market acceptance

General practitioners’ perceptions of the barriers and solutions to good quality palliative care in dementia

The general practitioner (GP) is in a pivotal position to initiate and adapt care for their patients living with dementia. This study aimed to elicit GPs' perceptions of the potential barriers and solutions to the provision of good-quality palliative care in dementia in their practices. A postal survey of GPs across Northern Ireland was conducted with open-ended items soliciting for barriers in their practices and possible solutions; 40.6% (138/340) were returned completed. Barriers to palliative care in dementia were perceived to be a dementia knowledge deficit for healthcare staff and the public, a resource shortfall within the GP practice and community, poor team coordination alongside inappropriate dementia care provision, and disagreements from and within families. These findings have significant implications for educators and clinicians as enhanced dementia education and training were highlighted as a strong agenda for GPs with the suggestions of dementia awareness programmes for the public.

Understanding Desistance from Sexual Offending: A Thematic Review of Research Findings

Although there is a substantial body of work on desistance from crime in general, comparatively little is known about desistance from sexual crime. The broad aim of this paper is to provide an overview of the research methodology and preliminary findings from a recent empirical study on desistance from sexual offending conducted by the authors. Such findings have potentially important implications for policy and practice concerning sex offender risk assessment, treatment and management.

Analysis of electric vehicle charging using the traditional generation expansion planning analysis tool WASP-IV

Electric vehicles (EV) are proposed as a measure to reduce greenhouse gas emissions in transport and support increased wind power penetration across modern power systems. Optimal benefits can only be achieved, if EVs are deployed effectively, so that the exhaust emissions are not substituted by additional emissions in the electricity sector, which can be implemented using Smart Grid controls. This research presents the results of an EV roll-out in the all island grid (AIG) in Ireland using the long term generation expansion planning model called the Wien Automatic System Planning IV (WASP-IV) tool to measure carbon dioxide emissions and changes in total energy. The model incorporates all generators and operational requirements while meeting environmental emissions, fuel availability and generator operational and maintenance constraints to optimize economic dispatch and unit commitment power dispatch. In the study three distinct scenarios are investigated base case, peak and off-peak charging to simulate the impacts of EV’s in the AIG up to 2025.

Investigation into the potential of using micro gas turbines in plug-in hybrid electric vehicles

The transport sector is considered to be one of the most dependent sectors on fossil fuels. Meeting ecological, social and economic demands throughout the sector has got increasingly important in recent times. A passenger vehicle with a more environmentally friendly propulsion system is the hybrid electric vehicle. Combining an internal combustion engine and an electric motor offers the potential to reduce carbon dioxide emissions. The overall objective of this research is to provide an appraisal of the use of a micro gas turbine as the range extender in a plug-in hybrid electric vehicle. In this application, the gas turbine can always operate at its most efficient operating point as its only requirement is to recharge the battery. For this reason, it is highly suitable for this purpose. Gas turbines offer many benefits over traditional internal combustion engines which are traditionally used in this application. They offer a high power-to-weight ratio, multi-fuel capability and relatively low emission levels due to continuous combustion.

Electric vehicle capacity forecasting model with application to load levelling

There are many uncertainties in forecasting the charging and discharging capacity required by electric vehicles (EVs) often as a consequence of stochastic usage and intermittent travel. In terms of large-scale EV integration in future power networks this paper develops a capacity forecasting model which considers eight particular uncertainties in three categories. Using the model, a typical application of EVs to load levelling is presented and exemplified using a UK 2020 case study. The results presented in this paper demonstrate that the proposed model is accurate for charge and discharge prediction and a feasible basis for steady-state analysis required for large-scale EV integration.