Analgesics:a comparison of therapeutic knowledge and inter-professional liaison between general practitioners and community pharmacists

The aim of this study was to ascertain general practitioners' (GPs') and pharmacists' knowledge of analgesics, to establish professional opinion on their use, and to assess the extent of pharmacist input into the prescribing of analgesics. Pharmacists displayed a better knowledge of analgesics than their colleagues in general practice, but had little input into the prescribing decisions made by GPs. Pharmacists' knowledge is not being put to best use in contributing to the preparation of practice formularies, and links between these two health professional groups need to be developed further.

Automatic decomposition and efficient semi-structured meshing of complex solids

In this paper, a novel approach to automatically sub-divide a complex geometry and apply an efficient mesh is presented. Following the identification and removal of thin-sheet regions from an arbitrary solid using the thick/thin decomposition approach developed by Robinson et al. [1], the technique here employs shape metrics generated using local sizing measures to identify long-slender regions within the thick body. A series of algorithms automatically partition the thick region into a non-manifold assembly of long-slender and complex sub-regions. A structured anisotropic mesh is applied to the thin-sheet and long-slender bodies, and the remaining complex bodies are filled with unstructured isotropic tetrahedra. The resulting semi-structured mesh possesses significantly fewer degrees of freedom than the equivalent unstructured mesh, demonstrating the effectiveness of the approach. The accuracy of the efficient meshes generated for a complex geometry is verified via a study that compares the results of a modal analysis with the results of an equivalent analysis on a dense tetrahedral mesh.

Refractory cachexia and truth-telling about terminal prognosis; A qualitative study

The purpose of this paper is to examine the consequences that medical practitioners’ decisions about whether or not to be candid about terminal prognosis have for those suffering from refractory cachexia and their families. It presents the findings of a qualitative study which used focus groups and semi-structured interviews of a volunteer sample of doctors, nurses and dieticians in a cancer centre of a large teaching hospital in Northern Ireland. Respondents reported that some physicians tended to avoid discussing terminal prognosis in a direct manner with their patients. Nurses and dieticians tended to be reluctant to engage in conversations about weight loss with patients with cachexia. One of the reasons they reported for their lack of acknowledgement of weight loss concerned the close association between refractory cachexia and terminal prognosis. Because they viewed the telling of bad news as an exclusive prerogative of medical practitioners, they did not feel in a position to discuss cachexia because they were concerned that this had the potential to raise end-of-life issues that lay outside the boundaries of their professional role. This meant patients and their families were provided with little information about how to cope with the distressing consequences of cachexia.

How smart do you need to be to get it wrong? The role of cognitive capacity in the development of heuristic-based judgment

We examined the relationship between cognitive capacity and heuristic responding on four types of reasoning and decision-making tasks. A total of 84 children, between 5 years 2 months and 11 years 7 months of age, participated in the study. There was a marked increase in heuristic responding with age that was related to increases in cognitive capacity. These findings are inconsistent with the predominant dual-process accounts of reasoning and decision making as applied to development. We offer an alternative explanation of the findings, considering them in the context of recent claims concerning the role of working memory in contextualized reasoning.

Dual-processes in learning and judgment:Evidence from the multiple cue probability learning paradigm

Multiple cue probability learning (MCPL) involves learning to predict a criterion based on a set of novel cues when feedback is provided in response to each judgment made. But to what extent does MCPL require controlled attention and explicit hypothesis testing? The results of two experiments show that this depends on cue polarity. Learning about cues that predict positively is aided by automatic cognitive processes, whereas learning about cues that predict negatively is especially demanding on controlled attention and hypothesis testing processes. In the studies reported here, negative, but not positive cue learning related to individual differences in working memory capacity both on measures of overall judgment performance and modelling of the implicit learning process. However, the introduction of a novel method to monitor participants' explicit beliefs about a set of cues on a trial-by-trial basis revealed that participants were engaged in explicit hypothesis testing about positive and negative cues, and explicit beliefs about both types of cues were linked to working memory capacity. Taken together, our results indicate that while people are engaged in explicit hypothesis testing during cue learning, explicit beliefs are applied to judgment only when cues are negative. © 2012 Elsevier Inc.

Structured data access annotations for massively parallel computations

We describe an approach aimed at addressing the issue of joint exploitation of control (stream) and data parallelism in a skeleton based parallel programming environment, based on annotations and refactoring. Annotations drive efficient implementation of a parallel computation. Refactoring is used to transform the associated skeleton tree into a more efficient, functionally equivalent skeleton tree. In most cases, cost models are used to drive the refactoring process. We show how sample use case applications/kernels may be optimized and discuss preliminary experiments with FastFlow assessing the theoretical results. © 2013 Springer-Verlag.

Positive aspects and challenges associated with caring for a dying relative at home

Research has consistently shown that family caregivers have a variety of unmet needs, despite comprehensive professional support for caregivers being a central aim of palliative care. This sub-study of a larger randomized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care. During semi-structured interviews in their homes, family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges. These were associated with their own ill health, family circumstances, insufficient skills to manage patient symptoms, limited time for themselves and inadequate support from health professionals. Despite these challenges, 60% of family caregivers were readily able to identify positive aspects of the role. Previous research has tended to focus on the negative impact of caregiving. The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration, as does the long-term impact of the caregiver role on those who are unable to recognize positive elements.

Dealing with a problem that doesn't exist?:Professional responses to female perpetrated child sexual abuse

Female involvement in sexual offences against children is more common than is generally thought and has serious implications for the long-term emotional and psychological well-being of victims. Drawing on findings from: a comprehensive review of the literature; an overview of relevant literature and legislation; and an electronic survey of Multi-Agency Public Protection Panels; this paper explores the criminal justice response to female sex offending in England, Wales and Northern Ireland. The literature highlights that the way in which professionals identify and respond to child sexual abuse has been shown to be influenced by the gender of the perpetrator. Equally, whilst similar to male sex offending in terms of the intrusiveness and seriousness of the abuse, some aspects of female sex offending can cause particular problems for professionals. The fact that some sexual abuse can be disguised as childcare can make it difficult for professionals to identify this type of abuse whilst high rates of co-offending bring additional difficulties in determining the degree of female involvement and assigning responsibility. The survey findings indicate that risk assessment tools for female sex offenders is a key area requiring development and point towards small inconsistencies in the current practice of risk assessing females in the community. The survey also identifies the lack of treatment programmes for this group of offenders as well as drawing attention to the need for national policies and procedures, staff training and the identification of areas of good practice. Increased discussion and debate about how best to work with this group of sex offenders is also required. Copyright © 2007 John Wiley & Sons, Ltd.

End-of-Life care and people with intellectual disabilities: A multi-media educational resource

Aim This study aimed to develop and evaluate a multi-media educational resource in palliative and end-of-life care for specialist palliative care and intellectual disability services which promoted collaborative working. Methods: A mixed methods design involving three phases was used. Qualitative data were obtained from semi-structured interviews with a purposive sample of professionals (n=30) and family carers (n=5) and from two focus groups with people with intellectual disabilities (n=17). Data were content analysed as outlined y Newell and Burnard (2006). This identified training needs and issues, in end-of-life care for this population which were confirmed through quantitative data from services in a regional scoping study analysed using descriptive statistics. A DVD and manual were developed and evaluated with twelve professionals. Data were collected using a solicited diary, the Readiness for Inter-professional Learning Scale, Likert Scales and an evaluation questionnaire. Thematic analysis and descriptive statistics appropriate to data were used.Results: Findings suggest that this resource demonstrates the need for and benefits of partnership working and transferability of this learning to practice could address issues at end-of-life for people with intellectual disabilities. Conclusions: Findings of this study have importance for partnership working and service provision in end-of-life care for this population.

Compositional Divergence and Convergence in Local Communities and Spatially Structured Landscapes

Community structure depends on both deterministic and stochastic processes. However, patterns of community dissimilarity (e.g. difference in species composition) are difficult to interpret in terms of the relative roles of these processes. Local communities can be more dissimilar (divergence) than, less dissimilar (convergence) than, or as dissimilar as a hypothetical control based on either null or neutral models. However, several mechanisms may result in the same pattern, or act concurrently to generate a pattern, and much research has recently been focusing on unravelling these mechanisms and their relative contributions. Using a simulation approach, we addressed the effect of a complex but realistic spatial structure in the distribution of the niche axis and we analysed patterns of species co-occurrence and beta diversity as measured by dissimilarity indices (e.g. Jaccard index) using either expectations under a null model or neutral dynamics (i.e., based on switching off the niche effect). The strength of niche processes, dispersal, and environmental noise strongly interacted so that niche-driven dynamics may result in local communities that either diverge or converge depending on the combination of these factors. Thus, a fundamental result is that, in real systems, interacting processes of community assembly can be disentangled only by measuring traits such as niche breadth and dispersal. The ability to detect the signal of the niche was also dependent on the spatial resolution of the sampling strategy, which must account for the multiple scale spatial patterns in the niche axis. Notably, some of the patterns we observed correspond to patterns of community dissimilarities previously observed in the field and suggest mechanistic explanations for them or the data required to solve them. Our framework offers a synthesis of the patterns of community dissimilarity produced by the interaction of deterministic and stochastic determinants of community assembly in a spatially explicit and complex context.

Sugar–derived organogels as templates for structured, photoluminescent conjugated polymer-inorganic hybrid materials

Co-assembly of an inorganic–organic hybrid material through the combination of supramolecular organogel self-assembly, phase partitioning of a conjugated polymer (CP) and transcription of an inorganic oxide leads to a hybrid material with structured domains of organogel, CP and silica within tube and rod microstructures.