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.

All lads together? Racism, masculinity and multicultural/anti-racist strategies in a primary school

This article examines the articulation of racism and masculinity as manifest amongst infant children in a multi-ethnic, inner-city primary school. Drawing upon a year-long ethnographic study of the school, it will highlight some of the inherent problems of multicultural/anti-racist strategies which are not sufficiently grounded in an understanding of racism and how iti complexly interrelates with other systems of inequality, in this case gender. The article will show how many of the racist incidents and processes evident amongst the infant children can only be understood within the context of their expressions of masculinity. With this as a starting point, the article will go on to outline and assess one particular strategy of the school to try and engage older African/Caribbean boys through sports and particularly football. It will be shown how, as a result of this 'multicultural/anti-racist' strategy, a distinct masculine ethos has been created within the school which, ironically, provides a strong context for racist incidents to flourish. The article will conclude by arguing for a more complex and context-specific understanding of racism and will reiterate the concerns of a number of black feminist writers of the early 1980s that strategies to combat racism can only be successful alongside strategies addressing all forms of subordination.

Politicians, elections and catastrophe: the general election of 1847

Over the last decade, much new research has appeared on the subject of the Great Irish Famine but, remarkably, a major political event during the famine - the 1847 general election - has received virtually no mention. Recent work on politics in this period has tended to concentrate on political reaction in Britain rather than Ireland. The aim of this article is to examine the response of Irish politicians to the famine during the general election of 1847. The main source has been the political addresses and nomination speeches of most of the 140 candidates. The evidence from this material shows that, although the famine was an important matter in many constituencies, it was not the dominant issue countrywide. Various proposals to deal with the famine emerged, but there was an absence of agreed, practical measures to deal with immediate problems. The parties in Ireland failed to create a common platform to challenge the government over its efforts. Ideological constraints played an important part in these failures. The general election of 1847 represents a lost opportunity to tackle some of the effects of the famine.

After Housing Policy: Housing and the UK General Election 2001

This paper describes the results of a review of the housing content of UK General Election 2001 manifestos. Housing policy was of little importance during the election campaign. The main British political parties had, essentially, a shared housing agenda - to promote and facilitate home ownership, support area and community regeneration, tackle homelessness, improve the private rented sector, and prevent building on greenfield sites. Many issues of importance to housing specialists received little or no attention, most notably that of low demand. Some policy variations within the UK were evident, for example in attitudes towards greenfield development, home ownership and stock transfer. The paper concludes that differences in housing policy are emerging within the UK as part of a new politics of devolution and that the days of a single housing policy approach for the UK are over.

Think, code, succeed: The Programming Studio as a games-based collaboration:Paper published in the Proceedings of the Association for Teacher Education in Europe conference: Teacher Education through Partnerships and Collaborative Learning Communities, Glasgow, UK. ATEE, 2015

This paper investigates the profile of teachers in the island of Ireland who declared themselves willing to undertake professional development activities in programming, in particular to master programming by taking on-line courses involving the design of computer games. Using the Technology Acceptance Model (TAM), it compares scores for teachers “willing” to undertake the courses with scores for those who declined, and examines other differences between the groups of respondents. Findings reflect the perceived difficulties of programming and the current low status accorded to the subject in Ireland. The paper also reviews the use of games-based learning as a “hook” to engage learners in programming and discusses the role of gamification as a tool for motivating learners in an on-line course. The on-line course focusing on games design was met with enthusiasm, and there was general consensus that gamification was appropriate for motivating learners in structured courses such as those provided.

General Nurses’ Experiences of End-Of-Life Care in the Acute Hospital Setting

Approximately 90% of the UK population spend some time in hospital in their final year of life, and more than half of the population die in hospital. This review aims to explore the experiences of general nurses when providing end-of-life care to patients in the acute hospital setting. Nine studies were identified through a literature search, and each was then analysed and evaluated until themes emerged. Six themes were drawn from the literature: lack of education and knowledge, lack of time with patients, barriers arising in the culture of the health-care setting, communication barriers, symptom management, and nurses' personal issues. The themes cause concern about the quality of end-of-life care being provided in the acute care setting. The literature appears to be consistent in the view that terminally ill patients are best cared for in specialised care settings, such as palliative care units and hospices. However, increasing demands on health services will result in greater numbers of dying patients being admitted to the acute hospital setting. It is therefore paramount that general nurses' educational needs are met to ensure they develop clinical competence to provide high-quality holistic end-of-life care.

General and Respiratory Health Outcomes in Adult Survivors of Bronchopulmonary Dysplasia: A Systematic Review

Background: The purpose of this systematic literature review was to examine current empirical research on general and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia (BPD).

Methods: We searched seven databases up to the end of November 2010 (MEDLINE, PubMed, EMBASE, PsycINFO, Maternity and Infant Care, Cumulative Index of Nursing and Allied Health Literature, and Web of Knowledge). We independently screened and included only those studies concerning the assessment of outcome measures in adult survivors of BPD. Data on methodologic design and findings were extracted from each included study; in addition, the methodologic quality of each study was assessed using the Critical Appraisal Skills Programme checklist.

Results: Fourteen cohort studies met the review criteria. Of those, a total of eight studies were considered to be of high quality (score 9-12), five of moderate quality (score 5-8), and only one was of low quality (score 0-4). In all studies of adult survivors of BPD, differences were found between the index and control groups, suggesting that many adults survivors of BPD who were born preterm or with very low birth weight had more respiratory symptoms and pulmonary function abnormalities compared with their peers. Five studies concerning radiologic findings reported structural changes persisting into adulthood. Findings from three studies suggested impairment in exercise capacity, although firm conclusions were limited by the small sample size in the studies reviewed.

Conclusions: Compared with adults born at term, adult survivors of BPD have more impairment in general and respiratory health, which does not seem to diminish over time.

Recruiting Participants for Randomized Controlled Trials of Music Therapy: A Practical Illustration

Background: Failure to recruit sufficient numbers of participants to randomized controlled trials is a common and serious problem. This problem may be additionally acute in music therapy research.

Objective: To use the experience of conducting a large randomized controlled trial of music therapy for young people with emotional and behavioral difficulties to illustrate the strategies that can be used to optimize recruitment; to report on the success or otherwise of those strategies; and to draw general conclusions about the most effective approaches.

Methods: Review of the methodological literature, and a narrative account and realist analysis of the recruitment process.

Results: The strategies adopted led to the achievement of the recruitment target of 250 subjects, but only with an extension to the recruitment period. In the pre-protocol stage of the research, these strategies included the engagement of non-music therapy clinical investigators, and extensive consultation with clinical stakeholders. In the protocol development and initial recruitment stages, they involved a search of systematic reviews of factors leading to under-recruitment and of interventions to promote recruitment, and the incorporation of their insights into the research protocol and practices. In the latter stages of recruitment, various stakeholders including clinicians, senior managers and participant representatives were consulted in an attempt to uncover the reasons for the low recruitment levels that the research was experiencing.

Conclusions: The primary mechanisms to promote recruitment are education, facilitation, audit and feedback, and time allowed. The primary contextual factors affecting the effectiveness of these mechanisms are professional culture and organizational support.

Degradation of poly-L-lactide. Part 1: in vitro and in vivo physiological temperature degradation

Poly-L-Lactide is a bioresorbable polymer which degrades through hydrolysis of its ester linkage influenced by initial molecular weight and degree of crystallinity. Polymers belonging to the aliphatic polyester family currently represent the most attractive group of polymers that meet the medical and physical demands for safe clinical applications. Compression moulded PLLA pellets were produced as rods, sterilized and degraded both in vitro and in vivo (sub-dermal implantation model). The material molecular weight, crystallinity, mechanical strength and thermal properties were evaluated. In both in vitro and in vivo environments, degradation proceeded at the same rate and followed the general sequence of aliphatic polyester degradation, ruling out enzymes accelerating the degradation rate in vivo. By 44 weeks duration of implantation the PLLA rods were still biocompatible, before any mass loss was observed.

Trends in C-O and C-N bond formations over transition metal surfaces: An insight into kinetic sensitivity in catalytic reactions

Transition metal catalyzed bond formation is a fundamental process in catalysis and is of general interest throughout chemistry. To date, however, the knowledge of association reactions is rather limited, relative to what is known about dissociative processes. For example, surprisingly little is known about how the bond-forming ability of a metal, in general, varies across the Periodic Table. In particular, the effect of reactant valency on such trends is poorly understood. Herein, the authors examine these key issues by using density functional theory calculations to study CO and CN formations over the 4d metals. The calculations reveal that the chemistries differ in a fundamental way. In the case of CO formation, the reaction enthalpies span a much greater range than those of CN formation. Moreover, CO formation is found to be kinetically sensitive to the metal; here the reaction barriers (E-a) are found to be influenced by the reaction enthalpy. CN formation, conversely, is found to be relatively kinetically insensitive to the metal, and there is no correlation found between the reaction barriers and the reaction enthalpy. Analysis has shown that at the final adsorbed state, the interaction between N and the surface is relatively greater than that of O. Furthermore, in comparison with O, relatively less bonding between the surface and N is observed to be lost during transition state formation. These greater interactions between N and the surface, which can be related to the larger valency of N, are found to be responsible for the relatively smaller enthalpy range and limited variation in E-a for CN formation. (C) 2007 American Institute of Physics.

General insight into CO oxidation: A density functional theory study of the reaction mechanism on platinum oxides

CO oxidation on PtO2(110) has been studied using density functional theory calculations. Four possible reaction mechanisms were investigated and the most feasible one is the following: (i) the O at the bridge site of PtO2(110) reacts with CO on the coordinatively unsaturated site (CUS) with a negligible barrier; (ii) O-2 adsorbs on the bridge site and then interacts with CO on the CUS to form an OO-CO complex; (iii) the bond of O-OCO breaks to produce CO2 with a small barrier (0.01 eV). The CO oxidation mechanisms on metals and metal oxides are rationalized by a simple model: The O-surface bonding determines the reactivity on surfaces; it also determines whether the atomic or molecular mechanism is preferred. The reactivity on metal oxides is further found to be related to the 3rd ionization energy of the metal atom.