53 resultados para Marc records problems

em QUB Research Portal - Research Directory and Institutional Repository for Queen's University Belfast


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The Northern Hemisphere cooling event 8200 years ago is believed to represent the last known major freshwater pulse into the North Atlantic as a result of the final collapse of the North American Laurentide ice sheet. This pulse of water is generally believed to have occurred independently of orbital variations and provides an analogue for predicted increases in high-latitude precipitation and ice melt as a result of anthropogenically driven future climate change. The precise timing, duration and magnitude of this event, however, are uncertain, with suggestions that the 100-yr meltwater cooling formed part of a longer-term cold period in the early Holocene. Here we undertook a multiproxy, high-resolution investigation of a peat sequence at Dooagh, Achill Island, on the west coast of Ireland, to determine whether the 8200-year cold event impacted upon the terrestrial vegetation immediately downwind of the proposed changes in the North Atlantic. We find clear evidence for an oscillation in the early Holocene using various measures of pollen, indicating a disruption in the vegetation leading to a grassland-dominated landscape, most probably driven by changes in precipitation rather than temperature. Radiocarbon dating was extremely problematic, however, with bulk peat samples systematically too young for the North Atlantic event, suggesting significant contamination from downward root penetration. The sustained disruption to vegetation over hundreds of years at Dooagh indicates the landscape was impacted by a long-term cooling event in the early Holocene, and not the single century length 8200-year meltwater event proposed in many other records in the North Atlantic region.

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This 1 year prospective study involved nine general practitioners in an urban health centre who routinely record all patient contacts on computer. The study determines by comparison with a manual record how accurately doctors record laboratory investigations on computer and compares the effectiveness of three interventions in improving the completeness of computerized recording of presenting symptoms, problems/diagnoses and laboratory investigations. Recording was analysed for 1 month prior to and for two 1 month periods following each intervention. A control group was used. A total of 7983 patient contacts were analysed. Intervention led to an improvement in the recording of presenting symptoms and problems/diagnoses. Recording of investigations on the computer showed no improvement, remaining at one-third of the total in the treatment room book for both study and control doctors. The effectiveness of the different forms of intervention depended on both the aspect of the consultation considered and the familiarity of individual doctors with the method of data collection. Aspects considered less important required greater intervention to bring about a marked improvement, as did doctors relatively new to the practice. It may not be possible to get all aspects of the consultation recorded with the same degree of accuracy. This has implications for the accuracy of retrospective studies dependent on existing computerized data.

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Background: Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. Aims: To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). Methods: Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. Results: Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa=0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged =5 years) and adults. Conclusions: Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients. © 2012 Primary Care Respiratory Society UK. All rights reserved.

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The use of social work case files as an important research resource is being threatened by the increasing regulation of both the research process and access to personal identifiable information. While these developments can be seen as a reaction to specific incidents of inappropriate research and the misuse of personal information, it is argued that the pendulum has swung too far the other way, and in seeking to protect the rights of vulnerable individuals, the lives of these same individuals may go unstudied with the consequence that they receive less appropriate services. Drawing upon the current research of the authors, this article explores the difficulties encountered in gaining access to social work case files for research purposes without the explicit consent of service users and highlights the uncertainty surrounding this issue. Suggestions are made for improvements in the situation.

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Building on Habermas’s conceptualisation of modes of reasoning, the authors proposed that an application of critical theory to the present bureaucratised nature of communication between state representatives and welfare recipients (Howe 1992) might open up ways in which social workers could reconceptualise their practice. In a subsequent edition of this journal, three of the present authors introduced the radical theatre of Augusto Boal as a methodology which might provide an expressive route for social workers seeking to build a practice combining the intellectual analysis of critical theory with new ways of working (Spratt et al. 2000). Boal’s method recognises the oppressed status of groups who come to the attention of agents of the state and, through the use of a range of theatrical techniques, introduces strategies to facilitate the conscious recognition of such collective oppressions and develop dialogical ways to address them. In the last paper, the authors presented one such technique, ‘image theatre’, and demonstrated its use with social workers in consciousness raising and developing strategies for collective action.

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This paper investigates evidence for palaeoclimatic changes during the period ca. 1500-500 cal. yr BC through peat humification studies on seven Irish ombrotrophic bogs. The sites are well-correlated by the identification of three mid-first millennium BC tephras, which enable the humification records at specific points in time to be directly compared. Phases of temporarily increased wetness are suggested at ca. 1300-1250 cal. yr BC, ca. 1150-1050 cal. yr BC, ca. 940 cal. yr BC and ca. 740 cal. yr BC. The last of these is confirmed to be synchronous at five sites, suggesting external forcing on a regional scale. The timing of this wet-shift is constrained by two closely dated tephras and is demonstrated to be distinct from the widely reported changes to cooler/wetter conditions associated with a solar minimum at 850-760 cal. yr BC, at which time the Irish sites appear instead to experience drier conditions. The results suggest the possibility of either non-uniform responses to solar forcing in northwest Europe at this time, or the existence of unrelated climate events in the early first millennium BC. The findings caution against the correlation of loosely dated palaeoclimate data if the effects of forcing mechanisms are to be understood.