Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study

OBJECTIVE: To assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records. DESIGN: Subjective estimates of the risk of coronary heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that had been calculated with the Framingham equation; calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease. SETTING: General practices in central England. PARTICIPANTS: 18 general practitioners and 18 practice nurses. MAIN OUTCOME MEASURES: Agreement of results of risk estimation and risk calculation with reference calculation; agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease. RESULTS: Only a minority of patients' records contained all of the risk factors required for the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%). Agreement of risk calculations with the reference standard was moderate (kappa=0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners, depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa=0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79%, general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners (89%). CONCLUSIONS: Routine calculation of the risk of coronary heart disease in primary care is hampered by poor availability of data on risk factors. General practitioners and practice nurses are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically, to allow the use of the most appropriate calculation tools.

A class of perfect fluids in general relativity

This thesis is concerned with exact solutions of Einstein's field equations of general relativity, in particular, when the source of the gravitational field is a perfect fluid with a purely electric Weyl tensor. General relativity, cosmology and computer algebra are discussed briefly. A mathematical introduction to Riemannian geometry and the tetrad formalism is then given. This is followed by a review of some previous results and known solutions concerning purely electric perfect fluids. In addition, some orthonormal and null tetrad equations of the Ricci and Bianchi identities are displayed in a form suitable for investigating these space-times. Conformally flat perfect fluids are characterised by the vanishing of the Weyl tensor and form a sub-class of the purely electric fields in which all solutions are known (Stephani 1967). The number of Killing vectors in these space-times is investigated and results presented for the non-expanding space-times. The existence of stationary fields that may also admit 0, 1 or 3 spacelike Killing vectors is demonstrated. Shear-free fluids in the class under consideration are shown to be either non-expanding or irrotational (Collins 1984) using both orthonormal and null tetrads. A discrepancy between Collins (1984) and Wolf (1986) is resolved by explicitly solving the field equations to prove that the only purely electric, shear-free, geodesic but rotating perfect fluid is the Godel (1949) solution. The irrotational fluids with shear are then studied and solutions due to Szafron (1977) and Allnutt (1982) are characterised. The metric is simplified in several cases where new solutions may be found. The geodesic space-times in this class and all Bianchi type 1 perfect fluid metrics are shown to have a metric expressible in a diagonal form. The position of spherically symmetric and Bianchi type 1 space-times in relation to the general case is also illustrated.

Drug information in general practice pharmacy

The drug information sources currently available to general practice pharmacists have been identified. The use of and attitudes to these sources were assessed as well as the perceived information needs of practising pharmacists. The special requirements of women pharmacists and pharmacists working part-time were studied. The relationship of the medical representative as an information source for pharmacists was evaluated. Participation in continuing education programmes as a vital means of ensuring current information awareness and knowledge for the practising profession has been considered. Investigations were mainly pursued by questionnaire survey, while computer facilities were used for the processing and the analyses of data. The desirability of collated and evaluated information from one or more independent authoritative sources has been discussed. The increasing advisory role of the general practice pharmacist and the needs of the patient and potential customer have been discussed, with projections for the pharmacist's future health care contribution.

Overdetermined Strata in General Families of Polynomials

2000 Mathematics Subject Classification: 12D10.

Global Waves with Non-Positive Energy in General Relativity

2000 Mathematics Subject Classification: 35Lxx, 35Pxx, 81Uxx, 83Cxx.

An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice : The RAPiD Cluster Randomised Controlled Trial

Funding: This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study.

Learning strategies implemented by the students of Advanced Intensive English I courses for improving oral discourse in the Bachelor of Arts in English Teaching, Department of Foreign Languages, University of El Salvador, year 2014.

There are many learning strategies some, more successful than others when they are applied in a correct way. “Strategies are most successful when they are implemented in a system that encourages collaboration among staff and students, and in which each is a part of a well-planned whole system” (Johns Hopkins, 2000). Additionally, Learning strategies have become an effective instrument in the field of education because students can make use of several strategies in order to enhance their English level in terms of communication. To communicate in a meaningful way, it is important to express ideas inside and outside the classroom; it is part of the development and improvement of speaking.

Other-Regarding Preferences in General Equilibrium

We study competitive market outcomes in economies where agents have other-regarding preferences. We identify a separability condition on monotone preferences that is necessary and sufficient for one’s own demand to be independent of the allocations and characteristics of other agents in the economy. Given separability, it is impossible to identify other-regarding preferences from market behavior: agents be- have as if they had classical preferences that depend only on own consumption in competitive equilibrium. If preferences, in addition, depend only on the final allocation of consumption in society, the Sec- ond Welfare Theorem holds as long as an increase in resources can be distributed such that all agents are better off. Nevertheless, the First Welfare Theorem generally does not hold. Allowing agents to care about their own consumption and the distribution of consump- tion possibilities in the economy, we provide a condition under which agents have no incentive to make direct transfers, and show that this condition implies that competitive equilibria are efficient given prices.

Local influence analysis in general spatial models

South Carolina’s Arts In Basic Curriculum Project : A History 1987-2007

The Arts in Basic Curriculum (ABC) Project is a multifaceted initiative that has positively impacted arts education in South Carolina and the nation. Founded in 1987 the ABC Project has become a national model and influenced the advancement of education in and through the arts with a multitude of programs, models, and schemes. This is an overview of the full history. Parts I and II will chronicle events that were foundational to the project from inception in 1987 to the celebration of its 20th anniversary in 2007. Part III gives detailed descriptions of ten of the most important facets of the project.