GPs' perspectives on managing the NHS Health Check in primary care:a qualitative evaluation of implementation in one area of England

OBJECTIVES: To evaluate the implementation of the National Health Service (NHS) Health Check programme in one area of England from the perspective of general practitioners (GPs). DESIGN: A qualitative exploratory study was conducted with GPs and other healthcare professionals involved in delivering the NHS Health Check and with patients. This paper reports the experience of GPs and focuses on the management of the Heath Check programme in primary care. SETTING: Primary care surgeries in the Heart of Birmingham region (now under the auspices of the Birmingham Cross City Clinical Commissioning Group) were invited to take part in the larger scale evaluation. This study focuses on a subset of those surgeries whose GPs were willing to participate. PARTICIPANTS: 9 GPs from different practices volunteered. GPs served an ethnically diverse region with areas of socioeconomic deprivation. Ethnicities of participant GPs included South Asian, South Asian British, white, black British and Chinese. METHODS: Individual semistructured interviews were conducted with GPs face to face or via telephone. Thematic analysis was used to analyse verbatim transcripts. RESULTS: Themes were generated which represent GPs' experiences of managing the NHS Health Check: primary care as a commercial enterprise; 'buy in' to concordance in preventive healthcare; following protocol and support provision. These themes represent the key issues raised by GPs. They reveal variability in the implementation of NHS Health Checks. GPs also need support in allocating resources to the Health Check including training on how to conduct checks in a concordant (or collaborative) way. CONCLUSIONS: The variability observed in this small-scale evaluation corroborates existing findings suggesting a need for more standardisation. Further large-scale research is needed to determine how that could be achieved. Work needs to be done to further develop a concordant approach to lifestyle advice which involves tailored individual goal setting rather than a paternalistic advice-giving model.

Changing visual value of deciduous species in the climate change

The article deals with the changing visual value of deciduous species. Due to climate change, the climatic patterns found on the plants’ growing area may change. Therefore, foliage of deciduous trees changes itscolor in the fall season witha different timing and intensity. This shift can modify the functional, ornamental and ecological value of these plants in the fall season, which is of special interest in the context of landscape design. However, this effect of climate change hasn’t been examined in terms of landscape architecture yet.In the article we are looking for deciduous species that can be appropriate subjectsforresearch, we are giving suggestions for choosing the right location for a future research and proposing available resources of satellite images, that can provide the basis for evaluation of leaf coloring. We also review already existing methods for calculating the degree of fall leaf coloring.We propose a novel method of satellite image processing to evaluate the coloring of a stand. Leaf Coloring Index (LCI) shows the leaf color’s relation to the color realms. LCI is appropriate for setting up a phenological model based onclimate data in a future research. Based on future climate models, the change of the examined stand’s visual value can be predicted. The results might affect the future use of plant species in landscape architecture.

Stratégiai paradigmaváltás szervezeti verseny(képesség) és az Operations management központi szerepe (Central role of strategic paradigm change, corporate competitiveness and operations management)

Az elmúlt két évtized folyamán a menedzserek megtanultak a megújult szabályok szerint játszani. Tudatosították, hogy a vállalatuk eredményes navigálásához folyamatosan figyelniük és adaptálniuk kell a legújabb módszereket, elméleteket. Jelen tanulmányával a szerző ezt a folyamatot kívánja segíteni, valamint arra az alapvető kérdésre keresi a választ, hogy érdemes-e a rendkívül gyorsan változó világban hosszabb távú célok meghatározásával foglalkozni, és ha igen, akkor mire összpontosítsák a vállalatok erőfeszítéseiket. Milyen részletezettséggel, milyen módon határozzák meg az elképzeléseiket úgy, hogy közben megőrizzék a vállalat flexibilitását, a változások idején nélkülözhetetlen agilitást. A szerző arra vállalkozik, hogy feltárja a stratégiai paradigmaváltás fejlődését, a termelési stratégia, az operations management központi meghatározó szereppé válását, valamint áttekintse a termelési és szolgáltatási rendszervezetés (OM) elveinek, eszközeinek, módszereinek fejlődését, kölcsönhatását, összefüggéseit. _______ Change of paradigm has taken place in strategic planning. Fight for position turned into a fight of movement. Companies strive to achieve individual, not copyable organizational performance, as well as to realize their business strategies by means of value generating, proactive approach. Operative management now placed in the focus of production strategy is becoming the compass, the driving force of leadership. The management of production and service systems has grown into independent scientific disciplines. It yielded such principles, tools and methods which are present as world-renowned blueprints (scientific tools) in the field of maintaining and developing corporate performance. In the present study the author specifies and discusses the tools of operative management as criteria of value generation aiming at quality and cost efficiency. He analyses the backto- back character, interrelationship of quality, TQM (Total Quality Management), TPS (Toyota Production System) and JIT (Just in Time). He examines the effects thereof on corporate performance where significant and strong relationship can be demonstrated in case there is an ability to plan and develop new products. The current new OM (Operations Management) techniques increasingly rely upon the quality of human resources, the permanent improvement of procedures as well as focusing on tight cooperation with suppliers/customers. Supply chain management, core competence management, service management now represent a “new generation” of the OM methods, processes, serving at the same time as basis and starting point for expectable future techniques as well.

Schools and the formation of Black identity during the Civil Rights Movement: Change and resistance in Holly Springs, Mississippi, 1964--1974

Desegregation of social and public spaces was the most visible result of the Civil Rights Movement. After 1960, the integration of schools in Mississippi became a source of conflict. The social change of Civil Rights attacked the social order of White Resistance that supported the state superstructure. The public schools were a place for the discovery of identity for Blacks. The integrated on of the schools caused many Whites to leave rather than be integrated with Blacks. Desegregation of schools was also a slow process because the local and state government could not enforce the decisions of the US Courts, leading Blacks to realize their place in American society could only be secured through individual action. ^ This work explains the role of schooling during the integration of the Holly Springs Separate School System. The process of forging a new identity by local Blacks is examined against the forces of social change and resistance. I addition, this work examines the perils for the Blacks as they faced the uncertainty of change in the crucial Civil Rights years between 1964 and 1974. ^ This work analyzes how the Black community dealt with the problems triggered by the desegregation of the school system in Holly Springs, of a constructed social condition, a psychological state of being, the realities of racism and segregation, and the change and resistance between the individual and the collective. It is based on six months of field work investigation. Although the schools were a crucial aspect of community life for Blacks and Whites, Blacks did form their identity in them. Other institutions, such churches were more crucial. Second, the aspect of politeness and belief in law made the experience in Holly Springs unique to that place, and thus, warrants further study to determine its place within the Civil Rights Movement. Finally, while the political and economic control of Holly Springs remained with Whites, desegregation led to the resegregation of the public schools: as Whites left to private schools. ^

Automatic maintenance of category hierarchy

Category hierarchy is an abstraction mechanism for efficiently managing large-scale resources. In an open environment, a category hierarchy will inevitably become inappropriate for managing resources that constantly change with unpredictable pattern. An inappropriate category hierarchy will mislead the management of resources. The increasing dynamicity and scale of online resources increase the requirement of automatically maintaining category hierarchy. Previous studies about category hierarchy mainly focus on either the generation of category hierarchy or the classification of resources under a pre-defined category hierarchy. The automatic maintenance of category hierarchy has been neglected. Making abstraction among categories and measuring the similarity between categories are two basic behaviours to generate a category hierarchy. Humans are good at making abstraction but limited in ability to calculate the similarities between large-scale resources. Computing models are good at calculating the similarities between large-scale resources but limited in ability to make abstraction. To take both advantages of human view and computing ability, this paper proposes a two-phase approach to automatically maintaining category hierarchy within two scales by detecting the internal pattern change of categories. The global phase clusters resources to generate a reference category hierarchy and gets similarity between categories to detect inappropriate categories in the initial category hierarchy. The accuracy of the clustering approaches in generating category hierarchy determines the rationality of the global maintenance. The local phase detects topical changes and then adjusts inappropriate categories with three local operations. The global phase can quickly target inappropriate categories top-down and carry out cross-branch adjustment, which can also accelerate the local-phase adjustments. The local phase detects and adjusts the local-range inappropriate categories that are not adjusted in the global phase. By incorporating the two complementary phase adjustments, the approach can significantly improve the topical cohesion and accuracy of category hierarchy. A new measure is proposed for evaluating category hierarchy considering not only the balance of the hierarchical structure but also the accuracy of classification. Experiments show that the proposed approach is feasible and effective to adjust inappropriate category hierarchy. The proposed approach can be used to maintain the category hierarchy for managing various resources in dynamic application environment. It also provides an approach to specialize the current online category hierarchy to organize resources with more specific categories.

Experimental detection of sudden stiffness change in a structural system employing Laser Doppler Vibrometry

Sudden changes in the stiffness of a structure are often indicators of structural damage. Detection of such sudden stiffness change from the vibrations of structures is important for Structural Health Monitoring (SHM) and damage detection. Non-contact measurement of these vibrations is a quick and efficient way for successful detection of sudden stiffness change of a structure. In this paper, we demonstrate the capability of Laser Doppler Vibrometry to detect sudden stiffness change in a Single Degree Of Freedom (SDOF) oscillator within a laboratory environment. The dynamic response of the SDOF system was measured using a Polytec RSV-150 Remote Sensing Vibrometer. This instrument employs Laser Doppler Vibrometry for measuring dynamic response. Additionally, the vibration response of the SDOF system was measured through a MicroStrain G-Link Wireless Accelerometer mounted on the SDOF system. The stiffness of the SDOF system was experimentally determined through calibrated linear springs. The sudden change of stiffness was simulated by introducing the failure of a spring at a certain instant in time during a given period of forced vibration. The forced vibration on the SDOF system was in the form of a white noise input. The sudden change in stiffness was successfully detected through the measurements using Laser Doppler Vibrometry. This detection from optically obtained data was compared with a detection using data obtained from the wireless accelerometer. The potential of this technique is deemed important for a wide range of applications. The method is observed to be particularly suitable for rapid damage detection and health monitoring of structures under a model-free condition or where information related to the structure is not sufficient.

An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis

Introduction Seizures are harmful to the neonatal brain; this compels many clinicians and researchers to persevere further in optimizing every aspects of managing neonatal seizures. Aims To delineate the seizure profile between non-cooled versus cooled neonates with hypoxic-ischaemic encephalopathy (HIE), in neonates with stroke, the response of seizure burden to phenobarbitone and to quantify the degree of electroclinical dissociation (ECD) of seizures. Methods The multichannel video-EEG was used in this research study as the gold standard to detect seizures, allowing accurate quantification of seizure burden to be ascertained in term neonates. The entire EEG recording for each neonate was independently reviewed by at least 1 experienced neurophysiologist. Data were expressed in medians and interquartile ranges. Linear mixed models results were presented as mean (95% confidence interval); p values <0.05 were deemed as significant. Results Seizure burden in cooled neonates was lower than in non-cooled neonates [60(39-224) vs 203(141-406) minutes; p=0.027]. Seizure burden was reduced in cooled neonates with moderate HIE [49(26-89) vs 162(97-262) minutes; p=0.020] when compared with severe HIE. In neonates with stroke, the background pattern showed suppression over the infarcted side and seizures demonstrated a characteristic pattern. Compared with 10 mg/kg, phenobarbitone doses at 20 mg/kg reduced seizure burden (p=0.004). Seizure burden was reduced within 1 hour of phenobarbitone administration [mean (95% confidence interval): -14(-20 to -8) minutes/hour; p<0.001], but seizures returned to pre-treatment levels within 4 hours (p=0.064). The ECD index in cooled, non-cooled neonates with HIE, stroke and in neonates with other diagnoses were 88%, 94%, 64% and 75% respectively. Conclusions Further research exploring the treatment effects on seizure burden in the neonatal brain is required. A change to our current treatment strategy is warranted as we continue to strive for more effective seizure control, anchored with use of the multichannel EEG as the surveillance tool.

Some Temporal Aspects of Indexing and Classification: Toward a Metrics for Measuring Scheme Change

In this paper we discuss the temporal aspects of indexing and classification in information systems. Basing this discussion off of the three sources of research of scheme change: of indexing: (1) analytical research on the types of scheme change and (2) empirical data on scheme change in systems and (3) evidence of cataloguer decision-making in the context of scheme change. From this general discussion we propose two constructs along which we might craft metrics to measure scheme change: collocative integrity and semantic gravity. The paper closes with a discussion of these constructs.

Las reformas emprendidas en Túnez de la mano del FMI y el BM ¿Precedente para la revolución de los Jazmines?”(1987-2010)

El estallido de la “Revolución de los Jazmines” cuestionó el éxito de un país que por más de dos décadas fue exaltado por el Banco Mundial (BM) y el Fondo Monetario Internacional (FMI) por los logros alcanzados gracias a un programa de restructuración económica. Las exigencias e inconformidades de los manifestantes, que iban más allá de la falta de garantías democráticas, permitieron ver que el país sufría de problemas estructurales relacionados a los altos niveles de desempleo, la precariedad de la situación laboral y la desigualdad. Esta monografía pretende evaluar el papel que tuvieron las reformas económicas y en general el modelo de desarrollo que siguió Túnez de la mano del FMI y el BM, en el surgimiento y consolidación de las condiciones que dieron lugar a la Revolución de los Jazmines a finales del año 2010.

Elevated Cetp Activity During Acute Phase Of Myocardial Infarction Is Independently Associated With Endothelial Dysfunction And Adverse Clinical Outcome.

Recent data suggests that cholesteryl ester transfer protein (CETP) activity may interact with acute stress conditions via inflammatory-oxidative response and thrombogenesis. We investigated this assumption in patients with ST-elevation myocardial infarction (STEMI). Consecutive patients with STEMI (n = 116) were enrolled <24-h of symptoms onset and were followed for 180 days. Plasma levels of C-reactive protein (CRP), interleukin-2 (IL-2), tumor necrosis factor (TNFα), 8-isoprostane, nitric oxide (NOx) and CETP activity were measured at enrollment (D1) and at fifth day (D5). Flow-mediated dilation (FMD) was assessed by ultrasound and coronary thrombus burden (CTB) was evaluated by angiography. Neither baseline nor the change of CETP activity from D1 to D5 was associated with CRP, IL-2, TNFα, 8-isoprostane levels or CTB. The rise in NOx from D1 to D5 was inferior [3.5(-1; 10) vs. 5.5(-1; 12); p < 0.001] and FMD was lower [5.9(5.5) vs. 9.6(6.6); p = 0.047] in patients with baseline CETP activity above the median value than in their counterparts. Oxidized HDL was measured by thiobarbituric acid reactive substances (TBARS) in isolated HDL particles and increased from D1 to D5, and remaining elevated at D30. The change in TBARS content in HDL was associated with CETP activity (r = 0.72; p = 0.014) and FMD (r = -0.61; p = 0.046). High CETP activity at admission was associated with the incidence of sudden death and recurrent MI at 30 days (OR 12.8; 95% CI 1.25-132; p = 0.032) and 180 days (OR 3.3; 95% CI 1.03-10.7; p = 0.044). An enhanced CETP activity during acute phase of STEMI is independently associated with endothelial dysfunction and adverse clinical outcome.

Visual demonstration of the ionic strength effect in the classroom: the Debye-Hückel limiting law

The effects of ionic strength on ions in aqueous solutions are quite relevant, especially for biochemical systems, in which proteins and amino acids are involved. The teaching of this topic and more specifically, the Debye-Hückel limiting law, is central in chemistry undergraduate courses. In this work, we present a description of an experimental procedure based on the color change of aqueous solutions of bromocresol green (BCG), driven by addition of electrolyte. The contribution of charge product (z+|z-|) to the Debye-Hückel limiting law is demonstrated when the effects of NaCl and Na2SO4 on the color of BCG solutions are compared.

Effect of staining solutions and repolishing on color stability of direct composites

OBJECTIVES: The purpose of this study was to assess the color change of three types of composite resins exposed to coffee and cola drink, and the effect of repolishing on the color stability of these composites after staining. MATERIALS AND METHODS: Fifteen specimens (15 mm diameter and 2 mm thick) were fabricated from microhybrid (Esthet-X; Dentsply and Filtek Z-250; 3M ESPE) and high-density hybrid (Surefil; Dentsply) composites, and were finished and polished with aluminum oxide discs (Sof-Lex; 3M ESPE). Color of the specimens was measured according to the CIE L*a*b* system in a refection spectrophotometer (PCB 6807; BYK Gardner). After baseline color measurements, 5 specimens of each resin were immersed in different staining solutions for 15 days: G1 - distilled water (control), G2 - coffee, G3 - cola soft drink. Afterwards, new color measurement was performed and the specimens were repolished and submitted to new color reading. Color stability was determined by the difference (ΔE) between the coordinates L*, a*, and b* obtained from the specimens before and after immersion into the solutions and after repolishing. RESULTS: There was no statistically signifcant difference (ANOVA, Tukey's test; p>0.05) among the ΔE values for the different types of composites after staining or repolishing. For all composite resins, coffee promoted more color change (ΔE>3.3) than distilled water and the cola soft drink. After repolishing, the ΔE values of the specimens immersed in coffee decreased to clinically acceptable values (ΔE<3.3), but remained signifcantly higher than those of the other groups. CONCLUSIONS: No signifcant difference was found among composite resins or between color values before and after repolishing of specimens immersed in distilled water and cola. Immersing specimens in coffee caused greater color change in all types of composite resins tested in this study and repolishing contributed to decrease staining to clinically acceptable ΔE values.

Time resolved emission spectroscopy of poly(2,5-dicyano-p-phenylene-vinylene) films

Films of poly (2,5-dicyano-p-phenylene vinylene), DCNPPV, were obtained by electrochemical synthesis over gold thin layer (20 nm) transparent electrode deposited on a glass plate. The DCNPPV films of 4 µm thickness were produced by electropolymerization process of α,α,α',α'-tetrabromo-2-5-dicyano-p-xilene at different applied potentials (-0.15, -0.25, -0.40, -0.60, -0.80, and -1.0 V) using 0.1 mol L-1 of tetraethylammonium bromide in acetonitrile as the supporting electrolyte. The emission decays have three exponential components: a fast component in the picosecond range (200-400 ps), and two other of about one and five nanoseconds at 293 K. The fluorescence quenching process seems to occur by exciton trapping in a low-energy site and quenching by residual bromine monomer attached at the end of the polymer chain. However, the electrochemical synthesis generates entrapped bromide or ion pairs during the growth step of the film which also contributes to the deactivation. The change of the electrolyte from bromide to perchlorate reduces significantly this additional quenching effect by allowing ion exchange of formed bromide with the nonquenching perchloride anion.

Two dimensional analysis of inflatable structures by the positional FEM

This paper presents a, simple two dimensional frame formulation to deal with structures undergoing large motions due to dynamic actions including very thin inflatable structures, balloons. The proposed methodology is based on the minimum potential energy theorem written regarding nodal positions. Velocity, acceleration and strain are achieved directly from positions, not. displacements, characterizing the novelty of the proposed technique. A non-dimensional space is created and the deformation function (change of configuration) is written following two independent mappings from which the strain energy function is written. The classical New-mark equations are used to integrate time. Dumping and non-conservative forces are introduced into the mechanical system by a rheonomic energy function. The final formulation has the advantage of being simple and easy to teach, when compared to classical Counterparts. The behavior of a bench-mark problem (spin-up maneuver) is solved to prove the formulation regarding high circumferential speed applications. Other examples are dedicated to inflatable and very thin structures, in order to test the formulation for further analysis of three dimensional balloons.

Unconstrained Finite Element for Geometrical Nonlinear Dynamics of Shells

This paper presents a positional FEM formulation to deal with geometrical nonlinear dynamics of shells. The main objective is to develop a new FEM methodology based on the minimum potential energy theorem written regarding nodal positions and generalized unconstrained vectors not displacements and rotations. These characteristics are the novelty of the present work and avoid the use of large rotation approximations. A nondimensional auxiliary coordinate system is created, and the change of configuration function is written following two independent mappings from which the strain energy function is derived. This methodology is called positional and, as far as the authors' knowledge goes, is a new procedure to approximated geometrical nonlinear structures. In this paper a proof for the linear and angular momentum conservation property of the Newmark beta algorithm is provided for total Lagrangian description. The proposed shell element is locking free for elastic stress-strain relations due to the presence of linear strain variation along the shell thickness. The curved, high-order element together with an implicit procedure to solve nonlinear equations guarantees precision in calculations. The momentum conserving, the locking free behavior, and the frame invariance of the adopted mapping are numerically confirmed by examples. Copyright (C) 2009 H. B. Coda and R. R. Paccola.