eHealth as a challenge to `expert' power: a focus group study of internet use for health information and management

Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.

Patient involvement in primary care mental health:a focus group study

Background: Patient involvement in health care is a strong political driver in the NHS. However in spite of policy prominence, there has been only limited previous work exploring patient involvement for people with serious mental illness. Aim: To describe the views on, potential for, and types of patient involvement in primary care from the perspectives of primary care health professionals and patients with serious mental illness. Design of study: Qualitative study consisting of six patient, six health professional and six combined focus groups between May 2002 and January 2003. Setting: Six primary care trusts in the West Midlands, England. Method: Forty-five patients with serious mental illness, 39 GPs, and eight practice nurses participated in a series of 18 focus groups. All focus groups were audiotaped and fully transcribed. Nvivo was used to manage data more effectively. Results: Most patients felt that only other people with lived experience of mental illness could understand what they were going through. This experience could be used to help others navigate the health- and social-care systems, give advice about medication, and offer support at times of crisis. Many patients also saw paid employment within primary care as a way of addressing issues of poverty and social exclusion. Health professionals were, however, more reluctant to see patients as partners, be it in the consultation or in service delivery. Conclusions: Meaningful change in patient involvement requires commitment and belief from primary care practitioners that the views and experiences of people with serious mental illness are valid and valuable.

Patients' and health professionals' views on primary care for people with serious mental illness:focus group study

Objective: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. Design: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. Setting: Six primary care trusts in the West Midlands. Participants: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. Results: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. Conclusions: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

Study on Microcredit in Kerala with Special Reference to Employment and Income Generation through Microenterprises and Livelihood Projects

This study aimed to study the evolution and substance of microfinance as a major tool for combating poverty at the global and national level. The development of micro finance in Kerala is briefly discussed. It also indicates the importance and role of microcredit in bringing the poor up in the society through entrepreneurial initiatives. The current trends in the field are also discussed, leading to the need of the present research.

The causes of prescribing errors in English general practices: a qualitative study

Aim: To examine the causes of prescribing and monitoring errors in English general practices and provide recommendations for how they may be overcome. Design: Qualitative interview and focus group study with purposive sampling and thematic analysis informed by Reason’s accident causation model. Participants: General practice staff participated in a combination of semi-structured interviews (n=34) and six focus groups (n=46). Setting: Fifteen general practices across three primary care trusts in England. Results: We identified seven categories of high-level error-producing conditions: the prescriber, the patient, the team, the task, the working environment, the computer system, and the primary-secondary care interface. Each of these was further broken down to reveal various error-producing conditions. The prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health, were all identified as possible causes. The patient’s characteristics and the complexity of the individual clinical case were also found to have contributed to prescribing errors. The importance of feeling comfortable within the practice team was highlighted, as well as the safety of general practitioners (GPs) in signing prescriptions generated by nurses when they had not seen the patient for themselves. The working environment with its high workload, time pressures, and interruptions, and computer related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts, were all highlighted as possible causes of prescribing errors and often interconnected. Conclusion: This study has highlighted the complex underlying causes of prescribing and monitoring errors in general practices, several of which are amenable to intervention.

Discrete generator coordinate: Symmetry restoration in finite-dimensional spaces

Group theoretical-based techniques and fundamental results from number theory are used in order to allow for the construction of exact projectors in finite-dimensional spaces. These operators are shown to make use only of discrete variables, which play the role of discrete generator coordinates, and their application in the number symmetry restoration is carried out in a nuclear BCS wave function which explicitly violates that symmetry. © 1999 Published by Elsevier Science B.V. All rights reserved.

Whole ship energy optimization: the case study of a chemical tanker

La presente dissertazione investiga la possibilità di ottimizzare l’uso di energia a bordo di una nave per trasporto di prodotti chimici e petrolchimici. Il software sviluppato per questo studio può essere adattato a qualsiasi tipo di nave. Tale foglio di calcolo fornisce la metodologia per stimare vantaggi e miglioramenti energetici, con accuratezza direttamente proporzionale ai dati disponibili sulla configurazione del sistema energetico e sui dispositivi installati a bordo. Lo studio si basa su differenti fasi che permettono la semplificazione del lavoro; nell’introduzione sono indicati i dati necessari per svolgere un’accurata analisi ed è presentata la metodologia adottata. Inizialmente è fornita una spiegazione sul layout dell’impianto, sulle sue caratteristiche e sui principali dispositivi installati a bordo. Vengono dunque trattati separatamente i principali carichi, meccanico, elettrico e termico. In seguito si procede con una selezione delle principali fasi operative della nave: è seguito tale approccio in modo da comprendere meglio la ripartizione della richiesta di potenza a bordo della nave e il suo sfruttamento. Successivamente è svolto un controllo sul dimensionamento del sistema elettrico: ciò aiuta a comprendere se la potenza stimata dai progettisti sia assimilabile a quella effettivamente richiesta sulla nave. Si ottengono in seguito curve di carico meccanico, elettrico e termico in funzione del tempo per tutte le fasi operative considerate: tramite l’uso del software Visual Basic Application (VBA) vengono creati i profili di carico che possono essere gestiti nella successiva fase di ottimizzazione. L’ottimizzazione rappresenta il cuore di questo studio; i profili di potenza ottenuti dalla precedente fase sono gestiti in modo da conseguire un sistema che sia in grado di fornire potenza alla nave nel miglior modo possibile da un punto di vista energetico. Il sistema energetico della nave è modellato e ottimizzato mantenendo lo status quo dei dispositivi di bordo, per i quali sono considerate le configurazioni di “Load following”, “two shifts” e “minimal”. Una successiva investigazione riguarda l’installazione a bordo di un sistema di accumulo di energia termica, così da migliorare lo sfruttamento dell’energia disponibile. Infine, nella conclusione, sono messi a confronto i reali consumi della nave con i risultati ottenuti con e senza l’introduzione del sistema di accumulo termico. Attraverso la configurazione “minimal” è possibile risparmiare circa l’1,49% dell’energia totale consumata durante un anno di attività; tale risparmio è completamente gratuito poiché può essere raggiunto seguendo alcune semplici regole nella gestione dell’energia a bordo. L’introduzione di un sistema di accumulo termico incrementa il risparmio totale fino al 4,67% con un serbatoio in grado di accumulare 110000 kWh di energia termica; tuttavia, in questo caso, è necessario sostenere il costo di installazione del serbatoio. Vengono quindi dibattuti aspetti economici e ambientali in modo da spiegare e rendere chiari i vantaggi che si possono ottenere con l’applicazione di questo studio, in termini di denaro e riduzione di emissioni in atmosfera.

Impact Study of Nonverbal Facial Cues on Spontaneous Chatting with Virtual Humans

Non-verbal communication (NVC) is considered to represent more than 90 percent of everyday communication. In virtual world, this important aspect of interaction between virtual humans (VH) is strongly neglected. This paper presents a user-test study to demonstrate the impact of automatically generated graphics-based NVC expression on the dialog quality: first, we wanted to compare impassive and emotion facial expression simulation for impact on the chatting. Second, we wanted to see whether people like chatting within a 3D graphical environment. Our model only proposes facial expressions and head movements induced from spontaneous chatting between VHs. Only subtle facial expressions are being used as nonverbal cues - i.e. related to the emotional model. Motion capture animations related to hand gestures, such as cleaning glasses, were randomly used to make the virtual human lively. After briefly introducing the technical architecture of the 3D-chatting system, we focus on two aspects of chatting through VHs. First, what is the influence of facial expressions that are induced from text dialog? For this purpose, we exploited an emotion engine extracting an emotional content from a text and depicting it into a virtual character developed previously [GAS11]. Second, as our goal was not addressing automatic generation of text, we compared the impact of nonverbal cues in conversation with a chatbot or with a human operator with a wizard of oz approach. Among main results, the within group study -involving 40 subjects- suggests that subtle facial expressions impact significantly not only on the quality of experience but also on dialog understanding.

CPV hybrid system in ISFOC building, first results

PV Off-Grid systems have demonstrated to be a good solution for the electrification of remote areas [1]. A hybrid system is one kind of these systems. The principal characteristic is that it uses PV as the main generator and has a backup power supply, like a diesel generator, for instance, that is used when the CPV generation is not enough to meet demand. To study the use of CPV in these systems, ISFOC has installed a demonstration hybrid system at its headquarters. This hybrid system uses CPV technology as main generator and the utility grid as the backup generator. A group of batteries have been mounted as well to store the remaining energy from the CPV generator when nedeed. The energy flows are managed by a SMA system based on Sunny Island inverters and a Multicluster-Box (figure 1). The Load is the air-conditioning system of the building, as it has a consumption profile higher than the CPV generator and can be controlled by software [2]. The first results of this system, as well as the first chances of improvement, as the need of a bigger CPV generator and a better management of the energy stored in the batteries, are presented in this paper.

Are pharmacological randomised controlled clinical trials relevant to real-life asthma populations? : A protocol for an UNLOCK study from the IPCRG

Funding The IPCRG provided funding for this research project as an UNLOCK Group study for which the funding was obtained through an unrestricted grant by Novartis AG, Basel, Switzerland. Novartis has no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. This study will include data from the Optimum Patient Care Research Database and is undertaken in collaboration with Optimum Patient Care and the Respiratory Effectiveness Group.

FIU Medical Library Study Room

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Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.

Universal zero-bias conductance through a quantum wire side-coupled to a quantum dot

A numerical renormalization-group study of the conductance through a quantum wire containing noninteracting electrons side-coupled to a quantum dot is reported. The temperature and the dot-energy dependence of the conductance are examined in the light of a recently derived linear mapping between the temperature-dependent conductance and the universal function describing the conductance for the symmetric Anderson model of a quantum wire with an embedded quantum dot. Two conduction paths, one traversing the wire, the other a bypass through the quantum dot, are identified. A gate potential applied to the quantum wire is shown to control the current through the bypass. When the potential favors transport through the wire, the conductance in the Kondo regime rises from nearly zero at low temperatures to nearly ballistic at high temperatures. When it favors the dot, the pattern is reversed: the conductance decays from nearly ballistic to nearly zero. When comparable currents flow through the two channels, the conductance is nearly temperature independent in the Kondo regime, and Fano antiresonances in the fixed-temperature plots of the conductance as a function of the dot-energy signal interference between them. Throughout the Kondo regime and, at low temperatures, even in the mixed-valence regime, the numerical data are in excellent agreement with the universal mapping.