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.

State-of-the-art in lean design engineering:a literature review on white collar lean

Lean is usually associated with the ‘operations’ of a manufacturing enterprise; however, there is a growing awareness that these principles may be transferred readily to other functions and sectors. The application to knowledge-based activities such as engineering design is of particular relevance to UK plc. Hence, the purpose of this study has been to establish the state-of-the-art, in terms of the adoption of Lean in new product development, by carrying out a systematic review of the literature. The authors' findings confirm the view that Lean can be applied beneficially away from the factory; that an understanding and definition of value is key to success; that a set-based (or Toyota methodology) approach to design is favoured together with the strong leadership of a chief engineer; and that the successful implementation requires organization-wide changes to systems, practices, and behaviour. On this basis it is felt that this review paper provides a useful platform for further research in this topic.

Manufacture of controlled emulsions and particulates using membrane emulsification

Crossflow and rotating membrane emulsification techniques were used for making oil-in-water (O/W) emulsions. The emulsions produced from a variety of oils and monomers (viscosity 7–528 mPas) exhibited narrow size distributions over a wide droplet size range, with the average droplet size ranging from less than 1 µm up to 500 µm. The monomer emulsions were further encapsulated to produce microcapsules through subsequent polymerisation reactions. The monodispersity feature of the primary emulsions was retained after the encapsulation. In comparison with other homogenisation methods, our experimental results demonstrated that the membrane emulsification technique is not only superior in emulsion droplet size controls, but also advantageous in energy efficiency and industrial-scale productions.

Concentration of mannitol and other soluble carbohydrates in the crustose lichen Rhizocarpon geographicum

In symbiotic lichens which have Trebouxia as the algal partner, photosynthesis by the algae results in the production of the soluble carbohydrate ribitol which is then transported to the fungus where it is converted to arabitol and mannitol. Within the fungus, arabitol may act as a short-term carbohydrate reserve while mannitol may have a more protective function and be important in stress resistance. The concentrations of ribitol, arabitol, and mannitol were measured, using gas chromatography, in the central areolae and marginal hypothallus of the crustose lichen Rhizocarpon geographicum (L.) DC. growing on slate rocks in north Wales, UK. The concentrations of all three soluble carbohydrates were greater in the central areolae than in the marginal prothallus. In addition, the ratio of mannitol in the prothallus to that in the areolae was least in July. The concentration of an individual carbohydrate in the prothallus was correlated primarily with the concentrations of the other carbohydrates in the prothallus and not to their concentrations in the areolae. Low concentration of ribitol, arabitol, and mannitol in the marginal prothallus compared with the central areolae suggests either a lower demand for carbohydrate by the prothallus or limited transport from areolae to prothallus and may explain the low growth rates of this species. In addition, soluble carbohydrates appear to be partitioned differently through the year with an increase in mannitol compared with arabitol in more stressful periods.

Neuropathology of Basal Ganglia and its role in the Parkinsonian syndromes with special reference to the Globus pallidus

The globus pallidus, together with the striatum (caudate nucleus and putamen), substantia nigra, nucleus accumbens, and subthalamic nucleus constitute the basal ganglia, a group of nuclei which act as a single functional unit. The basal ganglia have extensive connections to the cerebral cortex and thalamus and exert control over a variety of functions including voluntary motor control, procedural learning, and motivation. The action of the globus pallidus is primarily inhibitory and balances the excitatory influence of other areas of the brain such as the cerebral cortex and cerebellum. Neuropathological changes affecting the basal ganglia play a significant role in the clinical signs and symptoms observed in the ‘parkinsonian syndromes’ viz., Parkinson’s disease (PD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and corticobasal degeneration (CBD). There is increasing evidence that different regions of the basal ganglia are differentially affected in these disorders. Hence, in all parkinsonian disorders and especially PD, there is significant pathology affecting the substantia nigra and its dopamine projection to the striatum. However, in PSP and MSA, the globus pallidus is also frequently affected while in DLB and CBD, whereas the caudate nucleus and/or putamen are affected, the globus pallidus is often spared. This chapter reviews the functional pathways of the basal ganglia, with special reference to the globus pallidus, and the role that differential pathology in these regions may play in the movement disorders characteristic of the parkinsonian syndromes.

Evaluation of vulnerability factors for cyclones : the case of Patuakhali, Bangladesh

Tropical cyclones are considered as the most severe natural disasters in Bangladesh; they cause extensive damage, create losses in the country׳s economy, and affect social settings. The impact of natural disasters has been further intensified due to various vulnerability factors within the Bangladeshi community such as low income; shortages of food; lack of assets such as land and permanent housing; dense population, illiteracy. This study evaluates the vulnerability factors for cyclones in the community based in the Patuakhali region of south western Bangladesh. The bottom-up research approach was adopted for the study, whereby the local community was consulted for their viewpoints by using focus group interviews and semi-structured interviews. Different community groups and social categories including both men and women, from different age groups and livelihoods, participated in the study. The study revealed how the community׳s vulnerability to cyclones has been further aggravated by socio-economic factors such as social status, political influences and economic conditions. The majority of the community in Patuakhali has been “knowingly” vulnerable to cyclone disaster as a result of the lack of alternatives especially in terms of their livelihood patterns. The vulnerability of women, due to their lack of authority, domestic work, and fear of exposure within the society was also highlighted. The study revealed how vulnerability factors are interlinked with each other making them further difficult to manage. This calls for multi-faceted disaster risk reduction strategies that targets vulnerability factors deriving from different origins and root causes.

Evaluation of vulnerability factors for cyclones:the case of Patuakhali, Bangladesh

Tropical cyclones are considered as the most severe natural disasters in Bangladesh; they cause extensive damage, create losses in the country[U+05F3]s economy, and affect social settings. The impact of natural disasters has been further intensified due to various vulnerability factors within the Bangladeshi community such as low income; shortages of food; lack of assets such as land and permanent housing; dense population, illiteracy. This study evaluates the vulnerability factors for cyclones in the community based in the Patuakhali region of south western Bangladesh. The bottom-up research approach was adopted for the study, whereby the local community was consulted for their viewpoints by using focus group interviews and semi-structured interviews. Different community groups and social categories including both men and women, from different age groups and livelihoods, participated in the study. The study revealed how the community[U+05F3]s vulnerability to cyclones has been further aggravated by socio-economic factors such as social status, political influences and economic conditions. The majority of the community in Patuakhali has been "knowingly" vulnerable to cyclone disaster as a result of the lack of alternatives especially in terms of their livelihood patterns. The vulnerability of women, due to their lack of authority, domestic work, and fear of exposure within the society was also highlighted. The study revealed how vulnerability factors are interlinked with each other making them further difficult to manage. This calls for multi-faceted disaster risk reduction strategies that targets vulnerability factors deriving from different origins and root causes. © 2014 Elsevier Ltd.

Validation of the drinking motives questionnaire - revised in six European countries

Highlights •This paper assesses the validity of the DMQ-R (Cooper, 1994) among university students in six different European countries. •Results provide support for similar DMQ-R factor structures across countries. •Drinking motives have similar meanings among European university students.

Chemical and mineral composition of rocks from the Philippine Sea

The book is devoted to geology of the Philippine Sea floor. This region is studied most extensively among other marginal seas of the Pacific Ocean. Rocks of the sedimentary and basalt layers within this sea have been studied during five legs of D/S Glomar Challenger. International geological expedition on board R/V Dmitry Mendeleev carried out according to the Project ''Ophiolites of Continents and Comparable Rocks of the Ocean Floor''obtained unique collection of rocks from the second and third layers of the ocean crust in the Philippine Sea. The book provides detailed petrographic and geochemical description of igneous and sedimentary formations from the Philippine Sea and compares them with rocks of the continental ophiolite association. An analysis of structure and history of the ocean crust formation in the region is based on all known geological information. The main periods of tectonic movement activation and nature of their manifestations within the sea are shown.

The Great Book of Ireland - Leabhar Mór na hÉireann

The Great Book of Ireland, Leabhar Mór na hÉireann, is an extraordinary modern vellum manuscript in a single volume which comprises the original work of 120 artists, 140 poets and nine composers. Produced in Dublin between 1989 and 1991, it has been acquired by University College Cork to be preserved in posterity on behalf of the Irish people. Conceived originally as a venture to create a saleable artefact which would help to fund the development plans of two arts organizations in Ireland, the original architects of the idea and editors of the end product were Theo Dorgan of Poetry Ireland and Gene Lambert of Clashganna Mills, with Eamonn Martin as business manager. Out of their initial meeting in March 1989 came the first tentative idea of producing an original artefact that would raise substantial funds for their charitable-status arts organizations, while at the same time being a venture worthwhile in itself. What was to emerge was a project of breath-taking ambition and scale – The Great Book of Ireland, Leabhar Mór na hÉireann, completed in 1991. Artists, poets, and composers were asked to contribute in their own medium what they believed represented their hopes, fears, dreams, or imaginings in the Ireland of that particular time, and which would have resonance in a thousand years - as the longevity of vellum allows. Each page of The Great Book is a unique artefact in itself, often multi-layered or palimpsestial in nature. The whole “united” in design by the work of the scribe, Denis Brown. This paper will describes the creation process of the book, its subsequent history, and future plans for the book at University College Cork.

Select Document: Sir George Radcliffe’s “Original of Government” (1639) and Absolutist Political Theory in Stuart Ireland

A seventeenth-century manuscript miscellany, which once belonged to Archbishop James Ussher of Armagh, contains a short treatise on the origins of government by Sir George Radcliffe. Radcliffe was legal assistant to Sir Thomas Wentworth, lord deputy of Ireland (from January 1640 earl of Strafford and lord lieutenant). The treatise insisted on the divine origin of all human political power and implied that the best form of government was absolute monarchy, in which the monarch was free of all human law and subject to divine restraint alone. It will be suggested below that the composition of this treatise can be dated to the summer of 1639. This introduction will offer an outline of Radcliffe’s education and political career, explain the genesis of his treatise on government, point out some pertinent aspects of its argument, and finally assess the document’s significance.

Stakeholder perceptions of ecosystem services of the Wami River and Estuary

Management of riverine and coastal ecosystems warrants enhanced understanding of how different stakeholders perceive and depend upon different kinds of ecosystem services. Employing a mixed methods approach, this study compares and contrasts the use and perceptions of upstream residents, downstream residents, tourism officials, and conservation organizations regarding the value of 30 ecosystem services provided by the Wami River and its estuary in Tanzania, and investigates their perceptions of the main threats to this system. Our findings reveal that all of the stakeholder groups place a high value on the provision of domestic water, habitat for wild plants and animals, tourism, and erosion control, and a relatively low value on the prevention of saltwater intrusion, refuge from predators, spiritual fulfillment, nonrecreational hunting, and the provision of traditional medications and inorganic materials for construction. Differences emerge, however, between the groups in the value assigned to the conservation of riverine and estuarine fauna and the provision of raw materials for building and handicrafts. Declining fish populations and an increasing human population are identified by the residents and conservation employees, respectively, as their prime concerns regarding the future conditions of the Wami River and its estuary. These groups also acknowledge increasing salinity levels and the loss of mangroves as other key concerns. The identification of these mutual interests and shared concerns can help build common ground among stakeholders while the recognition of potential tensions can assist managers in balancing and reconciling the multiple needs and values of these different groups.

Potential pathogenic fungi assessment through molecular biology in cork industry

Portugal has been the world leader in the cork sectr in terms of exports, employing ten thousands of workers. In this working activity, the permanent contact with cork may lead to the exposure to fungi raising concerns as occupational hazards in cork industry. A study was developed aiming at assessing fungal contamination due to Aspergillus fumigatus complex and Penicillium glabrum complex by molecular methods in three cork industries in the outskirt of Lisbon city. The chosen fungal species are the ones most frequently associated with respiratory problems in workers from these industries.