What do patients want to know about their medicines, and what do doctors want to tell them?: a comparative study

A two phase study is reported. In the first phase, we asked a number of doctors to rate a list of information categories (identified by Berry, Gillie and Banbury 1995) in terms of how important they felt it was for the items to be included in an explanation to a patient about a drug prescription. In the second phase, we presented a large sample of people with a scenario about visiting their doctor and being prescribed medication, together with an explanation about the prescription which was said to be provided by the doctor. Four different explanations were compared, which were either based on what people in our earlier study wanted to know about drug prescriptions or on what the doctors thought it was important lo tell them. We also manipulated whether or not the explanations conveyed negative information (e.g. about the possible side effects of the medication). The results showed that people 'preferred' the explanations based on what the participants in the earlier study wanted to know about their medicines, rather than those based on what the doctors thought they should be told. They also 'preferred' the explanations that did not convey negative information, rather than those that did convey some negative information. In addition, the inclusion of negative information affected ratings of likely compliance with the prescribed medication.

Infant feeding choices: experience, self-identity and lifestyle

In England 78% of mothers initiate breastfeeding and in the UK less than 1% exclusively breastfeed until 6 months, despite WHO recommendations to do so. This study investigated women’s infant feeding choices using in-depth interviews with 12 mothers of infants aged 7-18 weeks. Using content analysis, four themes emerged: (1) Information, Knowledge and Decision Making, (2) Physical Capability, (3) Family and Social Influences, (4) Lifestyle, Independence and Self-Identity. Whilst women were aware of the ‘Breast is Best’ message, some expressed distrust in this information if they had not been breastfed themselves. Women felt their own infant feeding choice was influenced by the perceived norm amongst family and friends. Women described how breastfeeding hindered their ability to retain their self-identities beyond motherhood as it limited their independence. Several second-time mothers felt they lacked support from health professionals when breastfeeding their second baby, even if they had previously encountered breastfeeding difficulties. The study indicates that experience of breastfeeding, and belief in the health benefits associated with it are important factors for initiation of breastfeeding, whilst decreased independence and self-identity may influence duration of breastfeeding. Intervention and support schemes should tackle all mothers, not just first-time mothers.

"Racism in a Melting Pot...?" Trinidadian mid-life transnational migrants' views on race and colour-class on return to their homes of descent

This paper deals with second-generation, one-and-a-half generation and ‘‘prolonged sojourner” Trinidadian transnational migrants, who have decided to ‘return’ to the birthplace of their parents. Based on 40 in-depth interviews, the paper considers both the positive and critical things that these youthful transnational migrants report about returning to, and living in, this multi-ethnic plural society and the salience of racial and colour-class stratification as part of their return migration experiences. Our qualitative analysis is based on the narratives provided by these youthful returnees, as relayed ‘‘in their own words”, presenting critical reflections on racism, racial identities and experiences as transnational Trinidadians. It is clear that it is contexts such as contemporary working environments, family and community that act as the reference points for the adaptation ‘‘back home” of this strongly middle-class cohort. We accordingly encounter a diverse, sometimes contesting set of racial issues that emerge as salient concerns for these returnees. The consensus is that matters racial remain as formidable legacies in the hierarchical stratification of Trinidadian society for a sizeable number. Many of our respondents reported the positive aspects of racial affirmation on return. But for another sub-set, the fact that multi-ethnic and multi-cultural mixing are proudly embraced in Trinidad meant that it was felt that return experiences were not overly hindered, or blighted by obstacles of race and colour-class. For these returnees, Trinidad and Tobago is seen as representing a 21st century ‘‘Melting Pot”. But for others the continued existence of racial divisions within society – between ethnic groups and among those of different skin shades – was lamented. In the views of these respondents, too much racial power is still ascribed to ‘near-whiteness’. But for the most part, the returnees felt that where race played a part in their new lives, this generally served to advantage them. However, although the situation in Trinidad appears to have been moderated by assumptions that it remains a racial ‘Melting Pot’, the analysis strongly suggests that the colour-class system of stratification is still playing an essential role, along with racial stereotyping in society at large.

Innovative use of vodcast (Video-Podcast) to enrich learning experience in structures laboratory

Students may have difficulty in understanding some of the complex concepts which they have been taught in the general areas of science and engineering. Whilst practical work such as a laboratory based examination of the performance of structures has an important role in knowledge construction this does have some limitations. Blended learning supports different learning styles, hence further benefits knowledge building. This research involves an empirical study of how vodcasts (video-podcasts) can be used to enrich learning experience in the structural properties of materials laboratory of an undergraduate course. Students were given the opportunity of downloading and viewing the vodcasts on the theory before and after the experimental work. It is the choice of the students when (before or after, before and after) and how many times they would like to view the vodcasts. In blended learning, the combination of face-to-face teaching, vodcasts, printed materials, practical experiments, writing reports and instructors’ feedbacks benefits different learning styles of the learners. For the preparation of the practical, the students were informed about the availability of the vodcasts prior to the practical session. After the practical work, students submitted an individual laboratory report for the assessment of the structures laboratory. The data collection consisted of a questionnaire completed by the students, follow-up semi-structured interviews and the practical reports submitted by them for assessment. The results from the questionnaire were analysed quantitatively, whilst the data from the assessment reports were analysed qualitatively. The analysis shows that most of the students who have not fully grasped the theory after the practical, managed to gain the required knowledge by viewing the vodcasts. According to their feedbacks, the students felt that they have control over how to use the material and to view it as many times as they wish. Some students who have understood the theory may choose to view it once or not at all. Their understanding was demonstrated by their explanations in their reports, and was illustrated by the approach they took to explicate the results of their experimental work. The research findings are valuable to instructors who design, develop and deliver different types of blended learning, and are beneficial to learners who try different blended approaches. Recommendations were made on the role of the innovative application of vodcasts in the knowledge construction for structures laboratory and to guide future work in this area of research.

Best Available Techniques (BAT) and coal fired power stations: Can the energy gap be plugged without increasing emissions?

At present, there is much anxiety regarding the security of energy supplies; for example, the UK and other European States are set to become increasingly dependant upon imports of natural gas from states with which political relations are often strained. These uncertainties are felt acutely by the electricity generating sector, which is facing major challenges regarding the choice of fuel mix in the years ahead. Nuclear energy may provide an alternative; however, in the UK, progress in replacing the first generation reactors is exceedingly slow. A number of operators are looking to coal as a means of plugging the energy gap. However, in the light of ever more stringent legal controls on emissions, this step cannot be taken without the adoption of sophisticated pollution abatement technology. This article examines the role which legal concepts such as Best Available Techniques (BAT) must play in bringing about these changes.

Global estimates of snow water equivalent from passive microwave instruments: history, challenges and future developments

Snow properties have been retrieved from satellite data for many decades. While snow extent is generally felt to be obtained reliably from visible-band data, there is less confidence in the measurements of snow mass or water equivalent derived from passive microwave instruments. This paper briefly reviews historical passive microwave instruments and products, and compares the large-scale patterns from these sources to those of general circulation models and leading reanalysis products. Differences are seen to be large between the datasets, particularly over Siberia. A better understanding of the errors in both the model-based and measurement-based datasets is required to exploit both fully. Techniques to apply to the satellite measurements for improved large-scale snow data are suggested.

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level. (C) 2008 Elsevier B.V. All rights reserved.

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level. (C) 2008 Elsevier B.V. All rights reserved.

Techniques for analysis of proteins by SDS-polyacrylamide gel electrophoresis and Western blotting

The separation of mixtures of proteins by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) is a technique that is widely used—and, indeed, this technique underlies many of the assays and analyses that are described in this book. While SDS-PAGE is routine in many labs, a number of issues require consideration before embarking on it for the first time. We felt, therefore, that in the interest of completeness of this volume, a brief chapter describing the basics of SDS-PAGE would be helpful. Also included in this chapter are protocols for the staining of SDS-PAGE gels to visualize separated proteins, and for the electrotransfer of proteins to a membrane support (Western blotting) to enable immunoblotting, for example. This chapter is intended to complement the chapters in this book that require these techniques to be performed. Therefore, detailed examples of why and when these techniques could be used will not be discussed here.

Condensation and moisture transport in cold roofs: effect of roof underlay

Cold pitched roofs, with their form of construction situating insulation on a horizontal ceiling, are intrinsically vulnerable to condensation. This study reports the results derived from using a simulation package (Heat, Air and Moisture modelling tool, or HAM-Tools) to investigate the risk of condensation in cold pitched roofs in housing fitted with a vapour-permeable underlay (VPU) of known characteristics. In order to visualize the effect of the VPUs on moisture transfer, several scenarios were modelled, and compared with the results from a conventional bituminous felt with high resistance (200 MNs/g, Sd = 40 m). The results indicate that ventilation is essential in the roof to reduce condensation. However, a sensitivity analysis proved that reducing the overall tightness of the ceiling and using lower-resistance VPUs would help in controlling condensation formation in the roof. To a large extent, the proposed characteristic performance of the VPU as predicted by manufacturers and some researchers may only be realistic if gaps in the ceiling are sealed completely during construction, which may be practically difficult given current construction practice.

In-service training needs in an African context: a study of headteacher and teacher perspectives in the Gucha District of Kenya

Improving the quality of teaching is an educational priority in Kenya, as in many developing countries. The present paper considers various aspects of in-service education, including views on the effectiveness of in-service, teacher and headteacher priorities in determining in-service needs and the constraints on providing in-service courses. These issues are examined though an empirical study of 30 secondary headteachers and 109 teachers in a district of Kenya. The results show a strong felt need for in-service provision together with a firm belief in the efficacy of in-service in raising pupil achievement. Headteachers had a stronger belief in the need for in-service for their teachers than did the teachers themselves. The priorities of both headteachers and teachers were dominated by the external pressures of the schools, in particular the pressures for curriculum innovation and examination success. The resource constraints on supporting attendance at in-service courses were the major problems facing headteachers. The results reflect the difficulties that responding to an externally driven in-service agenda creates in a context of scarce resources.

Young people with intellectual disabilities attending mainstream and segregated schooling: perceived stigma, social comparison and future aspirations

Mainstream schooling is a key policy in the promotion of social inclusion of young people with learning disabilities. Yet there is limited evidence about the school experience of young people about to leave mainstream as compared with segregated education, and how it impacts on their relative view of self and future aspirations. Sixty young people with mild to moderate intellectual disabilities in their final year of secondary school participated in this study. Twenty-eight individuals came from mainstream schools and 32 attended segregated school. They completed a series of self-report measures on perceptions of stigma, social comparison to a more disabled and non-disabled peer and the likelihood involved in attaining their future goals. The majority of participants from both groups reported experiencing stigmatized treatment in the local area where they lived. The mainstream group reported significant additional stigma at school. In terms of social comparisons, both groups compared themselves positively with a more disabled peer and with a non-disabled peer. While the mainstream pupils had more ambitious work-related aspirations, both groups felt it equally likely that they would attain their future goals. Although the participants from segregated schools came from significantly more deprived areas and had lower scores on tests of cognitive functioning, neither of these factors appeared to have an impact on their experience of stigma, social comparisons or future aspirations. Irrespective of schooling environment, the young people appeared to be able to cope with the threats to their identities and retained a sense of optimism about their future. Nevertheless, negative treatment reported by the children was a serious source of concern and there is a need for schools to promote the emotional well-being of pupils with intellectual disabilities.

Overseas trained teachers: part of a problem or part of a solution?

Overseas trained teachers (OTTs) have grown in numbers during the past decade, particularly in London and the South East of England. In this recruitment explosion many OTTs have experienced difficulties. In professional literature as well as press coverage OTTs often become part of a deficit discourse. A small-scale pilot investigation of OTT experience has begun to suggest why OTTs have been successful as well as the principal challenges they have faced. An important factor in their success was felt to be the quality of support in school from others on the staff. Major challenges included the complexity of the primary curriculum. The argument that globalisation leads to brain-drain may be exaggerated. Suggestions for further research are made, which might indicate the positive benefits OTTs can bring to a school.

Modelling the likely impact of healthy eating guidelines on agricultural production and land use in England and Wales

Quadratic programming techniques were applied to household food consumption data in England and Wales to estimate likely changes in diet under healthy eating guidelines, and the consequences this would have on agriculture and land use in England and Wales. The first step entailed imposing nutrient restrictions on food consumption following dietary recommendations suggested by the UK Department of Health. The resulting diet was used, in a second step as a proxy for demand in agricultural commodities, to test the impact of such a scenario on food production and land use in England and Wales and the impacts of this on agricultural landscapes. Results of the diet optimisation indicated a large drop in consumption of foods rich in saturated fats and sugar, essentially cheese and sugar-based products, along with lesser cuts of fat and meat products. Conversely, consumption of fruit and vegetables, cereals, and flour would increase to meet dietary fibre recommendations. Such a shift in demand would dramatically affect production patterns: the financial net margin of England and Wales agriculture would rise, due to increased production of high market value and high economic margin crops. Some regions would, however, be negatively affected, mostly those dependent on beef cattle and sheep production that could not benefit from an increased demand for cereals and horticultural crops. The effects of these changes would also be felt in upstream industries, such as animal feed suppliers. While arable dominated landscapes would be little affected, pastoral landscapes would suffer through loss of grazing management and, possibly, land abandonment, especially in upland areas.

Influences on secured lending property valuations in the UK

A significant part of bank lending in the UK is secured on commercial property and valuations play an important part in this process. They are an integral part of risk management within the banking sector. It is therefore important that valuations are independent and objective and are used properly to ensure that secured lending is soundly based from the perspective of both lender and borrower. The purpose of this research is to examine objectivity and transparency in the valuation process for bank lending and to identify any influences which may undermine the process. A detailed analysis of 31 valuation negligence cases has been followed by two focus groups of lenders and valuers and also questionnaire surveys of commercial lenders and valuers. Many stakeholders exist, for example lenders, borrowers and brokers, who are able to influence the process in various ways. The strongest evidence of overt influence in the process comes from the method of valuer selection with borrowers and brokers seen to be heavily involved. There is some also some evidence of influence during the draft valuation process. A significant minority of valuers feel that inappropriate pressure is applied by borrowers and brokers yet there is no apparent part of the process that leads to this. The panel system employed by lenders is found to be a significant part of the system and merits further examination. The pressure felt by valuers needs more investigation along with the question of if and how the process could dispel such feelings. This is seen as particularly important in the context of bank regulation.