Somatisation in primary care: experiences of primary care physicians involved in a training program and in a randomised controlled trial

Background: A new intervention aimed at managing patients with medically unexplained symptoms (MUS) based on a specific set of communication techniques was developed, and tested in a cluster randomised clinical trial. Due to the modest results obtained and in order to improve our intervention we need to know the GPs' attitudes towards patients with MUS, their experience, expectations and the utility of the communication techniques we proposed and the feasibility of implementing them. Physicians who took part in 2 different training programs and in a randomised controlled trial (RCT) for patients with MUS were questioned to ascertain the reasons for the doctors' participation in the trial and the attitudes, experiences and expectations of GPs about the intervention. Methods: A qualitative study based on four focus groups with GPs who took part in a RCT. A content analysis was carried out. Results: Following the RCT patients are perceived as true suffering persons, and the relationship with them has improved in GPs of both groups. GPs mostly valued the fact that it is highly structured, that it made possible a more comfortable relationship and that it could be applied to a broad spectrum of patients with psychosocial problems. Nevertheless, all participants consider that change in patients is necessary; GPs in the intervention group remarked that that is extremely difficult to achieve. Conclusion: GPs positively evaluate the communication techniques and the interventions that help in understanding patient suffering, and express the enormous difficulties in handling change in patients. These findings provide information on the direction in which efforts for improving intervention should be directed.

Combination of web usage, content and structure information for diverse web mining applications in the tourism context and the context of users with disabilities

188 p.

The Cache Inference Problem and its Application to Content and Request Routing

In many networked applications, independent caching agents cooperate by servicing each other's miss streams, without revealing the operational details of the caching mechanisms they employ. Inference of such details could be instrumental for many other processes. For example, it could be used for optimized forwarding (or routing) of one's own miss stream (or content) to available proxy caches, or for making cache-aware resource management decisions. In this paper, we introduce the Cache Inference Problem (CIP) as that of inferring the characteristics of a caching agent, given the miss stream of that agent. While CIP is insolvable in its most general form, there are special cases of practical importance in which it is, including when the request stream follows an Independent Reference Model (IRM) with generalized power-law (GPL) demand distribution. To that end, we design two basic "litmus" tests that are able to detect LFU and LRU replacement policies, the effective size of the cache and of the object universe, and the skewness of the GPL demand for objects. Using extensive experiments under synthetic as well as real traces, we show that our methods infer such characteristics accurately and quite efficiently, and that they remain robust even when the IRM/GPL assumptions do not hold, and even when the underlying replacement policies are not "pure" LFU or LRU. We exemplify the value of our inference framework by considering example applications.

Intelligent design assistant (IDA): a case base reasoning system for material and design

This paper describes the approach to the modelling of experiential knowledge in an industrial application of Case-Based Reasoning (CBR). The CBR involves retrieval techniques in conjunction with a relational database. The database is especially designed as a repository of experiential knowledge, and includes qualitative search indices. The system is intended to help design engineers and material engineers in the submarine cable industry. It consists of three parts: a materials database; a database of experiential knowledge; and a CBR system used to retrieve similar past designs based upon component and material qualitative descriptions. The system is currently undergoing user testing at the Alcatel Submarine Networks site in Greenwich.

Research and design challenges for developing personalised eLearning systems

While E-learning technologies are continuously developing, there are number of emerging issues and challenges that have significant impact on e-learning research and design. These include educational, technological, sociological, and psychological viewpoints. The extant literature points out that a large number of existing E-learning systems have problems with offering reusable, personalized and learner-centric content. While developers are placing emphasis on the technology aspects of e-learning, critical conceptual and pedagogical issues are often ignored. This paper will reports on our research in design and development of personalised e-learning systems and some of the challenges and issues faced.

Prospective, Randomized Assessment of Transfer of Training (ToT) and Transfer Effectiveness Ratio (TER) of Virtual Reality Simulation Training for Laparoscopic Skill Acquisition

OBJECTIVES:: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. DESIGN:: Prospective, randomized, and blinded. PARTICIPANTS:: In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. RESULTS:: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32- 42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2). CONCLUSIONS:: VR simulation training offers a powerful and effective platform for training safer skills.

Robust bimodal person identification using face and speech with limited training data and corruption of both modalities

This paper presents a novel method of audio-visual fusion for person identification where both the speech and facial modalities may be corrupted, and there is a lack of prior knowledge about the corruption. Furthermore, we assume there is a limited amount of training data for each modality (e.g., a short training speech segment and a single training facial image for each person). A new representation and a modified cosine similarity are introduced for combining and comparing bimodal features with limited training data as well as vastly differing data rates and feature sizes. Optimal feature selection and multicondition training are used to reduce the mismatch between training and testing, thereby making the system robust to unknown bimodal corruption. Experiments have been carried out on a bimodal data set created from the SPIDRE and AR databases with variable noise corruption of speech and occlusion in the face images. The new method has demonstrated improved recognition accuracy.

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels

Background
Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients’ adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).

Methods
We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients’ adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3).

Results
Eight TDF domains were perceived to influence patients’ and HCPs’ behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3).

Conclusions
Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.

The Role of Water Content and Paste Proportion on Physico-mechanical Properties of Alkali Activated Fly Ash–Ggbs Concrete

The growth of the construction industry worldwide poses a serious concern on the sustainability of the building material production chain, mainly due to the carbon emissions related to the production of Portland cement. On the other hand, valuable materials from waste streams, particularly from the metallurgical industry, are not used at their full potential. Alkali activated concrete (AAC) has emerged in the last years as a promising alternative to traditional Portland cement based concrete for some applications. However, despite showing remarkable strength and durability potential, its utilisation is not widespread, mainly due to the lack of broadly accepted standards for the selection of suitable mix recipes fulfilling design requirements, in particular workability, setting time and strength. In this paper, a contribution towards the design development of AAC synthetized from pulverised fuel ash (60%) and ground granulated blast furnace slag (40%) activated with a solution of sodium hydroxide and sodium silicate is proposed. Results from a first batch of mixes indicated that water content influences the setting time and that paste content is a key parameter for controlling strength development and workability. The investigation indicated that, for the given raw materials and activator compositions, a minimum water to solid (w/s) ratio of 0.37 was needed for an initial setting time of about 1 hour. Further work with paste content in the range of 30% to 33% determined the relationship between workability and strength development and w/s ratio and paste content. Strengths in the range of 50 - 60 MPa were achieved.

FEM based Virtual Prototyping and Design of Third Harmonic Excitation System for Low Voltage Brushless Alternators

Salient pole brushless alternators coupled to IC engines are extensively used as stand-by power supply units for meeting in- dustrial power demands. Design of such generators demands high power to weight ratio, high e ciency and low cost per KVA out- put. Moreover, the performance characteristics of such machines like voltage regulation and short circuit ratio (SCR) are critical when these machines are put into parallel operation and alterna- tors for critical applications like defence and aerospace demand very low harmonic content in the output voltage. While designing such alternators, accurate prediction of machine characteristics, including total harmonic distortion (THD) is essential to mini- mize development cost and time. Total harmonic distortion in the output voltage of alternators should be as low as possible especially when powering very sophis- ticated and critical applications. The output voltage waveform of a practical AC generator is replica of the space distribution of the ux density in the air gap and several factors such as shape of the rotor pole face, core saturation, slotting and style of coil disposition make the realization of a sinusoidal air gap ux wave impossible. These ux harmonics introduce undesirable e ects on the alternator performance like high neutral current due to triplen harmonics, voltage distortion, noise, vibration, excessive heating and also extra losses resulting in poor e ciency, which in turn necessitate de-rating of the machine especially when connected to non-linear loads. As an important control unit of brushless alternator, the excitation system and its dynamic performance has a direct impact on alternator's stability and reliability. The thesis explores design and implementation of an excitation i system utilizing third harmonic ux in the air gap of brushless al- ternators, using an additional auxiliary winding, wound for 1=3rd pole pitch, embedded into the stator slots and electrically iso- lated from the main winding. In the third harmonic excitation system, the combined e ect of two auxiliary windings, one with 2=3rd pitch and another third harmonic winding with 1=3rd pitch, are used to ensure good voltage regulation without an electronic automatic voltage regulator (AVR) and also reduces the total harmonic content in the output voltage, cost e ectively. The design of the third harmonic winding by analytic methods demands accurate calculation of third harmonic ux density in the air gap of the machine. However, precise estimation of the amplitude of third harmonic ux in the air gap of a machine by conventional design procedures is di cult due to complex geome- try of the machine and non-linear characteristics of the magnetic materials. As such, prediction of the eld parameters by conven- tional design methods is unreliable and hence virtual prototyping of the machine is done to enable accurate design of the third har- monic excitation system. In the design and development cycle of electrical machines, it is recognized that the use of analytical and experimental methods followed by expensive and in exible prototyping is time consum- ing and no longer cost e ective. Due to advancements in com- putational capabilities over recent years, nite element method (FEM) based virtual prototyping has become an attractive al- ternative to well established semi-analytical and empirical design methods as well as to the still popular trial and error approach followed by the costly and time consuming prototyping. Hence, by virtually prototyping the alternator using FEM, the important performance characteristics of the machine are predicted. Design of third harmonic excitation system is done with the help of results obtained from virtual prototype of the machine. Third harmonic excitation (THE) system is implemented in a 45 KVA ii experimental machine and experiments are conducted to validate the simulation results. Simulation and experimental results show that by utilizing third harmonic ux in the air gap of the ma- chine for excitation purposes during loaded conditions, triplen harmonic content in the output phase voltage is signi cantly re- duced. The prototype machine with third harmonic excitation system designed and developed based on FEM analysis proved to be economical due to its simplicity and has the added advan- tage of reduced harmonics in the output phase voltage.

Social networks and performance in knowledge creation. An application and a methodological proposal

El objetivo de esta tesis es predecir el rendimiento de los estudiantes de doctorado en la Universidad de Girona según características personales (background), actitudinales y de redes sociales de los estudiantes. La población estudiada son estudiantes de tercer y cuarto curso de doctorado y sus directores de tesis doctoral. Para obtener los datos se ha diseño un cuestionario web especificando sus ventajas y teniendo en cuenta algunos problemas tradicionales de no cobertura o no respuesta. El cuestionario web se hizo debido a la complejidad que comportan de las preguntas de red social. El cuestionario electrónico permite, mediante una serie de instrucciones, reducir el tiempo para responder y hacerlo menos cargado. Este cuestionario web, además es auto administrado, lo cual nos permite, según la literatura, unas respuestas mas honestas que cuestionario con encuestador. Se analiza la calidad de las preguntas de red social en cuestionario web para datos egocéntricos. Para eso se calcula la fiabilidad y la validez de este tipo de preguntas, por primera vez a través del modelo Multirasgo Multimétodo (Multitrait Multimethod). Al ser datos egocéntricos, se pueden considerar jerárquicos, y por primera vez se una un modelo Multirasgo Multimétodo Multinivel (multilevel Multitrait Multimethod). Las la fiabilidad y validez se pueden obtener a nivel individual (within group component) o a nivel de grupo (between group component) y se usan para llevar a cabo un meta-análisis con otras universidades europeas para analizar ciertas características de diseño del cuestionario. Estas características analizan si para preguntas de red social hechas en cuestionarios web son más fiables y validas hechas "by questions" o "by alters", si son presentes todas las etiquetas de frecuencia para los ítems o solo la del inicio y final, o si es mejor que el diseño del cuestionario esté en con color o blanco y negro. También se analiza la calidad de la red social en conjunto, en este caso específico son los grupos de investigación de la universidad. Se tratan los problemas de los datos ausentes en las redes completas. Se propone una nueva alternativa a la solución típica de la red egocéntrica o los respondientes proxies. Esta nueva alternativa la hemos nombrado "Nosduocentered Network" (red Nosduocentrada), se basa en dos actores centrales en una red. Estimando modelos de regresión, esta "Nosduocentered network" tiene mas poder predictivo para el rendimiento de los estudiantes de doctorado que la red egocéntrica. Además se corrigen las correlaciones de las variables actitudinales por atenuación debido al pequeño tamaño muestral. Finalmente, se hacen regresiones de los tres tipos de variables (background, actitudinales y de red social) y luego se combinan para analizar cual para predice mejor el rendimiento (según publicaciones académicas) de los estudiantes de doctorado. Los resultados nos llevan a predecir el rendimiento académico de los estudiantes de doctorado depende de variables personales (background) i actitudinales. Asimismo, se comparan los resultados obtenidos con otros estudios publicados.

Selenium supplementation of lactating dairy cows: effects on milk production and total selenium content and speciation in blood, milk and cheese

Forty-multiparous Holstein cows were used in a 16-wk continuous design study to determine the effects of either selenium (Se) source, selenized yeast (SY) (derived from a specific strain of Saccharomyces cerevisiae CNCM I-3060 Sel-Plex®) or sodium selenite (SS), or inclusion rate of SY on Se concentration and speciation in blood, milk and cheese. Cows received ad libitum a TMR with 1:1 forage:concentrate ratio on a dry matter (DM) basis. There were four diets (T1-T4) which differed only in either source or dose of Se additive. Estimated total dietary Se for T1 (no supplement), T2 (SS), T3 (SY) and T4 (SY) was 0.16, 0.30, 0.30 and 0.45 mg/kg DM, respectively. Blood and milk samples were taken at 28 day intervals and at each time point there were positive linear effects of SY on Se concentration in blood and milk. At day 112 blood and milk Se values for T1-T4 were 177, 208, 248, 279 ± 6.6 and 24, 38, 57, 72 ± 3.7 ng/g fresh material, respectively and indicate improved uptake and incorporation of Se from SY. While selenocysteine (SeCys) was the main selenised amino acid in blood its concentration was not markedly affected by treatment, but the proportion of total Se as selenomethionine (SeMet) increased with increasing inclusion rate of SY. In milk, there were no marked treatment effects on SeCys content, but Se source had a marked effect on the proportion of total Se as SeMet. At day 112 replacing SS (T2) with SY (T3) increased the SeMet concentration of milk from 36 to 111 ng Se/g and its concentration increased further to 157 ng Se/g as the inclusion rate of SY increased further (T4) to provide 0.45 mg Se/kg TMR. Neither Se source nor inclusion rate effected the keeping quality of milk. At day 112, milk from T1, T2, and T3 was made into a hard cheese and Se source had a marked effect on total Se and the proportion of total Se comprised as either SeMet or SeCys. Replacing SS (T2) with SY (T3) increased total Se, SeMet and SeCys content from 180 to 340 ng Se/g, 57 to 153 ng Se/g and 52 to 92 ng Se/g, respectively. Key words: dairy cow, milk and cheese, selenomethionine, selenocysteine, milk keeping quality