The removal of patients who live outside the practice boundary:a study of outside-area removals in Northern Ireland in 2001-2002

It has been suggested that there are significant overlaps between removals due to deregistration and removals arising because patients live outside the practice area. If this is true, it would mean that the current estimates of deregistration would need to be revised upwards. All outside-area removals for the calendar years 2001 and 2002 were reviewed and characterised by age, sex and Jarman score of the enumeration district of the patients' residence and distance from the practice. The average outside-area removal rate was just over one removal per practice per year. Removal rates were highest between the ages of 18 and 44 years; there were no significant differences between the sexes. Rates of removal increased exponentially with distance, although even at marked distances from the practice there were about 10 patients remaining on the list for each one removed. Residents in deprived areas were more likely to be removed, although because areas most distal to the practice tend to be affluent, overall there was a predominance of affluent patients among those who are removed. In Northern Ireland rates of outside-area removal are only slightly higher than those of deregistration. It is evident that GPs are exercising some discretion as to which of the outside-area patients they retain on their list. This has the potential to cause some misunderstanding and resentment among patients, as has been reported previously.

Arsenic residues in predatory birds from an area of Britain with naturally and anthropogenically elevated arsenic levels

Birds of prey forage over large areas and so might be expected to accumulate contaminants which are elevated but heterogeneously distributed in the general environment. The aim of this study was to test the hypothesis that arsenic levels in raptors from a region with elevated environmental arsenic concentrations were higher than those in birds from an uncontaminated part of Britain. Arsenic concentrations in the liver, kidney and muscle of kestrels, Falco tinnunculus, sparrowhawks, Accipiter nisus, and barn owls, Tyto alba, from south-west (SW) England, an area with naturally and anthropogenically (through mining) elevated environmental arsenic concentrations, were compared with those in birds from SW Scotland, where no such geochemical anomaly exists. Arsenic residues in kestrels from SW England were approximately three times greater than those in birds from SW Scotland for the three tissue types analysed. This was not the case for the other species in which arsenic residues were similar in birds from both regions. It is suggested that differences between species in both diet and arsenic metabolism could explain why kestrels have elevated arsenic tissue burdens in response to general environmental contamination but sparrowhawks and barn owls do not.

A Qualitative Evaluation of the Provision of Bereavement Care Accessed by Service Users Living in a Health and Social Care Trust Area in Northern Ireland

Within the health and social care sector in the United Kingdom, the
management of death and bereavement has become increasingly
challenging. This service evaluation sought to explore the bereavement
care offered to individuals living in one Health and Social Care
Trust catchment area of Northern Ireland. Qualitative interviews
were conducted with key government and voluntary agency staff.
The findings indicated that much of the bereavement provision is
based on the interest and initiative of individual staff members, with
few processes to assess the level of bereavement care needed and those
best skilled to provide it. Recommendations are made for a bereavement
care strategy that outlines a bereavement needs assessment process,
identifying the scope of interventions and protocols for practice.

Synthesis of spherical ultra-high-surface-area monodisperse amphipathic polymer sponges in the low-micrometer size range

Spherical, ultra-high specific surface area monodisperse polymer particles with diameters in the low micrometer size range are disclosed for the first time. The polymer particles are able to sorb significant levels of both hydrocarbon solvents and water, acting in effect as amphipathic micro-sponges. Exciting possibilities for exploitation of the particles in chromatography, diagnostics, sensors, delivery vehicles and catalysis are suggested.

Identifying optimal sites for natural recovery and restoration of impacted biogenic habitats in a special area of conservation using hydrodynamic and habitat suitability modelling

Selection of sites for successful restoration of impacted shellfish populations depends on understanding the dispersion capability and habitat requirements of the species involved. In Strangford Lough, Northern Ireland, the horse mussel (Modiolus modiolus) biogenic reefs cover only a fraction of their historical range with the remaining reefs badly damaged and requiring restoration. Previous experimental trials suggest that translocation of horse mussels accelerates reef recovery and has therefore been proposed as a suitable restoration technique. We used a series of coupled hydrodynamic and particle dispersal models to assess larval dispersion from remnant and translocated populations to identify suitable areas for adult live M. modiolus translocation in Strangford Lough, Northern Ireland. A maximum entropy model (MAXENT) was used to identify if dispersing larvae could reach habitat suitable for adult M. modiolus. From these we predicted if translocated mussels will reseed themselves or be able to act as larval sources for nearby reefs. The dispersal models showed that the remnant M. modiolus populations are largely self-recruiting with little connectivity between them. The majority of larvae settled near the sources and movement was largely dependent on the tides and not influenced by wind or waves. Higher reef elevation resulted in larvae being able to disperse further away from the release point. However, larval numbers away from the source population are likely to be too low for successful recruitment. There was also little connectivity between the Irish Sea and Strangford Lough as any larvae entering the Lough remained predominantly in the Strangford Narrows. The areas covered by these self-seeding populations are suitable for M. modiolus translocation according to the MAXENT model. As a result of this work and in conjunction with other field work we propose a combination of total protection of all remaining larval sources and small scale translocations onto suitable substrata in each of the identified self-recruiting areas.

A shared care model pilot for palliative home care in a rural area:Impact on symptoms, distress, and place of death

Context: Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives: To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods: An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models. Results: Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed. Conclusion: Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Characterization of Inter-Body Interference in Context Aware Body Area Networking (CABAN)

The characterization and understanding of body to body communication channels is a pivotal step in the development of emerging wireless applications such as ad-hoc personnel localisation and context aware body area networks (CABAN). The latter is a recent innovation where the inherent mobility of body area networks can be used to improve the coexistence of multiple co-located BAN users. Rather than simply accepting reductions in communication performance, sensed changes in inter-network co-channel interference levels may facilitate intelligent inter-networking; for example merging or splitting with other BANs that remain in the same domain. This paper investigates the inter-body interference using controlled measurements of the full mesh interconnectivity between two ambulatory BANs operating in the same environment at 2.45 GHz. Each of the twelve network nodes reported received signal strength to allow for the creation of carrier to interference ratio time series with an overall entire mesh sampling period of 54 ms. The results indicate that even with two mobile networks, it is possible to identify the onset of co-channel interference as the BAN users move towards each other and, similarly, the transition to more favourable physical layer channel conditions as they move apart. © 2011 IEEE.