Why people experiencing acute myocardial infarction delay seeking medical assistance

Background: Delay time from onset of symptoms of myocardial infarction to seeking medical assistance can have life- 31 threatening consequences. A number of factors have been associated with delay, but there is little evidence regarding the predictive 32 value of these indices. Aim: To explore potential predictors of patient delay from onset of symptoms to time medical assistance 33 was sought in a consecutive sample of patients admitted to CCU with acute myocardial infarction. Methods: The Cardiac Denial 34 of Impact Scale, Health Locus of Control Scale, Health Value Scale and Pennebaker Inventory of Limbic Languidness were 35 administered to 62 patients between 3 and 6 days after admission. Results: Attribution of symptoms to heart disease and health 36 locus of control had a significant predictive effect on patients seeking help within 60 min, while previous experience of heart 37 disease did not. Conclusion: Assisting individuals to recognise the potential for symptoms to have a cardiac origin is an important 38 objective. Interventions should take into account the variety of cognitive and behavioural factors involved in decision making.

Belief, Knowledge and Expertise. The emergence of the lay expert in medical sociology

The paper has three main aims. First, to trace – through the pages of the Journal – the changing ways in which lay understandings of health and illness have been represented during the 1979-2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re-assessment of what lay people can offer to a democratised and customer sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. Key words: Lay health beliefs, lay expertise, Alzheimer’s, Traumatic Brain Injury, Vaccinations

The impact of curricular change on medical students' knowledge of anatomy

Background: In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy. Aim: This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy. Setting: Medical student intakes for 1995-98 at the Queen's University of Belfast, UK. Methods: The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, 'old' curriculum, were compared with those from the student intakes of 1996-98, which undertook a new, 'systems-based' curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group. Results: The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum. Conclusion: The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy.

Development of a Complex Intervention for Secondary Prevention of Coronary Heart Disease in Primary Care Using the UK Medical Research Council Framework

Objective: To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. Study Design: Case report of intervention development. Methods: First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants’ experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). Results: Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information. Conclusion: Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.

Analysis and Synthesis of pHEMT Class-E Amplifiers with Shunt Inductor including ON-State Active-Device Resistance Effects

In this theoretical paper, the analysis of the effect that ON-state active-device resistance has on the performance of a Class-E tuned power amplifier using a shunt inductor topology is presented. The work is focused on the relatively unexplored area of design facilitation of Class-E tuned amplifiers where intrinsically low-output-capacitance monolithic microwave integrated circuit switching devices such as pseudomorphic high electron mobility transistors are used. In the paper, the switching voltage and current waveforms in the presence of ON-resistance are analyzed in order to provide insight into circuit properties such as RF output power, drain efficiency, and power-output capability. For a given amplifier specification, a design procedure is illustrated whereby it is possible to compute optimal circuit component values which account for prescribed switch resistance loss. Furthermore, insight into how ON-resistance affects transistor selection in terms of peak switch voltage and current requirements is described. Finally, a design example is given in order to validate the theoretical analysis against numerical simulation.

A new device for the study of electron-ion interactions

The conceptual design of a new electron beam ion trap primarily intended for the study of electron-ion interactions is outlined along with some preliminary predictions regarding its capabilities. (C) 2003 Elsevier Science B.V. All rights reserved.

A new device for the study of electron-ion interactions: The Belfast EBIT

An electron beam ion trap ( EBIT) has been designed and is currently under construction for use in atomic physics experiments at the Queen's University, Belfast. In contrast to traditional EBITs where pairs of superconducting magnets are used, a pair of permanent magnets will be used to compress the electron beam. The permanent magnets have been designed in conjunction with bespoke vacuum ports to give unprecedented access for photon detection. Furthermore, the bespoke vacuum ports facillitate a versatile, reconfigurable trap structure able to accommodate various in-situ detectors and in-line charged particle analysers. Although the machine will have somewhat lower specifications than many existing EBITs in terms of beam current density, it is hoped that the unique features will facilitate a number of hitherto impossible studies involving interactions between electrons and highly charged ions. In this article the new machine's design is outlined along with some suggestions of the type of process to be studied once the construction is completed.