Shore Shapers: Introducing children and the general public to biogeomorphological processes and geodiversity

Coastal processes and wildlife shape the coast into a variety of eye-catching and enticing landforms that attract people to marvel at, relax and enjoy coastal geomorphology. These landforms also influence biological communities by providing habitat and refuge. There are very few field guides to explain these processes to the general public and children. In contrast, there is a relative wealth of resources and organised activities introducing people to coastal wildlife, especially on rocky shores. These biological resources typically focus on the biology and climatic controls on their distribution, rather than how the biology interacts with its physical habitat. As an outcome of two recent rock coast biogeomorphology projects (detailed at: www.biogeomorph.org/coastal) a multi disciplinary team produced the first known guide to understanding how biogeomorphological processes help create coastal landforms. The ‘Shore Shapers’ guide (shoreshapers.org) is designed to: a. bring biotic geomorphic interactions (how animals, algae and microorganisms protect and shape rock) to life and b. introduce some of the geomorphological and geological controls on biogeomorphic processes and landform development. The guide provides scientific information in an accessible and interactive way – to help sustain children’s interest and extend their learning. We tested a draft version of the guide with children,the general public and volunteers on rocky shore rambles using social science techniques and present the findings, alongside initial results of an evaluation of a newer version of the guide and interactive workshops taking place throughout 2014.

Identidad territorial y paisaje. Evolución morfológica de los núcleos en Castilla y León.

Este estudio intenta esclarecer las transformaciones físicas y socioeconómicas de los asentamientos rurales de la región española de Castilla y León, durante la segunda mitad del siglo XX. Se analiza la evolución temporal de la forma urbana a través de un Sistema de Información Geográfico (SIG), calculando unos índices métricos y comparándolos con la información demográfica histórica. Los resultados pretenden mostrar los efectos de la especialización funcional económica, causada por la integración en las jerarquías productivas globales, sobre la estructura urbana. La pérdida gradual de las características tradicionales de los pueblos castellanos, como la compacidad y la integración en el entorno, debido a la pérdida o degradación de la arquitectura popular y la construcción de nuevas edificaciones industriales, supone un riesgo para las futuras políticas de desarrollo local. Se considera necesario preservar la identidad paisajística y evitar la destrucción del patrimonio cultural para poder revitalizar estos territorios.

Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.

Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study

Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. Design: Qualitative study using focus groups and indepth interviews. Setting: Primary care in Northern Ireland. Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. Main outcome measures: Participants' views about their own and colleagues' health. Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

Joint and soft tissue injections in the community: questionnaire survey of general practitioners' experiences and attitudes

To investigate the numbers and types of joint and soft tissue injections performed by general practitioners (GPs) and to explore attitudes to training in joint and soft tissue injection and perceived barriers to performing injections.

A randomised study of two training programmes for general practitioners in the techniques of shoulder injection

Training on patients in addition to conventional mannequins increased GPs shoulder injection activity and their level of confidence.Hospital injection clinicsa may provide a suitable setting in which to train GPs interested in developing their shoulder joint injection skills

Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics?

Objectives: To determine whether diagnostic triage by general practitioners (GPs) or rheumatology nurses (RNs) can improve the positive predictive value of referrals to early arthritis clinics (EACs).

Methods: Four GPs and two RNs were trained in the assessment of early in?ammatory arthritis (IA) by four visits to an EAC supervised by hospital rheumatologists. Patients referred to one of three EACs were recruited for study and assessed independently by a GP, an RN and one of six rheumatologists. Each assessor was asked to record their clinical ?ndings and whether they considered the patient to have IA. Each was then asked to judge the appropriateness of the referral according to predetermined guidelines. The rheumatologists had been shown previously to have a satisfactory level of agreement in the assessment of IA.

Results: Ninety-six patients were approached and all consented to take part in the study. In 49 cases (51%), the rheumatologist judged that the patient had IA and that the referral was appropriate. The assessments of GPs and RNs were compared with those of the rheumatologists. Levels of agreement were measured using the kappa value, where 1.0 represents total unanimity. The kappa value was
0.77 for the GPs when compared with the rheumatologists and 0.79 for the RNs. Signi?cant stiffness in the morning or after rest and objective joint swelling were the most important clinical features enabling the GPs and RNs to discriminate between IA and non-IA conditions.

Conclusion: Diagnostic triage by GPs or RNs improved the positive predictive value of referrals to an EAC with a degree of accuracy approaching that of a group of experienced rheumatologists.