Reluctance of general practice staff to register patients without documentation: a qualitative study in North East London.

BACKGROUND: Lack of access to documentation is a key barrier to GP registration, despite NHS England guidance stating that documents are not required. Staff attitudes and practice regarding registration of those without documentation are under- researched. AIM: To understand the processes through which registration might be refused for those without documents, and the factors operating to influence this. DESIGN AND SETTING: Qualitative study conducted in general practice across three clinical commissioning groups in North East London. METHOD: In total, 33 participants (GP staff involved in registering new patients) were recruited through email invitation. Semi-structured interviews and focus groups were conducted. Data were analysed using Braun and Clarke's reflexive thematic analysis. Two social theories informed this analysis: Lipsky's street-level bureaucracy and Bourdieu's theory of practice. RESULTS: Despite good knowledge of guidance, most participants expressed reluctance to register those without documentation, often introducing additional hurdles or requirements in their everyday practice. Two explanatory themes were generated: that those without documents were perceived as burdensome, and/or that moral judgements were made about their deservedness to finite resources. Participants described a context of high workload and insufficient funding. Some felt that GP services should be restricted by immigration status, as is widespread in secondary care. CONCLUSION: Improving inclusive registration practice requires addressing staff concerns, supporting navigation of high workloads, tackling financial disincentives to registering transient groups, and challenging narratives that undocumented migrants represent a 'threat' to NHS resources. Furthermore, it is imperative to acknowledge and address upstream drivers, in this instance the Hostile Environment

Distributed Intelligent MEMS: Progresses and Perspectives

International audienceMEMS research has until recently focused mainly on the engineering process, resulting in interesting products and a growing market. To fully realize the promise of MEMS, the next step is to add embedded intelligence. With embedded intelligence, the scalability of manufacturing will enable distributed MEMS systems consisting of thousands or millions of units which can work together to achieve a common goal. However, before such systems can become a reallity, we must come to grips with the challenge of scalability which will require paradigm-shifts both in hardware and software. Furthermore, the need for coordinated actuation, programming, communication and mobility management raises new challenges in both control and programming. The objective of this article is to report the progresses made by taking the example of two research projects and by giving the remaining challenges and the perspectives of distributed intelligent MEMS

SO(5) superconductor in a Zeeman magnetic field: Phase diagram and thermodynamic properties

In this paper we present calculations of the SO(5) quantum rotor theory of high-T$_{c}$ superconductivity in Zeeman magnetic field. We use the spherical approach for five-component quantum rotors in three-dimensional lattice to obtain formulas for critical lines, free energy, entropy and specific heat and present temperature dependences of these quantities for different values of magnetic field. Our results are in qualitative agreement with relevant experiments on high-T$_{c}$ cuprates.Comment: 4 pages, 2 figures, to appear in Phys. Rev. B, see http://prb.aps.or

DNA methylation profiling of the human major histocompatibility complex: A pilot study for the Human Epigenome Project

The Human Epigenome Project aims to identify, catalogue, and interpret genome-wide DNA methylation phenomena. Occurring naturally on cytosine bases at cytosine-guanine dinucleotides, DNA methylation is intimately involved in diverse biological processes and the aetiology of many diseases. Differentially methylated cytosines give rise to distinct profiles, thought to be specific for gene activity, tissue type, and disease state. The identification of such methylation variable positions will significantly improve our understanding of genome biology and our ability to diagnose disease. Here, we report the results of the pilot study for the Human Epigenome Project entailing the methylation analysis of the human major histocompatibility complex. This study involved the development of an integrated pipeline for high-throughput methylation analysis using bisulphite DNA sequencing, discovery of methylation variable positions, epigenotyping by matrix-assisted laser desorption/ionisation mass spectrometry, and development of an integrated public database available at http://www.epigenome.org. Our analysis of DNA methylation levels within the major histocompatibility complex, including regulatory exonic and intronic regions associated with 90 genes in multiple tissues and individuals, reveals a bimodal distribution of methylation profiles (i.e., the vast majority of the analysed regions were either hypo- or hypermethylated), tissue specificity, inter-individual variation, and correlation with independent gene expression data

Exactly solvable model of a quantum spin glass

A mean field spherical model with random couplings between pairs, quartets, and possibly higher multiplets of spins is considered. It has the same critical behavior as the Sherrington-Kirkpatrick model. It thus exhibits replica symmetry breaking. The order parameter function is solved exactly in the whole low temperature phase. The zero field cooled susceptibility remains finite at low $T$. Next a quantum version of the system is considered. Whereas the magnetic properties are not altered qualitatively, the thermodynamics is now regular at small temperatures.Comment: 4 pages postscript. Revised version, to appear in Phys. Rev. Let

Condensation vs. phase-ordering in the dynamics of first order transitions

The origin of the non commutativity of the limits $t \to \infty$ and $N \to \infty$ in the dynamics of first order transitions is investigated. In the large-N model, i.e. $N \to \infty$ taken first, the low temperature phase is characterized by condensation of the large wave length fluctuations rather than by genuine phase-ordering as when $t \to \infty$ is taken first. A detailed study of the scaling properties of the structure factor in the large-N model is carried out for quenches above, at and below T_c. Preasymptotic scaling is found and crossover phenomena are related to the existence of components in the order parameter with different scaling properties. Implications for phase-ordering in realistic systems are discussed.Comment: 15 pages, 13 figures. To be published in Phys. Rev.

Object knowledge modulates colour appearance

We investigated the memory colour effect for colour diagnostic artificial objects. Since knowledge about these objects and their colours has been learned in everyday life, these stimuli allow the investigation of the influence of acquired object knowledge on colour appearance. These investigations are relevant for questions about how object and colour information in high-level vision interact as well as for research about the influence of learning and experience on perception in general. In order to identify suitable artificial objects, we developed a reaction time paradigm that measures (subjective) colour diagnosticity. In the main experiment, participants adjusted sixteen such objects to their typical colour as well as to grey. If the achromatic object appears in its typical colour, then participants should adjust it to the opponent colour in order to subjectively perceive it as grey. We found that knowledge about the typical colour influences the colour appearance of artificial objects. This effect was particularly strong along the daylight axis

Dimensional Crossover in the Large N Limit

We consider dimensional crossover for an $O(N)$ Landau-Ginzburg-Wilson model on a $d$-dimensional film geometry of thickness $L$ in the large $N$-limit. We calculate the full universal crossover scaling forms for the free energy and the equation of state. We compare the results obtained using ``environmentally friendly'' renormalization with those found using a direct, non-renormalization group approach. A set of effective critical exponents are calculated and scaling laws for these exponents are shown to hold exactly, thereby yielding non-trivial relations between the various thermodynamic scaling functions.Comment: 25 pages of PlainTe

Risk of Major Complications From Coronary Angioplasty Performed Immediately After Diagnostic Coronary Angiography: Results From the Registry of the Society for Cardiac Angiography and Interventions

AbstractObjectives. This study was designed to determine the risk of performing percutaneous transluminal coronary angioplasty (PTCA) at the time of diagnostic catheterization (“combined procedures”).Background. Health care providers are under increasing pressure to combine diagnostic and interventional coronary procedures to reduce costs. However, the risk associated with combined procedures has not been rigorously assessed.Methods. A multicenter cohort study of 35,700 patients undergoing elective PTCA from 1992 through 1995 was performed to determine the risk of major complications (myocardial infarction, emergency coronary artery bypass graft surgery or death) from combined relative to staged procedures (i.e., performing PTCA at a session subsequent to diagnostic catheterization).Results. The risks of major complications from combined and staged procedures were 2.0% and 1.6%, respectively (unadjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05 to 1.57). After adjusting for clinical and angiographic differences and clustering by laboratory, the risk from combined procedures was not significantly elevated (multivariable OR 1.18, 95% CI 0.89 to 1.55). However, several subgroups of patients did have an increased risk from combined procedures: patients with multivessel disease (multivariable OR 1.64, 95% CI 1.13 to 2.39); women (multivariable OR 1.64, 95% CI 1.05 to 2.55); patients >65 years old (multivariable OR 1.40, 95% CI 1.02 to 1.93); and patients undergoing multilesion PTCA (multivariable OR 1.53, 95% CI 1.06 to 2.21). The risk of combined relative to staged procedures decreased over the 4-year period (multivariable p = 0.029).Conclusions. Combining PTCA with diagnostic catheterization appears to be safe in many patients. However, several subgroups of patients may be at increased risk. Careful patient selection will most likely remain critical to ensuring the safety of combined procedures.(J Am Coll Cardiol 1997;30:193–200

RATAN-600 7.6-cm Deep Sky Strip Surveys at the Declination of the SS433 Source During the 1980-1999 Period. Data Reduction and the Catalog of Radio Sources in the Right-Ascension Interval 7h < R.A. < 17h

We use two independent methods to reduce the data of the surveys made with RATAN-600 radio telescope at 7.6 cm in 1988-1999 at the declination of the SS433 source. We also reprocess the data of the "Cold" survey (1980-1981). The resulting RCR (RATAN COLD REFINED) catalog contains the right ascensions and fluxes of objects identified with those of the NVSS catalog in the right-ascension interval 7h < R.A. < 17h. We obtain the spectra of the radio sources and determine their spectral indices at 3.94 and 0.5 GHz. The spectra are based on the data from all known catalogs available from the CATS, Vizier, and NED databases, and the flux estimates inferred from the maps of the VLSS and GB6 surveys. For 245 of the 550 objects of the RCR catalog the fluxes are known at two frequencies only: 3.94 GHz (RCR) and 1.4 GHz (NVSS). These are mostly sources with fluxes smaller than 30 mJy. About 65% of these sources have flat or inverse spectra (alpha > -0.5). We analyze the reliability of the results obtained for the entire list of objects and construct the histograms of the spectral indices and fluxes of the sources. Our main conclusion is that all 10-15 mJy objects found in the considered right-ascension interval were already included in the decimeter-wave catalogs.Comment: 26 pages, 18 figure