Patients' unvoiced agendas in general practice consultations.

Objective: To investigate patients' agendas before consultation and to assess which aspects of agendas are voiced in the consultation and the effects of unvoiced agendas on outcomes. Design: Qualitative study. Setting: 20 general practices in south east England and the West Midlands. Participants: 35 patients consulting 20 general practitioners in appointment and emergency surgeries. Results: Patients' agendas are complex and multifarious. Only four of 35 patients voiced all their agendas in consultation. Agenda items most commonly voiced were symptoms and requests for diagnoses and prescriptions. The most common unvoiced agenda items were: worries about possible diagnosis and what the future holds; patients' ideas about what is wrong; side effects; not wanting a prescription; and information relating to social context. Agenda items that were not raised in the consultation often led to specific problem outcomes (for example, major misunderstandings), unwanted prescriptions, non-use of prescriptions, and non-adherence to treatment. In all of the 14 consultations with problem outcomes at least one of the problems was related to an unvoiced agenda item. Conclusion: Patients have many needs and when these are not voiced they can not be addressed. Some of the poor outcomes in the case studies were related to unvoiced agenda items. This suggests that when patients and their needs are more fully articulated in the consultation better health care may be effected. Steps should be taken in both daily clinical practice and research to encourage the voicing of patients' agenda

Active router approach to defeating denial-of-service attacks in networks

Denial-of-service attacks represent a major threat to modern organisations who are increasingly dependent on the integrity of their computer networks. A new approach to combating such threats introduces active routers into the network architecture. These active routers offer the combined benefits of intrusion detection, firewall functionality and data encryption and work collaboratively to provide a distributed defence mechanism. The paper provides a detailed description of the design and operation of the algorithms used by the active routers and demonstrates how this approach is able to defeat a SYN and SMURF attack. Other approaches to network design, such as the introduction of a firewall and intrusion detection systems, can be used to protect networks, however, weaknesses remain. It is proposed that the adoption of an active router approach to protecting networks overcomes many of these weaknesses and therefore offers enhanced protection

Misunderstandings in general practice prescribing decisions: a qualitative study

Objectives: To identify and describe misunderstandings between patients and doctors associated with prescribing decisions in general practice. Design: Qualitative study. Setting: 20 general practices in the West Midlands and south east England. Participants: 20 general practitioners and 35 consulting patients. Main outcome measures: Misunderstandings between patients and doctors that have potential or actual adverse consequences for taking medicine. Results: 14 categories of misunderstanding were identified relating to patient information unknown to the doctor, doctor information unknown to the patient, conflicting information, disagreement about attribution of side effects, failure of communication about doctor's decision, and relationship factors. All the misunderstandings were associated with lack of patients' participation in the consultation in terms of the voicing of expectations and preferences or the voicing of responses to doctors' decisions and actions. They were all associated with potential or actual adverse outcomes such as non-adherence to treatment. Many were based on inaccurate guesses and assumptions. In particular doctors seemed unaware of the relevance of patients' ideas about medicines for successful prescribing. Conclusions: Patients' participation in the consultation and the adverse consequences of lack of participation are important. The authors are developing an educational intervention that builds on these findings

The Impact of a River on the Water Quality of Nearby Wells: A Case Study of Aluko River, Ilorin, Nigeria

Hand dug wells were sampled in 5 selected areas in the vicinity of River Aluko course, Ilorin. The ranges of the average value of the parameters studied are: 6.8-8.3 for pH; 325-524 mg/l for total hardness (TH); 0.039-0.69 for organic carbon content; 29-30 OC for temperature; 0.683-0.863 mg/l for total dissolved solids (TDS); 0.014- 0.068 mg/l for total suspended solids (TSS); 0.701-0.914 mg/l for total solids (TS); 6.60-21.50 mg/l for total alkalinity; 0.73-1.90 mg/l for chloride; 0.129-0.273 mg/l for nitrate; and 0.008-0.243 mg/l for sulphate. All the trace metals except Fe and K were within the WHO standard for drinking water. The % bioavialable metals (F1 + F2 + F3) for Fe, Mn, Ni, Zn, Co, Cd and Cu ranges between 87.1 and 95.4, 20.7 and 78.4, 39.3 and 68.7, 42.5 and 65.8, 64.0 and 86.6 and 92.9, 88.2 and 92.9, 40.00 and 60.10 respectively. The proportion of the mean metals concentrations of the bioavailable metals follows the order Fe > Cd > Co > Ni > Zn > Cu > Mn and the % bioavailable metal for the five locations is in the order: Ikokoro > Baboko > Ita-Amodu > Opomolu > Edun. The assessment of the well sediment using enrichment factor, EF, and geoaccumulation index revealed that Co and Cd from all the sampling points were evidenced as having more enrichment and mostly due to anthropogenic sources; whereas, Mn, Ni, and Zn were enriched from natural sources.Keywords: Bioavailability, Geochemical indices, Sequential extraction, Well-wate

Comparative dissolution of natural goethite samples in HCl and HNO3

The dissolution of goethite samples in mineral acids from to extreme parts of Nigeria (Osogbo and Kaduna) have been investigated. The rate of dissolution was found to be slightly faster in HCl than HNO3. The higherrate of dissolution in HCl could be attributed to the complexing ability of Cl- in addition to the H+ effect while lowering effect by NO3- was attributed to adsorption of NO3 on to the goethite surface. Mononuclear complexes, especially bidentate of oxyanion are found to accelerate dissolution as opposed to binuclear complexes. A binuclearbidentate surface complex formation between NO3 - and Fe3+ was therefore proposed to account for the inhibition observed. The possible formation of Fe—Cl reduces both the surface positive charge and the repulsion between the oxide surface and protons in solution. This produced accelerated proton dissolution. The effect of temperature on theinitial dissolution rate fit into Arrhenius equation, with Kaduna goethite exhibiting higher rate than Osogbo type in both acids. The activation energies for Kaduna goethite sample are 66.11 and 82.43 kJmol-1 in 0.1M HCl and 0.1M HNO3 respectively while for Osogbo goethite sample are 54.60 and 76.32 kJmol-1 in 0.1M HCl and 0.1M HNO3 respectively. The frequency factors of 8.4 x 10-4 & 11.17 x10-4 and 5.0 x 10-5 and 3.09 x 10-3 for Kaduna and Osogbo goethite samples were obtained. @JASE

Numerical simulation of flow surrounding a thermoacoustic stack:single-stack against double-stack plate domain

Over the last few decades, numerical simulation has fast become an effective research tool in analyzing internal and external fluid flow. Much of the unknowns associated with microscopic bounded and unbounded fluid behavior generally not obtainable via experimental approach can now be explained in details with computational fluid dynamics modeling. This has much assist designers and engineers in developing better engineering designs. However, the choice of the computational domain selected plays an important role in exhibiting the correct flow patterns associated with changes in certain parameters. This research looked at the outcomes when two computational domains were chosen to represent a system of parallel stack plates in a thermoacoustic resonator. Since the stack region is considered the “heart” of the system, accurate modeling is crucial in understanding the complex thermoacoustic solid-fluid interactions that occur. Results showed that although the general flow pattern and trends have been produced with the single and double plate stack system, details of a neighboring solid wall do affect the developments of vortices in the stack region. The symmetric assumption in the computational domain may result in the absence of details that could generate an incomplete explanation of the patterns observed such as shown in this study. This is significant in understanding the solid-fluid interactions that is thermoacoustic phenomena

S-duality and 2d Topological QFT

We study the superconformal index for the class of N=2 4d superconformal field theories recently introduced by Gaiotto. These theories are defined by compactifying the (2,0) 6d theory on a Riemann surface with punctures. We interpret the index of the 4d theory associated to an n-punctured Riemann surface as the n-point correlation function of a 2d topological QFT living on the surface. Invariance of the index under generalized S-duality transformations (the mapping class group of the Riemann surface) translates into associativity of the operator algebra of the 2d TQFT. In the A_1 case, for which the 4d SCFTs have a Lagrangian realization, the structure constants and metric of the 2d TQFT can be calculated explicitly in terms of elliptic gamma functions. Associativity then holds thanks to a remarkable symmetry of an elliptic hypergeometric beta integral, proved very recently by van de Bult.Comment: 25 pages, 11 figure

Dihydrobenz[e][1,4]oxazepin-2(3H)-ones, a new anthelmintic chemotype immobilising whipworm and reducing infectivity in vivo

Trichuris trichiura is a human parasitic whipworm infecting around 500 million people globally, damaging the physical growth and educational performance of those infected. Current drug treatment options are limited and lack efficacy against the worm, preventing an eradication programme. It is therefore important to develop new treatments for trichuriasis. Using Trichuris muris, an established model for T. trichiura, we screened a library of 480 novel drug-like small molecules for compounds causing paralysis of the ex vivo adult parasite. We identified a class of dihydrobenz[e][1,4]oxazepin-2(3H)-one compounds with anthelmintic activity against T. muris. Further screening of structurally related compounds and resynthesis of the most potent molecules led to the identification of 20 active dihydrobenzoxazepinones, a class of molecule not previously implicated in nematode control. The most active immobilise adult T. muris with EC50 values around 25–50μM, comparable to the existing anthelmintic levamisole. The best compounds from this chemotype show low cytotoxicity against murine gut epithelial cells, demonstrating selectivity for the parasite. Developing a novel oral pharmaceutical treatment for a neglected disease and deploying it via mass drug administration is challenging. Interestingly, the dihydrobenzoxazepinone OX02983 reduces the ability of embryonated T. muris eggs to establish infection in the mouse host in vivo. Complementing the potential development of dihydrobenzoxazepinones as an oral anthelmintic, this supports an alternative strategy of developing a therapeutic that acts in the environment, perhaps via a spray, to interrupt the parasite lifecycle. Together these results show that the dihydrobenzoxazepinones are a new class of anthelmintic, active against both egg and adult stages of Trichuris parasites. They demonstrate encouraging selectivity for the parasite, and importantly show considerable scope for further optimisation to improve potency and pharmacokinetic properties with the aim of developing a clinical agent

Blasting Standards for the Ghanaian Mining Industry

Ghana is a well known mining nation and hard rock mining has been going on since the 10th century. Mining companies in Ghana are well aware of the regulatory requirements to carry out blasting activities such that neighbouring communities are protected from excessive impact as a result of blast vibrations amongst other known blast impacts. However in the absence of local blasting standards in respect of ground vibrations companies are compelled to import standards from their countries of origin or from some other sources. Communities continue to complain of cracks in their house as efforts by companies have not produced the desired results. This paper studied the building types in the mining communities and determined threshold levels for ground vibrations based on crack monitoring activities carried out on some structures within the communities. The results revealed that much lower ground vibration levels than those currently adopted were required to protect the type of structures prevalent in the mining communities. The paper makes some recommendation for best practice

Comparison of System Call Representations for Intrusion Detection

Over the years, artificial neural networks have been applied successfully in many areas including IT security. Yet, neural networks can only process continuous input data. This is particularly challenging for security-related non-continuous data like system calls. This work focuses on four different options to preprocess sequences of system calls so that they can be processed by neural networks. These input options are based on one-hot encoding and learning word2vec or GloVe representations of system calls. As an additional option, we analyze if the mapping of system calls to their respective kernel modules is an adequate generalization step for (a) replacing system calls or (b) enhancing system call data with additional information regarding their context. However, when performing such preprocessing steps it is important to ensure that no relevant information is lost during the process. The overall objective of system call based intrusion detection is to categorize sequences of system calls as benign or malicious behavior. Therefore, this scenario is used to evaluate the different input options as a classification task. The results show, that each of the four different methods is a valid option when preprocessing input data, but the use of kernel modules only is not recommended because too much information is being lost during the mapping process.Comment: 12 pages, 1 figure, submitted to CISIS 201