Living with childhood asthma: parental perceptions of risk in the household environment and strategies for coping

Aim To explore parents’ perceptions of environmental household risks to their child’s asthma and to identify the strategies they adopt in relation to these perceived risks. Background The prevalence of childhood asthma is increasing worldwide and especially in the UK. Asthma is more common in areas of socio-economic disadvantage. Household environmental factors have been implicated in some of this increase. A number of factors in the home environment have been found to act as triggers to asthma symptoms, including high humidity levels, poor ventilation, mould, second-hand tobacco smoke and pet allergens. Little is known about how parents, as the main care-givers and decision makers in the home, perceive and cope with the risks posed by these triggers. Methods Semi-structured interviews were conducted with a purposive sample of parents of 32 children with asthma aged 4 to 16 years and living in a socio-economically disadvantaged urban community in the North East of England. Interviews were audiotaped, transcribed verbatim and analysed using constant comparison techniques. Findings All parents were aware of some of the risks their children faced at home. Some appeared to know more than others and coping styles varied. A typology of three groups of parents was identified: those who actively seek advice and adopt clear preventative strategies (preventers); those who minimize the risks and only react when things go wrong (reactors); and those who engage in compensatory activities in an attempt to trade-off between harms and benefits (compensators). The unifying themes underpinning these different styles are that all parents are motivated to maintain normal family life but that they adopt different strategies to achieve this

Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care

Aim To understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care. Design and procedure Mixed-measures design. Quantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software. Setting The first HealthPathways UK site, South Tyneside, England. Participants General practitioners, nurses, practice managers, hospital consultants and system leaders (managers, commissioners) (n=76). Results Use of the pathways significantly increased over time. Themes were developed showing how online care pathways were used—leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and perceived availability of resources. Inter-related themes were arranged into configurations consisting of contextual influences, mechanisms and outcomes. Recommendations were made for future implementations, such as improved data collection processes to understand how and why there was variance in the use of pathways. Conclusions This study was early in the implementation process; however, emerging themes will facilitate the future implementation and use of online care pathways. Recommendations are made for further research to include other health and social care users and patients to inform future developments

The effect of anaerobic digestate derived composts on the metabolite composition and thermal behaviour of rosemary

Abstract The study reports on the effect of anaerobic digestate derived composts on the metabolite composition and thermal behaviour of rosemary (Rosmarinus officinalis L.). Plants were cultivated in semiarid soil under four different fertiliser treatments (composts of anaerobic digested cattle (C) or pig slurry (P) at 30t/ha and 60 t/ha, and two control treatments (inorganic fertiliser and no fertiliser application). Samples of leaves and stems were analysed to investigate the effect of treatment on chemical composition and thermochemical properties. Three orthogonal analytical approaches were used, namely: Fourier transform mid infrared spectroscopy (FTIR), gas chromatography/mass spectrometry (GC/MS) and thermochemical gravimetric analysis (TGA). FTIR and GC/MS showed fertiliser treatment resulted in tissue specific changes in sample metabolite composition. Fertiliser treatment was detected to change the thermogravimetric properties of the leaf samples and from inorganic and composted pig slurry digestate treatments had greater ash content and lower proportions of fixed carbon compared with samples from the unfertilised control treatment. This study provides information on how the composition of rosemary might be altered by fertiliser application in regions of poor soil, and has implications for biomass quality when rosemary is grown on semi-wild sites for the purpose of soil improvement

Control of Magnetic Behavior in LaMnO3 Thin Films through Cationic Vacancies

The magnetic behavior of lanthanum manganite thin films (LaMnO3) deposited on strontium titanate (SrTiO3) was explored as a function of manganese oxidation state, as controlled by the presence of cation and oxygen vacancies. This was done in response to the inconsistent magnetic properties found in literature. The films were characterized using Rutherford backscattering spectroscopy, wide-angle x-ray diffraction, x-ray reflectivity and vibrating sample magnetometry. The films were found to exhibit an antiferromagnetic to ferromagnetic transition consistent with that found in strontium-doped LaMnO3 systems, where the manganese oxidation state is controlled by the fraction of strontium present.M.S., Materials Science and Engineering -- Drexel University, 201

Talking about depression during interactions with GPs: a qualitative study exploring older people’s accounts of their depression narratives

Background: Older people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. This contributes to problems for GPs in both detecting and managing depression in primary care. The aim of this study was to explore older people’s accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs. Methods: Adopting a qualitative Interpretivist methodological approach, semi-structured interviews were conducted by IG based on the principles of grounded theory and situational analysis. GPs working in north east England recruited patients aged over 65 with depression. Data analysis was carried out with a process of constant comparison, and categories were developed via open and axial coding and situational maps. There were three levels of analysis; the first developed open codes which informed the second level of analysis where the typology was developed from axial codes. The typology derived from second level analysis only is presented here as older people’s views are rarely reported in isolation. Results: From the sixteen interviews with older people, it was evident that there were differences in how they understood and accepted their depression and that this influenced what they shared or withheld in their narratives. A typology showing three categories of older people was identified: those who appeared to talk about their depression freely yet struggled to accept aspects of it (Superficial Accepter), those who consolidated their ideas about depression aloud (Striving to Understand) and those who shared minimal detail about their depression and viewed it as part of them rather than a treatable condition (Unable to Articulate). The central finding was that older people’s acceptance and understanding of their depression guided their depression narratives. Conclusions: This study identified differences between older people in ways they understand, accept and share their depression. Recognising that their depression narratives can change and listening for patterns in what older people share or withhold may help GPs in facilitating communication to better understand the patient when they need to implement alternative approaches to patient management

The perspectives of older people and GPs on depression in later life and its management : the stories they tell and ways they respond to each other

Depression in older people is under recognized and under treated in primary care. This is despite symptoms being similar across the lifespan and many older people with depression regularly seeing their general practitioner (GP). Problems specific to its management set it apart from depression in younger people, and include both disparities in the way older people and GPs perceive depression and a shared view that it is a normal part of aging, as well as barriers to the way older people talk about it and the help GPs provide. This evidence indicates a lack of understanding about the ways both groups perceive depression, and how their different situations, positions and needs may influence what they say and do and ways they respond to each other in consultations. The research aim is therefore to explore how older people’s and GPs’ different positions and situations influence the ways they perceive depression. Particular focus is on influences reported by older people over ways they talk about depression and influences reported by GPs over ways they respond. In doing this the study seeks practical solutions to help GPs identify depression in older people and provide them with appropriate help. The methodology and methods of this study are informed by a recent version of grounded theory, Situational Analysis (Clarke, 2005), which is philosophically orientated between symbolic interactionism and social constructionism. Clarke (2005) builds on the work of Strauss and Corbin (1998), assuming a social constructionist approach to grounded theory to enable exploration of how people’s views are formed and how this influences their actions. Theory can be generated and located within changing and multi-faceted contexts by considering the wider situations of both the researcher and the researched and looking at the data from multiple perspectives such as historical, geographical and biographical. Semi structured interviews were conducted with older people and GPs as the main form of data, with the researcher’s (IG’s) observations of interviews as contextual data. Using this approach a theoretical model has been developed to explain how older people and GPs operate in consultations for depression, proposing how different types of older people and GPs are likely to respond to each other. The stories older people report telling about their depression and the ways GPs report responding show the “porous” and “flexible” (Clarke, 2005, p.111) positions they can take in consultations: the interview data suggests that older people can move between stages of understanding and accepting their depression, and GPs can move between styles of working and employ different combinations of skills in response to older people’s stories. This element of change is key to the findings of this study and indicates the fluidity of their positions, where they change depending on what they perceive to be influences over them at the time. This study highlights the importance of recognizing differences between ways older people and GPs operate in consultations and the different factors that influence ways they respond to each other. It suggests how GPs working in different styles might help older people based on the different ways they tell their stories, and a key message is that GPs who can adapt their skills to those needs are likely to be most successful in managing it. For example some older people may need GPs to help them make sense of their problems before they will accept treatment or therapy for depression and others may need GPs to take the lead on decisions when they are at rock bottom. The theoretical model suggests how GPs can quickly identify depression in older people and the stage of depression they are at by the stories they tell, and how they might adapt their skills in response to provide them with the most appropriate help. This is intended as a step towards understanding the reasons underlying what happens in consultations for depression in later life, and finding solutions for problems existing in its management.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An electrostatic elliptical mirror for neutral polar molecules

Focusing optics for neutral molecules finds application in shaping and steering molecular beams. Here we present an electrostatic elliptical mirror for polar molecules consisting of an array of microstructured gold electrodes deposited on a glass substrate. Alternating positive and negative voltages applied to the electrodes create a repulsive potential for molecules in low-field-seeking states. The equipotential lines are parallel to the substrate surface, which is bent in an elliptical shape. The mirror is characterized by focusing a beam of metastable CO molecules and the results are compared to the outcome of trajectory simulations.Comment: 5 pages, 4 figure

The perspectives of older people and GPs on depression in later life and its management: the stories they tell and ways they respond to each other.

Depression in older people is under recognized and under treated in primary care. This is despite symptoms being similar across the lifespan and many older people with depression regularly seeing their general practitioner (GP). Problems specific to its management set it apart from depression in younger people, and include both disparities in the way older people and GPs perceive depression and a shared view that it is a normal part of aging, as well as barriers to the way older people talk about it and the help GPs provide. This evidence indicates a lack of understanding about the ways both groups perceive depression, and how their different situations, positions and needs may influence what they say and do and ways they respond to each other in consultations. The research aim is therefore to explore how older people’s and GPs’ different positions and situations influence the ways they perceive depression. Particular focus is on influences reported by older people over ways they talk about depression and influences reported by GPs over ways they respond. In doing this the study seeks practical solutions to help GPs identify depression in older people and provide them with appropriate help. The methodology and methods of this study are informed by a recent version of grounded theory, Situational Analysis (Clarke, 2005), which is philosophically orientated between symbolic interactionism and social constructionism. Clarke (2005) builds on the work of Strauss and Corbin (1998), assuming a social constructionist approach to grounded theory to enable exploration of how people’s views are formed and how this influences their actions. Theory can be generated and located within changing and multi-faceted contexts by considering the wider situations of both the researcher and the researched and looking at the data from multiple perspectives such as historical, geographical and biographical. Semi structured interviews were conducted with older people and GPs as the main form of data, with the researcher’s (IG’s) observations of interviews as contextual data. Using this approach a theoretical model has been developed to explain how older people and GPs operate in consultations for depression, proposing how different types of older people and GPs are likely to respond to each other. The stories older people report telling about their depression and the ways GPs report responding show the “porous” and “flexible” (Clarke, 2005, p.111) positions they can take in consultations: the interview data suggests that older people can move between stages of understanding and accepting their depression, and GPs can move between styles of working and employ different combinations of skills in response to older people’s stories. This element of change is key to the findings of this study and indicates the fluidity of their positions, where they change depending on what they perceive to be influences over them at the time. This study highlights the importance of recognizing differences between ways older people and GPs operate in consultations and the different factors that influence ways they respond to each other. It suggests how GPs working in different styles might help older people based on the different ways they tell their stories, and a key message is that GPs who can adapt their skills to those needs are likely to be most successful in managing it. For example some older people may need GPs to help them make sense of their problems before they will accept treatment or therapy for depression and others may need GPs to take the lead on decisions when they are at rock bottom. The theoretical model suggests how GPs can quickly identify depression in older people and the stage of depression they are at by the stories they tell, and how they might adapt their skills in response to provide them with the most appropriate help. This is intended as a step towards understanding the reasons underlying what happens in consultations for depression in later life, and finding solutions for problems existing in its management