Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland

Objectives: To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change. Design: Qualitative focus group study consisting of 11 focus groups with 67 participants. Setting: General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland. Sample: Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes. Results: General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes. Conclusions: Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered

The 3D printing of a polymeric electrochemical cell body and its characterisation

An undivided flow cell was designed and constructed using additive manufacturing technology and its mass transport characteristics were evaluated using the reduction of ferricyanide, hexacyanoferrate (III) ions at a nickel surface. The dimensionless mass transfer correlation Sh = aRebScdLee was obtained using the convective-diffusion limiting current observed in linear sweep voltammetry; this correlation compared closely with that reported in the literature from traditionally machined plane parallel rectangular flow channel reactors. The ability of 3D printer technology, aided by computational graphics, to rapidly and conveniently design, manufacture and re-design the geometrical characteristics of the flow cell ishighlighted

Sports review: A content analysis of the International Review for the Sociology of Sport, the Journal of Sport and Social Issues and the Sociology of Sport Journal across 25 years

The International Review for the Sociology of Sport, the Journal of Sport and Social Issues and Sociology of Sport Journal have individually and collectively been subject to a systematic content analysis. By focusing on substantive research papers published in these three journals over a 25-year time period it is possible to identify the topics that have featured within the sociology of sport. The purpose of the study was to identify the dominant themes, sports, countries, methodological frameworks and theoretical perspectives that have appeared in the research papers published in these three journals. Using the terms, identified by the author(s), that appear in the paper’s title, abstract and/or listed as a key word, subject term or geographical term, a baseline is established to reflect on the development of the sub-discipline as represented by the content of these three journals. It is suggested that the findings illustrate what many of the more experienced practitioners in the field may have felt subjectively. On the basis of this systematic, empirical study it is now possible to identify those areas have received extensive coverage and those which are under-researched within the sociology of sport. The findings are used to inform a discussion of the role of academic journals and the recent contributions made by Michael Silk, David Andrews, Michael Atkinson and Dominic Malcolm on the past, present and future of the ‘sociology of sport’

Fermiology and electronic homogeneity of the superconducting overdoped cuprate Tl-2201 revealed by quantum oscillations

We report an angular quantum oscillation study of Tl_2Ba_2CuO_{6+delta} for two different doping levels (Tc = 10K and 26 K) and determine the Fermi surface size and topology in considerable detail. Our results show that Fermi liquid behavior is not confined to the edge of the superconducting dome and is robust up to at least T_c^{max}/3.5. Superconductivity is found to survive up to a larger doping p_c = 0.31 than in La_{2-x}Sr_xCuO_4. Our data imply that electronic inhomogeneity does not play a significant role in the loss of superconductivity and superfluid density in overdoped cuprates, and point towards a purely magnetic or electronic pairing mechanismComment: 4 page

Survival of children in Cape Town known to be vertically infected with HIV-1

Objective. To determine the survival patterns of children in Cape Town known to be vertically infected with HIV.Design. Retrospective record review of children diagnosed with symptomatic HIV infection during the period 1 December 1990 - 31 May 1995.Setting. Hospitals in the Cape Town metropolitan area.Patients. 193 children were known to be vertically HIV infected. HIV diagnosis was based on the following criteria: two positive HIV enzyme-linked immunosorbent assays (ELlSAs) in children older than 15 months and a positive ELlSA together with a positive polymerase chain reaction (PCR) in younger children. The mothers of the children were known to be HIV-positive. On the basis of the presenting clinical findings children were assigned to a disease severity category (A, B or C) according to the Centers for Disease Control and Prevention (CDC)'s 1994 revised classification system for HIV infection in children.Outcome measures. Survival was analysed according to the Kaplan-Meier method. Survival time was defined as the length of time between clinical diagnosis of HIV and death or last contact with the health services. Mortality risk in relation to specific variables at diagnosis such as age and clinical manifestations was determined by calculation of odds ratios (ORs) with 95% confidence intervals (Cls).Results. The median age at diagnosis was 5 months; 72% of children were aged less than 1 year at diagnosis. According to the CDC clinical classification, 47 (24%) fell into category A, 111 (58%) into category Band 35 (18%) into category C. Of the 193 patients 85 (44%) were alive at the time of review, 65 (34%) had died and 43 (22%) were lost to folloW-Up. Risk of death was significantly associated with age less than 6 months (OR 4.7, Cl 2.1 - 10.3) and severe disease, Le. CDC category C (OR 2.7; Cl 1.1 - 6.9) at time of diagnosis. The median survival for all the children from time of diagnosis was 32 months. Infants diagnosed before 6 months of age had significantly shorter median survival (10 months) compared with 36 months for those diagnosed at 7 - 12 months of age. For the children over the age of 12 months the cumulative proportion surviving at 48 months was 78%. Children with severe disease (category C) had a median survival of 21 months, significantly lower than that in category B (32 months). For the children in category A the cumulative proportion surviving at 48 months was 66%.Conclusion. The median survival of children with HIV was 32 months from time of diagnosis, and survival was influenced by age and disease severity

Eradication of poliomyelitis in South Africa

An international campaign under the leadership of the World Health Organisation is underway to eradicate polio from the world by the year 2000. South Africa may already be free of polio. However, to ensure eradication we need to move from a polio control programme to a polio eradication programme. This necessitates the institution of a surveillance programme for acute flaccid paralysis (AFP) and improvement of the delivery of polio vaccine. All children with AFP (including those with suspected GuillainBarre syndrome) should be investigated with stool culture to exclude polio. Primary care services need strengthening so that oral polio vaccine coverage greater than 90% is achieved in all regions by all authorities. Outbreak response activities need to be developed. Consideration needs to be given to national immunisation days and mopping-up activities

Non-generality of the Kadowaki-Woods ratio in correlated oxides

An explicit expression for the Kadowaki-Woods ratio in correlated metals is derived by invoking saturation of the (high-frequency) Fermi-liquid scattering rate at the Mott-Ioffe-Regel limit. Significant deviations observed in a number of oxides are quantitatively explained due to variations in carrier density, dimensionality, unit cell volume and the number of individual sheets in the Brillouin zone. A generic re-scaling of the original Kadowaki-Woods plot is also presented.Comment: 9 pages of text, 1 table, 2 figure

Precision Measurement of the n-3He Incoherent Scattering Length Using Neutron Interferometry

We report the first measurement of the low-energy neutron-$^3$He incoherent scattering length using neutron interferometry: $b_i' = (-2.512\pm 0.012{statistical}\pm0.014{systematic})$ fm. This is in good agreement with a recent calculation using the AV18+3N potential. The neutron-$^3$He scattering lengths are important for testing and developing nuclear potential models that include three nucleon forces, effective field theories for few-body nuclear systems, and neutron scattering measurements of quantum excitations in liquid helium. This work demonstrates the first use of a polarized nuclear target in a neutron interferometer.Comment: 4 figure