Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.

Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management

FROM PAPER TO PLASTIC BY 2002: RETAILERS' PERSPECTIVE ON ELECTRONIC BENEFIT TRANSFER SYSTEMS FOR FOOD STAMPS

The Food Stamp Program (FSP) is working under the deadline of October 1, 2002, to coordinate a change from the current paper disbursement system of paper food stamps to an electronic transfer system of benefits, known as EBT. The Food and Nutrition Service of the U.S. Department of Agriculture has been studying the effectiveness of differing vehicles for benefit dispersal since the inception of the FSP in the 1960's. The merits of a direct cash payment have been compared to those of the paper system by the USDA and an array of professional groups and research organizations. The adoption of the electronic benefit transfer (EBT) system engenders a new set of questions about the effects of EBT on benefit recipients, retailers and the administering government agencies. Issues surrounding the transition from paper to plastic are still problematic for retailers in spite of the rapidly approaching deadline. National interoperability of EBT as well as fees involved with EBT operation are still points of contention for retailers. Anecdotal evidence from retailers also point to kinks in the institutional operation of EBT. Peak-loading problems with the electronic network system generate a host of undesirable consequences for benefit recipients and retailers. These problems impede the electronic system from taking advantage of the positive network effects that could arise from this new technology.Food Consumption/Nutrition/Food Safety, Food Security and Poverty, Marketing, Research and Development/Tech Change/Emerging Technologies,

Modelling evacuation using escalators: a London Underground dataset

This paper presents a brief analysis of an escalator human factors dataset collected in a London Underground (subway) station in England. The data analysis highlights and quantifies a variety of escalator human factors. Using the buildingEXODUS evacuation software, a series of evacuation scenarios of a hypothetical underground station are then presented. The simulation results demonstrate that escalator strategies and associated human factors can have a considerably influence upon an evacuation compared to using stairs alone

Microflanging of CuZn30 Specimens Using Electromagnetic Forming

In this research, electro-magnetic (EM) forming was investigated as an alternative process to form microscale components. Both EM and quasi-static flanging experiments were conducted with CuZn30 specimens of 0.127, 0.508 and 1.588 mm thicknesses that were heat treated to achieve 2 and 10 grains through the thickness to assess this parameter. Results from the quasi-static tests showed that as the sample size decreased with a constant grain size through thickness ratio, the springback angle increased. For the 0.127mm and 0.508mm thickness specimens, the EM results showed that the flanging angle increased as the power input increased from 1.7 to 3.7 kJ. For 3.7 kJ energies and above, complete 90 degree flanging with no springback was achieved for the 0.508mm specimens. However, EM flanging could not be achieved for the 1.588mm case. Microhardness testing conducted on specimens of similar flanging angles yielded no observable change in deformation between the EM and quasi-static processes for the 0.508mm specimens

Analysis of Media Agenda-Setting Effects on Consumer Confidence in the Safety of the U.S. Food System

Results from continuous tracking of consumer confidence and media coverage of food safety events over a 67 week period between May 2008 and August 2009 are reported. An ordered probit model is used to test the hypothesis that media coverage of food safety events affects consumer confidence in the safety of the U.S. food system. The results show that media coverage significantly and negatively affected consumer confidence in the safety of nation’s food supply during the sample period. Socioeconomic and demographic factors such as geographic region, use of media source, household size, age, ethnicity, education, and gender also had significant affects on consumer confidence in the safety of United States food supply.Food Safety, Consumer Confidence, Mass media, ordered probit, Food Consumption/Nutrition/Food Safety,

Temporal changes in temperature may suggest microhabitat shifts in larval spongillafly Climacia areolaris Hagen (Neuroptera: Sisyridae) abundance and density in a temperate freshwater lake

Abiotic factors such as temperature and depth are known to affect aquatic insect populations and are thought to be major variables that directly impact how communities are assembled and populations distributed. The purpose of this study was to examine the role of temperature and depth in structuring C. areolaris populations within a temperate freshwater quarry. Larval densities among individual sponges at different depths were determined over six months in a Pennsylvania quarry. Sponges from four depths (7.0 - 8.0 m; 8.1 - 9.0 m; 9.1 - 10.0 m and 10.1 - 12.0) were collected once per month (n = 3) using SCUBA. Temperature data were collected at four depths (n = 3 samples/depth). Larval densities significantly varied over the study period, but were not significantly different between depths on any date. Mean total larval density was significantly higher in March, April and May compared to dates later in the season. This result followed an inverse pattern where there was a significant effect of date on temperature, but no difference between depths. There was a detectable change in relative abundance of the sisyrid populations among the depths; the two shallowest depth ranges collectively represented \u3e50% of the population during March and April, but were \u3c 50% throughout the rest of the summer. There was also a significant negative relationship of larval density with temperature. Few studies have documented the role of abiotic factors such as depth and temperature on the spatial and temporal structuring of spongillafly microdistribution within a quarry environment

Consumer Confidence in the Food System, Media Coverage and Stock Prices of Food Companies: A Regression Analysis

A series of recent and serious food safety incidents have generated a national debate over the significant costs that they impose on various stakeholders - consumers, industry, or the government. This paper examines the impact of media coverage of food safety and defense issues on consumer confidence in food safety, and measures the response of stock prices of food companies to changes in consumer confidence. Results show that, increases in media coverage have a negative impact on consumer confidence, and that decreases in the levels of consumer confidence on food safety have a negative impact on stock prices of food companies, in particular for the larger firms. These findings confirm that the financial performance of food the industry is negatively affected by category-specific food safety events, and the effects of media coverage on consumer confidence in the safety of the food system.Agribusiness, Food Consumption/Nutrition/Food Safety,

Osteonecrosis in patients with acute lymphoblastic leukaemia: a national questionnaire study

Objectives: To establish prevalence, management and long-term outcomes of osteonecrosis (ON) in young people diagnosed with acute lymphoblastic leukaemia (ALL) between 2003 and 2011. Design, setting, participants: This study assessed ON in 3113 patients aged 1–24 years who participated in the UK national leukaemia study UKALL 2003. UKALL 2003 recruited patients in 40 UK hospitals between 2003 and 2011 and included patients between ages 1 and 25 diagnosed with ALL. Results: 170 patients were diagnosed with ON, giving a prevalence of 5.5%. The multivariable analysis showed that the risk of ON was highest for children aged between 10 and 20 years (ages 10–15 years, OR 23.7, 95% CI 14.8 to 38.0; ages 16–20 years, OR 22.5, 95% CI 12.7 to 39.8, compared with age <10 years). Among ethnic groups, Asian patients had the highest risk of ON (OR 1.92, 95% CI 1.1 to 3.6, compared with White patients). Eighty-five per cent of patients with ON had multifocal ON. Thirty-eight per cent of patients with ON required surgery and 19% of patients with ON required a hip replacement. Fifteen per cent of patients who had surgery still describe significant disability or use of a wheelchair. Conclusions: ON has considerable morbidity for patients being treated for ALL, with a high burden of surgery. Age and ethnicity were found to be the most significant risk factors for development of ON, with Asian patients and patients aged 10–20 years at diagnosis of ALL at greatest risk. These results will help risk stratify patients at diagnosis of ALL, and help tailor future prospective studies in this area

BLT-EC (Breach, Leach and Transport-Equilibrium Chemistry) data input guide. A computer model for simulating release and coupled geochemical transport of contaminants from a subsurface disposal facility

The BLT-EC computer code has been developed, implemented, and tested. BLT-EC is a two-dimensional finite element computer code capable of simulating the time-dependent release and reactive transport of aqueous phase species in a subsurface soil system. BLT-EC contains models to simulate the processes (container degradation, waste-form performance, transport, chemical reactions, and radioactive production and decay) most relevant to estimating the release and transport of contaminants from a subsurface disposal system. Water flow is provided through tabular input or auxiliary files. Container degradation considers localized failure due to pitting corrosion and general failure due to uniform surface degradation processes. Waste-form performance considers release to be limited by one of four mechanisms: rinse with partitioning, diffusion, uniform surface degradation, and solubility. Transport considers the processes of advection, dispersion, diffusion, chemical reaction, radioactive production and decay, and sources (waste form releases). Chemical reactions accounted for include complexation, sorption, dissolution-precipitation, oxidation-reduction, and ion exchange. Radioactive production and decay in the waste form is simulated. To improve the usefulness of BLT-EC, a pre-processor, ECIN, which assists in the creation of chemistry input files, and a post-processor, BLTPLOT, which provides a visual display of the data have been developed. BLT-EC also includes an extensive database of thermodynamic data that is also accessible to ECIN. This document reviews the models implemented in BLT-EC and serves as a guide to creating input files and applying BLT-EC

A reaction–diffusion analysis of energetics in large muscle fibers secondarily evolved for aerobic locomotor function

The muscles that power swimming in the blue crab, Callinectes sapidus, grow hypertrophically, such that in juvenile crabs the cell diameters ar