Ground water heat pumps: a general survey for the potential consumer

This paper describes ground water heat pumps covering design, performance and alternative methods of use. Methods of water discharge are shown and discussed. Economic comparisons are made to other heat systems and recommendations given.No embarg

St Lawrences's The story of a hospital, 1870-1994

SIGLEAvailable from British Library Document Supply Centre-DSC:96/18012 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia

Abstract Background Cambodia has made significant progress towards achieving malaria elimination by 2025. Cases continue to decrease and are primarily concentrated in forested areas. Forest-goers are most at risk of malaria due to their proximity to the forest, poor sleeping conditions, frequent mobility, and distance from health services. Consistent use of long-lasting insecticidal nets or hammock nets (LLINs/LLIHNs), early diagnosis and treatment of cases are central to reducing disease burden. The aim of this study was to understand forest-goers’ knowledge, attitudes, and practices related to malaria prevention and care-seeking, and to identify key behavioural determinants of LLIN/LLIHN use and prompt care-seeking within 24 h of developing a fever. Methods A mixed-methods study design consisting of a cross-sectional survey and qualitative in-depth interviews was implemented in two Cambodian provinces. Survey participants (N = 654) were recruited using respondent driven sampling. Interview participants (N = 28) were selected using purposive sampling. Findings from the survey were analysed using univariate and bivariate analysis and multivariate weighted logistic regression. Interviews were coded and analysed using thematic content analysis. Results All study participants had heard of malaria and 98% knew that malaria was transmitted by mosquitoes. LLIN/LLIHN ownership was high (94%). Although 99% of participants perceived LLIN/LLIHN use as an important malaria prevention measure, only 76% reported using one during their last visit to the forest. Only 39% of survey participants who reported seeking care did so within the recommended 24 h from fever onset during their last febrile illness. Among all study participants, 43% did not seek any healthcare during their last febrile episode. In controlled regression models, perceived community social norms were significantly associated with LLIN/LLIHN use (OR: 2.7, 96% CI 1.99–2.64) and care-seeking within 24 h of fever onset (OR: 1.7, 95% CI 1.00–2.88). Social support from other forest-goers was also significantly associated with LLIN/LLIHN use (OR: 4.9, 95% CI 1.32–18.12). Conclusions Study findings are consistent with other studies on LLIN/LLIHN use and care-seeking behaviours. While rates of LLIN/LLIHN ownership were high among the study population, rates of use were not as high. More concerning were the delayed care-seeking behaviours. Social behaviour change activities should incorporate social norms and social support as mechanisms for behaviour change given the identified positive correlations with LLIN/LLIHN use and prompt care-seeking

General anaesthesia and day-case patient anxiety

Aims: This paper is a report of a study carried out to uncover the most anxiety provoking aspects of general anaesthesia and determine what interventions may help to alleviate such anxiety. Background: General anaesthesia has proven to be highly anxiety provoking. With the rise in elective day surgery, this aspect of the patients’ experience has become a prominent issue. Indeed, with the brief hospital stay, limited contact with healthcare professionals, restricted formal anxiety management and acute psychological impact of day surgery, such anxiety may be increasing. Method: As part of a larger study, a questionnaire was given on the day of surgery to 1250 adult patients undergoing surgery and general anaesthesia. The issue examined was anxiety in relation to the environment, hospital personnel and general anaesthesia. Participants were requested to return the questionnaire by mail 24 - 48 hours following surgery and 460 completed questionnaires were returned. Findings: A total of 85% of patients experienced some anxiety on the day of surgery. Immediate pre-operative experiences and concerns regarding unconsciousness were highly anxiety provoking. Using factor analysis Pre-operative Anaesthetic Information, Anaesthetic Catastrophising, Final Support, Personal Support, Imminence of Surgery, Possible Adverse Events and Final Pre-operative Experiences were identified as central features. Multiple regression demonstrated Pre-operative Anaesthetic Information, Anaesthetic Catastrophising and Imminence of Surgery were statistically significantly associated with an overall increased level of anxiety. Conclusions: Focusing on the timely, formal delivery of information about anaesthesia management, emphasising the notion of ‘controlled unconsciousness’ and dispelling misconceptions associated with general anaesthesia may help to limit patient anxiety