Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

<b>Background</b> Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.<p></p> <b>Methods</b> A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.<p></p> <b>Results</b> Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.<p></p> <b>Conclusions</b> Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings

Vulnerability to bushfires in rural Australia: a case study from East Gippsland, Victoria

This paper investigates the nature and causes of vulnerability to bushfires in the Wulgulmerang district of East Gippsland, Victoria, in south-eastern Australia. In 2003 bushfires devastated the small population of this isolated farming district, destroying homes, agricultural assets and public infrastructure. The ?res also adversely affected the health, livelihoods and social lives of many local people. The paper examines: (i) how and why people were exposed to hazards during the bushfires; and (ii) how and why people were differentially capable of coping and adapting to the fires' impacts. Qualitative methods were primarily used to investigate these questions, including semi-structured interviews with residents and landholders of the district and others who responded to the fires in an official or unofficial capacity. Vulnerability is shown to arise from the circumstances of people's everyday lives, which are shaped by factors both within and beyond their control. Local pressures and challenges such as drought, declining farm incomes, depopulation, and the inaccessibility of essential services e are shown to increase people's exposure to hazards and reduce their capacities to cope and adapt. The paper demonstrates the fundamental importance of sustainable livelihoods and regional economic vitality to the long-term goal of vulnerability reduction

At The Jazz Band Ball

https://digitalcommons.library.umaine.edu/mmb-vp/5737/thumbnail.jp

Crystallization of Yamato 980459 at 0.5 GPA: Are Residual Liquids Like QUE 94201?

The Martian basaltic meteorites Y980459 and QUE94201 (henceforth referred to as Y98 and QUE respectively) are thought to represent magmatic liquid compositions, rather than being products of protracted crystallization and accumulation like the majority of other martian meteorites. Both meteorite compositions have been experimentally crystallized at 1 bar, and liquidus phases were found to match corresponding mineral core compositions in the meteorites, consistent with the notion that these meteorites represent bona fide melts. They also represent the most primitive and most evolved basaltic martian samples, respectively. Y98 has Mg# (molar Mg/Mg+Fe) approximates 65, and lacks plagioclase; whereas QUE has Mg# approximates 40, and lacks olivine. However they share important geochemical characteristics (e.g. superchondritic CaO/Al2O3, very high epsilon(sub Nd) and low Sr-87/Sr-87) that suggest they sample a similar highly depleted mantle reservoir. As such, they represent likely endmembers of martian magmatic liquid compositions, and it is natural to seek petrogenetic linkages between the two. We make no claim that the actual meteorites themselves share a genetic link (the respective ages rule that out); we are exploring only in general whether primitive martian liquids like Y98 could evolve to liquids resembling QUE. Both experimental and computational efforts have been made to determine if there is indeed such a link. Recent petrological models at 1 bar generated using MELTS suggest that a QUE-like melt can be derived from a parental melt with a Y98 composition. However, experimental studies at 1 bar have been less successful at replicating this progression. Previous experimental crystallization studies of Y98 by our group at 0.5 GPa have produced melt compositions approaching that of QUE, although these results were complicated by the presence of small, variable amounts of H2O in some of the runs owing to the use of talc/pyrex experimental assemblies. Therefore we have repeated the four experiments, augmented with additional runs, all using BaCO3 cell assemblies, which are devoid of water, and these new experiments supersede those reported earlier. Here we report results of experiments simulating equilibrium crystallization; fractional crystallization experiments are currently underway

Using atmospheric model output to simulate the meteorological tsunami response to Tropical Storm Helene (2000)

[1] In the fall of both 1999 and 2000, unexpected “rapid tides” occurred along the coast of the Avalon Peninsula of Newfoundland. These rapid tides have been linked to the passing of Tropical Storm Jose (1999) and Tropical Storm Helene (2000) over the Grand Banks. Here we examine the dynamic ocean response to Tropical Storm Helene (2000) using a barotropic shallow water ocean model forced by atmospheric pressure and surface winds derived from a simulation of Helene using a dynamical model of the atmosphere. The ocean model is able to capture the main features of the observed response at the coast of Newfoundland as seen in the available tide gauge data. Results show that the simulated sea level response at the coast is driven by a combination of wind stress and atmospheric pressure forcing, the former generally dominating. An exception is Conception Bay, Newfoundland, where the response is captured mainly by atmospheric pressure forcing. Offshore near the edge of the Grand Banks, atmospheric pressure and wind stress forcing are equally important. The wind-forced response depends on the divergence of the surface wind stress and hence on the structure of the storm in the atmospheric model simulation. Sensitivity studies show the importance of having a small time interval (on the order of minutes) at which the atmospheric forcing is supplied to the ocean model and show the importance of the location of the storm track

Effect of expertise on diagnosis accuracy, non-technical skills and thought processes during simulated high-fidelity anaesthetist scenarios

Background The expert performance approach can be used to examine expertise during representative field-based tasks, while collecting process-tracing measures such as think-aloud verbal reports. Collecting think-aloud verbal reports provides an insight into the cognitive mechanisms that support performance during tasks. Method We examined the thought processes and performance of anaesthetists during simulated environments. Verbal reports of thinking and the anaesthetists’ non-technical skills (ANTS) were recorded to examine cognitive processes, non-technical behaviours and diagnosis accuracy during fully immersive, high-fidelity medical scenarios. Skilled (n=6) and less skilled (n=9) anaesthetists were instructed to respond to medical scenarios experienced in theatre. Results Skilled participants demonstrated higher diagnosis accuracy and ANTS scores compared to less skilled participants. Furthermore, skilled participants engaged in deeper thinking and verbalised more evaluation, prediction and deep planning statements. Conclusions The ability to employ an effective cognitive processing strategy, more efficient non-technical behaviours and superior diagnosis is associated with superior performance in skilled participants

Predicting sexual problems in women: The relevance of sexual excitation and sexual inhibition

This is the post-print version of the article. The official published version can be obtained from the link below.Data from a non-clinical sample of 540 heterosexual women were used to examine the relationships between scores on the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) and ratings of current sexual problems, lifetime arousal difficulty, lifetime orgasm difficulty, and lifetime problems with low sexual interest. Multiple regression analyses also included several demographic/background variables as predictors: age, full-time employment, completed college, children in household, married, health ratings, importance of sex, and whether the woman was in a sexual relationship. The strongest statistical predictors of both current and lifetime sexual problems were the SESII-W inhibition factors Arousal Contingency and Concerns about Sexual Function. Demographic factors did not feature largely in any of the models predicting sexual problems even when statistically significant relationships were found. If future research supports the predictive utility of the SESII-W in identifying women who are more likely to experience sexual difficulties, these scales may be used as prognostic factors in treatment studies.This study was funded, in part, by a grant from the Lilly Centre for Women's Health

The protective performance of selected UK police body armor challenged by M75 grenades

UK Police ‘soft’ body armor is designed to provide protection from sharp-weapons and low-velocity pistol ammunition; if ‘hard’ armor plates are fitted then high-velocity rifle protection is provided. Several different levels of protection for both soft and hard armor are available and these are tailored to the individual police officers’ role. The level of protection offered by these types of armor from fragmentation threats is not known as fragmentation is not typically considered a threat to UK Police Officers. However, fragmentation from devices such as grenades may be a threat to certain specialized units and during terrorist incidents. In this work, neither the soft nor hard UK Police body armor (HG2 and RF1 respectively) investigated were perforated when challenged by M75 Yugoslavian grenades at a distance of 1 m from the point of detonation. The effect due to blast was not considered. The work has provided confidence regarding the performance of selected police body armor against fragmentation from a selected grenade threat