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

A Cluster of Class I/f/II YSOs Discovered Near the Cepheid SU Cas

Preliminary constraints are placed on a cluster of YSOs (J2000 02:54:31.4 +69:20:32.5) discovered in the field of the classical Cepheid SU Cas. WISE 3.4, 4.6, 12, and 22 um images reveal that the cluster deviates from spherical symmetry and exhibits an apparent diameter of 3x6'. SEDs constructed using 2MASS Ks (2.2 um) and WISE photometry indicate that 19 (36%) class I, 21 (40%) class f, and 13 (25%) class II objects lie r<3' from the cluster center. Conversely, 11 (18%) class I, 13 (21%) class f, and 37 (61%) class II objects were detected for r>3'. Approximately 50% of the class I sources within r<3' were classified solely using WISE photometry owing to the absence of detections by 2MASS.Comment: Accepted for Publication (MNRAS

Event-based relaxation of continuous disordered systems

A computational approach is presented to obtain energy-minimized structures in glassy materials. This approach, the activation-relaxation technique (ART), achieves its efficiency by focusing on significant changes in the microscopic structure (events). The application of ART is illustrated with two examples: the structure of amorphous silicon, and the structure of Ni80P20, a metallic glass.Comment: 4 pages, revtex, epsf.sty, 3 figure

Multimorbidity analysis with low condition counts:A robust Bayesian approach for small but important subgroups

Background: Robustly examining associations between long-term conditions may be important in identifying opportunities for intervention in multimorbidity but is challenging when evidence is limited. We have developed a Bayesian inference framework that is robust to sparse data and used it to quantify morbidity associations in the oldest old, a population with limited available data.Methods: We conducted a retrospective cross-sectional study of a representative dataset of primary care patients in Scotland as of March 2007. We included 40 long-term conditions and studied their associations in 12,009 individuals aged 90 and older, stratified by sex (3,039 men, 8,970 women). We analysed associations obtained with Relative Risk (RR), a standard measure in the literature, and compared them with our proposed measure, Associations Beyond Chance (ABC). To enable a broad exploration of interactions between long-term conditions, we built networks of association and assessed differences in their analysis when associations are estimated by RR or ABC.Findings: Our Bayesian framework was appropriately more cautious in attributing association when evidence is lacking, particularly in uncommon conditions. This caution in reporting association was also present in reporting differences in associations between sex and affected the aggregated measures of multimorbidity and network representations.Interpretation: Incorporating uncertainty into multimorbidity research is crucial to avoid misleading findings when evidence is limited, a problem that particularly affects small but important subgroups. Our proposed framework improves the reliability of estimations of associations and, more in general, of research into disease mechanisms and multimorbidity. <br/

Wakeful rest alleviates interference-based forgetting

Retroactive interference (RI)—the disruptive influence of events occurring after the formation of a new memory—is one of the primary causes of forgetting. Placing individuals within an environment that postpones interference should, therefore, greatly reduce the likelihood of information being lost from memory. For example, a short period of wakeful rest should diminish interference-based forgetting. To test this hypothesis, participants took part in a foreign language learning activity and were shown English translations of 20 Icelandic words for immediate recall. Half of the participants were then given an 8-min rest before completing a similar or dissimilar interfering distractor task. The other half did not receive a rest until after the distractor task, at which point interference had already taken place. All participants were then asked to translate the Icelandic words for a second time. Results revealed that retention was significantly worse at the second recall test, but being allowed a brief rest before completing the distractor task helped reduce the amount of forgetting. Taking a short, passive break can shield new memories from RI and alleviate forgetting.ERAS Scheme, University of Wolverhampto

Impact of culture towards disaster risk reduction

Number of natural disasters has risen sharply worldwide making the risk of disasters a global concern. These disasters have created significant losses and damages to humans, economy and society. Despite the losses and damages created by disasters, some individuals and communities do not attached much significance to natural disasters. Risk perception towards a disaster not only depends on the danger it could create but also the behaviour of the communities and individuals that is governed by their culture. Within this context, this study examines the relationship between culture and disaster risk reduction (DRR). A comprehensive literature review is used for the study to evaluate culture, its components and to analyse a series of case studies related to disaster risk. It was evident from the study that in some situations, culture has become a factor for the survival of the communities from disasters where as in some situations culture has acted as a barrier for effective DRR activities. The study suggests community based DRR activities as a mechanism to integrate with culture to effectively manage disaster risk

Mapping Children's Discussions of Evidence in Science to Assess Collaboration and Argumentation

The research reported in this paper concerns the development of children's skills of interpreting and evaluating evidence in science. Previous studies have shown that school teaching often places limited emphasis on the development of these skills, which are necessary for children to engage in scientific debate and decision-making. The research, undertaken in the UK, involved four collaborative decision-making activities to stimulate group discussion, each was carried out with five groups of four children (10-11 years old). The research shows how the children evaluated evidence for possible choices and judged whether their evidence was sufficient to support a particular conclusion or the rejection of alternative conclusions. A mapping technique was developed to analyse the discussions and identify different "levels" of argumentation. The authors conclude that suitable collaborative activities that focus on the discussion of evidence can be developed to exercise children's ability to argue effectively in making decisions