Preregistration house officers in general practice: review of evidence

OBJECTIVES: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices. DESIGN: Review of all studies that reported on placements of preregistration house officers in general practice. SETTING: 19 accounts of preregistration house officers’ experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England. PARTICIPANTS: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers. MAIN OUTCOME MEASURES: Main findings or themes weighted according to number of studies reporting them and weighted for sample size. RESULTS: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral. CONCLUSIONS: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision

The iconography of Asphyxiophilia: From fantasmatic fetish to forensic fact

This is a post print version of the article. The official published version can be accessed from the link below

Farming the Iveragh uplands: A tale of humans and nature

The rugged beauty of the Iveragh peninsula has fascinated many a passing visitor and never fails to make some of us linger or stay for good. For those who need proof of the area’s uniqueness, a variety of national and European designations provide ample attestation of the splendour of Iveragh’s scenery, the diversity of its landscape and its heritage. Being surrounded on three sides by the Atlantic, Iveragh is the largest and most geographically isolated peninsula in Ireland whose western extremity, the Great Skellig, forms the westernmost point of Europe. Despite its maritime location, Iveragh’s character is fundamentally determined by the mountains, valleys and streams that form the peninsula’s interior—the bequest of a landscape sculpted by ice thousands of years ago (Crowley and Sheehan, 2009). Distinctive mountain scene in the Bridia Valley, Glencar Perhaps most distinctive, however, are the extensive blanket bogs and upland heather moorlands that cover most of the peninsula and captivate the imagination with the wild and austere appeal of an area where life did not change much for man and beast until relatively recently. Having come into existence in the wake of woodland clearances, the cutting of vegetation for fuel and the harvesting of crops for food and fiber by Neolithic farmers in the first and second millennium BC, this unique cultural landscape continues to be managed by traditional farmers and their animals to the present day. The value of areas such as Iveragh as repositories of a unique flora and fauna has long been recognized, but they have entered a period of major transformation as the agricultural economy that lay behind them no longer exists (Webb, 1998). The single largest danger is that farming communities may not survive the present discussion of how competitive European agriculture should be, as under present market conditions they are unable to compete without fundamentally changing their way of farming (Luick, 1998). The last 10 years have seen a growing debate over the future of areas like the Iveragh peninsula that may be ‘marginal’ in agricultural terms, but that are quite essential to life in Europe as we know and cherish it. Upland farmed landscapes provide clean water, maintain a rich plant and animal life and help to keep families in regions that offer few alternative employment opportunities – at the same time as attracting millions of tourists each year. The Caragh in Glencar—one of Europe’s cleanest rivers. Such areas, also termed high nature value farmland, cover about 25% of all agricultural land in Ireland and include, besides Iveragh, other parts of Kerry, Connemara, Mayo, Donegal, the Comeraghs, Wicklow, the Burren and the offshore Islands. The farming systems of these areas are characterised by extensive mixed livestock grazing and little agro-chemical inputs combined with labour-intensive management practices. Without dedicated farmers and their families, the character of these areas would change completely leading to the disappearance of unique cultural landscapes with effects such as rural depopulation and the loss of local communities. Already farming systems have changed substantially with livestock being concentrated on better quality land while marginal areas are being abandoned. Along with this, there are changes in the animals being farmed. The traditional Scotch Blackface sheep are increasingly crossed with or replaced by lowland breeds to satisfy market demands for heavy lamb. This has led to a softening in sheep and the fear among farmers that the traditional grazers of the uplands may be extinct in years to come. Going, too, is the use of the native rustic Kerry cow that grazed the rough Farming the Iveragh Uplands grasses, bracken, gorse and soft rushes in the winter - growth that sheep cannot control. Unsurprisingly, this disruption over a relatively short time, in what was formerly a sustainable relationship between farming and nature, will have implications for the area’s flora and fauna. Some of the repercussions are obvious; others need to be researched in more depth if appropriate solutions are to be formulated. It is now a stated objective of EU environment and rural development policy to maintain and conserve traditional farming systems like the one practised on Iveragh. Beyond acknowledging the importance of traditional farming for nature conservation and local livelihoods, it is necessary to understand how such farming systems function and to determine how the inevitable process of change can be redirected to provide a way of life that is socially and economically rewarding for farm families while preserving the farming practices necessary for Iveragh’s unique landscape to persist into the future. In this light, University College Cork (UCC) in conjunction with the Environmental Research Institute (ERI) and funded by Science Foundation Ireland (SFI) initiated BioUp, a 3 year research programme to investigate the upland farming system and rich biodiversity associated with it. Managing rural change in the uplands calls for the active involvement of many stakeholders, including farmers and agricultural advisory groups, land owners, conservation groups, forestry, tourism, and local authorities. In the BioUp project, researchers and stakeholders worked closely together. It is hoped that this will help to obtain a better understanding of the social, economic and environmental challenges facing Iveragh and promote greater public appreciation of the indispensable contributions made by farm families to maintaining our unique heritage - a service that has gone unappreciated too long

The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland.

BACKGROUND: Overdose is a major cause of death among PWID, and for opioid overdoses naloxone administration can reduce harm. However, globally there is limited national level data on the extent of non-fatal overdose and naloxone uptake. The first national level data on the extent of self-reported overdose and self-reported receipt of naloxone among UK PWID, providing a baseline to monitor the impact of the recent policy change regarding naloxone availability, is presented. METHODS: Data on self-reported overdose and receipt of naloxone during the preceding year for 2013-2014 from a national survey of PWID was analysed. Participants who reported injecting during the preceding year were included. RESULTS: Participants (3850) were predominantly male (75%); mean age was 36 years. The most commonly injected drugs were: heroin (91%), crack (45%) and amphetamine (29%). 15% (591) reported overdosing during the preceding year. There were no differences in the proportion reporting overdose by age or gender, but overdose was more common among those who: injected multiple drugs; recently ceased addiction treatment; injected with used needles/syringes; ever had transactional sex; had used a sexual health clinic or emergency department and lived in Wales or Northern Ireland. Among those reporting an overdose during the preceding year, a third reported two to four overdoses and 7.5% five or more overdoses; half reported receiving naloxone. Those reporting naloxone receipt in the preceding year were more likely to: live in Wales or Northern Ireland; ever received used needles/syringes; ever been imprisoned; and less likely to have injected two drug types. CONCLUSION: These data provide a baseline for monitoring the impact of the 2015 UK policy change to improve take-home naloxone access. Interventions tackling overdose should promote naloxone awareness and access, and target those who; are poly-drug injectors, have ceased treatment, share needles/syringes and whose drug use links to sexual activity

Evidencia en video de fratricidio y canibalismo, movimiento de polluelos e interacciones con depredadores en nidos de Circus cyaneus

During a nest-camera study of Hen Harriers (Circus cyaneus), we recorded siblicide, cannibalism, movement of nestlings by adult birds, and interactions with predators. We deployed cameras at 13 nests across three study areas in Ireland between 2008 and 2010. At a nest with two well-developed nestlings (approximately 25–30 d old), the older nestling killed its sibling and fed on it. This was the first documented case of siblicide in this species, to our knowledge. Recordings also revealed three other events of cannibalism in which one of the nestlings in a brood died from unknown causes and was then eaten by its siblings (n = 1), by the adult male (n = 1), or was used by the adult female to feed the remaining nestlings (n = 1). At two nests, recordings showed the adult female picking up and moving nestlings that were outside the nest cup. In addition, cameras recorded two instances of full brood predation by red fox (Vulpes vulpes) and an attack on a nest by a female Eurasian Kestrel (Falco tinnunculus) that had no apparent consequences for the nestlings or the female Hen Harrier. The behaviors reported here, which are difficult to observe directly, may have important consequences for our understanding of productivity and population dynamics of Hen Harriers.Durante un estudio sobre patrones de actividad de individuos reproductores de Circus cyaneus realizado con cámaras para monitoreo de nidos, registramos comportamientos de fratricidio, canibalismo, movimientos de polluelos e interacciones con depredadores. Colocamos cámaras en 13 nidos distribuidos en tres áreas de estudio en Irlanda entre 2008 y 2010. En un nido con dos polluelos en un estado de desarrollo avanzado (c. 25-30 días), el polluelo de mayor edad mató al otro y se alimentó de él. Este es el primer caso documentado de fratricidio en esta especie. Obtuvimos imágenes de otros tres casos de canibalismo en que uno o más polluelos fallecieron por causas desconocidas y sus cadáveres fueron usados como alimento por los otros polluelos (n = 1), por el macho adulto (n = 1) o por la hembra adulta para alimentar a los otros polluelos (n = 1). En dos nidos, las imágenes muestran a la hembra adulta repetidamente recogiendo polluelos que se alejan del nido para intentar llevarlos al nido. Por último, las cámaras captaron dos eventos de depredación de polluelos por parte de Vulpes vulpes y un enfrentamiento entre la hembra adulta de C. cyaneus y una hembra de Falco tinnunculus sin consecuencias para los polluelos o la hembra adulta. Estos comportamientos, difíciles de detectar mediante metodologías de monitoreo tradicionales, pueden tener consecuencias para el éxito reproductivo y la dinámica poblacional de esta especie

Analysis of social attitude to the new end use of recycled water for household laundry in Australia by the regression models

Recycled water for household laundry can be regarded as a promising strategy to alleviate the current demand on scarce water supplies. Public acceptability becomes fairly important to ensure the successful establishment and development of this new end use. To address the issue, this study conducted social surveys in two locations of Australia, Port Macquarie and Melbourne, where respondents were asked 17 questions. The regression models provide conclusions about which characteristics are more likely to lead to the acceptance of recycled water from society. Three attitudinal variables (RWAlterDW, Attitude and Cost) and three psychological variables (Odour, Reading and SmallUnit) were found to be the key driving forces behind domestic water reuse behaviour. These findings could drive the future research direction to achieve better public perception of this new end use of recycled water. © 2013 Elsevier Ltd