Reluctance of general practice staff to register patients without documentation: a qualitative study in North East London.

BACKGROUND: Lack of access to documentation is a key barrier to GP registration, despite NHS England guidance stating that documents are not required. Staff attitudes and practice regarding registration of those without documentation are under- researched. AIM: To understand the processes through which registration might be refused for those without documents, and the factors operating to influence this. DESIGN AND SETTING: Qualitative study conducted in general practice across three clinical commissioning groups in North East London. METHOD: In total, 33 participants (GP staff involved in registering new patients) were recruited through email invitation. Semi-structured interviews and focus groups were conducted. Data were analysed using Braun and Clarke's reflexive thematic analysis. Two social theories informed this analysis: Lipsky's street-level bureaucracy and Bourdieu's theory of practice. RESULTS: Despite good knowledge of guidance, most participants expressed reluctance to register those without documentation, often introducing additional hurdles or requirements in their everyday practice. Two explanatory themes were generated: that those without documents were perceived as burdensome, and/or that moral judgements were made about their deservedness to finite resources. Participants described a context of high workload and insufficient funding. Some felt that GP services should be restricted by immigration status, as is widespread in secondary care. CONCLUSION: Improving inclusive registration practice requires addressing staff concerns, supporting navigation of high workloads, tackling financial disincentives to registering transient groups, and challenging narratives that undocumented migrants represent a 'threat' to NHS resources. Furthermore, it is imperative to acknowledge and address upstream drivers, in this instance the Hostile Environment

The moisture effect on 223Ra and 224Ra measurements using Mn-cartridges

Important processes in the ocean can be evaluated with radioactive nuclides, including radium isotopes. An approach for quantifying radium isotopes in seawater with in-situ pumps has been developed in advance of the GEOTRACES program [1]. Precise measurements of 223Ra and 224Ra by means of the delayed coincidence counting system (RaDeCC) [2] are dependent on the moisture content of the medium [3]. In order to verify the optimum moisture content for this new approach, a set of measurements of the Mn-cartridge standards under different moisture conditions was conducted, as this was done previously for acrylic fiber. At a time, an amount of water equivalent to 5% of the cartridges weight was added, and the activities were determined. The variation of 224Ra activity occurs mainly between 0 to 15% of humidity. Under moisture conditions higher than 15%, the emanation efficiency reaches an optimum plateau until 100% of moisture. This result differs slightly from those found for 224Ra measurements using the acrylic fiber (plateau from 30 to 100 %) [3]. The 223Ra Mn-cartridge standard reaches the plateau under 5% of humidity, and above 50% moisture the activity seems to decrease. Considering the counting error (7%), it is hard to state that the effect of the moisture is critical. However, this decrease can be related to the shorter half-life of the 219Rn compared to the time needed to its diffusion through the water film, which could be a reason for the frequently observed lower efficiency of the 223Ra channel of the RaDeCC system [4]. [1] Henderson et al. (2013) J. Radioanal. Nucl. Chem. 296, 357–362. [2] Moore and Arnold (1996) J. Geophys. Res. 101, 321–1329. [3] Sun and Torgersen (1998) Mar. Chem. 61, 163–171. [4] Charette et al. (2012) Limnol. Oceanogr. 10, 451–463

CAMPLET:Seasonal Adjustment Without Revisions

Seasonality in economic time series can ‘obscure’ movements of other components in a series that are operationally more important for economic and econometric analyses. In practice, one often prefers to work with seasonally adjusted data to assess the current state of the economy and its future course. This paper presents a seasonal adjustment program called CAMPLET, an acronym of its tuning parameters, which consists of a simple adaptive procedure to extract the seasonal and the non-seasonal component from an observed series. Once this process is carried out there will be no need to revise these components at a later stage when new observations become available. The paper describes the main features of CAMPLET. We evaluate the outcomes of CAMPLET and X-13ARIMA-SEATS in a controlled simulation framework using a variety of data generating processes and illustrate CAMPLET and X-13ARIMA-SEATS with three time series: U.S. non-farm payroll employment, operational income of Ahold and real GDP in the Netherlands

Platelet responses to agonists in a cohort of highly characterised platelet donors are consistent over time.

BACKGROUND AND OBJECTIVES: Platelet function shows significant inheritance that is at least partially genetically controlled. There is also evidence that the platelet response is stable over time, but there are few studies that have assessed consistency of platelet function over months and years. We aimed to measure platelet function in platelet donors over time in individuals selected from a cohort of 956 donors whose platelet function had been previously characterised. MATERIALS AND METHODS: Platelet function was assessed by flow cytometry, measuring fibrinogen binding and P-selectin expression after stimulation with either cross-linked collagen-related peptide or adenosine 5'-diphosphate. Eighty-nine donors from the Cambridge Platelet Function Cohort whose platelet responses were initially within the lower or upper decile of reactivity were retested between 4 months and five and a half years later. RESULTS: There was moderate-to-high correlation between the initial and repeat platelet function results for all assays (P ≤ 0·007, r2 0·2961-0·7625); furthermore, the range of results observed in the initial low and high responder groups remained significantly different at the time of the second test (P ≤ 0·0005). CONCLUSION: Platelet function remains consistent over time. This implies that this potential influence on quality of donated platelet concentrates will remain essentially constant for a given donor

Effects of an acute physical activity break on test anxiety and math test performance

(1) Background: Test anxiety has been found to negatively affect students’ mental health and academic performance. A primary explanation for this is that anxiety-related thoughts occupy working memory resources during testing that cannot be used for test-related processes (such as information retrieval and problem-solving). The present intervention study investigated whether physical activity could decrease anxiety levels and improve math test performance in sixth-grade children. (2) Methods: Sixty-eight children of 11–12 years from two primary schools in New South Wales, Australia were categorised as low or high anxious from their scores on a trait-anxiety questionnaire. After this assessment, they were randomly assigned to the activity break condition, in which they had to do several physical activities of moderate intensity (e.g., star jumps) for 10 min, or the control condition, in which they played a vocabulary game for 10 min. The outcome measures were children’s anxiety levels at the beginning, during, and at the end of the test, invested mental effort, perceived task difficulty and math test perfo

Proteomics as a quality control tool of pharmaceutical probiotic bacterial lysate products

Probiotic bacteria have a wide range of applications in veterinary and human therapeutics. Inactivated probiotics are complex samples and quality control (QC) should measure as many molecular features as possible. Capillary electrophoresis coupled to mass spectrometry (CE/MS) has been used as a multidimensional and high throughput method for the identification and validation of biomarkers of disease in complex biological samples such as biofluids. In this study we evaluate the suitability of CE/MS to measure the consistency of different lots of the probiotic formulation Pro-Symbioflor which is a bacterial lysate of heat-inactivated Escherichia coli and Enterococcus faecalis. Over 5000 peptides were detected by CE/MS in 5 different lots of the bacterial lysate and in a sample of culture medium. 71 to 75% of the total peptide content was identical in all lots. This percentage increased to 87–89% when allowing the absence of a peptide in one of the 5 samples. These results, based on over 2000 peptides, suggest high similarity of the 5 different lots. Sequence analysis identified peptides of both E. coli and E. faecalis and peptides originating from the culture medium, thus confirming the presence of the strains in the formulation. Ontology analysis suggested that the majority of the peptides identified for E. coli originated from the cell membrane or the fimbrium, while peptides identified for E. faecalis were enriched for peptides originating from the cytoplasm. The bacterial lysate peptides as a whole are recognised as highly conserved molecular patterns by the innate immune system as microbe associated molecular pattern (MAMP). Sequence analysis also identified the presence of soybean, yeast and casein protein fragments that are part of the formulation of the culture medium. In conclusion CE/MS seems an appropriate QC tool to analyze complex biological products such as inactivated probiotic formulations and allows determining the similarity between lots

Trends door meetgegevens : keuzes bij een opdrachtverstrekking

Het bepalen van een trend door meetgegevens is niet triviaal. Het hangt af van welke trend-methodiek gebruikt is. Het hangt ook af van welke databewerkingen toegepast zijn. Elk instituut heeft zijn eigen werkwijze. Daardoor kan het voorkomen dat, op basis van dezelfde set aan ruwe meetgegevens, het ene instituut zegt dat de trend dalend is, het andere zegt dat het stijgend is, en de volgende zegt dat het stabiel is. Tegenstrijdige conclusies, daar worden opdrachtgevers niet blij van. In deze notitie worden een aantal keuzes genoemd waarmee de opdrachtgever, en de hoofd- en onderaannemers ervan, rekening kunnen houden bij een opdrachtverstrekking. Het voorkomen van tegenstrijdige trendanalyse-conclusies kan geminimaliseerd worden als de juiste keuzes ge-maakt worden. Er wordt daarbij aanbevolen om een ‘werkgroep statistiek’ in het leven te roepen. Deze is op incidentele basis oproepbaar en kan betrokken worden bij trendanalyses, als vraagbaak en/of om (on)gevraagd advies te geven. De scope van zo’n werkgroep statistiek beperkt zich niet tot de Evaluatie Meststoffenwet. Het kan ook op andere terreinen ingezet worden. Ook wordt aanbevolen om zo vroeg mogelijk te starten met de afstemming tussen opdrachtgever en hoofd-aannemer (verantwoordelijk voor het ‘verzamelrapport’) en tussen de hoofd- en onderaannemers (verantwoordelijk voor de onderliggende onderzoeksrapporten). Hiermee kan voorkomen worden dat tijdens het stressvolle productieproces nog problemen optreden

Extending colonic mucosal microbiome analysis - Assessment of colonic lavage as a proxy for endoscopic colonic biopsies

This study was supported through GI Research funds and MRC Grant Ref: MR/M00533X/1 to GH.Peer reviewedPublisher PD