Blood tests in primary care:a qualitative study of communication and decision making between doctors and patients

OBJECTIVE: Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results, these aims may not be fulfilled. Shared decision‐making is widely advocated; yet, most research focusses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore communication and decision‐making around diagnostic blood tests in primary care. METHODS: Qualitative interviews were undertaken with patients and clinicians in UK primary care. Patients were interviewed at the time of blood testing, with a follow‐up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians' and patients' expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding. RESULTS: A total of 80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision‐making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing that they were protecting patients from anxiety. CONCLUSION: Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not have sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision‐making led to downstream consequences when test results did not fulfil patients' expectations. Although shared decision‐making is recommended as best practice, it does not reflect the reality of doctors' and patients' accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis. PATIENT OR PUBLIC CONTRIBUTION: A patient and public involvement group comprising five participants with lived experience of blood testing in primary care met regularly during the study. They contributed to the development of the research objectives, planning recruitment methods, reviewing patient information leaflets and topic guides and also contributed to discussion of emerging themes at an early stage in the analysis process

A video life-world approach to consultation practice: The relevance of a socio-phenomenological approach

This article discusses the [development and] use of a video life-world schema to explore alternative orientations to the shared health consultation. It is anticipated that this schema can be used by practitioners and consumers alike to understand the dynamics of videoed health consultations, the role of the participants within it and the potential to consciously alter the outcome by altering behaviour during the process of interaction. The study examines health consultation participation and develops an interpretative method of analysis that includes image elicitation (via videos), phenomenology (to identify the components of the analytic framework), narrative (to depict the stories of interactions) and a reflexive mode (to develop shared meaning through a conceptual framework for analysis). The analytic framework is derived from a life-world conception of human mutual shared interaction which is presented here as a novel approach to understanding patient-centred care. The video materials used in this study were derived from consultations in a Walk-in Centre (WiC) in East London. The conceptual framework produced through the process of video analysis is comprised of different combinations of movement, knowledge and emotional conversations that are used to classify objective or engaged WiC health care interactions. The videoed interactions organise along an active or passive, facilitative or directive typical situation continuum illustrating different kinds of textual approaches to practice that are in tension or harmony. The schema demonstrates how practitioners and consumers interact to produce these outcomes and indicates the potential for both consumers and practitioners to be educated to develop practice dynamics that support patient-centred care and impact on health outcomes

Preparing for a Northwest Passage: A Workshop on the Role of New England in Navigating the New Arctic

Preparing for a Northwest Passage: A Workshop on the Role of New England in Navigating the New Arctic (March 25 - 27, 2018 -- The University of New Hampshire) paired two of NSF\u27s 10 Big Ideas: Navigating the New Arctic and Growing Convergence Research at NSF. During this event, participants assessed economic, environmental, and social impacts of Arctic change on New England and established convergence research initiatives to prepare for, adapt to, and respond to these effects. Shipping routes through an ice-free Northwest Passage in combination with modifications to ocean circulation and regional climate patterns linked to Arctic ice melt will affect trade, fisheries, tourism, coastal ecology, air and water quality, animal migration, and demographics not only in the Arctic but also in lower latitude coastal regions such as New England. With profound changes on the horizon, this is a critical opportunity for New England to prepare for uncertain yet inevitable economic and environmental impacts of Arctic change

A Connection Approach to Numerical Relativity

We discuss a general formalism for numerically evolving initial data in general relativity in which the (complex) Ashtekar connection and the Newman-Penrose scalars are taken as the dynamical variables. In the generic case three gauge constraints and twelve reality conditions must be solved. The analysis is applied to a Petrov type \{1111\} planar spacetime where we find a spatially constant volume element to be an appropriate coordinate gauge choice.Comment: 17 pages, LaTe

Salinity from Space Unlocks Satellite-Based Assessment of Ocean Acidification

Approximately a quarter of the carbon dioxide (CO2) that we emit into the atmosphere is absorbed by the ocean. This oceanic uptake of CO2 leads to a change in marine carbonate chemistry resulting in a decrease of seawater pH and carbonate ion concentration, a process commonly called “Ocean Acidification”. Salinity data are key for assessing the marine carbonate system, and new space-based salinity measurements will enable the development of novel space-based ocean acidification assess- ment. Recent studies have highlighted the need to develop new in situ technology for monitoring ocean acidification, but the potential capabilities of space-based measurements remain largely untapped. Routine measurements from space can provide quasi-synoptic, reproducible data for investigating processes on global scales; they may also be the most efficient way to monitor the ocean surface. As the carbon cycle is dominantly controlled by the balance between the biological and solubility carbon pumps, innovative methods to exploit existing satellite sea surface temperature and ocean color, and new satellite sea surface salinity measurements, are needed and will enable frequent assessment of ocean acidification parameters over large spatial scales

Ephemeris Updates for Seven Selected HATNet Survey Transiting Exoplanets

We refined the ephemeris of seven transiting exoplanets HAT-P-6b, HAT-P-12b, HAT-P-18b, HAT-P-22b, HAT-P-32b, HAT-P-33b, and HAT-P-52b. We observed 11 transits from eight observatories in different filters for HAT-P-6b and HAT-P-32b. Also, the Exoplanet Transit Database (ETD) observations for each of the seven exoplanets were analyzed, and the light curves of five systems were studied using Transiting light Exoplanet Survey Satellite (TESS) data. We used Exofast-v1 to simulate these ground- and space-based light curves and estimate mid-transit times. We obtained a total of 11, 175 and 67 mid-transit times for these seven exoplanets from our observations, ETD and TESS data, respectively, along with 155 mid-transit times from the literature. Then, we generated transit timing variation (TTV) diagrams for each using derived mid-transit times as well as those found in the literature. The systems' linear ephemeris was then refined and improved using the Markov Chain Monte Carlo (MCMC) method. All of the studied exoplanets, with the exception of the HAT-P-12b system, displayed an increasing trend in the orbital period in the TTV diagrams.Comment: 11 Pages, submitted to the Astrophysics journa

The CMS Tracker Readout Front End Driver

The Front End Driver, FED, is a 9U 400mm VME64x card designed for reading out the Compact Muon Solenoid, CMS, silicon tracker signals transmitted by the APV25 analogue pipeline Application Specific Integrated Circuits. The FED receives the signals via 96 optical fibers at a total input rate of 3.4 GB/sec. The signals are digitized and processed by applying algorithms for pedestal and common mode noise subtraction. Algorithms that search for clusters of hits are used to further reduce the input rate. Only the cluster data along with trigger information of the event are transmitted to the CMS data acquisition system using the S-LINK64 protocol at a maximum rate of 400 MB/sec. All data processing algorithms on the FED are executed in large on-board Field Programmable Gate Arrays. Results on the design, performance, testing and quality control of the FED are presented and discussed