Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator

Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care

Statistics of the geomagnetic secular variation for the past 5Ma

A new statistical model is proposed for the geomagnetic secular variation over the past 5Ma. Unlike previous models, the model makes use of statistical characteristics of the present day geomagnetic field. The spatial power spectrum of the non-dipole field is consistent with a white source near the core-mantle boundary with Gaussian distribution. After a suitable scaling, the spherical harmonic coefficients may be regarded as statistical samples from a single giant Gaussian process; this is the model of the non-dipole field. The model can be combined with an arbitrary statistical description of the dipole and probability density functions and cumulative distribution functions can be computed for declination and inclination that would be observed at any site on Earth's surface. Global paleomagnetic data spanning the past 5Ma are used to constrain the statistics of the dipole part of the field. A simple model is found to be consistent with the available data. An advantage of specifying the model in terms of the spherical harmonic coefficients is that it is a complete statistical description of the geomagnetic field, enabling us to test specific properties for a general description. Both intensity and directional data distributions may be tested to see if they satisfy the expected model distributions

Study of fluid transients in closed conduits progress report no. 64-5, 1-30 nov. 1964

Fluid transients in closed conduit

Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.

Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management

Low-density polybenzimidazole foams for thermal insulation and fire protection

Fire-resistant and nonsmoking foam can be prepared in desirable density range of 24 to 50 kg/cu m by controlled thermal crosslinking of polybenzimidazole prepolymer. Reproducible foams of specific density can be produced by controlling volative content and melting temperature of prepolymer

Design considerations and test facilities for accelerated radiation effects testing

Test design parameters for accelerated dose rate radiation effects tests for spacecraft parts and subsystems used in long term mission (years) are detailed. A facility for use in long term accelerated and unaccelerated testing is described

Systems development of a stall/spin research facility using remotely controlled/augmented aircraft models. Volume 1: Systems overview

A ground based, general purpose, real time, digital control system simulator (CSS) is specified, developed, and integrated with the existing instrumentation van of the testing facility. This CSS is built around a PDP-11/55, and its operational software was developed to meet the dual goal of providing the immediate capability to represent the F-18 drop model control laws and the flexibility for expansion to represent more complex control laws typical of control configured vehicles. Overviews of the two CSS's developed are reviewed as well as the overall system after their integration with the existing facility. Also the latest version of the F-18 drop model control laws (REV D) is described and the changes needed for its incorporation in the digital and analog CSS's are discussed

Inelastic neutron scattering studies of methyl chloride synthesis over alumina

Not only is alumina the most widely used catalyst support material in the world, it is also an important catalyst in its own right. One major chemical process that uses alumina in this respect is the industrial production of methyl chloride. This is a large scale process (650 000 metric tons in 2010 in the United States), and a key feedstock in the production of silicones that are widely used as household sealants. In this Account, we show how, in partnership with conventional spectroscopic and reaction testing methods, inelastic neutron scattering (INS) spectroscopy can provide additional insight into the active sites present on the catalyst, as well as the intermediates present on the catalyst surface.<p></p> INS spectroscopy is a form of vibrational spectroscopy, where the spectral features are dominated by modes involving hydrogen. Because of this, most materials including alumina are largely transparent to neutrons. Advantageously, in this technique, the entire “mid-infrared”, 0–4000 cm<sup>–1</sup>, range is accessible; there is no cut-off at 1400 cm<sup>–1</sup> as in infrared spectroscopy. It is also straightforward to distinguish fundamental modes from overtones and combinations. <p></p> A key parameter in the catalyst’s activity is the surface acidity. In infrared spectroscopy of adsorbed pyridine, the shifts in the ring stretching modes are dependent on the strength of the acid site. However, there is a very limited spectral range available. We discuss how we can observe the low energy ring deformation modes of adsorbed pyridine by INS spectroscopy. These modes can undergo shifts that are as large as those seen with infrared inspectroscopy, potentially enabling finer discrimination between acid sites. <p></p> Surface hydroxyls play a key role in alumina catalysis, but in infrared spectroscopy, the presence of electrical anharmonicity complicates the interpretation of the O–H stretch region. In addition, the deformations lie below the infrared cut-off. Both of these limitations are irrelevant to INS spectroscopy, and all the modes are readily observable. When we add HCl to the catalyst surface, the acid causes changes in the spectra. We can then deduce both that the surface chlorination leads to enhanced Lewis acidity and that the hydroxyl group must be threefold coordinated. <p></p> When we react η-alumina with methanol, the catalyst forms a chemisorbed methoxy species. Infrared spectroscopy clearly shows its presence but also indicates the possible coexistence of a second species. Because of INS spectroscopy’s ability to discriminate between fundamental modes and combinations, we were able to unambiguously show that there is a single intermediate present on the surface of the active catalyst. This work represents a clear example where an understanding of the chemistry at the molecular level can help rationalize improvements in a large scale industrial process with both financial and environmental benefits. <p></p&gt

Video communication policy at CERN

Many video images are transmitted around the CERN site. The main sources of these images are the beam observation cameras in the accelerators, site and machine access control cameras, and "teletext" pages showing various information such as machine status. Other images transmitted around the site include broadcasts of important meetings between conference rooms. Many methods of transmission and distribution of these images are in use. Some of the systems in use date from the very early days of the laboratory, whereas the newest systems use the latest technology. This paper will give an overview of the systems in use at CERN today, and present different options for rationalisation