Response to requests for general practice out of hours: geographical analysis in north west England

The organisation of out of hours general practice (GP) in the UK has changed rapidly in recent years as practice based rotas and deputising services have given way to GP cooperatives in many areas. At the same time, the proportion of patients contacting an out of hours service who receive telephone advice only, rather than a face to face consultation, has risen substantially, although patients continue to express strong preferences for personal contact with a doctor out of hours. We examined the effect of the distance of the patient from the primary care centre on the doctor’s decision to see the patient face to face

A comparison of methods for calculating general practice level socioeconomic deprivation

Background: A measure of the socioeconomic deprivation experienced by the registered patient population of a general practice is of interest because it can be used to explore the association between deprivation and a wide range of other variables measured at practice level. If patient level geographical data are available a population weighted mean area-based deprivation score can be calculated for each practice. In the absence of these data, an area-based deprivation score linked to the practice postcode can be used as an estimate of the socioeconomic deprivation of the practice population. This study explores the correlation between Index of Multiple Deprivation 2004 (IMD) scores linked to general practice postcodes (main surgery address alone and main surgery plus any branch surgeries), practice population weighted mean IMD scores, and practice level mortality (aged 1 to 75 years, all causes) for 38 practices in Rotherham UK. Results: Population weighted deprivation scores correlated with practice postcode based scores (main surgery only, Pearson r = 0.74, 95% CI 0.54 to 0.85; main plus branch surgeries, r = 0.79, 95% CI 0.63 to 0.89). All cause mortality aged 1 to 75 correlated with deprivation (main surgery postcode based measure, r = 0.50, 95% CI 0.22 to 0.71; main plus branch surgery based score, r = 0.55, 95% CI 0.28 to 0.74); population weighted measure, r = 0.66, 95% CI 0.43 to 0.81). Conclusion: Practice postcode linked IMD scores provide a valid proxy for a population weighted measure in the absence of patient level data. However, by using them, the strength of association between mortality and deprivation may be underestimated

Border parasites: schistosomiasis control among Uganda's fisherfolk

Copyright @ 2012 Taylor & Francis. This article has been made publically available through the Brunel Open Access Publishing Fund.It is recognized that the control of schistosomisais in Uganda requires a focus on fisherfolk. Large numbers suffer from this water-borne parasitic disease; notably along the shores of lakes Albert and Victoria and along the River Nile. Since 2004, a policy has been adopted of providing drugs, free of charge, to all those at risk. The strategy has been reported to be successful, but closer investigation reveals serious problems. This paper draws upon long-term research undertaken at three locations in northwestern and southeastern Uganda. It highlights consequences of not engaging with the day to day realities of fisherfolk livelihoods; attributable, in part, to the fact that so many fisherfolk live and work in places located at the country’s international borders, and to a related tendency to treat them as "feckless" and "ungovernable". Endeavours to roll out treatment end up being haphazard, erratic and location-specific. In some places, concerted efforts have been made to treat fisherfolk; but there is no effective monitoring, and it is difficult to gauge what proportion have actually swallowed the tablets. In other places, fisherfolk are, in practice, largely ignored, or are actively harassed in ways that make treatment almost impossible. At all sites, the current reliance upon resident "community" drug distributors or staff based at static clinics and schools was found to be flawed.The Schistosomiasis Control Initiative, Imperial College, under the auspices of the Bill and Melinda Gates Foundation

Fast iterative solution of reaction-diffusion control problems arising from chemical processes

PDE-constrained optimization problems, and the development of preconditioned iterative methods for the efficient solution of the arising matrix system, is a field of numerical analysis that has recently been attracting much attention. In this paper, we analyze and develop preconditioners for matrix systems that arise from the optimal control of reaction-diffusion equations, which themselves result from chemical processes. Important aspects in our solvers are saddle point theory, mass matrix representation and effective Schur complement approximation, as well as the outer (Newton) iteration to take account of the nonlinearity of the underlying PDEs

Asking the experts : developing and validating parental diaries to assess children's minor injuries

The methodological issues involved in parental reporting of events in children's everyday lives are discussed with reference to the development and validation of an incident diary, collecting concurrent data on minor injuries in a community study of children under eight years old. Eighty-two mothers participated in a comparison over nine days of daily telephone interviews and structured incident diaries. Telephone methods resulted in more missing data, and participants in both groups expressed a preference for the diary method. This diary was then validated on a sample of 56 preschool and school-aged children by comparing injury recording by a research health visitor with that of their mothers. Each failed to report some injuries, but there was good agreement overall, and in descriptive data on injuries reported by both. Parental diaries have the potential to provide rich data, of acceptable validity, on minor events in everyday life

The "zeroth law" of turbulence: Isotropic turbulence simulations revisited

The dimensionless kinetic energy dissipation rate C_epsilon is estimated from numerical simulations of statistically stationary isotropic box turbulence that is slightly compressible. The Taylor microscale Reynolds number Re_lambda range is 20 < Re_lambda < 220 and the statistical stationarity is achieved with a random phase forcing method. The strong Re_lambda dependence of C_epsilon abates when Re_lambda approx. 100 after which C_epsilon slowly approaches approx 0.5 a value slightly different to previously reported simulations but in good agreement with experimental results. If C_epsilon is estimated at a specific time step from the time series of the quantities involved it is necessary to account for the time lag between energy injection and energy dissipation. Also, the resulting value can differ from the ensemble averaged value by up to +-30%. This may explain the spread in results from previously published estimates of C_epsilon.Comment: 7 pages, 7 figures. Submitted to Phys. Rev.

Acute effects of aircraft noise on cardiovascular admissions - an interrupted time-series analysis of a six-day closure of London Heathrow Airport caused by volcanic ash

Acute noise exposure may acutely increase blood pressure but the hypothesis that acute exposure to aircraft noise may trigger cardiovascular events has not been investigated. This study took advantage of a six-day closure of a major airport in April 2010 caused by volcanic ash to examine if there was a decrease in emergency cardiovascular hospital admissions during or immediately after the closure period, using an interrupted daily time-series study design. The population living within the 55 dB(A) noise contour was substantial at 0.7 million. The average daily admission count was 13.9 (SD 4.4). After adjustment for covariates, there was no evidence of a decreased risk of hospital admission from cardiovascular disease during the closure period (relative risk 0.97 (95% CI 0.75–1.26)). Using lags of 1–7 days gave similar results. Further studies are needed to investigate if transient aircraft noise exposure can trigger acute cardiovascular events

Adopt Publication

A note from the Winter 1939 issue of the Veterinary Student, as well as congratulatory notes on the ISU Veterinarian\u27s 50th anniversary from Dean Pearson of the College of Veterinary Medicine, and Nolan Hartwig, Secretary/Treasurer of the Alumni Association