General practitioners' perceptions of effective health care

Objectives: To explore general practitioners' perceptions of effective health care and its application in their own practice; to examine how these perceptions relate to assumptions about clinicians' values and behaviour implicit in the evidence based medicine approach. Design: A qualitative study using semistructured interviews. Setting: Eight general practices in North Thames region that were part of the Medical Research Council General Practice Research Framework. Participants: 24 general practitioners, three from each practice. Main outcome measures: Respondents' definitions of effective health care, reasons for not practising effectively according to their own criteria, sources of information used to answer clinical questions about patients, reasons for making changes in clinical practice. Results: Three categories of definitions emerged: clinical, patient related, and resource related. Patient factors were the main reason given for not practising effectively; others were lack of time, doctors' lack of knowledge and skills, lack of resources, and "human failings." Main sources of information used in situations of clinical uncertainty were general practitioner partners and hospital doctors. Contact with hospital doctors and observation of hospital practice were just as likely as information from medical and scientific literature to bring about changes in clinical practice. Conclusions: The findings suggest that the central assumptions of the evidence based medicine paradigm may not be shared by many general practitioners, making its application in general practice problematic. The promotion of effective care in general practice requires a broader vision and a more pragmatic approach which takes account of practitioners' concerns and is compatible with the complex nature of their work

On the Control of Distributed Parameter Systems using a Multidimensional Systems Setting

The unique characteristic of a repetitive process is a series of sweeps, termed passes, through a set of dynamics defined over a finite duration with resetting before the start of the each new one. On each pass an output, termed the pass profile is produced which acts as a forcing function on, and hence contributes to, the dynamics of the next pass profile. This leads to the possibility that the output, i.e. the sequence of pass profiles, will contain oscillations which increase in amplitude in the pass-to-pass direction. Such behavior cannot be controlled by standard linear systems approach and instead they must be treated as a multidimensional system, i.e. information propagation in more than one independent direction. Physical examples of such processes include long-wall coal cutting and metal rolling. In this paper, stability analysis and control systems design algorithms are developed for a model where a plane, or rectangle, of information is propagated in the passto- pass direction. The possible use of these in the control of distributed parameter systems is then described using a fourthorder wavefront equation

Hammett Correlations in the \u3csup\u3e1\u3c/sup\u3eH NMR Spectra of Some N-Arlydihalonicotinamides

Excellent linear correlations of amide proton chemical shifts (Snh) (in DMSO-d6 ) with Hammett substituent constants (5) for a series of 4-substituted anilides of four dihalonicotinic acid systems were observed. Dihalonicotinanilides with chlorine in the pyridine 2 - position exhibited a more positive slope in a Hammett plot of S^H vs - aR- where R is the substituent in the 4 position of the benzene ring. This observation is explained in terms of the inductive effect of chlorine which results in a slightly more acidic amide proton, which in turn causes an enhanced hydrogen bonding tendency to solvent. Four disubstituted anilides were also prepared, and the 5NH of these derivatives correlated well with the additive value of the 6R\u27s of the two substituents

A 2D systems approach to iterative learning control for discrete linear processes with zero Markov parameters

In this paper a new approach to iterative learning control for the practically relevant case of deterministic discrete linear plants with uniform rank greater than unity is developed. The analysis is undertaken in a 2D systems setting that, by using a strong form of stability for linear repetitive processes, allows simultaneous con-sideration of both trial-to-trial error convergence and along the trial performance, resulting in design algorithms that can be computed using Linear Matrix Inequalities (LMIs). Finally, the control laws are experimentally verified on a gantry robot that replicates a pick and place operation commonly found in a number of applications to which iterative learning control is applicable

Subscale, hydrogen-burning, airframe-integrated-scramjet: Experimental and theoretical evaluation of a water cooled strut airframe-integrated-scramjet: Experimental leading edge

A water-cooled leading-edge design for an engine/airframe integrated scramjet model strut leading edge was evaluated. The cooling design employs a copper cooling tube brazed just downstream of the leading edge of a wedge-shaped strut which is constructed of oxygen-free copper. The survival of the strut leading edge during a series of tests at stagnation point heating rates confirms the practicality of the cooling design. A finite difference thermal model of the strut was also proven valid by the reasonable agreement of calculated and measured values of surface temperature and cooling-water heat transfer

Random packing of spheres in Menger sponge

Random packing of spheres inside fractal collectors of dimension 2 < d < 3 is studied numerically using Random Sequential Adsorption (RSA) algorithm. The paper focuses mainly on the measurement of random packing saturation limit. Additionally, scaling properties of density autocorrelations in the obtained packing are analyzed. The RSA kinetics coefficients are also measured. Obtained results allow to test phenomenological relation between random packing saturation density and collector dimension. Additionally, performed simulations together with previously obtained results confirm that, in general, the known dimensional relations are obeyed by systems having non-integer dimension, at least for d < 3.Comment: 13 pages, 6 figure

How embodied interactions manifest themselves during collaborative learning in classroom settings

New physical computing toolkits offer much promise for promoting collaborative learning by engendering embodied interactions that can support collaborative discovery. To examine how these can unfold during a learning activity, we conducted a classroom study where pairs of children explored mappings between various sensors and actuators embedded in a physical-digital artifact. We found how a number of embodied interactions emerged that were effectively used to progress learning through the processes of showing, sharing and contestin