Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

Robust designs for Poisson regression models

We consider the problem of how to construct robust designs for Poisson regression models. An analytical expression is derived for robust designs for first-order Poisson regression models where uncertainty exists in the prior parameter estimates. Given certain constraints in the methodology, it may be necessary to extend the robust designs for implementation in practical experiments. With these extensions, our methodology constructs designs which perform similarly, in terms of estimation, to current techniques, and offers the solution in a more timely manner. We further apply this analytic result to cases where uncertainty exists in the linear predictor. The application of this methodology to practical design problems such as screening experiments is explored. Given the minimal prior knowledge that is usually available when conducting such experiments, it is recommended to derive designs robust across a variety of systems. However, incorporating such uncertainty into the design process can be a computationally intense exercise. Hence, our analytic approach is explored as an alternative

Study of the April 20, 2007 CME-Comet Interaction Event with an MHD Model

This study examines the tail disconnection event on April 20, 2007 on comet 2P/Encke, caused by a coronal mass ejection (CME) at a heliocentric distance of 0.34 AU. During their interaction, both the CME and the comet are visible with high temporal and spatial resolution by the STEREO-A spacecraft. Previously, only current sheets or shocks have been accepted as possible reasons for comet tail disconnections, so it is puzzling that the CME caused this event. The MHD simulation presented in this work reproduces the interaction process and demonstrates how the CME triggered a tail disconnection in the April 20 event. It is found that the CME disturbs the comet with a combination of a $180^\circ$ sudden rotation of the interplanetary magnetic field (IMF), followed by a $90^\circ$ gradual rotation. Such an interpretation applies our understanding of solar wind-comet interactions to determine the \textit{in situ} IMF orientation of the CME encountering Encke.Comment: 13 pages, 3 figures, accepted by the ApJ Letter

Photochemical production of O3 in biomass burning plumes in the boundary layer over northern Australia

In situ aircraft measurements of ozone (O3) and its precursors were made over northern Australia in August-September 1999 during the Biomass Burning and Lightning Experiment Phase B (BIBLE-B). A clear positive correlation of O3 with carbon monoxide (CO) was found in biomass burning plumes in the boundary layer (<3 km). The ΔO3/ΔCO ratio (linear regression slope of O3-CO correlation) is found to be 0.12 ppbv/ppbv, which is comparable to the ratio of 0.15 ppbv/ppbv observed at 0-4 km over the Amazon and Africa in previous studies. The net flux of O3 exported from northern Australia during BIBLE-B is estimated to be 0.3 Gmol O3/day. In the biomass burning region, large enhancements of O3 were coincident with the locations of biomass burning hot spots, suggesting that major O3 production occurred near fires (horizontal scale <50 km)

Interaction of Saturn's magnetosphere and its moons: 3. Time variation of the Enceladus plume

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95380/1/jgra20677.pd

Cusp plasma intrusion and Pc 5

第2回極域科学シンポジウム/第35回極域宙空圏シンポジウム 11月16日（水） 統計数理研究所 3階リフレッシュフロ

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

BACKGROUND Genital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis. METHODS In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed. RESULTS Perceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT--many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people. CONCLUSIONS GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.The Australian Federal Government Department of Health and Ageing Chlamydia Pilot Program of Targeted Grants funded the study

Charge Violation and Alice Behavior in Global and Textured Strings

Spontaneous breaking of global symmetries can produce ``Alice'' strings: line defects which make unbroken symmetries multivalued, induce apparent charge violation via Aharonov-Bohm interactions, and form point defects when twisted into loops. We demonstrate this behavior for both divergent and textured global Alice strings. Both adiabatically scatter charged particles via effective Wilson lines. For textured Alice strings, such Wilson lines occur at all radii, and are multivalued only inside the string. This produces measurable effects, including path-dependent charge violation.Comment: 32 pages, 2 epsfigs, Revte