The family practitioner family : the use of metaphor in understanding changes in primary health care organizations

Current UK health policy guidance locates primary care at the frontiers of health care modernization. New organizational structures have resulted in general practitioner (GP) practices being brought together in Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) each serving a much larger population group than the traditional GP practice. These changes have been accompanied with a need to explore new ways of working and thinking. This paper draws upon the experiences of nurses and GPs participating in an evaluation of workforce planning issues in primary health care. It explores how practitioners working in PCGs across one geographical area were able to gain a better understanding of what these changes, to both the structure and process of practice, might involve. During this developmental process the respondents used ‘the family’ metaphor, as a form of ‘shorthand’ to orientate themselves to the new responsibilities, challenges and opportunities presented by these changes to primary health care. It was in the use of terms and constructs that were familiar to their ‘everyday life’ experiences that made taking the first tentative steps in the change process easier. This paper suggests that using metaphors may be a powerful tool for policy makers, practitioners,managers and for researchers as they seek to communicate a plan for change and in understanding what these changes might mean

Gated rotation mechanism of site-specific recombination by ϕC31 integrase

Integrases, such as that of the Streptomyces temperate bacteriophage ϕC31, promote site-specific recombination between DNA sequences in the bacteriophage and bacterial genomes to integrate or excise the phage DNA. ϕC31 integrase belongs to the serine recombinase family, a large group of structurally related enzymes with diverse biological functions. It has been proposed that serine integrases use a “subunit rotation” mechanism to exchange DNA strands after double-strand DNA cleavage at the two recombining att sites, and that many rounds of subunit rotation can occur before the strands are religated. We have analyzed the mechanism of ϕC31 integrase-mediated recombination in a topologically constrained experimental system using hybrid “phes” recombination sites, each of which comprises a ϕC31 att site positioned adjacent to a regulatory sequence recognized by Tn3 resolvase. The topologies of reaction products from circular substrates containing two phes sites support a right-handed subunit rotation mechanism for catalysis of both integrative and excisive recombination. Strand exchange usually terminates after a single round of 180° rotation. However, multiple processive “360° rotation” rounds of strand exchange can be observed, if the recombining sites have nonidentical base pairs at their centers. We propose that a regulatory “gating” mechanism normally blocks multiple rounds of strand exchange and triggers product release after a single round

Inverse Modelling to Obtain Head Movement Controller Signal

Experimentally obtained dynamics of time-optimal, horizontal head rotations have previously been simulated by a sixth order, nonlinear model driven by rectangular control signals. Electromyography (EMG) recordings have spects which differ in detail from the theoretical rectangular pulsed control signal. Control signals for time-optimal as well as sub-optimal horizontal head rotations were obtained by means of an inverse modelling procedures. With experimentally measured dynamical data serving as the input, this procedure inverts the model to produce the neurological control signals driving muscles and plant. The relationships between these controller signals, and EMG records should contribute to the understanding of the neurological control of movements

Hierarchical and High-Girth QC LDPC Codes

We present a general approach to designing capacity-approaching high-girth low-density parity-check (LDPC) codes that are friendly to hardware implementation. Our methodology starts by defining a new class of "hierarchical" quasi-cyclic (HQC) LDPC codes that generalizes the structure of quasi-cyclic (QC) LDPC codes. Whereas the parity check matrices of QC LDPC codes are composed of circulant sub-matrices, those of HQC LDPC codes are composed of a hierarchy of circulant sub-matrices that are in turn constructed from circulant sub-matrices, and so on, through some number of levels. We show how to map any class of codes defined using a protograph into a family of HQC LDPC codes. Next, we present a girth-maximizing algorithm that optimizes the degrees of freedom within the family of codes to yield a high-girth HQC LDPC code. Finally, we discuss how certain characteristics of a code protograph will lead to inevitable short cycles, and show that these short cycles can be eliminated using a "squashing" procedure that results in a high-girth QC LDPC code, although not a hierarchical one. We illustrate our approach with designed examples of girth-10 QC LDPC codes obtained from protographs of one-sided spatially-coupled codes.Comment: Submitted to IEEE Transactions on Information THeor

Keck Spectroscopy of Faint 3 < z < 7 Lyman Break Galaxies: III. The Mean Ultraviolet Spectrum at z=4

We present and discuss the mean rest-frame ultraviolet spectrum for a sample of 81 Lyman Break Galaxies (LBGs) selected to be B-band dropouts with a mean redshift of z=3.9 and apparent magnitudes z_AB<26. Most of the individual spectra are drawn from our ongoing survey in the GOODS fields with the Keck DEIMOS spectrograph, and we have augmented our sample with published data taken with FORS2 on the VLT. In general we find similar trends in the spectral diagnostics to those found in the earlier, more extensive survey of LBGs at z=3 undertaken by Shapley et al (2003). Specifically, we find low-ionization absorption lines which trace the presence of neutral outflowing gas are weaker in galaxies with stronger Lyman-alpha emission, bluer UV spectral slopes, lower stellar masses, lower UV luminosities and smaller half-light radii. This is consistent with a physical picture whereby star formation drives outflows of neutral gas which scatters Lyman-alpha and gives rise to strong low-ionization absorption lines, while increasing the stellar mass, size, metallicity, and dust content of galaxies. Typical galaxies are thus expected to have stronger Lyman-alpha emission and weaker low-ionization absorption at earlier times (higher redshifts). Indeed, our mean spectrum at z=4 shows somewhat weaker low-ionization absorption lines than at z=3 and available data at higher redshift indicates a rapid decrease in low-ionization absorption strength with redshift. We argue that the reduced low-ionization absorption is likely caused by a decrease in the covering fraction and/or velocity range of outflowing neutral gas at earlier epochs. Our continuing survey will enable us to extend these diagnostics more reliably to higher redshift and determine the implications for the escape fraction of ionizing photons which governs the role of early galaxies in cosmic reionization. [Abridged]Comment: 17 pages, 12 figures, submitted to ApJ. Comments welcom

Keck Spectroscopy of Faint 3<z<7 Lyman Break Galaxies:- II. A High Fraction of Line Emitters at Redshift Six

As Lyman-alpha photons are scattered by neutral hydrogen, a change with redshift in the Lyman-alpha equivalent width distribution of distant galaxies offers a promising probe of the degree of ionization in the intergalactic medium and hence when cosmic reionization ended. This simple test is complicated by the fact that Lyman-alpha emission can also be affected by the evolving astrophysical details of the host galaxies. In the first paper in this series, we demonstrated both a luminosity and redshift dependent trend in the fraction of Lyman-alpha emitters seen within color-selected Lyman-break galaxies (LBGs) over the range 3<z<6; lower luminosity galaxies and those at higher redshift show an increased likelihood of strong emission. Here we present the results from much deeper 12.5 hour exposures with the Keck DEIMOS spectrograph focused primarily on LBGs at z~6 which enable us to confirm the redshift dependence of line emission more robustly and to higher redshift than was hitherto possible. We find 54+/-11% of faint z~6 LBGs show strong (W_0>25 A) emission, an increase of 1.6x from a similar sample observed at z~4. With a total sample of 74 z~6 LBGs, we determine the luminosity-dependent Lyman-alpha equivalent width distribution. Assuming continuity in these trends to the new population of z~7 sources located with the Hubble WFC3/IR camera, we predict that unless the neutral fraction rises in the intervening 200 Myr, the success rate for spectroscopic confirmation using Lyman-alpha emission should be high.Comment: 6 pages, 3 figures, submitted to ApJ

Visual enhancements in pick-and-place tasks: Human operators controlling a simulated cylindrical manipulator

A teleoperation simulator was constructed with vector display system, joysticks, and a simulated cylindrical manipulator, in order to quantitatively evaluate various display conditions. The first of two experiments conducted investigated the effects of perspective parameter variations on human operators' pick-and-place performance, using a monoscopic perspective display. The second experiment involved visual enhancements of the monoscopic perspective display, by adding a grid and reference lines, by comparison with visual enhancements of a stereoscopic display; results indicate that stereoscopy generally permits superior pick-and-place performance, but that monoscopy nevertheless allows equivalent performance when defined with appropriate perspective parameter values and adequate visual enhancements