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

Preliminary studies of electromagnetic sounding of cometary nuclei

The internal structure of a comet could be determined with a spacecraft borne electromagnetic sounder. A dielectric profile of the comet could be produced in direct analogy with terrestrial glacier and ice sheet sounding experiments. This profile would allow the detection of a rocky core or ice layers if they exist, just as layers in the ice and the bedrock interface have been clearly observed through the Greenland ice sheet. It would also provide a gross estimate of the amount of dust in the icy region. Models for the response of the nucleus and cometary plasma to electromagnetic sounding are developed and used to derive experimental parameters. A point system design was completed. Preliminary engineering study results indicate that the sounder is well within the bounds of current space technology

Medicinal cannabis for the treatment of chronic refractory pain: An investigation of the adverse event profile and health-related quality of life impact of an oral formulation

Introduction: Medicinal cannabis is prescribed in Australia for patients with chronic refractory pain conditions. However, measures of safety and effectiveness of different cannabinoids are lacking. We designed an observational study to capture effectiveness, adverse events (AEs), and health-related quality of life (HRQoL) measures in patients prescribed an oral medicinal cannabis formulation at Cannabis Access Clinics through the Cannabis Access Clinics Observational study (CACOS). Objectives: We aimed to evaluate effectiveness, reported AEs, and change in patient-reported outcomes in individuals prescribed a cannabinoid oil formulation for management of chronic pain. Methods: A cross-sectional analysis was conducted on patients prescribed an oil formulation of Δ9-tetrahydrocannabinol and cannabidiol for pain symptoms of at least 3-month duration. Clinician-reported AEs were organized by system, organ, class, and frequency. Analysis of patient-reported responses to a questionnaire was conducted using published minimal clinically important differences to determine meaningful change in HRQoL over time. Results: More than half (n = 91/151, 60.3%) of the participants experienced at least one AE during the observation period (mean 133 ± 116 days). No serious AEs were reported. Patient-reported pain impact scores were significantly reduced across the cohort (p = 0.034), and pain intensity scores verged on significance (p = 0.053). The majority of patients saw meaningful improvements in sleep (49.3%) and fatigue (35.6%). Conclusion: This analysis presents real-world data collected as part of standard of care. More than one-third of patients benefited from oral medicinal cannabis, which is impactful given the refractory nature of their pain. Amelioration of the impact of pain confirms continued prescribing of this formulation and validates our observational methodology as a tool to determine the therapeutic potency of medicinal cannabinoids

Mirror, mirror: reflections on the emotionally intelligent practitioner

Nurturance, love, compassion, respect, humanity, self awareness, mind emptying and mindfulness are all qualities considered necessary for the development of the therapeuticrelationship which is central to holistic care. Likewise raised levels of academia within nurse education have lead to the notion of emotional intelligence where such qualities, often associated with tacit and experiential knowledge, are inextricably bound with theory, practice and research. In an environment where nursing theory and research dominate, we suggest that such qualities are more likely to be attained if those expected to portray them,students, are themselves in receipt of the same or similar qualities from the organisations, namely education and practice.This paper explores the concept of preparedness in terms of developing the above qualities with those we educate and what might be required of educationalists in achieving this goal. Using psychoanalytic concepts of mirroring, holding and containing we explore the role of the educationalist in ‘preparing’ nurses to become emotionally intelligent practitioners. If we are to move from the rhetoric to the reality of an emotionally intelligent practitioner, nurseeducators need to ensure that the student experience, in terms of their own learning, becomes the centre of their educational universe. We believe that this is more likely tooccur when we as educationalists are able to personalise the educational process through mirroring love, care and nurturance, thus validating the emotional context of the students’ personal experience as a foundation for their learning

Revised stratigraphy of the Blanchetown Clay, Murray Basin: age constraints on the evolution of paleo Lake Bungunnia

Paleo Lake Bungunnia covered more than 40 000 km2 of southern Australia during the Plio-Pleistocene, although the age and origin of the lake remain controversial. The Blanchetown Clay is the main depositional unit and outcrop at Nampoo Station in far-western New South Wales provides the most continuous lacustrine section preserved in the basin. Here the Blanchetown Clay represents the maximum lake fill and comprises: (i) a basal well-sorted sand with interbedded clay (Chowilla Sand), representing initial flooding at the time of lake formation; (ii) a thick sequence of green-grey clay comprised dominantly of kaolinite and illite, with the apparently cyclic occurrence of illite interpreted to represent cool and dry glacial climatic intervals; and (iii) a 2.6 m-thick sequence of finely laminated silt and silty clay, here defined as the Nampoo Member of the Blanchetown Clay. New magnetostratigraphic data constrain the age of the oldest lake sediments to be younger than 2.581 Ma (Matuyama-Gauss boundary) and probably as young as 2.4 Ma. This age is significantly younger than the age of 3.2 Ma previously suggested for lake formation. The youngest Blanchetown Clay is older than 0.781 Ma (Brunhes-Matuyama boundary) and probably as old as 1.2 Ma. The Nampoo Station section provides a framework for the construction of a regional Plio-Pleistocene stratigraphy in the Murray Basin.<br /

Distinct contributions of the fornix and inferior longitudinal fasciculus to episodic and semantic autobiographical memory

Autobiographical memory (AM) is multifaceted, incorporating the vivid retrieval of contextual detail (episodic AM), together with semantic knowledge that infuses meaning and coherence into past events (semantic AM). While neuropsychological evidence highlights a role for the hippocampus and anterior temporal lobe (ATL) in episodic and semantic AM, respectively, it is unclear whether these constitute dissociable large-scale AM networks. We used high angular resolution diffusion-weighted imaging and constrained spherical deconvolution-based tractography to assess white matter microstructure in 27 healthy young adult participants who were asked to recall past experiences using word cues. Inter-individual variation in the microstructure of the fornix (the main hippocampal input/output pathway) related to the amount of episodic, but not semantic, detail in AMs e independent of memory age. Conversely, microstructure of the inferior longitudinal fasciculus, linking occipitotemporal regions with ATL, correlated with semantic, but not episodic, AMs. Further, these significant correlations remained when controlling for hippocampal and ATL grey matter volume, respectively. This striking correlational double dissociation supports the view that distinct, large-scale distributed brain circuits underpin context and concepts in AM

Post-Pandemic, Translational Research, and Indigenous Communities

It is well documented that American Indian/Alaska Native/Native Hawaiian/First Nations, known as Indigenous Peoples, have among the most significant health disparities in the world. Clinical services for these populations are typically underfunded, and Indigenous Peoples often have preexisting and co-occurring health conditions. These factors combined with a multitude of social inequities make Indigenous communities extremely susceptible to infectious diseases, including COVID- 19. This paper discusses perspectives on the post-pandemic frameworks and policies toward translational science as an approach to advance health promotion for community-based interventions, dissemination, and sustainability. The importance of exercising Indigenous self-determination, public health authority, and population health sovereignty is emphasized

Irrigated greywater in an urban sub-division as a potential source of metals to soil, groundwater and surface water

Increased water demands in dry countries such as Australia, have led to increased adoption of various water reuse practices. Irrigation of greywater (all water discharged from the bathrooms, laundry and kitchen apart from toilet waste) is seen as a potential means of easing water demands; however, there is limited knowledge of how greywater irrigation impacts terrestrial and aquatic environments. This study compared four greywater irrigated residential lots to adjacent non-irrigated lots that acted as controls. Accumulation and potential impacts of metals in soil, groundwater and surface water, as a result of greywater irrigation, were assessed by comparing measured concentrations to national and international guidelines. Greywater increased concentrations of some metals in irrigated soil and resulted in As, B, Cr and Cu exceeding guidelines after only four years of irrigation. Movement of metals from the irrigation areas resulted in metal concentrations in groundwater (Al, As, Cr, Cu, Fe, Mn, Ni and Zn) and surface water (Cu, Fe and Zn) exceeding environmental quality guidelines again within four years. These results are unlikely to be universally applicable but indicate the need to consider metals in greywater in order to minimize potential adverse environmental effects from greywater irrigation