Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

OBJECTIVES: To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. DESIGN: Qualitative, semistructured interview study. SETTING: 13 general practices in Leicester. PARTICIPANTS: 18 general practitioners and 13 practice nurses. RESULTS: Health professionals did not report substantially changing their clinical practice to claim the new payments and made only minimal changes in practice organisation. The new health promotion payment did not overcome general practitioners' resistance towards raising the issue of smoking when they felt that doing so could cause confrontation with patients. General practitioners who made the largest number of claims altered the way in which they recorded patients' smoking status rather than raising the topic of smoking more frequently with patients. Participants had strong negative views on die new payment, feeling it would also be viewed negatively by patients. They were, however, more positive about health promotion payments that rewarded "extra" effort-for example, setting up practice based smoking cessation clinics. CONCLUSIONS: General practitioners and practice nurses were negative about a new health promotion payment, despite agreeing to pilot it. Health promotion payments do not automatically generate effective health promotion activity, and policymakers should consider careful piloting and evaluation of future changes in health promotion payments

Celebrating 20 Years of IGHV Mutation Analysis in CLL.

The division of CLL into 2 broad subsets with highly significant differences in clinical behavior was reported in 2 landmark papers in Blood in 1999.1,2 The simple analysis of the mutational status of the IGV regions provided both a prognostic indicator and an insight into the cellular origins. Derivation from B cells with very low or no IGV mutations generally leads to a more aggressive disease course than derivation from B cells with higher levels. This finding focused attention on surface Ig (sIg), the major B-cell receptor, and revealed dynamic antigen engagement in vivo as a tumor driver. It has also led to new drugs aimed at components of the intracellular activation cascades. After 20 years, the 2 senior authors of those papers have looked at the history of the observations and at the increasing understanding of the role of sIg in CLL that have emanated from them. As in the past, studies of CLL have provided a link between biology and the clinic, enabling more precise targeting which attacks critical pathways but minimizes side effects

Exploration of the psychological impact and adaptation to cardiac events in South Asians in the UK: a qualitative study.

OBJECTIVE: There is little research on how different ethnic groups adapt after an acute cardiac event. This qualitative study explores between-ethnicity and within-ethnicity variation in adaptation, and the psychological impact of an acute cardiac event among UK South Asian and white British people. SETTING: We purposively sampled people by ethnic group from general practices in London who had a new myocardial infarction, angina or acute arrhythmia in the preceding 18 months. PARTICIPANTS: We conducted 28 semistructured interviews for exploring the psychological symptoms, experiences and adaptations following a cardiac event among South Asians (Indian and Bangladeshi) in comparison to white British people. Data were analysed using a thematic 'framework' approach. RESULTS: Findings showed heterogeneity in experiences of the cardiac event and its subsequent psychological and physical impact. Adaptation to the event related predominantly to life circumstances, personal attitudes and employment status. Anxiety and low mood symptoms were common sequelae, especially in the Bangladeshi group. Indian men tended to normalise symptoms and the cardiac event, and reported less negative mood symptoms than other groups. Fear of physical exertion, particularly heavy lifting, persisted across the groups. Some people across all ethnic groups indicated the need for more psychological therapy postcardiac event. Socioeconomic circumstances, age and prior work status appeared to be more important in relation to adaptation after a cardiac event than ethnic status. CONCLUSIONS: Heterogeneity in views and experiences related to the socioeconomic background, age and work status of the participants along with some cultural influences. Rehabilitation programmes should be flexibly tailored for individuals in particular and where relevant, specific support should be provided for returning to work

Crucial Dependence of ``Precarious'' and ``Autonomous'' phi^4s Upon the Normal-ordering Mass

Using the Gaussian wave-functional approach with the normal-ordering renormalization prescription, we show that for the (3+1)-dimensional massive lambda phi^4 theory, ``precarious'' and ``autonomous'' phi^4s can exist if and only if the normal-ordering mass is equal to the classical masses at the symmetrc and asymmetric vacua, respectively.Comment: 6 pages, no figures, Revtex file, accepted for publication in Mod. Phys. Lett.

NEOWISE observations of comet C/2013 A1 (Siding Spring) as it approaches Mars

The Near-Earth Object Wide-field Infrared Survey Explorer (NEOWISE) mission observed comet C/2013 A1 (Siding Spring) three times at 3.4 {\mu}m and 4.6 {\mu}m as the comet approached Mars in 2014. The comet is an extremely interesting target since its close approach to Mars in late 2014 will be observed by various spacecraft in-situ. The observations were taken in 2014 Jan., Jul. and Sep. when the comet was at heliocentric distances of 3.82 AU, 1.88 AU, and 1.48 AU. The level of activity increased significantly between the Jan. and Jul. visits but then decreased by the time of the observations in Sep., approximately 4 weeks prior to its close approach to Mars. In this work we calculate Af\r{ho} values, and CO/CO2 production rates.Comment: 9 pages, 3 figures, accepted by Astrophysical Journal Letter

The economic value of remote sensing by satellite: An ERTS overview and the value of continuity of service. Volume 2: Source document

The economic value of an ERS system with a technical capability similar to ERTS, allowing for increased coverage obtained through the use of multiple active satellites in orbit is presented. A detailed breakdown of the benefits achievable from an ERS system is given and a methodology for their estimation is established. The ECON case studies in agriculture, water use, and land cover are described along with the current ERTS system. The cost for a projected ERS system is given