Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

Objectives: To explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. Methods: Postal survey of 356 London-based GPs, assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. Results: Currently, 65% of GPs were providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role; and 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that 'palliative care is mainly district nursing (DN) work'. Many were unaware of out-of-hours DN and specialist palliative care services. Multi-variable analysis found four GP characteristics - larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of palliative care - were associated with agreement that palliative care was central to a GP's role. Conclusion: A minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care

Fertility control as a means of controlling bovine tuberculosis in badger (Meles meles) populations in south-west England: predictions from a spatial stochastic simulation model

A spatial stochastic simulation model was used to assess the potential of fertility control, based on a yet-to-be-developed oral bait-delivered contraceptive directed at females, for the control of bovine tuberculosis in badger populations in south-west England. The contraceptive had a lifelong effect so that females rendered sterile in any particular year remained so for the rest of their lives. The efficacy of fertility control alone repeated annually for varying periods of time was compared with a single culling operation and integrated control involving an initial single cull followed by annually repeated fertility control. With fertility control alone, in no instance was the disease eradicated completely while a viable badger population (mean group size of at least one individual) was still maintained. Near eradication of the disease (less than 1% prevalence) combined with the survival of a minimum viable badger population was only achieved under a very limited set of conditions, either with high efficiency of control (95%) over a short time period (1-3 years) or a low efficiency of control (20%) over an intermediate time period (10-20 years). Under these conditions, it took more than 20 years for the disease to decline to such low levels. A single cull of 80% efficiency succeeded in near eradication of the disease (below 1% prevalence) after a period of 6-8 years, while still maintaining a viable badger population. Integrated strategies reduced disease prevalence more rapidly and to lower levels than culling alone, although the mean badger group size following the onset of control was smaller. Under certain integrated strategies, principally where a high initial cull (80%) was followed by fertility control over a short (1-3 year) time period, the disease could be completely eradicated while a viable badger population was maintained. However, even under the most favourable conditions of integrated control, it took on average more than 12 years following the onset of control for the disease to disappear completely from the badger population. These results show that whilst fertility control would not be a successful strategy for the control of bovine tuberculosis in badgers if used alone, it could be effective if used with culling as part of an integrated strategy. This type of integrated strategy is likely to be more effective in terms of disease eradication than a strategy employing culling alone. However, the high cost of developing a suitable fertility control agent, combined with the welfare and conservation implications, are significant factors which should be taken into account when considering its possible use as a means of controlling bovine tuberculosis in badger populations in the UK

Math modeling for helicopter simulation of low speed, low altitude and steeply descending flight

A math model was formulated to represent some of the aerodynamic effects of low speed, low altitude, and steeply descending flight. The formulation is intended to be consistent with the single rotor real time simulation model at NASA Ames Research Center. The effect of low speed, low altitude flight on main rotor downwash was obtained by assuming a uniform plus first harmonic inflow model and then by using wind tunnel data in the form of hub loads to solve for the inflow coefficients. The result was a set of tables for steady and first harmonic inflow coefficients as functions of ground proximity, angle of attack, and airspeed. The aerodynamics associated with steep descending flight in the vortex ring state were modeled by replacing the steady induced downwash derived from momentum theory with an experimentally derived value and by including a thrust fluctuations effect due to vortex shedding. Tables of the induced downwash and the magnitude of the thrust fluctuations were created as functions of angle of attack and airspeed

A model for the screen printing of Newtonian fluids

A preliminary investigation into aspects of the off-contact screen-printing process is presented. A mathematical model for the printing of a thin film of Newtonian fluid is proposed, in which the screen is modelled as a permeable membrane, and the entire region above and below the screen is flooded. By drawing upon widely used industrial circuit printing practices, the distinguished limit of greatest interest to this industry is identified. Numerical and asymptotic solutions of this distinguished limit are presented that reproduce many of the features observed in industrial screen-printing

Comment on ``Stripes and the t-J Model''

This is a comment being submitted to Physical Review Letters on a recent letter by Hellberg and Manousakis on stripes in the t-J model.Comment: One reference correcte

Systematic study of d-wave superconductivity in the 2D repulsive Hubbard model

The cluster size dependence of superconductivity in the conventional two-dimensional Hubbard model, commonly believed to describe high-temperature superconductors, is systematically studied using the Dynamical Cluster Approximation and Quantum Monte Carlo simulations as cluster solver. Due to the non-locality of the d-wave superconducting order parameter, the results on small clusters show large size and geometry effects. In large enough clusters, the results are independent of the cluster size and display a finite temperature instability to d-wave superconductivity.Comment: 4 pages, 3 figures; updated with version published in PRL; added values of Tc obtained from fit

Linear Optical CNOT Gate in the Coincidence Basis

We describe the operation and tolerances of a non-deterministic, coincidence basis, quantum CNOT gate for photonic qubits. It is constructed solely from linear optical elements and requires only a two-photon source for its demonstration.Comment: Submitted to Physical Review

The self-care for people initiative: the outcome evaluation.

To determine the effects of a community-based training programme in self-care on the lay population

Self-care in primary care: findings from a longitudinal comparison study.

To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients