Shaping the future for primary care education and training project. Finding the evidence for education & training to deliver integrated health and social care: the primary care workforce perspective

This report is one of a series of outputs from the Shaping the Future in Primary Care Education and Training project (www.pcet.org.uk) funded by the North West Development Agency (NWDA). It is the result of a collaborative initiative between the NWDA, the North West Universities Association and seven Higher Education Institutions in the North West of England. The report presents an evidence base drawn from the analysis of the experiences and aspirations of integrated health and social care, as reported by members of the current primary health and social care workforce working in or with Primary Care Trusts (PCTs) in the North West region

On the role of magnetic reconnection in jet/accretion disk systems

The most accepted model for jet production is based on the magneto-centrifugal acceleration out off an accretion disk that surrounds the central source (Blandford & Payne, 1982). This scenario, however, does not explain, e.g., the quasi-periodic ejection phenomena often observed in different astrophysical jet classes. de Gouveia Dal Pino & Lazarian (2005) (hereafter GDPL) have proposed that the large scale superluminal ejections observed in microquasars during radio flare events could be produced by violent magnetic reconnection (MR) episodes. Here, we extend this model to other accretion disk systems, namely: active galactic nuclei (AGNs) and young stellar objects (YSOs), and also discuss its role on jet heating and particle acceleration.Comment: To be published in the IAU Highlights of Astronomy, Volume 15, XXVII IAU General Assembly, August 2009, Ian F. Corbett et al., eds., 201

Bilateral Panner’s disease in sickle cell anaemia: Case report

Avascular necrosis is common in sickle cell disease in various vulnerable areas such as in the femoral or humeral heads. Panner’s disease however is described as avascular necrosis of the capitellum, which commonly occurs in a younger age group. It is a pathological process believed to be caused by interference in the blood supply to the growing capitellar epiphysis. A 17 year old boy with sickle cell disease presented with pain on pronation and supination of both elbows, particularly on the lateral side. These movements were restricted in both elbows. Plain radiograph of his elbows showed fragmentation of the capitellum with signs of revascularisation. We have performed a thorough literature search and have not found other reported cases of Panner’s avascular necrosis of the capitellum in association with sickle cell disease. We conclude that Panner’s disease is a possible complication of sickle cell anaemia

Mental health care: perceptions of people with schizophrenia and their carers

The current study aims to discover the opinions of patients and their (informal and formal) carers concerning the mental health care of individuals with long term schizophrenic disorders within different contexts and cultures. It's a qualitative study with focus groups, in which 6 research centers (from Argentina, Brazil, Chile, Spain, England and Venezuela) participated. Eight focus groups were conducted in each center, totaling 303 individuals in 46 groups. The data were analyzed with the aid of the Qualitative Solutions and Research/Non-numerical Unstructured Data Indexing program (QSR NUD*IST 4.0). The perception regarding the quality of care is influenced by the professional-patient relationship and the availability of resources. Poor quality of care is also perceived as discrimination. People with schizophrenia in general consider themselves to be ostracized by professionals and services and lacking in more humanized care. In the contexts in which community care is less advanced, the complaints center on resources and services that do not meet demands. On the other hand, in more developed contexts criticism centers more on the attitude of the professionals and the professional-patient relationship. Over and above the need for resources and services, people with schizophrenia require more humanized health care

An evaluation of South Africa's national drug policy: standard treatment guidelines/essential drugs list and its impact on rational drug prescribing at public hospital oupatient clinics: a case study of the Northern Province

During the years of apartheid, South Africa developed two health care systems, public and private, that were fragmented and segregated by race. The private health care system (almost exclusively white patients) was on the same level as the tertiary care in industrialised countries, while the public health care system (almost exclusively black and coloured) was similar to the primary health care systems in many developing countries. Even so, South Africa in 1996 was spending much more than any other African country on health care, 8.5% of the GDP per year (McIntyre 1995). The political tide turned in 1996 and with new governments came a new focus on equity of health care, access and services. Equity in health care and access are the main foci of health initiatives in South Africa. This research evaluated the impact of the National Drug Policy (1996), and the National Drug Programme (NDP). The NDP's key component is the Standard Treatment Guidelines/Essential Drugs List (STG/EDL) to be used in South Africa's public hospitals' outpatient clinics at all levels (primary, secondary, and tertiary). This study is a cross-sectional case study that evaluates the effectiveness of the implementation of this policy through strategies to encourage prescribers to use the STGIEDL as a regular part of their prescribing repertoire. The research techniques included a combination of quantitative analyses with a drug utilisation survey (DUS) that measured adherence to rational prescribing measures, and qualitative analyses in depth interviews with nurses, pharmacists, physicians and administrators. The results of both the drug utilisation survey of 1,204 prescriptions from eleven clinics and 20 interviews showed that there was little evidence of rational prescribing in public hospital clinics. Overall the prescribers at the clinic level did not adhere to the NDP and rational prescribing. The one major change observed was that the hospital clinic pharmacy would substitute most brand medicines for generic ones, unless the physician formally requests the brand drug. The one clinic that was the most adherent to the rational prescribing standard had a pharmacist who was enrolled in a rational prescribing and monitoring course. In addition, the manager pharmacist developed an EDP bulletin for all the staff and encouraged the use of the Standard Treatment Guidelines Essential Drugs list for all staff in the hospital clinic. In summary, this study shows that the major goals of the National Drug Policy (NDP), the rational prescribing of drugs and equity of access to health care and services, have note been reached. Even though there is some progress towards attaining these goals will require an effort of all stakeholders through enforceable legislation, allocated budgets, patient and prescriber education, and a bottom-up approach to policy implementation

Scars of intense accretion episodes at metal-rich white dwarfs

A re-evaluation of time-averaged accretion rates at DBZ-type white dwarfs points to historical, time-averaged rates significantly higher than the currently observed episodes at their DAZ counterparts. The difference between the ongoing, instantaneous accretion rates witnessed at DAZ white dwarfs, which often exceed 10 8gs -1, and those inferred over the past 10 5-10 6yr for the DBZ stars can be of a few orders of magnitude, and therefore must result from high-rate episodes of tens to hundreds of years so that they remain undetected to date. This paper explores the likelihood that such brief, intense accretion episodes of gas-phase material can account for existing data. For reasonable assumptions about the circumstellar gas, accretion rates approaching or exceeding 10 15gs -1 are possible, similar to rates observed in quiescent cataclysmic variables, and potentially detectable with future X-ray missions or wide-field monitoring facilities. Gaseous debris that is prone to such rapid accretion may be abundant immediately following a tidal disruption event via collisions and sublimation, or if additional bodies impinge upon an extant disc. Particulate disc matter accretes at or near the Poynting-Robertson drag rate for long periods between gas-producing events, consistent with rates inferred for dusty DAZ white dwarfs. In this picture, warm DAZ stars without infrared excesses have rates consistent with accretion from particulate discs that remain undetected. This overall picture has implications for quasi-steady state models of accretion and the derived chemical composition of asteroidal debris in DBZ white dwarfs

Geochemistry and geobarometry of Eocene dykes intruding the Ladakh Batholith

We present further distinguishing characteristics among Eocene dykes found along the Southern margin of the Ladakh batholith (NW-India). Coupled evidence from field structures and Nd-Sr isotope data showed that there are two broad dyke provinces extending over 50 km: between Leh and Tunglung, an 'eastern', ENE-trending family with higher crustal assimilation; between Tunglung and Hemis Shugpachan, the ...postprin

Magnetic Field Evolution in Accreting White Dwarfs

We discuss the evolution of the magnetic field of an accreting white dwarf. We first show that the timescale for ohmic decay in the liquid interior is 8 to 12 billion years for a dipole field, and 4 to 6 billion years for a quadrupole field. We then compare the timescales for ohmic diffusion and accretion at different depths in the star, and for a simplified field structure and spherical accretion, calculate the time-dependent evolution of the global magnetic field at different accretion rates. In this paper, we neglect mass loss by classical nova explosions and assume the white dwarf mass increases with time. In this case, the field structure in the outer layers of the white dwarf is significantly modified for accretion rates above the critical rate (1-5) x 10^(-10) solar masses per year. We consider the implications of our results for observed systems. We propose that accretion-induced magnetic field changes are the missing evolutionary link between AM Her systems and intermediate polars. The shorter ohmic decay time for accreting white dwarfs provides a partial explanation of the lack of accreting systems with 10^9 G fields. In rapidly accreting systems such as supersoft X-ray sources, amplification of internal fields by compression may be important for Type Ia supernova ignition and explosion. Finally, spreading matter in the polar cap may induce complexity in the surface magnetic field, and explain why the more strongly accreting pole in AM Her systems has a weaker field. We conclude with speculations about the field evolution when classical nova explosions cause the white dwarf mass to decrease with time.Comment: To appear in MNRAS (15 pages, 10 figures); minor revision

Remarkable thermal stability of gold nanoparticles functionalised with ruthenium phthalocyanine complexes

© 2016 IOP Publishing Ltd. A gold nanoparticle (AuNP) ruthenium phthalocyanine (RuPc) nanocomposite has been synthesised that exhibits high thermal stability. Electrical resistance measurements revealed that the nanocomposite is stable up to ∼320 °C. Examination of the nanocomposite and the RuPc stabiliser complex using thermogravimetric analysis and differential scanning calorimetry show that the remarkable thermal stability is due to the RuPc molecules, which provide an effective barrier to sintering of the AuNPs