Studying clinical reasoning, part 2: Applying social judgement theory

Part 1 of this paper (Harries and Harries 2001) examined the reasoning studies of the 1980s and 1990s and critiqued the ethnographic and informationprocessing approaches, based on stated information use. The need for an approach that acknowledged the intuitive nature of experienced thinkers’ reasoning was identified. Part 2 describes such an approach ± social judgement theory ± and presents a pilot application in occupational therapy research. The method used is judgement analysis. The issue under study is that of prioritisation policies in community mental health work. The results present the prioritisation policies of four occupational therapists in relation to managing community mental health referrals

Building pharmacist-patient relationships : a thesis presented in partial fulfillment of the requirements for the degree of Master of Education (Adult Education) at Massey University, Palmerston North, New Zealand

Relationships between pharmacists and patients have become more important with the adoption of patient-centred care in the provision of healthcare in New Zealand. Competence standards for communication and relationship building, which have been introduced for pharmacists, highlight the importance of continuing professional development for best practice. This study explored how pharmacists built relationships with patients and how communication skills training might contribute to this process. A quantitative survey method including both closed and open questions was used to elicit the views of pharmacists and this was analysed using an interpretive process. Pharmacists were found to build relationships using a friendly and respectful approach with appropriate questioning and listening techniques and checking for understanding. It took time to build relationships, but they were seen as essential. Learning to build relationships happened during everyday practice over time. Focused study with experiential methods was seen as helpful by some respondents, although transfer of this learning to practice in real life was found to be challenging. The literature supported these findings including the recognition of difficulty with implementing changes into practice

Antiretroviral treatment uptake and attrition among HIV-positive patients with tuberculosis in Kibera, Kenya

Using data of human immunodeficiency virus-positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow-up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre-ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing

The effect of primordial fluctuations on neutrino oscillations

Recent work has shown that neutrino oscillations in matter can be greatly enhanced by flips between mass eigenstates if the medium is fluctuating with a period equal to the neutrino oscillation length. Here we investigate the effect of the primordial fluctuations on the neutrino oscillations in the early universe. We calculate the oscillation probability in the case of a general power law fluctuation spectrum and for a more realistic spectrum predicted by inflation. We also include the effect of the amplification of fluctuations resulting from the QCD phase transition. We find that there is a region of parameter space where this mechanism would be the dominant mechanism for producing sterile neutrinos. However this conclusion does not take account of the damping of fluctuations on the neutrino oscillation scale when the neutrinos decouple from the plasma. We find that this reduces the probability of flips between the mass eigenstates to an unobservable level.Comment: 11 pages, 3 Figure

Transition of pupils from Key Stage 2 to 3 deemed gifted and talented in mathematics: an initial study

In this article Geoff Tennant and Dave Harries report on the early stages of a research project looking to examine the transition from Key Stage (KS) 2 to 3 of children deemed Gifted and Talented (G&T) in mathematics. An examination of relevant literature points towards variation in definition of key terms and underlying rationale for activities. Preliminary fieldwork points towards a lack of meaningful communication between schools, with primary school teachers in particular left to themselves to decide how to work with children deemed G&T. Some pointers for action are given, along with ideas for future research and a request for colleagues interested in working with us to get in touch

Cost of producing school meals in Wales : a report commissioned from the Wales Audit Office by the Welsh Assembly Government

The financial modelling to identify local authority expenditure on school meals is not yet sufficiently refined or owned by the authorities to serve as a robust and comprehensive management tool. Wales spent more than £90 million on the school meal service (42 per cent of which was spent by local authorities) during 2007-08 and the cost, funding and takeup of schools meals varied considerably across local authorities

Fission induced plasmas

The possibility of creating a plasma from fission fragments was investigated, as well as the probability of utilizing the energy of these particles to create population inversion leading to laser action. Eventually, it is hoped that the same medium could be used for both fissioning and lasing, thus avoiding inefficiences in converting one form of energy to the other. A central problem in understanding a fission induced plasma is to obtain an accurate model of the electron behavior; some calculations are presented to this end. The calculations are simple, providing a compendium of processes for reference