Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

<b>Background</b> Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.<p></p> <b>Methods</b> A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.<p></p> <b>Results</b> Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.<p></p> <b>Conclusions</b> Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings

'Learning together': Sharing international experience on new models of primary care

No abstract available

The role of exploratory talk in classroom search engine tasks

© 2014 Association for Information Technology in Teacher Education. While search engines are commonly used by children to find information, and in classroom-based activities, children are not adept in their information seeking or evaluation of information sources. Prior work has explored such activities in isolated, individual contexts, failing to account for the collaborative, discourse-mediated nature of search engine use which is common in classroom contexts. This small-scale study explored the established ‘typology of talk’, particularly ‘exploratory talk’, in a classroom search context. The authors found that the most successful pupils were those who engaged in the most exploratory talk. This finding has practical classroom implications: the collaborative nature of search and potential of collaboration and discourse should be exploited in search-based tasks. This study also indicates a rich area for future research

Collaborative Epistemic Discourse in Classroom Information Seeking Tasks

We discuss the relationship between information seeking, and epistemic beliefs – beliefs about the source, structure, complexity, and stability of knowledge – in the context of collaborative information seeking discourses. We further suggest that both information seeking, and epistemic cognition research agendas have suffered from a lack of attention to how information seeking as a collaborative activity is mediated by talk between partners – an area we seek to address in this paper. A small-scale observational study using sociocultural discourse analysis was conducted with eight eleven year old pupils who carried out search engine tasks in small groups. Qualitative and quantitative analysis were performed on their discussions using sociocultural discourse analytic techniques. Extracts of the dialogue are reported, informed by concordance analysis and quantitative coding of dialogue duration. We find that 1) discourse which could be characterised as ‘epistemic’ is identifiable in student talk, 2) that it is possible to identify talk which is more or less productive, and 3) that epistemic talk is associated with positive learning outcomes

Identification of proteins in the postsynaptic density fraction by mass spectrometry

Our understanding of the organization of postsynaptic signaling systems at excitatory synapses has been aided by the identification of proteins in the postsynaptic density (PSD) fraction, a subcellular fraction enriched in structures with the morphology of PSDs. In this study, we have completed the identification of most major proteins in the PSD fraction with the use of an analytical method based on mass spectrometry coupled with searching of the protein sequence databases. At least one protein in each of 26 prominent protein bands from the PSD fraction has now been identified. We found 7 proteins not previously known to be constituents of the PSD fraction and 24 that had previously been associated with the PSD by other methods. The newly identified proteins include the heavy chain of myosin-Va (dilute myosin), a motor protein thought to be involved in vesicle trafficking, and the mammalian homolog of the yeast septin protein cdc10, which is important for bud formation in yeast. Both myosin-Va and cdc10 are threefold to fivefold enriched in the PSD fraction over brain homogenates. Immunocytochemical localization of myosin-Va in cultured hippocampal neurons shows that it partially colocalizes with PSD-95 at synapses and is also diffusely localized in cell bodies, dendrites, and axons. Cdc10 has a punctate distribution in cell bodies and dendrites, with some of the puncta colocalizing with PSD-95. The results support a role for myosin-Va in transport of materials into spines and for septins in the formation or maintenance of spines

The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study

<b>Background</b> Multimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the 'typology' of multimorbidity in different age groups and its association with socioeconomic status.<p></p> <b>Aim</b> To characterise multimorbidity type and most common conditions in a large nationally representative primary care dataset in terms of age and deprivation.<p></p> <b>Design and setting</b> Cross-sectional analysis of 1 272 685 adults in Scotland.<p></p> <b>Method</b> Multimorbidity type of participants (physical-only, mental-only, mixed physical, and mental) and most common conditions were analysed according to age and deprivation.<p></p> <b>Results</b> Multimorbidity increased with age, ranging from 8.1% in those aged 25–34 to 76.1% for those aged ≥75 years. Physical-only (56% of all multimorbidity) was the most common type of multimorbidity in those aged ≥55 years, and did not vary substantially with deprivation. Mental-only was uncommon (4% of all multimorbidity), whereas mixed physical and mental (40% of all multimorbidity) was the most common type of multimorbidity in those aged <55 years and was two- to threefold more common in the most deprived compared with the least deprived in most age groups. Ten conditions (seven physical and three mental) accounted for the top five most common conditions in people with multimorbidity in all age groups. Depression and pain featured in the top five conditions across all age groups. Deprivation was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimorbid patients at different ages.<p></p> <b>Conclusion</b> Mixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards

Teacher interventions in small group work in secondary mathematics and science lessons

Collaborative problem solving, when students work in pairs or small groups on a curriculum-related task, has become an increasingly common feature of classroom education. This paper reports a study of a topic which has received relatively little attention: how teachers can most usefully intervene when students are working in a group, but have encountered some sort of problem. The data used comes from a large scale interventional study of mathematics and science teaching in secondary schools in south east England, in which interactions between teachers and students were recorded in their usual classrooms. We identify the typical problem situations which lead to teachers’ interventions, and describe the different ways teachers were observed to intervene. We examine the different types of intervention, and consider how effective they are in helping group work proceed in a productive manner. Finally, we offer some conclusions about the practical implications of these findings.This is the final version of the article. It was first available from Taylor & Francis via http://dx.doi.org/10.1080/09500782.2015.112536

High Data Density Temperature Measurement for Quasi Steady-State Flows

A new optical instrument, the liquid crystal point diffraction interferometer (LCPDI), is used to measure the temperature distribution across a heated chamber filled with silicone oil. Data taken using the LCPDI are compared to equivalent measurements made with a traversing thermo-couple and the two data sets show excellent agreement. This instrument maintains the compact, robust design of Linniks point diffraction interferometer and adds to it phase stepping capability for quantitative interferogram analysis. The result is a compact, simple to align, environmentally insensitive interferometer capable of accurately measuring optical wave-fronts with very high data density and with automated data reduction

Connecting observations of student and teacher learning: an examination of dialogic processes in Lesson Study discussions in mathematics

Lesson Study is rapidly becoming one of the most adopted models of teacher professional development worldwide. In this paper, we examine the teachers’ discussions that are an integral part of the Lesson Study research cycle. In particular, we investigate the ‘dialogic mechanisms’ that enable teachers’ pedagogical intentions to be developed within the context of discussions that stem from observations of students as they address mathematical problems. In so doing we hypothesize about the nature of the ‘dialogic space’ that is created and how this allows teachers to move from the collaborative analysis of student outcomes to an enhanced understanding of pedagogical intentions in mathematics. Data for this paper derive from a large research project taking place in Camden, London. This project aims to implement Lesson Study in the context of the introduction of a New National Curriculum for Mathematics in England. It involves a large cohort of mathematics teachers across primary and secondary schools. Quantitative analysis of video-recorded Lesson Study discussions is reviewed and one illustrative case study is included to contextualise the quantitative data. Findings suggest that a focus on student outcomes enables teachers to collaborate effectively on developing pedagogical intentions to directly address student need. Further, it seems that particular features of dialogue are evident where teachers move to an agreed perspective on pedagogic change; and evidence of ‘supportive moves’ in interactions suggest that a form of dialogic space is necessary if all teachers in a Lesson Study group are to learn from shared understandings about future teaching and learning needs.The research was funded from the Office of the Lord Mayor of London

An Investigation into the Critical Factors of on-site Waste Segregation in the UK Construction and Demolition Sector.

This paper provides an in-depth exploration into critical factors affecting the use of on-site waste segregation strategies in the UK C&D market. Utilising data from two separate survey questionnaires; this study confirms usage of on-site segregation strategies by many UK contractors where physical site space and project budgets allow. However, through assessment of stakeholder perceptions, this paper also identifies several key barriers that are impeding overall effectiveness. Amongst many factors, this study indicates how issues such as poor attitude and a lack of knowledge of the benefits amongst workers, could be having a profound effect on successful adaptation of ground level recycling initiatives. This research project then finishes by ranking existent barriers by importance, with the goal of suggesting proposals for overcoming these challenges. Ultimately, weighing the critical factors and prospective barriers to on-site segregation in the UK C&D sector, this study makes recommendation of multiple incentives, but suggests that enhanced training initiatives could be a crucial element for instigating long-term industry improvement in respect of recycling and on-site waste segregation strategies