The family practitioner family : the use of metaphor in understanding changes in primary health care organizations

Current UK health policy guidance locates primary care at the frontiers of health care modernization. New organizational structures have resulted in general practitioner (GP) practices being brought together in Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) each serving a much larger population group than the traditional GP practice. These changes have been accompanied with a need to explore new ways of working and thinking. This paper draws upon the experiences of nurses and GPs participating in an evaluation of workforce planning issues in primary health care. It explores how practitioners working in PCGs across one geographical area were able to gain a better understanding of what these changes, to both the structure and process of practice, might involve. During this developmental process the respondents used ‘the family’ metaphor, as a form of ‘shorthand’ to orientate themselves to the new responsibilities, challenges and opportunities presented by these changes to primary health care. It was in the use of terms and constructs that were familiar to their ‘everyday life’ experiences that made taking the first tentative steps in the change process easier. This paper suggests that using metaphors may be a powerful tool for policy makers, practitioners,managers and for researchers as they seek to communicate a plan for change and in understanding what these changes might mean

Explicating the role of partnerships in changing the health and well-being of local communities in urban regeneration areas: evaluation of the Warnwarth conceptual framework for partnership evaluation

This literature review is one of three outputs from a project: Explicating the role of partnerships in changing the health and well-being of local communities, one of a number of projects in a larger Higher Education Funding Council Strategic Development Fund project (HEFCE) entitled: Urban Regeneration: Making a Difference. This was a collaborative venture between Manchester Metropolitan University, Northumbria University, University of Salford and University of Central Lancashire. Bradford University was an affiliated partner

Review of Alataleberis McKenzie and Warne, 1986 and description of Alatapacifica gen. nov. (Ostracoda, Crustacea) from the Cenozoic of Australasia

Species originally assigned to the pterygocytherine genus Alataleberis by McKenzie &amp; Warne, 1986 are placed here in two genera&mdash;Alataleberis sensu stricto and Alatapacifica gen. nov. Alataleberis species possess poorly defined dorsal ridges marked by a few spines in adult specimens and lack a subcentral tubercle. Alatapacifica species possess well-developed and buttressed dorsal ridges and a well-developed subcentral tubercle. Pterygocytherine genera/species groups recognized here from the southwest Pacific region are Alataleberis, Alatapacifica (septarca and robusta species groups), Alatahermanites Whatley &amp; Titterton, 1981 and the velivola species group of Pterygocythereis Blake, 1933.<br /

Explicating the role of partnerships in changing the health and well-being of local communities: a profile of neighbourhood renewal activity focused on promoting health and well-being in Salford and the north west region and the north east of England

This scoping and mapping report is one of three outputs from a project: Explicating the role of partnerships in changing the health and well-being of local communities, one of a number of projects in a larger Higher Education Funding Council Strategic Development Fund project ( HEFCE ) entitled: Urban Regeneration: Making a Difference. This was a collaborative venture between Manchester Metropolitan University, Northumbria University, University of Salford and University of Central Lancashire. Bradford University was an affiliated partner

Neohornibrookella sorrentae (Chapman and Crespin, 1928) and allied ostracod taxa from the Neogene of southeastern Australia: Systematic and palaeoceanographical relationships, palaeoecology and palaeobiogeography

Three closely allied shallow marine taxa, Neohornibrookella sorrentae (Chapman and Crespin), Neohornibrookella glyphica (Neil), and Neohornibrookella nepeani sp. nov. are recorded from latest early Miocene to late Pliocene strata in southeastern Australia. These taxa, together with Neohornibrookella quadranodosa (Holden) from the Miocene of Midway Island (Northwestern Hawaiian Islands), form a morphologically distinct group of relatively large species (the sorrentae-group) within the genus Neohornibrookella Jellinek. Latitudinal expansion of the subtropical and warm-temperate climatic belts together with the influence of warm western boundary surface currents associated with the North and South Pacific gyres, are likely to have played key roles in the Miocene dispersal of this species group. Species of the sorrentae-group first migrated south from equatorial west Pacific regions into southeastern Australia during the early Miocene, under the influence of the East Australian Current. During three time intervals (i) latest early Miocene, (ii) latest late Miocene and (iii) earliest late Pliocene, forceful pulses of the East Australian Current played a significant role in propelling the widespread distribution of thermophilic Neohornibrookella species across southeast Australian shallow marine realms. During intervening middle and late Miocene times, Neohornibrookella species are only sporadically present across the Bass Strait region of southeast Australia, indicating a weaker East Australian Current influence and the cooling influence of coastal upwelling. During the mid early Pliocene Neohornibrookella species disappeared from the western Bass Strait region, suggesting the complete exclusion of East Australian Current waters from this region. This was probably due to the counteracting influence of the eastward flowing Zeehan Current (extension of the Leeuwin Current) impinging on the western Bass Strait region. This mid early Pliocene palaeobiogeographical partition in Bass Strait, defined by the distribution of sorrentae-group species, is here termed the Bassian Gateway. The two species, N. sorrentae and N. glyphica, occur concurrently during the mid Miocene in southeast Australia, but are associated with different lithofacies. It is hypothesised that there is a heterochronic evolutionary relationship expressed in the ornament of these two species. The thaerocytherid genera Neohornibrookella Jellinek, Tenedocythere Sissingh and Bosasella Bonaduce are here included in the new ostracod subfamily Tenedocytherinae

Hearing the voices of young people who self-harm : implications for service providers

The incidence of adolescent self-harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self-harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self-harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young people’s experiences of help and support for self-harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self-harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people

Co-Infection by Chytrid Fungus and Ranaviruses in Wild and Harvested Frogs in the Tropical Andes.

While global amphibian declines are associated with the spread of Batrachochytrium dendrobatidis (Bd), undetected concurrent co-infection by other pathogens may be little recognized threats to amphibians. Emerging viruses in the genus Ranavirus (Rv) also cause die-offs of amphibians and other ectotherms, but the extent of their distribution globally, or how co-infections with Bd impact amphibians are poorly understood. We provide the first report of Bd and Rv co-infection in South America, and the first report of Rv infections in the amphibian biodiversity hotspot of the Peruvian Andes, where Bd is associated with extinctions. Using these data, we tested the hypothesis that Bd or Rv parasites facilitate co-infection, as assessed by parasite abundance or infection intensity within individual adult frogs. Co-infection occurred in 30% of stream-dwelling frogs; 65% were infected by Bd and 40% by Rv. Among terrestrial, direct-developing Pristimantis frogs 40% were infected by Bd, 35% by Rv, and 20% co-infected. In Telmatobius frogs harvested for the live-trade 49% were co-infected, 92% were infected by Bd, and 53% by Rv. Median Bd and Rv loads were similar in both wild (Bd = 101.2 Ze, Rv = 102.3 viral copies) and harvested frogs (Bd = 103.1 Ze, Rv = 102.7 viral copies). While neither parasite abundance nor infection intensity were associated with co-infection patterns in adults, these data did not include the most susceptible larval and metamorphic life stages. These findings suggest Rv distribution is global and that co-infection among these parasites may be common. These results raise conservation concerns, but greater testing is necessary to determine if parasite interactions increase amphibian vulnerability to secondary infections across differing life stages, and constitute a previously undetected threat to declining populations. Greater surveillance of parasite interactions may increase our capacity to contain and mitigate the impacts of these and other wildlife diseases

A Tale of Two Stories: A Narrative of Bulimia in a Research Study of Anorexia, and the Dilemmas of a Novice Researcher.

The purpose of this paper is two-fold: Firstly, it reports on one man's experience of bulimia. After being interviewed it became evident that he did not meet the inclusion criteria for the study, which was focussed on anorexia in men. Secondly, the paper explores the implications for a novice researcher of including someone in a study who does not meet the inclusion criteria. The researcher's story reflects upon the implications of self-doubt when embarking upon sensitive research, and the morality of holding onto a rogue participant's story. It offers others an opportunity to consider and learn from this experience