Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

OBJECTIVES: To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. DESIGN: Qualitative, semistructured interview study. SETTING: 13 general practices in Leicester. PARTICIPANTS: 18 general practitioners and 13 practice nurses. RESULTS: Health professionals did not report substantially changing their clinical practice to claim the new payments and made only minimal changes in practice organisation. The new health promotion payment did not overcome general practitioners' resistance towards raising the issue of smoking when they felt that doing so could cause confrontation with patients. General practitioners who made the largest number of claims altered the way in which they recorded patients' smoking status rather than raising the topic of smoking more frequently with patients. Participants had strong negative views on die new payment, feeling it would also be viewed negatively by patients. They were, however, more positive about health promotion payments that rewarded "extra" effort-for example, setting up practice based smoking cessation clinics. CONCLUSIONS: General practitioners and practice nurses were negative about a new health promotion payment, despite agreeing to pilot it. Health promotion payments do not automatically generate effective health promotion activity, and policymakers should consider careful piloting and evaluation of future changes in health promotion payments

The Accretion Flows and Evolution of Magnetic Cataclysmic Variables

We have used a model of magnetic accretion to investigate the accretion flows of magnetic cataclysmic variables. Numerical simulations demonstrate that four types of flow are possible: discs, streams, rings and propellers. The fundamental observable determining the accretion flow, for a given mass ratio, is the spin-to-orbital period ratio of the system. If IPs are accreting at their equilibrium spin rates, then for a mass ratio of 0.5, those with Pspin/Porb < 0.1 will be disc-like, those with 0.1 < Pspin/Porb < 0.6 will be stream-like, and those with Pspin/Porb ~ 0.6 will be ring-like. The spin to orbital period ratio at which the systems transition between these flow types increases as the mass ratio of the stellar components decreases. For the first time we present evolutionary tracks of mCVs which allow investigation of how their accretion flow changes with time. As systems evolve to shorter orbital periods and smaller mass ratios, in order to maintain spin equilibrium, their spin-to-orbital period ratio will generally increase. As a result, the relative occurrence of ring-like flows will increase, and the occurrence of disc-like flows will decrease, at short orbital periods. The growing number of systems observed at high spin-to-orbital period ratios with orbital periods below 2h, and the observational evidence for ring-like accretion in EX Hya, are fully consistent with this picture.Comment: Accepted for publication in ApJ. 6 figures - included here at low resolutio