196,438 research outputs found
How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: a micro-analysis
No full textPeople with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n = 16), and practice nurse led (n = 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; ‘direct’, ‘embedded’, and ‘oblique’. Both settings provided interactional ‘slots’ for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated ‘oblique’ formats. We suggest that the attenuation of the ‘oblique’ format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns
Concentration fluctuations in atmospheric dispersion
No full textThis report summarizes work done at Brunel University under Agreement No.2066/62 from
15 July 1986 to 14 July 1989. The title of the project was Concentration Fluctuations in Atmospheric Dispersion. The report has three principal components. These are:
(i) theoretical work on the electrostatic effects associated with dispersing charged tracers.
(ii) extensive analysis of several datasets taken with the CDE sensor system, particularly one obtained at RAF Cardington on 10 May 1988;
(iii) interpretation of the results of the analysis.
The conclusions of the report include recommendations for further work to exploit the
advantages that the system has over many others
Protocol for the THREAD (THREshold for AntiDepressants) study: a randomised controlled trial to determine the clinical and cost-effectiveness of antidepressants plus supportive care, versus supportive care alone, for mild to moderate depression in UK general practice
No full textBackground: Depression guidelines in the UK recommended a policy of watchful waiting for mild depression due to a lack of evidence for the effectiveness of antidepressant treatment for mild cases. However there has been relatively little research carried out in primary care to help establish the severity threshold at which antidepressant treatment is effective and cost-effective.Methods/Design: The THREAD (THREshold for AntiDepressants) study is a multi-centre randomised controlled trial designed to determine the clinical and cost effectiveness of a selective serotonin reuptake inhibitor (SSRI) plus general practitioner (GP) supportive care, versus supportive care alone, for mild to moderate depression in primary care. The aim is to recruit 300 patients from three centres (Southampton, London and Liverpool). Depressive symptoms will be assessed at baseline, 12 weeks and 26 weeks, using the 17-item Hamilton Depression Rating Scale (HDRS). Two severity sub-groups of patients will be recruited, with HDRS scores of 12–15, and 16–19. Possible predictors of response will be explored including life events and difficulties and alcohol consumption. Analysis of covariance, controlling for baseline value, severity group and centre will be used to estimate the overall treatment effectiveness (difference in HDRS score) at final follow up. The primary analysis will be by 'intention to treat' using double sided tests. The interaction between severity sub-group and treatment will be tested, and if appropriate, effects within separate severity sub-groups estimated. The economic analysis will compare the two treatment groups in terms of mean costs and cost effectiveness.Discussion: The results of this study will give GPs important information to help them determine the severity of depression at which antidepressant treatment is likely to be cost-effective
La ventilation par embout buccal dans les maladies neuromusculaires
No full textLe document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252e atelier international ENMC consacré, du 6 ou 8 mars 2020, au « Développement de recommandations pour l’utilisation de la ventilation par embout buccal dans les maladies neuromusculaires », et publié très récemment dans la revue Neuromuscular Disorders (M. Chatwin, M. Gonçalves, J. Gonzalez-Bermejo, M. Toussaint, et al. 252nd ENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6th to 8th 2020, Amsterdam, the Netherlands. Neuromuscular Disorders 2020 ; 30 : 772–81. https://doi.org/10.1016/j.nmd.2020.07.00
Dr. Duane M. Jackson, Morehouse College, July 2011
No full textThis video is a conversation with Dr. Duane M. Jackson. Dr. Jackson talks about his paper, "Recall and the Serial Position Effect: The Role of Primacy and Recency on Accounting Students' Performance." Jackie Daniel, AUC Woodruff Library, is the interviewer
Physical structures, advection and mixing in the region of Goban Spur
No full textThe physical context for ocean margin exchange at Goban Spur is described. Observations adjacent to, prior to and during the Ocean Margin EXchange (OMEX) project of 1993–1996 are used. They include currents measured on moorings, drogued-buoy tracks; temperature and other data from CTD profiles, especially as indicators of vertical mixing; evidence from models, particularly for turbulence causing vertical mixing. These data are combined in estimates of (seasonally dependent) mean flow, tidal currents, other current variability, exchange and mixing over the main cross-slope section studied in OMEX and in nearby and contrasted locations (aided by the use of earlier and adjacent measurements). Causative physical processes are discussed: potentially northward flow along the continental slope, effects of Goban Spur topography, eddies, wind-driven transport, cascading, tides, fronts, internal tides, internal waves, surface waves. Among these, there is evidence that• the along-slope flow, typically O(0.05 m s?1), is reduced or even reversed in spring, is generally weaker than at some other margin sectors owing to the non-meridional alignment and indentations in the Celtic Sea slope, and may sometimes overshoot rather than follow the depth contours around Goban Spur;• tidal currents are O(0.2 m s?1) on the adjacent shelf but O(0.1 m s?1) or less over most of Goban Spur; they increase to the southeast;• other (wind- and eddy-forced) contributions to the currents are typically O(0.1 m s?1) or less, except on the shelf, and decrease with depth;• wind-, tide- and wave-forced currents are probably the most consistent agents of cross-slope exchange O(1 m2 s?1), with topographic effects being important locally (canyons, spurs);• stratification starts intermittently until early June, becomes shallower through June and deepens by September. In 1995, one storm on 5–8 September roughly doubled the upper mixed-layer depth to >40 m and reinstated maximal primary production in the upper mixed layer;• vertical mixing is intermittent, dominated by surface inputs (wind and waves); towards the southeast, internal waves of tidal origin are increasingly important for mixing across the thermocline;• in the context of nutrient provision for primary production in the upper mixed layer, diffusion through the summer thermocline appears to be small unless internal waves strongly increase mixing.<br/
The Effects of EU Enlargement on European Drug Policy
No full textIn May this year ten new countries joined the existing European Union(EU) member states after long and complex accession negotiations. This article examines preparations for accession that were made in the area of illicit drug policy and discusses both their effectiveness and possible limitations. In the areas of drug trafficking and production and the exchange of information between member states some concrete policy measures have been almost directly transferable to new member states, largely due to the high degree of cooperation between existing member states in these areas. However, in the more controversial areas of harm reduction and dealing with drug use and drug users there are no concrete EU guidelines in place and policy is left up to the national governments of individual countries. In this important area many existing EU member
states have adopted important measures designed to reduce the harm of official drug policy but these practices are not proving to be so easily transferable to new member states. This article discusses the consequences of failing to adequately develop policy across the EU in this important area and suggests that failing to address this important issue in the new member states could have far reaching ramifications for the rest of Europe
"Reflections on the subject of Emigration from Europe with a view to Settlement in the United States" By M. Carey.
No full text"Reflections on the subject of Emigration from Europe with a view to Settlement in the United States: containing bried sketches of the moral and political character of those states.
By M. Carey, member of the American philosophical, and of the American Antiquarian Society, and author of The Olive Branch, Cindiciae Hibernicae, essays on banking, on political economy, and on internal improvement.
To which are now added the English editor's comments on the subject; together with Important Advice to Emigrants, and Cautions Against Impositions Practiced in the Outports
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