5,931 research outputs found
General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland - a pilot prospective study using structural equation modelling
No full text<b>Objective</b> The aim of this pilot prospective study was to investigate the relationships between general practitioners (GPs) empathy, patient enablement, and patient-assessed outcomes in primary care consultations in an area of high socio-economic deprivation in Scotland.<p></p>
<b>Methods</b> This prospective study was carried out in a five-doctor practice in an area of high socio-economic deprivation in Scotland. Patients’ views on the consultation were gathered using the Consultation and Relational Empathy (CARE) Measure and the Patient Enablement Instrument (PEI). Changes in main complaint and well-being 1 month after the contact consultation were gathered from patients by postal questionnaire. The effect of GP empathy on patient enablement and prospective change in outcome was investigated using structural equation modelling.<p></p>
<b>Results</b> 323 patients completed the initial questionnaire at the contact consultation and of these 136 (42%) completed and returned the follow-up questionnaire at 1 month. Confirmatory factor analysis confirmed the construct validity of the CARE Measure, though omission of two of the six PEI items was required in order to reach an acceptable global data fit. The structural equation model revealed a direct positive relationship between GP empathy and patient enablement at contact consultation and a prospective relationship between patient enablement and changes in main complaint and well-being at 1 month.<p></p>
<b>Conclusion</b> In a high deprivation setting, GP empathy is associated with patient enablement at consultation, and enablement predicts patient-rated changes 1 month later. Further larger studies are desirable to confirm or refute these findings.<p></p>
<b>Practice implications</b> Ways of increasing GP empathy and patient enablement need to be established in order to maximise patient outcomes. Consultation length and relational continuity of care are known factors; the benefit of training and support for GPs needs to be further investigate
A burst search for gravitational waves from binary black holes
No full textCompact binary coalescence (CBC) is one of the most promising sources of gravitational waves. These sources are usually searched for with matched filters which require accurate calculation of the GW waveforms and generation of large template banks. We present a complementary search technique based on algorithms used in un-modeled searches. Initially designed for detection of un-modeled bursts, which can span a very large set of waveform morphologies, the search algorithm presented here is constrained for targeted detection of the smaller subset of CBC signals. The constraint is based on the assumption of elliptical polarization for signals received at the detector. We expect that the algorithm is sensitive to CBC signals in a wide range of masses, mass ratios and spin parameters. In preparation for the analysis of data from the fifth LIGO-Virgo science run (S5), we performed preliminary studies of the algorithm on test data. We present the sensitivity of the search to different types of simulated binary black hole waveforms. Also, we discuss how to extend the results of the test run into a search over all of the current LIGO-Virgo data set
Rayleigh number dependence of the Archimedes number dependent large-scale flow structure formation in mixed convection
No full textWe report on experimental investigations of large-scale flow structure formation in mixed convection. We characterize the flow field by measuring the velocity fields within a rectangular model room using 2D2C PIV. The control parameters are the Reynolds number Re, the Rayleigh number Ra and the Prandtl number Pr. All parameters are linked through the Archimedes number Ar. In 6.4x10-2 ≤ Ar ≤ 1.39x101, 4.2x103 ≤ Re ≤ 6.35x104 and Ra = 3.1x107, Ra = 1.8x108 and Pr = 0.713 we found flow 3 different flow structures. While keeping Ra and Pr constant and varying Ar through Re variations, we found an Ar dependence of the largescale flow structure formation within 6.4x10-2 ≤ Ar ≤ 1.39x101. Furthermore, we found a Ra dependence of the structure formation, which shifts the transition points between the structures to higher Archimedes numbers and reduces the mean velocities within the investigated domain
Reynolds numbers near the ultimate state of turbulent Rayleigh-Bénard convection
No full textWe report on measurements of the mean-flow Reynolds number ReU and the rms fluctuation Reynolds number ReV in turbulent Rayleigh-Bénard convection as a function of the Rayleigh number Ra for 4 x 1011 < Ra < 2 1014 and Pr ' 0:8. Both can be described by the same power law with an effective exponent = 0:44, in agreement with predictions for ReU but in disagreement with predictions for ReV
Logarithmic variance profiles and the corresponding f-1 spectra of temperature fluctuations in turbulent Rayleigh-Bénard convection
No full textWe report experimental results for the temperature variance 2(z) and the corresponding frequency spectra P(f) in turbulent Rayleigh-Bénard convection (RBC) in a cylindrical sample of aspect ratioT= D/L = 1:00 (D = 1:12 m is the diameter and L = 1:12 m the height). The measurements were conducted in the Rayleigh-number range 1011 < Ra < 1:35 1014 and Pr ' 0:8. For Ra = 1:35x1014, 2(z) could be described well by a logarithmic dependence on the vertical position z in a range of z 1 < z < z 2 with z 1 ' 70 and z 2 = 0:1L. Here L=(2Nu) is the thickness of a thin thermal sublayer adjacent to the horizontal plate where the heat flux (denoted by the Nusselt number Nu) is carried mostly by thermal diffusion. In the log layer, we found that the temperature spectra had a significant frequency range over which P(f) f with close to 1. As Ra decreased, increased so that the log layer became thinner. At Ra = 2:05 1011, z 2 < z 1 and therefore there was no range for a log layer. Correspondingly, the temperature spectrum near the horizontal plate did not have the f1 scaling form either
How useful are clinical guidelines for the management of obesity in general practice?
No full textObesity is a major public health issue and numerous clinical guidelines have been published to support management. One of the most comprehensive guidelines on obesity was published by the National Institute for Health and Clinical Excellence (NICE) in 2006 (NICE guideline 43) which aims to offer practical recommendations based on the available evidence and has a strong focus on primary care both in terms of prevention and clinical care. The current article summarises these guidelines in relation to primary care, reports on new evidence and developments since they were published, and critically appraises the usefulness of guidelines for management of obesity
Lagrangian Raylaigh-Bénard convection
No full textUsing passive tracers as sensors, we obtain Lagrangian measurements of tracers position, velocity and temperature in Rayleigh-Bénard convection at Ra=10^7-10^9. We report on statistics of temperature, velocity, and heat transport (Nusselt number). We observe that the Nusselt number is characterized by a largely intermittent behavior, likely due to the interaction of temperature with turbulent velocity fluctuations
Photochemical behavior of some p-styryistilbenes and related compounds: Spectral properties and photoisomerization in solution and in solid state
No full textAuthor Posting. © The Authors (2006) This is the author's version of the work. It is posted here for personal use, not for redistribution. The definitive version was published in PHOTOCHEMISTRY AND PHOTOBIOLOGY, 82(6): 1645-1650. https://doi.org/10.1562/2006-01-17-RA-780ArticlePhotochemistry and Photobiology. 82(6): 1645-1650 (2006)journal articl
Verbesserung der Wundheilung durch wassergefiltertes Infrarot A (wIRA) bei Patienten mit chronischen venösen Unterschenkel-Ulzera einschließlich infrarot-thermographischer Beurteilung
No full textBackground: Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects.
Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up.
Methods: 10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun® radiator type 501, 10 mm water cuvette, water-filtered spectrum 550–1400 nm) or visible light irradiation (VIS; only possible in one patient). The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm2 wIRA and approximately 45 mW/cm2 VIS). Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer). The main variable of interest was “percent change of ulcer size over time” including complete wound closure. Additional variables of interest were thermographic image analysis, patient’s feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator), assessment of feeling of the wound area (by patient), assessment of wound healing (by clinical investigator) and assessment of the cosmetic state (by patient and by clinical investigator). For these assessments visual analogue scales (VAS) were used.
Results: The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10 patients, a clear reduction of pain and pain medication consumption (e.g. from 15 to 0 pain tablets per day), and a normalization of the thermographic image (before the beginning of the therapy typically hyperthermic rim of the ulcer with relative hypothermic ulcer base, up to 4.5°C temperature difference). In one patient the therapy of an ulcer of one leg was performed with the fully active radiator (wIRA(+VIS)), while the therapy of an ulcer of the other leg was made with a control group radiator (only VIS without wIRA), showing a clear difference in favour of the wIRA treatment. All mentioned VAS ratings improved remarkably during the period of irradiation treatment, representing an increased quality of life. Failures of complete or nearly complete wound healing were seen only in patients with arterial insufficiency, in smokers or in patients who did not have venous compression garment therapy.
Discussion and conclusions: wIRA can alleviate pain considerably (with an impressive decrease of the consumption of analgesics) and accelerate wound healing or improve a stagnating wound healing process and diminish an elevated wound exudation and inflammation both in acute and in chronic wounds (in this study shown in chronic venous stasis ulcers of the lower legs) and in problem wounds including infected wounds. In chronic recalcitrant wounds complete healing is achieved, which was not reached before. Other studies have shown that even without a disturbance of wound healing an acute wound healing process can be improved (e.g. reduced pain) by wIRA.
wIRA is a contact-free, easily used and pleasantly felt procedure without consumption of material with a good penetration effect, which is similar to solar heat radiation on the surface of the earth in moderate climatic zones. Wound healing and infection defence (e.g. granulocyte function including antibacterial oxygen radical formation of the granulocytes) are critically dependent on a sufficient energy supply (and on sufficient oxygen). The good clinical effect of wIRA on wounds and also on problem wounds and wound infections can be explained by the improvement of both the energy supply and the oxygen supply (e.g. for the granulocyte function). wIRA causes as a thermal effect in the tissue an improvement in three decisive factors: tissue oxygen partial pressure, tissue temperature and tissue blood flow. Besides this non-thermal effects of infrared-A by direct stimulation of cells and cellular structures with reactions of the cells have also been described. It is concluded that wIRA can be used to improve wound healing, to reduce pain, exudation, and inflammation and to increase quality of life.Hintergrund: Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hoher Gewebepenetration bei geringer thermischer Oberflächenbelastung. wIRA vermag über thermische und nicht-thermische Effekte wesentliche und energetisch bedeutsame Faktoren der Wundheilung zu verbessern.
Ziel der Studie: prospektive Studie (primär randomisiert, kontrolliert, verblindet geplant, de facto mit einer Ausnahme nur eine Kohorte möglich) mit wassergefiltertem Infrarot A (wIRA) in der Therapie von Patienten mit therapierefraktären chronischen venösen Unterschenkel-Ulzera mit thermographischer Verlaufskontrolle.
Methoden: 10 Patienten (5 Männer, 5 Frauen, Median des Alters 62 Jahre) mit 11 therapierefraktären chronischen venösen Unterschenkel-Ulzera wurden mit wassergefiltertem Infrarot A und sichtbarem Licht (wIRA(+VIS), Hydrosun®-Strahler Typ 501, 10 mm Wasserküvette, wassergefiltertes Spektrum 550–1400 nm) oder mit sichtbarem Licht (VIS; nur bei einem Patienten möglich) bestrahlt. Die unbedeckten Wunden der Patienten wurden zwei- bis fünfmal pro Woche über bis zu 2 Monate (typischerweise bis zum Wundschluss oder Fast-Wundschluss des Ulkus) für jeweils 30 Minuten mit einem Standardabstand von 25 cm bestrahlt (ungefähr 140 mW/cm2 wIRA und ungefähr 45 mW/cm2 VIS). Hauptzielvariable war die „prozentuale Änderung der Ulkusgröße über die Zeit“ einschließlich des kompletten Wundschlusses. Zusätzliche Zielvariablen waren thermographische Bildanalyse, Schmerzempfinden des Patienten in der Wunde, Schmerzmittelverbrauch, Einschätzung des Effekts der Bestrahlung (durch Patient und durch klinischen Untersucher), Einschätzung des Patienten des Gefühls im Wundbereich, Einschätzung der Wundheilung durch den klinischen Untersucher sowie Einschätzung des kosmetischen Zustandes (durch Patienten und durch klinischen Untersucher). Für diese Erhebungen wurden visuelle Analogskalen (VAS) verwendet.
Ergebnisse: Die Studie ergab eine vollständige oder fast vollständige Abheilung der Unterschenkel-Ulzera bei 7 Patienten sowie eine deutliche Ulkusverkleinerung bei 2 weiteren der 10 Patienten, eine bemerkenswerte Minderung der Schmerzen und des Schmerzmittelverbrauchs (von z.B. 15 auf 0 Schmerztabletten täglich) und eine Normalisierung des thermographischen Bildes (vor Therapiebeginn typischerweise hyperthermer Ulkusrandwall mit relativ hypothermem Ulkusgrund, bis zu 4,5°C Temperaturdifferenz). Bei einem Patienten wurde ein Ulkus an einem Bein mit dem Vollwirkstrahler (wIRA(+VIS)) therapiert, während ein Ulkus am anderen Bein mit einem Kontrollgruppenstrahler (nur VIS, ohne wIRA) behandelt wurde, was einen deutlichen Unterschied zugunsten der wIRA-Therapie zeigte. Alle aufgeführten VAS-Einschätzungen verbesserten sich während der Bestrahlungstherapie-Periode sehr stark, was einer verbesserten Lebensqualität entsprach. Ein kompletter oder fast kompletter Wundschluss wurde nur bei Patienten mit peripherer arterieller Verschlusskrankheit, Rauchern oder Patienten mit fehlender venöser Kompressionstherapie nicht erreicht.
Diskussion und Schlussfolgerungen: wIRA kann sowohl bei akuten Wunden als auch bei chronischen Wunden (in dieser Studie für chronische venöse Unterschenkelulzera gezeigt) und Problemwunden einschließlich infizierter Wunden Schmerzen deutlich mindern (mit eindrucksvoller Abnahme des Schmerzmittelverbrauchs) und die Wundheilung beschleunigen oder einen stagnierenden Wundheilungsprozess verbessern sowie eine erhöhte Wundsekretion und Entzündung mindern.
Bei chronischen therapierefraktären Wunden werden vollständige Abheilungen erreicht, die zuvor nicht erreicht wurden. Andere Studien haben sogar ohne Wundheilungsstörung eine Verbesserung (z.B. Schmerzreduktion) der akuten Wundheilung durch wIRA gezeigt.
wIRA ist ein kontaktfreies, verbrauchsmaterialfreies, leicht anzuwendendes, als angenehm empfundenes Verfahren mit guter Tiefenwirkung, das der Sonnenwärmestrahlung auf der Erdoberfläche in gemäßigten Klimazonen nachempfunden ist.
Wundheilung und Infektionsabwehr (z.B. Granulozytenfunktion einschließlich antibakterieller Sauerstoffradikalbildung der Granulozyten) hängen ganz entscheidend von einer ausreichenden Energieversorgung (und von ausreichend Sauerstoff) ab. Die gute klinische Wirkung von wIRA auf Wunden und auch auf Problemwunden und Wundinfektionen lässt sich über die Verbesserung sowohl der Energiebereitstellung als auch der Sauerstoffversorgung (z.B. für die Granulozytenfunktion) erklären. wIRA bewirkt als thermischen Effekt im Gewebe eine Verbesserung von drei entscheidenden Faktoren: Sauerstoffpartialdruck im Gewebe, Gewebetemperatur und Gewebedurchblutung. Daneben wurden auch nicht-thermische Effekte von Infrarot A durch direkte Reizsetzung auf Zellen und zelluläre Strukturen mit Reaktionen der Zellen beschrieben.
Es wird geschlossen, dass wIRA verwendet werden kann, um Wundheilung zu verbessern, Schmerzen, Sekretion und Entzündung zu reduzieren und die Lebensqualität zu steigern
Aspect-ratio dependence of the transition to the ultimate state of turbulent Rayleigh-Bénard convection
No full textWe report on measurements of the ultimate-state transition in turbulent Rayleigh-B\'enard convection obtained in a large facility known as the ``Uboot of G\"ottingen" and using pressurized sulfur hexafluoride as the convecting fluid. We found that the transition occurs over a range of which becomes more narrow as increases, ranging from which is at most weakly dependent on and close to to which varies from about for to about for
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