bluuebunny/crossref_metadata_2025 huggingface dataset:
Scale-Up Strategy in Quality by Design Approach for Pharmaceutical Blending Process with Discrete Element Method Simulation
Authors: Yeom Su Bin , Choi Du Hyung
Published: June 2019

An approach combining quality by design (QbD) and the discrete element method (DEM) is proposed to establish an effective scale-up strategy for the blending process of an amlodipine formulation prepared by the direct compression method. Critical process parameters (CPPs) for intermediate critical quality attributes (IQAs) were identified using risk assessment (RA) in the QbD approach. A Box–Behnken design was applied to obtain the operating space for a laboratory-scale. A DEM model was developed by the input parameters for the amlodipine formulation; blending was simulated on a laboratory-scale V-blender (3 L) at optimal settings. The efficacy and reliability of the DEM model was validated through a comparison of simulation and experimental results. Change of operating space was evaluated using the validated DEM model when scaled-up to pilot-scale (10 L). Pilot-scale blending was simulated on a V-blender and double-cone blender at the optimal settings derived from the laboratory-scale operating space. Both pilot-scale simulation results suggest that blending time should be lower than the laboratory-scale optimized blending time to meet target values. These results confirm the change of operating space during the scale-up process. Therefore, this study suggests that a QbD-integrated DEM simulation can be a desirable approach for an effective scale-up strategy.
Inhibitory Activities of Momilactones A, B, E, and 7-Ketostigmasterol Isolated from Rice Husk on Paddy and Invasive Weeds
Authors: Quan Nguyen Van , Xuan Tran Dang , Tran Hoang-Dung , Dieu Thuy Nguyen Thi Dieu
Published: June 2019

Rice husk has been exploited as a potential source of allelochemicals. In this study, four bioactive compounds including momilactone E (ME), 7-ketostigmasterol (7KS), momilactone A (MA), and momilactone B (MB) were isolated by column chromatography (CC) to yield 2.7, 0.3, 11.7, and 8.3 mg/kg rice husk, respectively. The structures of the isolated compounds were identified and confirmed by spectroscopic techniques consisting of 1H and 13C nuclear magnetic resonance (NMR), electrospray ionization mass (ESI), high-resolution mass spectrometry (HR-MS) and infrared spectroscopy (IS). An advanced quantitative method for MA and MB was achieved to increase the detectable yields of MA and MB in rice husk to 51.96 and 42.33 µg/mL, respectively. The inhibitory activities of MA, MB, ME, and 7KS were examined on lettuce (Lactuca sativa), barnyard grass (Echinochloa crus-galli), and tall goldenrod (Solidago altissima) in bioassays. The allelopathic activities of ME and 7KS were compared with those of potent phytoalexin momilactones A (MA) and B (MB), and the standard p-hydroxybenzoic acid (pHA). Results showed that both MA and MB exhibited stronger inhibitory activity than ME and 7KS. MB exerted greater inhibitions than MA but the mixture of MA and MB (1:1, v/v) possessed a similar level of inhibition to MB. On the other hand, although ME and 7KS presented non-significant inhibition, their mixture of ME-7KS (1:1, v/v) displayed a remarkable inhibition on the growth of S. altissima. Findings of this study revealed that MA, MB, and the mixture ME-7KS had the potential to control the invasive plant S. altissima and the noxious paddy weed E. crus-galli in vitro, but their mode of actions should be further investigated.
Self-Healing Anti-Atomic-Oxygen Phosphorus-Containing Polyimide Film via Molecular Level Incorporation of Nanocage Trisilanolphenyl POSS: Preparation and Characterization
Authors: Wu Bohan , Zhang Yan , Yang Dayong , Yang Yanbin , Yu Qiang , Che Li , Liu Jingang
Published: June 2019

Protection of polymeric materials from the atomic oxygen erosion in low-earth orbit spacecrafts has become one of the most important research topics in aerospace science. In the current research, a series of novel organic/inorganic nanocomposite films with excellent atomic oxygen (AO) resistance are prepared from the phosphorous-containing polyimide (FPI) matrix and trisilanolphenyl polyhedral oligomeric silsesquioxane (TSP–POSS) additive. The PI matrix derived from 2,2’-bis(3,4-dicarboxyphenyl)hexafluoropropane dianhydride (6FDA) and 2,5-bis[(4-amino- phenoxy)phenyl]diphenylphosphine oxide (BADPO) itself possesses the self-healing feature in AO environment. Incorporation of TSP–POSS further enhances the AO resistance of the FPI/TSP composite films via a Si–P synergic effect. Meanwhile, the thermal stability of the pristine film is maintained. The FPI-25 composite film with a 25 wt % loading of TSP–POSS in the FPI matrix exhibits an AO erosion yield of 3.1 × 10−26 cm3/atom after an AO attack of 4.0 × 1020 atoms/cm2, which is only 5.8% and 1.0% that of pristine FPI-0 film (6FDA-BADPO) and PI-ref (PMDA-ODA) film derived from 1,2,4,5-pyromellitic anhydride (PMDA) and 4,4’-oxydianline (ODA), respectively. Inert phosphorous and silicon-containing passivation layers are observed at the surface of films during AO exposure.
Advances in Energy Systems Engineering and Process Systems Engineering in China—A Review Starting from Sargent’s Pioneering Work
Authors: Qian Wenhan , Liu Pei , Li Zheng
Published: June 2019

Process systems engineering (PSE), after being proposed by Sargent and contemporary researchers, has been fast developing in various domains and research communities around the world in the last couple of decades, with energy systems engineering featuring a typical yet still fast propagating domain, and the Chinese PSE community featuring a typical community with its own unique challenges for applying PSE theory and methods. In this paper, development of energy systems engineering and process systems engineering in China is discussed, and Sargent’s impacts on these two fields are the main focus. Pioneering work conducted by Sargent is firstly discussed. Then, a venation on how his work and thoughts have motivated later researchers and led to progressive advances is reviewed and analyzed. It shows that Sargent’s idea of optimum design and his work on nonlinear programming and superstructure modelling have resulted in well-known methods that are widely adopted in energy systems engineering and PSE applications in tackling problems in China. Following Sargent’s pioneering ideas and conceptual design of the PSE mansion, future development directions of energy systems engineering are also discussed.
Teaching Dante in the History of Christian Theology
Authors: Whitfield Bryan J.
Published: June 2019

Outside of core curriculum programs or Great Books classes, few undergraduates who are not literature majors read and discuss Dante’s Divine Comedy. This paper describes the redesign of a course in the history of Christian theology as a model for integrating the study of Dante into additional contexts within general education. Reading Dante not only as poet but also as theologian can enhance students’ learning and their engagement with medieval theology. A focused reading of Paradiso provides a novel and exciting way for a survey course in historical theology to balance general education’s needs for both breadth and depth. At the same time, reading Dante also helps students to experience the significant intersections of culture and theology in the medieval period.
Four-band Thermal Mosaicking: A New Method to Process Infrared Thermal Imagery of Urban Landscapes from UAV Flights
Authors: Yang Yichen , Lee Xuhui
Published: June 2019

Unmanned aerial vehicles (UAVs) support a large array of technological applications and scientific studies due to their ability to collect high-resolution image data. The processing of UAV data requires the use of mosaicking technology, such as structure-from-motion, which combines multiple photos to form a single image mosaic and to construct a 3-D digital model of the measurement target. However, the mosaicking of thermal images is challenging due to low lens resolution and weak contrast in the single thermal band. In this study, a novel method, referred to as four-band thermal mosaicking (FTM), was developed in order to process thermal images. The method stacks the thermal band obtained by a thermal camera onto the RGB bands acquired on the same flight by an RGB camera and mosaics the four bands simultaneously. An object-based calibration method is then used to eliminate inter-band positional errors. A UAV flight over a natural park was carried out in order to test the method. The results demonstrated that with the assistance of the high-resolution RGB bands, the method enabled successful and efficient thermal mosaicking. Transect analysis revealed an inter-band accuracy of 0.39 m or 0.68 times the ground pixel size of the thermal camera. A cluster analysis validated that the thermal mosaic captured the expected contrast of thermal properties between different surfaces within the scene.
The Impact of Occupational Tasks on Firefighter Hydration During a Live Structural Fire
Authors: Walker Adam , Pope Rodney , Schram Ben , Gorey Richard , Orr Robin
Published: June 2019

Structural firefighting is a highly stressful occupation with firefighters performing intense bouts of physical activity in environmental extremes while wearing impermeable, heavy and restrictive personal protective equipment. The aim of this study was to investigate the impact of performing occupational tasks during an active structural fire on firefighters’ hydration status. Nine fully qualified firefighters (mean ± SD age = 39.22 ± 7.89 years) completed a 15 min ‘live’ fire scenario while performing occupational tasks. Urine Specific Gravity (USG), body weight and tympanic membrane temperature were measured pre-scenario and at 0 and 20 min post-scenario. There was a significant decrease in body weight (0 min and 20 min p < 0.0005) and increase in tympanic membrane temperature (0 min and 20 min p < 0.0005) following the fire scenario. There was no significant change in USG post-scenario. Short duration firefighting operations can cause significant fluid loss, as measured by change in body weight but not necessarily USG.
Bad Witches: Gender and the Downfall of Elizabeth Holmes of Theranos and Disney’s Maleficent
Authors: Dundes Lauren , Buitelaar Madeline Streiff , Streiff Zachary
Published: June 2019

Female villains, both fictional and real, are subject to unconscious gender bias when part of their iniquity involves the disruption of male authority. Disney’s most popular animated villain, Maleficent, from Sleeping Beauty (1959) and Elizabeth Holmes of the now-disgraced blood testing startup, Theranos, reveled in their power, deviating from idealized feminine propriety. An analysis of scenes featuring Maleficent, the “mistress of all evil”, and coverage of Elizabeth Holmes, once the first self-made female billionaire, illustrate how powerful women with hubris are censured beyond their misdeeds. Elizabeth Holmes’ adoption of a deep voice and other masculine characteristics parallels Maleficent’s demeanor and appearance that signal female usurpation of traditional male power. Both antagonists also engage in finger pricking that penetrates the skin and draws blood, acts associated with symbolic male potency. The purported ability to bewitch, in conjunction with the adoption of patterns associated with male dominance, suggest that Maleficent and Elizabeth Holmes wield power over men and wield the power of men. Discomfort with the way in which magical powers were allegedly employed by these women echo historical fears of witches accused of appropriating male power. Furthermore, powerful women who encroach on male authority but ultimately fail to upend the gender hierarchy trigger schadenfreude beyond that expected from their wrongdoings. In the end, the stories of Maleficent and Elizabeth Holmes celebrate the downfall of women who brazenly embrace power, without showing women how to challenge the gender hierarchy.
“Boys ‘Round Here”: Masculine Life-Course Narratives in Contemporary Country Music
Authors: Pruitt Cenate
Published: June 2019

Country music remains one of the most popular genres in U.S. American society but is historically under-researched compared to rock, rap and other styles. This article extends the social science literature on the genre by examining themes of masculine identity in popular country hits of the current century. A content analysis of 35 top country hits from the last 15 years of the Billboard charts reveals three key masculine archetypes: the lover, the family man and particularly the country boy, which is the dominant masculine image within the last few years of the genre. Together, the three create a life-course narrative where the rambunctious country boy will eventually settle into monogamous heterosexual romance, with marriage and fatherhood presented as the ultimate achievement of successful manhood. A fourth, lesser, archetype, the roughneck, presents an “arrested development” version of the country boy, fully-grown but rejecting the social and familial responsibilities of the other archetypes. These narratives simultaneously challenge some aspects of hegemonic masculinity (urbanity, white-collar labor) while reinforcing others (whiteness, heterosexuality).
Ricin: An Ancient Story for a Timeless Plant Toxin
Authors: Polito Letizia , Bortolotti Massimo , Battelli Maria , Calafato Giulia , Bolognesi Andrea
Published: June 2019

The castor plant (Ricinus communis L.) has been known since time immemorial in traditional medicine in the pharmacopeia of Mediterranean and eastern ancient cultures. Moreover, it is still used in folk medicine worldwide. Castor bean has been mainly recommended as anti-inflammatory, anthelmintic, anti-bacterial, laxative, abortifacient, for wounds, ulcers, and many other indications. Many cases of human intoxication occurred accidentally or voluntarily with the ingestion of castor seeds or derivatives. Ricinus toxicity depends on several molecules, among them the most important is ricin, a protein belonging to the family of ribosome-inactivating proteins. Ricin is the most studied of this category of proteins and it is also known to the general public, having been used for several biocrimes. This manuscript intends to give the reader an overview of ricin, focusing on the historical path to the current knowledge on this protein. The main steps of ricin research are here reported, with particular regard to its enzymatic activity, structure, and cytotoxicity. Moreover, we discuss ricin toxicity for animals and humans, as well as the relation between bioterrorism and ricin and its impact on environmental toxicity. Ricin has also been used to develop immunotoxins for the elimination of unwanted cells, mainly cancer cells; some of these immunoconjugates gave promising results in clinical trials but also showed critical limitation.
Structure and Activity of a Cytosolic Ribosome-Inactivating Protein from Rice
Authors: De Zaeytijd Jeroen , Rougé Pierre , Smagghe Guy , Van Damme Els J.M.
Published: June 2019

Ribosome-inactivating proteins (RIPs) are cytotoxic enzymes that inhibit protein translation by depurinating ribosomal RNA. Although most plant RIPs are synthesized with leader sequences that sequester them away from the host ribosomes, several RIPs from cereals lack these signal peptides and therefore probably reside in the cytosol near the plant ribosomes. More than 30 RIP genes have been identified in the rice (Oryza sativa spp. japonica) genome, many of them lacking a signal peptide. This paper focuses on a presumed cytosolic type-1 RIP from rice, referred to as OsRIP1. Using 3D modeling it is shown that OsRIP1 structurally resembles other cereal RIPs and has an active site that meets the requirements for activity. Furthermore, localization studies indicate that OsRIP1-eGFP fusion proteins reside in the nucleocytoplasmic space when expressed in epidermal cells of Nicotiana benthamiana or Arabidopsis thaliana suspension cells. Finally, OsRIP1 was recombinantly produced in Escherichia coli and was demonstrated to possess catalytic activity. Interestingly, this recombinant RIP inactivates wheat ribosomes far less efficiently than rabbit ribosomes in an in vitro system. These findings raise some interesting questions concerning the mode of action and physiological role of OsRIP1. This is the first time a RIP from rice is investigated at protein level and is shown to possess biological activity.
Ocular Equivocation: The Rivalry Between Wheatstone and Brewster
Authors: Wade Nicholas J.
Published: June 2019

Ocular equivocation was the term given by Brewster in 1844 to binocular contour rivalry seen with Wheatstone’s stereoscope. The rivalries between Wheatstone and Brewster were personal as well as perceptual. In the 1830s, both Wheatstone and Brewster came to stereoscopic vision armed with their individual histories of research on vision. Brewster was an authority on physical optics and had devised the kaleidoscope; Wheatstone extended his research on audition to render acoustic patterns visible with his kaleidophone or phonic kaleidoscope. Both had written on subjective visual phenomena, a topic upon which they first clashed at the inaugural meeting of the British Association for the Advancement of Science in 1832 (the year Wheatstone made the first stereoscopes). Wheatstone published his account of the mirror stereoscope in 1838; Brewster’s initial reception of it was glowing but he later questioned Wheatstone’s priority. They both described investigations of binocular contour rivalry but their interpretations diverged. As was the case for stereoscopic vision, Wheatstone argued for central processing whereas Brewster’s analysis was peripheral and based on visible direction. Brewster’s lenticular stereoscope and binocular camera were described in 1849. They later clashed over Brewster’s claim that the Chimenti drawings were made for a 16th-century stereoscope. The rivalry between Wheatstone and Brewster is illustrated with anaglyphs that can be viewed with red/cyan glasses and in Universal Freeview format; they include rivalling ‘perceptual portraits’ as well as examples of the stimuli used to study ocular equivocation.
A Sensitivity Analysis of Simulated Infiltration Rates to Uncertain Discretization in the Moisture Content Domain
Authors: Liu Lulu , Yu Han
Published: June 2019

An unconditionally mass conservative hydrologic model proposed by Talbot and Ogden provides an effective and fast technique for estimating region-scale water infiltration. It discretizes soil moisture content into a proper but uncertain number of hydraulically interacting bins such that each bin represents a collection of pore sizes. To simulate rainfall-infiltration, a two-step alternating process runs until completion; and these two steps are surface water infiltration into bins and redistribution of inter-bin flow. Therefore, a nonlinear dynamical system in time is generated based on different bin front depths. In this study, using rigorous mathematical analysis first reveals that more bins can produce larger infiltration fluxes, and the overall flux variation is nonlinear with respect to the number of bins. It significantly implies that a greater variety of pore sizes produces a larger infiltration rate. An asymptotic analysis shows a finite change in infiltration rates for an infinite number of bins, which maximizes the heterogeneity of pore sizes. A corollary proves that the difference in the predicted infiltration rates using this model can be quantitatively bounded under a specific depth ratio of the deepest to the shallowest bin fronts. The theoretical results are demonstrated using numerical experiments in coarse and fine textured soils. Further studies will extend the analysis to the general selection of a suitable number of bins.
Key Aesthetic Appeal Concepts of Coastal Dunes and Forests on the Example of the Curonian Spit (Lithuania)
Authors: Urbis Arvydas , Povilanskas Ramūnas , Šimanauskienė Rasa , Taminskas Julius
Published: June 2019

The main objective of the study was to elicit key concepts determining the aesthetic appeal of coastal dunes and forests using the example of the Curonian Spit (Lithuania). The mixed approach included three methods: (1) paired comparison survey of 45 coastal landscapes, (2) semi-structured interviews with local inhabitants, and (3) eliciting the key aesthetic appeal concepts by a panel of experts using the Delphi technique. The results of the paired comparison survey show that the most aesthetically appealing landscapes of the Curonian Spit are: (1) white mobile dunes, (2) white dunes with grey (grassland) dunes in the background, and (3) grey dunes with white dunes in the background. The local inhabitants considered the concept of visual coherence as the best, explaining the aesthetic appeal of the dune and the forest landscapes on the spit. The experts of the Delphi survey considered that the concepts of stewardship, naturalness, imageability, and visual scale best define the scenic appeal. The appeal of the least attractive landscapes, in their opinion, was shaped by the concepts of naturalness, disturbance, and complexity. We conclude that the notions of visitors, local inhabitants and experts differ on the aesthetic appeal concepts of coastal dunes and forests, suggesting potential management conflicts.
Occupational therapy: an emerging role in primary care
Authors: Chamberlain Emily , Truman Juliette , Scallan Samantha , Lyon-Maris Johnny , Pike Amanda
Published: June 2019

Background

GPs in the UK are under significant pressure in delivering primary care and this has highlighted the need for workforce development. Occupational therapists (OTs) are highly skilled practitioners working across health and social care sectors. Educated at pre-registration level to work with physical and mental health issues, OTs can potentially provide valuable support to GPs. To date OTs are not routinely utilised within primary care. For over 10 years the University of Southampton OT Department has developed placements in a range of settings for students, but never previously in primary care.

Aim

The focus of this study was to determine whether role emerging placements in primary care enhanced the learning of OT students and to consider what can be learned about the role of occupational therapy in primary care.

Method

A case study approach was used to evaluate the project. Methods of data collection for this study included: observation of small group teaching sessions and end of placement interviews with students, educators, and members of the primary care teams involved in the placements.

Results

Analysis of the data indicates OT skills can be utilised in general practice in a number of ways, in certain areas, potentially saving face-to-face consultations with GPs.

Conclusion

OTs are an underutilised profession in frontline primary care. The role of OT has not been well researched as a ‘first point of contact’ healthcare professional in primary care. OTs’ broad training in mental health, physical frailty, and learning disabilities are potentially valuable to service delivery in general practice.
Medical students’ perceptions of a career in general practice
Authors: Banner Kimberley , Alberti Hugh , Stewart Jane
Published: June 2019

Background

Recruitment into general practice is falling and many training programmes in the UK have unfilled training posts. In 2016 NHS England pledged to increase the number of graduates entering GP training to 50%. However in 2017 only 15.3% of foundation year 2 doctors commenced general practice.

Aim

This work aims to understand medical students’ perceptions of a career in general practice, and how this may affect their career intentions.

Method

As part of a larger, longitudinal study at four UK universities. First and fourth year students were invited to a focus group to discuss their perceptions of a career in general practice. The recordings were transcribed and content analysis was performed.

Results

The perceptions discussed could be broadly grouped into three categories. ‘The GP’ highlighted students’ ideas of the GP as someone who was dedicated, could create rapport, and wanted a family life. The ‘Job of the GP’ indicated students were positive about the continuity of care the job offered, but felt the work was isolating and paperwork heavy. Finally, external factors such as denigration and the ‘GP land’ concept also had an impact on students’ perceptions.

Conclusion

Further work is needed to understand how these perceptions develop, how this may impact students career intentions, and how this research could be used to improve GP recruitment. This data will form part of a wider longitudinal study, the results of which will be analysed for themes and personal narratives of the students.
Investigating the impact of case-mix on general practice cancer diagnostic outcome indicators
Authors: Gildea Carolynn , Lyratzopoulos Georgios , McPhail Sean , Swann Ruth , Abel Gary
Published: June 2019

Background

The Cancer Services profiles report indicators of cancer diagnostic activity for all English general practices. A recent study reported that several indicators were dominated by chance, with some practice-level variation explained by the practice’s age-sex profile.

Aim

To assess the variation explained by patient-level case-mix and whether the practice age-sex profile adequately adjusts for this.

Method

Five indicators from Cancer Waiting Times (2016/17, 6050 practices) or Routes to Diagnosis (2015, 6355 practices) data were considered: Two Week Wait (TWW) conversion and detection rates, and emergency-, referred- and other-diagnosis proportions. Mixed-effect logistic regression adjusted for patient-level case-mix, using national cancer registration data on age, sex, deprivation, referral/cancer-type and, where possible, ethnicity and stage at diagnosis, with and without practice-level age-sex profile.

Results

Chance explained 60–85% of practice-level variation, with the combination of chance and patient-level case-mix explaining 75% (TWW conversion rate) to 89% (emergency diagnosis proportion). For TWW conversion rate, there was considerable overlap in the variance explained by practice- and patient-level factors. For the other indicators, practice- or patient-level factors were largely independent.

Conclusion

Chance is not synonymous with case-mix and is the dominant source of variation in single-year practice indicators. Therefore, we recommend the continued aggregation of data over multiple years. For most studied indicators, adjustment for the age-sex profile of the whole practice population is not a substitute for case-mix of individual cancer patients and so should not be used. Patient-level case-mix adjustment leads to a modest reordering of practices and so may not be a priority.
‘Just asking the question’: a qualitative study of health professionals’ experiences and perceptions of recording torture in vulnerable migrants in primary care settings
Authors: Whyatt Gemma , Cooper Max
Published: June 2019

Background

A large proportion of vulnerable migrants may be survivors of torture, with complex health needs as a result; yet there is a lack of guidance or understanding of how to identify and record signs of torture. Clinical professionals in primary care are in a unique position to care for and support this patient population.

Aim

The primary aim of this study was to explore the primary care context of how signs of torture could be better recorded to support patients and meet their needs.

Method

This was a qualitative research study conducted through remote interviews with health professionals from a range of clinical backgrounds and experience of working with survivors of torture.

Results

Twelve health professionals participated in the study, with results analysed using applied thematic analysis. Seven themes were identified, ranging from the barriers to asking about and disclosing torture, the underlying purpose of doing so, political factors affecting this issue and various ways to potentially improve recording torture.

Conclusion

Before clinical professionals can record torture, they must first ask the patient about it as survivors are unlikely to raise the topic themselves. Many clinical professionals lack the awareness or confidence to do this, thereby warranting further discussion on strategies to educate clinical professionals about torture. Accessible guidance and a simple, systematic method to identify survivors of torture which is suitable for a primary care setting is necessary, with suggestions for further research including routine enquiry and targeted screening.
Plugging in the safety gaps: an exploration of patients’ attitudes towards an integrative approach to gathering safety information via Electronic Health Records (EHRs)
Authors: Albutt Abigail , Louch Gemma , O’Hara Jane , Shire Katy , Khatoon Binish
Published: June 2019

Background

It is now widely accepted that patients can meaningfully provide feedback on the safety of their care, and recent efforts have concentrated on novel ways of gathering this feedback. Increasingly, patients are encouraged to access their electronic health record (EHR), with access associated with improved patient satisfaction and enhanced patient safety through identifying medication errors.

Aim

With a view to developing a novel intervention to gather safety information from patients in primary care, this study aimed to explore patients’ views on the feasibility and acceptability of inputting feedback on care experiences directly into their EHR.

Method

A qualitative design and opportunity sampling strategy was used. Fifteen primary care users participated in semi-structured interviews which focused on inputting feedback into EHRs. Thematic analysis was utilised to analyse transcribed interviews.

Results

The majority of participants were interested in viewing their EHR and felt they would benefit from providing feedback about their care experiences directly into their EHR. Three key themes were identified: monitoring EHR for improvement; security of EHR; and centralising EHR across care settings. Specific barriers and levers were recognised within each theme.

Conclusion

Allowing patients to have access to their EHR has the potential to improve patient experience and safety from a primary care user perspective. Nevertheless, there are barriers to consider such as, potential to increase staff workload as additional capacity may be required to interpret and act on feedback to produce service improvements.
Fertility awareness based contraceptive apps: a case study in the digital age
Authors: Shemtob Lara , Littlewood Rebecca
Published: June 2019

Background

Fertility awareness based (FAB) contraceptive mobile applications (apps) rely on women logging their menstrual cycle data to predict non-fertile days. Paid social media advertisements for these apps have led to hundreds of thousands of downloads. This rapidly expanding market lacks quality assurance, reflective of wider issues surrounding innovation versus regulation of digital health interventions.

Aim

To present the results of a literature review carried out to bring together data on FAB contraceptive apps, to better understand the validity of evidence for their use as contraceptive methods. This is combined with context on the climate of advertising and regulation, to illustrate the challenges of innovation in the digital age.

Method

Databases Medline and Embase were searched according to the strategy: ‘fertility-based awareness AND app*’. Eight articles were included in the final thematic analysis.

Results

This study found apps being used for contraception that were not developed for this purpose; apps inaccurately reporting reliability for preventing pregnancy; there is a need for further training for women using FAB contraceptive apps; and there are limitations of current evidence base and challenges to improving this. In the context of poor regulation and advertising loop holes there is significant risk of misleading users of FAB contraceptive apps.

Conclusion

The limited evidence on FAB contraceptive apps should be applied to the public with caution. Incongruities between women’s understanding and expectations of FAB apps compared to reality demonstrate the need for robust regulation around paid advertising, issues echoed elsewhere with other digital health interventions.
How the Health and Social Care Act 2012 has affected commissioning of mental health in England
Authors: Patel Alisha
Published: June 2019

Background

NHS mental health services are under pressure due to chronic underfunding and constrained resources. The Health & Social Care Act implemented an extensive restructure of the NHS and introduced three new legal duties: duty to arrange, promote competition, and integrate services.

Aim

To establish how the Health and Social Care Act 2012 affected commissioning of mental health services in England and how the duties are being fulfilled.

Method

Freedom of Information (FOI) requests were sent to all 211 clinical commissioning groups in England. The number, value, and length of all contracts for mental health services were requested from 2013 to 2016 by type and name of provider; as well as a range of quality and performance data.

Results

The FOI received a 93% response rate. CCGs commissioned between 1–127 contracts each: 65.3% of all contracts were awarded to the third sector (private for profit, not for profit, and voluntary organisations), amounting to 6% of the total value of contracts commissioned. NHS foundation trusts were awarded 25% of contracts, worth 70% of the total value of contracts. 71% of contracts had no evidence of quality monitoring.

Conclusion

The high volume and low value of contracts commissioned to third sector organisations fulfils the new duty to arrange but not to integrate; showing considerable fragmentation of mental health provision. The emerging external market is a result of the Health & Social Care Act promoting diversification of the provider market. Finally, the lack of quality and performance data raises concerns over the transparency and accountability of an NHS that is increasingly being provided by companies.
The outcomes of triaging rheumatology referrals at a single point of access
Authors: Forgie Bethan , Mallett Lisa , Pritchard Helen , Turner Lauren
Published: June 2019

Background

East Surrey Clinical Commissioning Group established a musculoskeletal triage service for primary care referrals in December 2017 in order to reduce pressure on secondary care.

Aim

To analyse the processing of rheumatology referrals through the single point of access.

Method

A total of 158 referrals over an 8-month period were triaged, 50 of which had available final outcome data. Using a standardised form for GPs, data including initial GP diagnosis, appropriateness for secondary care, any requirement for additional information, relevant blood tests needed before the appointment, and if the patient could be seen by a GP with an extended role in rheumatology were recorded. The resultant rheumatological diagnosis from secondary care was recorded.

Results

Of 158 referrals, 86% were triaged to secondary care, the remainder were referred back to primary care or an alternative healthcare professional. Additional information from the EMIS record was added to 67% of all referrals and additional blood tests were requested in 26%. Of the 50 patients with outcome data, 40% were thought to have non-inflammatory conditions and could be seen in the community setting; this was confirmed in 85% after rheumatology assessment. The most frequent diagnosis in this group was fibromyalgia. Where an inflammatory condition was suspected by the referrer this was confirmed in 68%.

Conclusion

A significant number of referrals could be seen by a specialist GP in a community setting, the biggest single sub-set of these patients have chronic non-inflammatory pain. The provision of community GP-led rheumatology clinics could improve patient experience, reduce costs, and reduce the burden on secondary care.
Does applicant specialty ambition influence medical school choice?
Authors: Rees Eliot , Harrison David , Mattick Karen , Woolf Katherine
Published: June 2019

Background

The NHS is critically short of doctors. The sustainability of the UK medical workforce depends on medical schools producing more future GPs who are able and willing to care for under-served patient populations. The evidence for how medical schools should achieve this is scarce. We know medical schools vary in how they attract, select, and educate future doctors. We know some medical schools produce more GPs, but it is uncertain whether those school recruit more students who are interested in general practice.

Aim

This study seeks to explore how applicants’ future speciality ambitions influence their choice of medical school.

Method

One-to-one semi-structured interviews and focus groups were conducted with medical applicants and first year medical students at eight medical schools around the UK. Interviews were audiorecorded and transcribed verbatim. Transcripts were analysed through thematic analysis by one researcher. A sample of 20% of transcripts were analysed by a second researcher.

Results

Sixty-six individuals participated in 61 individual interviews and one focus group. Interviews lasted a mean of 54 minutes (range 22–113). Twelve expressed interest in general practice, 40 favoured other specialities, and 14 were unsure. Participants’ priorities varied by speciality aspiration; those interested in general practice described favouring medical schools with early clinical experience and problem-based learning curricula, and were less concerned with cadaveric dissection and the prestige of the medical school.

Conclusion

Many applicants consider future speciality ambitions before applying to medical school. Speciality aspiration appears to influence priority of medical schools’ attributes.
The Royal College of General Practitioners (RCGP) quality improvement initiative using Clinical Practice Research Datalink (CPRD) data: Lessons learned
Authors: Booth Helen , Yelland Eleanor , Mullett David , Gallagher Arlene , Padmanabhan Shivani , Welburn Stephen , Valentine Janet , Myles Puja
Published: June 2019

Background

Quality improvement (QI) is a priority for general practice, and GPs are expected to participate and provide evidence of QI activity. Pressures on the primary care workforce require approaches to QI to prioritise efficiency and effectiveness.

Aim

This project aimed generate and scale up bespoke QI reports for GP practices contributing data to CPRD.

Method

CPRD is a UK government research service facilitating public health research using anonymised primary care data. A pilot report was designed with stakeholders and covered two indicators from the RCGP Patient Safety Toolkit. The reports enabled GPs to identify patients needing case review and to benchmark data on practice-level prescribing. Reports for 12 practices, containing real patient data, were sent to GPs and feedback was obtained via interviews. The report was scaled up to 457 practices and a survey sent out to request feedback.

Results

GPs used the reports to review the care of individual patients, and to implement QI actions such as adding flags to patients notes. One participant used the report as evidence for their annual appraisal. Survey response was limited (n = 31.7%) but overwhelmingly positive. Responders highlighted the importance of clinical input when developing indicators and ensuring the tone of the reports is supportive.

Conclusion

The collaborative RCGP/CPRD QI reports are unique in their ability to provide benchmarking and case-finding on a national scale. The indicators selected must lead to actionable reports. Clinical input is required to ensure code lists are appropriate and that reports are clinically relevant. CPRD aims to send out two reports annually.
Досвід українців східної галичини у побудові системи місцевого самоврядування (кінець ХІХ – початок ХХ ст.)
Authors: Панфілова Т. О.
Published: June 2019

Висвітлено складні події кінця ХІХ – початку ХХ ст., які відбувалися на теренах Східної Галичини. Йдеться про процеси, що стосуються історичного досвіду українців у побудові системи місцевого самоврядування, формування Галицького Крайового Сейму, міських, сільських органів виконавчої влади, про вічовий рух за загальне виборче право як важливий етап боротьби за становлення структур громадянського суспільства. Проаналізовано перспективи українського державoтвoрення початку ХХ ст., які переконливо вказують на наявність і готовність українства власними силами будувати кооперацію, банківську та кредитну справу, а також необхідні управлінські структури, які наприкінці ХІХ – початку ХХ ст. вражали бажанням змін і давали приклад українцям по інший бік Дніпра.
Підвищення ефективності системи державного управління при приведенні у вищі ступені бойової готовності сил оборони за рахунок резервного контуру оповіщення
Authors: Устименко О. В.
Published: June 2019

Розглянуто вдосконалену модель системи приведення у вищі ступені бойової готовності сил оборони, що враховує додатковий, резервний, контур оповіщення на базі системи ситуаційних центрів державних органів, що належать до сектору безпеки і оборони, варіант блок-схеми та алгоритм функціонування системи приведення у вищі ступені бойової готовності Збройних сил України (далі – ЗС України). Критерієм підвищення ефективності системи приведення у вищі ступені бойової готовності визначено виграш у часі доведення сигналу до підрозділів і частин ЗС України. За результатами аналізу алгоритму функціонування системи приведення у вищі ступені бойової готовності ЗС України доведено, що ефективність системи, у разі використання резервного контуру оповіщення, підвищується.
Сутність та особливості здійснення митного контролю
Authors: Товт В. М.
Published: June 2019

Розглянуто сутність та особливості здійснення митного контролю. Здійснено оцінку підходів науковців до розуміння сутності контролю та митного контролю. Досліджено особливості здійснення митного контролю в сучасних умовах та його ознаки. Проаналізовано основні елементи митного контролю та їх взаємозв’язок.
Прогнозування змін чисельності економічно активного населення в районах Львівської області
Authors: Матвіїшин Є. Г.
Published: June 2019

Запропоновано методику прогнозування змін структури населення районів. Застосовано підхід, що ґрунтується на аналізі змін 5-річних когорт. Зроблено порівняння районів Львівської області за змінами чисельності населення віком від 15 до 70 років.
Державна політика розвитку механізмів саморегулювання в сфері соціально-економічних відносин у будівництві
Authors: Марушева О. А.
Published: June 2019

Акцентовано увагу на актуальності питання формування ефективного механізму саморегулювання в сфері соціально-економічних відносин у будівництві, що потребує здійснення аналізу наукових досліджень та дасть змогу формувати альтернативні рішення, беручи до уваги міжнародний досвід. Узагальнено інформаційні ресурси, що представляють наукові розробки вітчизняних і закордонних вчених. Визначено сутність міжнародних підходів до формування і реалізації механізмів саморегулювання в сфері соціально-економічних відносин у будівництві. Вказано на необхідність свідомої передачі державою частини функцій із нормативно-правового регулювання соціально-економічних відносин у будівництві недержавному сектору. Зазначено, що у Німеччині, Великобританії, США саме саморегулюючим організаціям належать функції з ліцензійного забезпечення господарської діяльності, яка пов’язана зі створенням будівель та споруд, проведенням професійної атестації. Зауважено, що таку процедуру професійної атестації проходять архітектори, інженери-проектувальники, інженери технічного нагляду та експерти, що дає змогу врегулювати допуск на ринок цих категорій осіб тощо. Доведено, що зазначені організації (т. зв. палати) володіють певними владними повноваженнями, що, як правило, є монопольними повноваженнями держави. Обґрунтовано, що для впровадження світових тенденцій та підтримки напряму подальшого роздержавлення національної системи нормативно-правового регулювання соціально-економічних відносин у галузі будівництва необхідно посилити інституційну спроможність організацій саморегулювання та удосконалити законодавче підґрунтя, щоб мати можливість впровадити європейські та кращі світові моделі його організаційної структури.
Etnografia de arquivos e sociologia reflexiva
Authors: Sorá Gustavo
Published: June 2019

O objetivo deste trabalho é refl etir sobre parâmetros metodológicos para a pesquisa em arquivos de agentes ligados à confi guração da cultura escrita. Nos últimos anos, o “aparecimento” de arquivos de editoras deu lugar a certa euforia e projetos para reuni-los e disponibilizá-los para estudo. O encantamento que parece derivar dessas valiosas ações pode conduzir à naturalização dos acervos editoriais como um passo evidente do assentamento de um campo de pesquisas de recente formação. Contra esse mágico perigo, o aproveitamento dos seus conteúdos surge ao aplicar a dúvida metódica sobre os arquivos como espaços de pesquisa: como, quando, onde surgem essas reservas documentais? Qual é sua especifi cidade e de que modo exigem esquemas de interpretação apropriados? Algumas destas questões são pensadas na objetivação da minha própria relação de pesquisa com os arquivos da editora José Olympio. Através desse exercício apresento a história desse arquivo e as suas possibilidades de existência em diversos momentos da trajetória desta empresa-cultural. Entre outros aspectos, analiso a evolução e dispersão do arquivo; os usos que o próprio José Olympio fez dos documentos do arquivo como emblemas de grandeza cultural e os diferentes estados desse arquivo não como uma coleção de documentos, mas como um espaço social, quero dizer, como um fato produzido pela ação humana e defi nido a partir das práticas e dos interesses específi cos daqueles que podemos chamar de guardiões do arquivo e da memória de um âmbito social.
Memórias do Rio Doce
Authors: Campos Adriana Pereira , Rodrigues Jaime
Published: June 2019

x
Aplicação da ferramenta de aprimoramento de imagens DStretch® em sítios rupestres
Authors: Guedes Carolina
Published: June 2019

O sítio rupestre Bom Nome IV, pesquisado em 2009 apresentou um baixo estado de conservação, sendo constantemente afetado por bioturbações. Esse fato, invariavelmente, levou à degradação das pinturas, que se apresentaram de forma vestigial, dificultando a leitura completa e a compreensão do painel rupestre como um todo. Através da utilização do software de aprimoramento de imagens DStretch® que destacou traços e pigmentos anteriormente invisíveis ao olho humano, pode ser realizada uma releitura do painel, gerando novos dados. Utilizada pelos pesquisadores que atuam nas diversas áreas rupestres espalhadas pelos continentes, essa ferramenta é uma das mais eficazes no pós-processamento e tratamento dos dados obtidos em sítio. Além disso, é a mais eficaz no aprimoramento de imagens rupestres vestigiais. Nesse artigo apresento a aplicação dessa ferramenta no sítio rupestre Bom Nome IV, localizado no município de Pão de Açúcar, no sertão alagoano, demonstrando sua alta eficácia para a releitura dos grafismos que foram registrados nas pesquisas arqueológicas de 2009 bem como na identificação de registros inéditos.
O Acervo de prontuários do Manicômio Judiciário do Estado de São Paulo (1903- 1930)
Authors: Rodrigues Jaime , Miranda Marcia Eckert , Botelho Denilson
Published: June 2019

x
O tabelião e a escrava
Authors: Seabra Ricardo
Published: June 2019

O carácter transversal da escravatura na sociedade portuguesa do período moderno já tem sido alvo de estudo. Todavia, existem menos referências que nos permitam debruçar sobre essa matéria na Idade Média. Ao realizarmos uma investigação sobre o tema do tabelionado régio na cidade do Porto (Portugal), uma cidade portuária de elevada importância para o comércio do reino português, levantamos cerca de 1400 actos notariais distribuídos por vários arquivos portugueses, para um período compreendido entre os séculos XIII e XV, dos quais apenas um menciona uma escrava. O interesse acrescido deste documento não se limita ao seu cariz de excepção quanto mais nos aproxima da escravatura numa vertente comercial e doméstica.