Proper general decomposition (PGD) for the resolution of Navier–Stokes equations

In this work, the PGD method will be considered for solving some problems of fluid mechanics by looking for the solution as a sum of tensor product functions. In the first stage, the equations of Stokes and Burgers will be solved. Then, we will solve the Navier–Stokes problem in the case of the lid-driven cavity for different Reynolds numbers (Re = 100, 1000 and 10,000). Finally, the PGD method will be compared to the standard resolution technique, both in terms of CPU time and accuracy.Région Poitou-Charente

Enhancing the quality and safety of care through training generalist doctors: a longitudinal, mixed-methods study of a UK broad-based training programme

Objective Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service. Setting and participants We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9). Results From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees’ ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients’ psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated. Conclusions Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to training support the development of generalist doctors, which is well-suited to a changing health service

'Black sheep in the herd'? The role, status and identity of generalist doctors in secondary care

Changing patient demographics raise important challenges for healthcare providers around the world. Medical generalists can help to bridge gaps in existing healthcare provision. Various approaches to medical generalism can be identified, for example hospitalists in the US and the restructuring of care away from medical disciplines in the Netherlands, which have different implications for training and service provision. Drawing on international debates around the definition and role of generalism, this paper explores one manifestation of generalism in the UK in order to understand how abstract ideas work in practice and some of the benefits and challenges. Broad-based training (BBT) is a two-year postgraduate training programme for doctors recently piloted in England. The programme provided 6-month placements in four specialties (General Practice, Core Medicine, Psychiatry and Paediatrics) and aimed to develop broad-based practitioners adept at managing complex and specialty integration. Our longitudinal, mixed-methods evaluation of the programme demonstrates that although trainees value becoming more holistic in their medical practice, they also raise concerns about being perceived differently by co-workers, and report feeling isolated. Using identity theory to explore the interplay between generalism and existing boundaries of professionalism in healthcare provision, we argue that professional identity, based on disciplinary structure and maintained by boundary work, troubles identity formation for generalist trainees who transcend normative disciplinary boundaries. We conclude that it is important to address these challenges if generalism in secondary care settings is to realise its potential contribution to meeting increasing health service demands

Resources Annotation, Retrieval and Presentation: a semantic annotation management system

International audienceThis paper addresses the problem of the management of resources metadata. A variety of responses are discussed, and we describe one possible way forward, which uses a semantic annotation management tool. The term 'semantic' describes the ability to create, retrieve, query and navigate knowledgeably about things identified by a Web URI. The support for this semantic tool is RDF, through the integration of Jena, an open-source RDF API provided by HP laboratory. Thanks to RDF capabilities, this tool offers new search features such as hierarchical browsing based on the structure of RDF vocabularies and faceted-browsing using properties lists defined by the end-user. The navigation inside annotations uses intuitive modes such as left/right and backward/forward movements. Presentation is controlled by the user using a subset of the Fresnel language to specify how RDF graphs are presented. This work is ongoing; certain open issues are raised

‘It's surprising how differently they treat you’: a qualitative analysis of trainee reflections on a new programme for generalist doctors

Objectives An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences. Setting 9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex. Participants Focus group participants (61 in total) from the first and second cohorts of BBT. Results Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity. Conclusions By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of ‘belongingness’ to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision

Feasibility analysis and simulation of reverse electrodialysis for the regeneration of power in desalination plants

This document presents a multi-faceted parametric review on the reverse electrodialysis process regarding ideal and real feed solutions. A hybrid forward osmosis - reverse electrodialysis model is presented for the optimal utilisation of desalination brine effluent for electrical power generation. The power generated is recommended to offset the high energy requirements of seawater reverse osmosis desalination due to relative proximity of brine. The proposed large scale reverse electrodialysis plant has the potential to minimise both capital and operating expenditure of an up-scaled system while maximising net power output. A multi-variable optimisation of the process is achieved using the simulation model derived within the study, concluding with a 10.3% reduction in the specific energy consumption of Perth’s Seawater Desalination Plant located in Kwinana when utilising a series-parallel arrangement of reverse electrodialysis units. However, the model is not specific to a Western Australian context and can be used wherever an opportunity for salinity gradient power generation exists

Complementary and Alternative Therapy among American Indians Suffering from Depression and Anxiety

The American Indian population shows the highest percent of lifetime major depression at 19.17 percent compared to other ethnic groups in the United States. Anxiety among American Indians is ten times higher than other ethnic groups. Because of these statistics, American Indians also have a suicide rate that is 1.5 times higher than the national average. Unfortunately, due to a lack of funding and qualified health care provides for American Indians, improper and insufficient diagnosing and treatment for these diseases causes burden for suffers and their families. Several studies suggest that American Indians are the highest users of complementary and alternative medicine (CAM) in the United States. Using CAM as an alternative to Western medicine could help decrease the prevalence and lifetime suffering of depression and anxiety especially if they used traditional American Indian healing ceremonies. A literature review was conducted to find out what CAM therapies may be used to treat depression and anxiety. Scant research has been done involving American Indians sufferers with depression and anxiety. There is also a tack of research involving Traditional American Indian healing ceremonies as a possible CAM therapy. This report discusses the significance, literature review, conclusions and recommendations of the finding