The child, the family and the GP: tensions and conflicts of interest for GPs in safeguarding children May 2006-October 2008 Executive summary May 2009 and Research Brief March 2010

This Executive Summary and Research Brief provide an overview of a research project (full report available on the repository) exploring the key role identified for GPs in safeguarding children. The initial focus of this research was to investigate potential ‘conflicts of interest’ where parents and children were both patients of the GP and to identify strategies for managing these conflicts. In response to initial feedback from the piloting of research tools, the focus of the research was broadened to explore and understand the range of conflicts, interests and tensions that might constrain the participation and engagement of GPs in safeguarding children and child protection processes, and the complexity of relationships between GPs, parents and children, and other professionals. A summary of the study methods, strengths and limitations and key findings is provided, together with messages for policy, research and practice

Invited Panel: Evidence Based Practice (EBP) – The Problem and Challenges, The Need within IS research and practice, Open Access Publishing.

Launch of the ‘Journal for Evidence Based Information Systems’ (EBIS): An open access journal for IS researchers and practitioners – An independent journal in association with the UKAI

Sleep duration and risk of fatal and nonfatal stroke : a prospective study and meta-analysis

Objective: To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. Methods: The prospective study included 9,692 stroke-free participants aged 42-81 years from the European Prospective Investigation into Cancer-Norfolk cohort. Participants reported sleep duration in 1998-2000 and 2002-2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. Results: After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. Conclusions: This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population

Daytime napping, sleep duration and serum C reactive protein: a population-based cohort study.

OBJECTIVES: To explore whether daytime napping and sleep duration are linked to serum C reactive protein (CRP), a pro-inflammatory marker, in an older aged British population. DESIGN: Cross-sectional study. SETTING: European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study. PARTICIPANTS: A total of 5018 men and women aged 48-92 years reported their sleep habits and had serum CRP levels measured. OUTCOME AND MEASURES: CRP was measured (mg/L) during 2006-2011 in fresh blood samples using high-sensitivity methods. Participants reported napping habits during 2002-2004, and reported sleep quantity during 2006-2007. Multivariable linear regression models were used to examine the association between napping and log-transformed CRP, and geometric mean CRP levels were calculated. RESULTS: After adjustment for age and sex, those who reported napping had 10% higher CRP levels compared with those not napping. The association was attenuated but remained borderline significant (β=0.05 (95% CI 0.00 to 0.10)) after further adjustment for social class, education, marital status, body mass index, physical activity, smoking, alcohol intake, self-reported health, pre-existing diseases, systolic blood pressure, hypnotic drug use, depression and in women-only hormone replacement therapy use. The geometric means (95% CI) of CRP levels were 2.38 (2.29 to 2.47) mg/L and 2.26 (2.21 to 2.32) mg/L for those who reported napping and no napping, respectively. A U-shaped association was observed between time spent in bed at night and CRP levels, and nighttime sleep duration was not associated with serum CRP levels. The association between napping and CRP was stronger for older participants, and among extremes of time spent in bed at night. CONCLUSIONS: Daytime napping was associated with increased CRP levels in an older aged British population. Further studies are needed to determine whether daytime napping is a cause for systemic inflammation, or if it is a symptom or consequence of underlying health problems.The design and conduct of the EPIC-Norfolk study and collection and management of the data was supported by programme grants from the Medical Research Council UK (G9502233, G0300128) and Cancer Research UK (C865/A2883). YL is supported by the Cambridge Overseas Trust. FPC leads the Sleep Health & Society Programme at the University of Warwick supported, in part, by the University of Warwick RDF and IAS. It has received funding by the NHS National Workforce Projects and the Economic & Social Research Council (ES/K002910/1).This is the final version. It was first published by BMJ Group at http://bmjopen.bmj.com/content/4/11/e006071.full

Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis.

OBJECTIVE: To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. METHODS: The prospective study included 9,692 stroke-free participants aged 42-81 years from the European Prospective Investigation into Cancer-Norfolk cohort. Participants reported sleep duration in 1998-2000 and 2002-2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. RESULTS: After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. CONCLUSIONS: This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population.The design and conduct of the EPIC-Norfolk study was supported by program grants from the Medical Research Council of the United Kingdom (grants G9502233 and G1000143) and Cancer Research UK (grants SP2024/0204 and C864/A14136). Ms. Leng is supported by Cambridge Commonwealth, European & International Trusts. Prof. Cappuccio leads the Sleep Health & Society Programme at the University of Warwick supported, in part, by the University of Warwick RDF and IAS. It has received funding by the NHS National Workforce Projects and the Economic & Social Research Council (ES/K002910/1).This is the final published version. It first appeared at http://www.neurology.org/content/early/2015/02/25/WNL.0000000000001371.short

SCOPE New Photographic Practices

The photographic practices brought together for this exhibition and publication provide a broad scope of how photographic and lens based media may be used in order to have a visceral and conceptual impact. The methods on show demonstrate the way that artists might pick and choose from the approaches, processes and debates that have arisen through the medium’s history. This collection of work features film, video and photography that demand a renegotiation of the relationship between camera, subject and viewer. Visual Art Centre Gallery, Tsinghua University, Beijing, Chin

Through the looking glass: public and professional perspectives on patient-centred professionalism in modern-day community pharmacy

This paper presents five consultation workshops with 29 community pharmacists, stakeholders and patients that examined "patient-centred professionalism" in terms of pharmacists' working day and environment. The concept is ill-defined in both medical and pharmacy literature and the study aimed to clarify the situated nature of the term for patients and health professionals across settings. Workshops were supported by bio-photographic datasets of "in-situ" practice and Nominal Group Work. The thematic content analyses led to the following aspects: building caring relationships; managing external forces; the effects of space and environment, and different roles and expectations. The study reveals how patient-centred professionalism cannot be defined in any singular or stationary sense, but should be seen as a "moveable feast", best understood through everyday examples of practice and interaction, in relation to whose experience is being expressed, and whose needs considered. The phrase is being mobilised by a whole set of interests and stakeholders to reshape practice, the effect of which remains both uncertain and contested. Whilst patients prioritise a quick and efficient dispensing service from knowledgeable pharmacists, pharmacists rail against increasing public demands and overtly formalised consultations that take them away from the dispensary where the defining aspects of their professionalism lie. URN: urn:nbn:de:0114-fqs100177Unser Beitrag stellt die Ergebnisse aus insgesamt fünf Workshops mit 29 Apotheker/innen, Patient/innen und weiteren Akteuren vor, die sich mit "Patient/innen-zentrierter Versorgung" in der Alltagsarbeit und -umgebung von Apotheker/innen befassten. Dieses Konzept ist in der relevanten Literatur nur ungenügend definiert, und ein Ziel der Studie war, dessen situativen Charakter für Patient/innen und im Gesundheitssystem Tätige zu präzisieren. In den Workshops kamen Fotografien aus der Alltagspraxis und spezifische Gruppenarbeitsverfahren zum Einsatz. Im Beitrag werden nach einer Information über die Teilnehmenden die Ergebnisse der thematischen Inhaltsanalyse zusammengefasst, die die folgenden Schwerpunkte erbrachte: Aufbau von Beziehungen mit Patient/innen, Umgang mit externen Einflussgrößen, (räumliche) Umgebungseffekte und Unterschiedlichkeit von Rollen und Erwartungen. Die Ergebnisse zeigen, dass "Patient/innen-zentrierte Versorgung" nicht in einer singulären oder statischen Weise definiert werden kann, sondern am besten nachvollziehbar ist entlang von Beispielen aus der Alltagspraxis und von Alltagsinteraktionen, abhängig davon, wessen Erfahrungen ausgedrückt und wessen Bedürfnisse im Fokus stehen sollen. Dieses Verständnis trifft für eine Vielzahl an Interessen und Akteuren zu, um Praxis zu rekonzeptualisieren, die zugleich auch fragil und strittig ist: Während Patient/innen möglichst schnelle und effektive Dienstleistungen von sachkundigen Apotheker/innen erwarten, wenden diese sich gegen wachsende öffentliche Ansprüche und zunehmend formalisierte Beratungen, die sie von der Art von Arbeit entfernen, die Kern ihrer professionellen Identität ist. URN: urn:nbn:de:0114-fqs100177Este documento presenta cinco talleres de consulta con 29 farmacéuticos comunitarios, los promotores y los pacientes que examinaron "el profesionalismo centrado en el paciente" en términos de jornada de trabajo de los farmacéuticos y el medio ambiente. El concepto está mal definido, tanto en la literatura médica y farmacéutica, y el estudio tuvo como objetivo aclarar la naturaleza situada del término en los pacientes y en los profesionales de la salud en diferentes contextos. Los talleres fueron apoyados por conjuntos de datos bio-fotográficas de la práctica "in-situ" y el Grupo Nominal de Trabajo. El análisis de contenido temático c a los siguientes aspectos: creación de relaciones afectuosas; gestión de fuerzas externas; los efectos del espacio y el medio ambiente, y roles y expectativas diferentes. El estudio revela cómo el profesionalismo centrado en el paciente no puede definirse en un sentido singular o estacional, pero debe ser visto como “fiesta ambulante”, mejor entendida a través de ejemplos de la vida diaria y la interacción, en relación con cuya experiencia se expresa, y cuyas necesidades considera. La frase está siendo movilizada por un juego entero de intereses y de los promotores para reformar la práctica, el efecto del cual sigue siendo incierto y puesto en debate. Mientras los pacientes priorizan un servicio de distribución rápido y eficiente de parte de farmacéuticos bien informados, los farmacéuticos critican severamente las crecientes demandas públicas y abiertamente formalizan consultas que se los llevan lejos del dispensario donde radican los aspectos de definición de su profesionalismo. URN: urn:nbn:de:0114-fqs10017

Decline of a rare moth at its last known English site : causes and lessons for conservation

The conditions required by rare species are often only approximately known. Monitoring such species over time can help refine management of their protected areas. We report population trends of a rare moth, the Dark Bordered Beauty Epione vespertaria (Linnaeus, 1767) (Lepidoptera: Geometridae) at its last known English site on a protected lowland heath, and those of its host-plant, Salix repens (L.) (Malpighiales: Salicaceae). Between 2007 and 2014, adult moth density reduced by an average of 30-35% annually over the monitored area, and its range over the monitored area contracted in concert. By comparing data from before this decline (2005) with data taken in 2013, we show that the density of host-plants over the monitored area reduced three-fold overall, and ten-fold in the areas of highest host-plant density. In addition, plants were significantly smaller in 2013. In 2005, moth larvae tended to be found on plants that were significantly larger than average at the time. By 2013, far fewer plants were of an equivalent size. This suggests that the rapid decline of the moth population coincides with, and is likely driven by, changes in the hostplant population. Why the host-plant population has changed remains less certain, but fire, frost damage and grazing damage have probably contributed. It is likely that a reduction in grazing pressure in parts of the site would aid host-plant recovery, although grazing remains an important site management activity. Our work confirms the value of constant monitoring of rare or priority insect species, of the risks posed to species with few populations even when their populations are large, of the potential conflict between bespoke management for species and generic management of habitats, and hence the value of refining our knowledge of rare species' requirements so that their needs can be incorporated into the management of protected areas

NGC 2770 - a supernova Ib factory?

NGC 2770 has been the host of three supernovae of Type Ib during the last 10 years, SN 1999eh, SN 2007uy and SN 2008D. SN 2008D attracted special attention due to the serendipitous discovery of an associated X-ray transient. In this paper, we study the properties of NGC 2770 and specifically the three SN sites to investigate whether this galaxy is in any way peculiar to cause a high frequency of SNe Ib. We model the global SED of the galaxy from broadband data and derive a star-formation and SN rate comparable to the values of the Milky Way. We further study the galaxy using longslit spectroscopy covering the major axis and the three SN sites. From the spectroscopic study we find subsolar metallicities for the SN sites, a high extinction and a moderate star-formation rate. In a high resolution spectrum, we also detect diffuse interstellar bands in the line-of-sight towards SN 2008. A comparison of NGC 2770 to the global properties of a galaxy sample with high SN occurance (at least 3 SN in the last 100 years) suggests that NGC 2770 is not particularly destined to produce such an enhancement of observed SNe observed. Its properties are also very different from gamma-ray burst host galaxies. Statistical considerations on SN Ib detection rates give a probability of ~1.5% to find a galaxy with three Ib SNe detected in 10 years. The high number of rare Ib SNe in this galaxy is therefore likely to be a coincidence rather than special properties of the galaxy itself. NGC 2770 has a small irregular companion, NGC 2770B, which is highly starforming, has a very low mass and one of the lowest metallicities detected in the nearby universe as derived from longslit spectroscopy. In the most metal poor part, we even detect Wolf-Rayet features, against the current models of WR stars which require high metallicities.Comment: 15 pages, 10 figures, submitted to Ap