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Objectives Glucocorticoids (GCs) ('steroids') are used to treat rheumatic diseases but adverse effects are common. We aimed to explore the impact of GC therapy on health-related quality of life (HRQoL), to inform the development of a treatment-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. Methods Semi-structured qualitative interviews were conducted with patients from the UK, USA and Australia, treated for a rheumatic condition with GCs in the last 2 years. Purposive sampling was used to select participants with a range of demographic and disease features. An initial conceptual framework informed interview prompts and cues. Interviews elicited GC-related physical and psychological symptoms and salient aspects of HRQoL in relation to GC therapy. Interview data were analysed inductively to develop initial individual themes and domains. Candidate questionnaire items were developed and refined. Results Sixty semi-structured qualitative interviews were conducted (UK n  = 34, USA n  = 10, Australia n  = 16). The mean age was 58 years; 39/60 were female; and 18 rheumatic diseases were represented. Some 126 individual themes were identified and organized into six domains: physical symptoms; psychological symptoms; psychological impact of steroids; impact of steroids on participation; impact of steroids on relationships; and benefits of steroids. Candidate questionnaire items were tested and refined by piloting with patient research partners, iterative rounds of cognitive interviews and linguistic translatability assessment, informing a draft questionnaire. Conclusion We describe an international qualitative study to develop candidate items for a treatment-specific PROM for patients with rheumatic diseases. A future survey will enable the validation of a final version of the PROM. [ABSTRACT FROM AUTHOR]

Can "urban-centric" local television news coverage of the COVID- 19 pandemic affect the behavior of rural residents with lived experiences so different from their "local" news coverage? Leveraging quasi-random geographic variation in media markets for 771 matched rural counties, we show that rural residents are more likely to practice social distancing if they live in a media market that is more impacted by COVID-19. Individual-level survey responses from residents of these counties confirm county-level behavioral differences and help attribute the differences we identify to differences in local television news coverage--selfreported differences only exist among respondents who prefer watching local news, and there are no differences in media usage or consumption across media markets. Although important for showing the ability of local television news to affect behavior despite urban-rural differences, the media-related effects we identify are at most half the size of the differences related to partisan differences. [ABSTRACT FROM AUTHOR]

To explore the role of teachers' biases in the underrepresentation of minorities and women in STEM, 128 secondary science teachers were asked to evaluate responses spoken with either falling or rising intonation by African American, Latino, and White ninth-grade boys and girls. Responses spoken by minority students were evaluated less favorably than identically worded responses spoken by White students, and rising intonation responses were evaluated less favorably than falling intonation responses. Female speakers have been shown to use rising intonation nearly twice as often as male speakers, so this bias against rising intonation responses disproportionately affects female students (an indirect effect of gender). [ABSTRACT FROM AUTHOR]

Although the majority of research on revolving-door lobbyists centers on the influence they exercise during their postgovernment careers, relatively little attention is given to whether future career concerns affect the behaviors of revolving-door lobbyists while they still work in government. We argue that the revolving-door incentivizes congressional staffers to showcase their legislative skills to the lobbying market in ways that affect policymaking in Congress. Using comprehensive data on congressional staffers, we find that employing staffers who later become lobbyists is associated with higher legislative productivity for members of Congress, especially in staffers' final terms in Congress. It also is associated with increases in a member's bill sponsorship in the areas of health and commerce, the topics most frequently addressed by clients in the lobbying industry, as well as granting more access to lobbying firms. These results provide the systematic empirical evidence of pre-exit effects of the revolving-door among congressional staff. [ABSTRACT FROM AUTHOR]

Knowledge of the force required to generate a subdural hematoma is important when considering the veracity of histories given by family members of young children. Traditional wisdom is that a substantial impact is required to cause an acute subdural hematoma. We present a case of acute subdural hematoma following a low-level fall in a 3-year-old patient. An antecedent head injury associated with normal CT scan might have had some bearing on this outcome. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Given the established relationship between student participation and learning, an equitable distribution of turns at talk is critically important. This paper examines the discursive strategies teachers use in allocating such turns during teacher-fronted lessons, demonstrating that the predominant strategy in many classrooms—one in which teachers avoid dispreferred (incorrect or inappropriate) responses by soliciting volunteers and nominating only those students who actively seek the floor—is inconducive to the goal of equity insofar as it allocates fewer turns to students who (due to culture, personality, etc.) volunteer less often. It is shown that the advantage of this strategy stems from teachers’ use of monologic recitation scripts. Consequently, abandoning such scripts in favor of more dialogic classroom discourse—as has long been recommended—would reduce the desirability of volunteer-based turn allocation, thus freeing teachers to promote an equitable distribution of opportunities for student participation by nominating students regardless of whether they seek the floor. [ABSTRACT FROM AUTHOR]

Textual variation between ‭ול‬ and ‭אל‬ occurs throughout the Hebrew Bible about thirty times. The initial impression might be that this is the result of unintentional scribal error, yet the vast majority of these occurrences of variation involve passages wherein both readings work equally well. It is also possible to determine in many cases the linear development from one reading to the other. The present article argues that the similar pronunciation of ‭ול‬ and ‭אל‬ became an occasion to introduce variant readings intentionally. [ABSTRACT FROM PUBLISHER]

Hand-foot-and-mouth disease is a common, usually mild childhood illness caused by enteroviruses. Over the last five years, coxsackievirus A6 has been identified as a causative agent in outbreaks in Europe, South- East Asia and America. It has an atypical presentation compared with other enteroviruses, with more widespread rash, larger blisters and subsequent skin peeling and/or nail shedding. We give the first description of an outbreak of coxsackievirus A6 in New Zealand and how health-care communication networks enabled detection of and dissemination of information about this emergent strain. [ABSTRACT FROM AUTHOR]

Aim Ambulance transportation offers important supportive care and treatment en route to definitive treatment. However, children may be at risk of under-utilising ambulance transportation, where private vehicle is possible. This study aims to determine how many of the sickest children present to hospitals in Auckland via ambulance and whether certain population groups are lower users of ambulance services. Methods Transportation, demographic and outcome data were collected and analysed for children presenting to Starship Children's Health ( Starship) from 1 January to 31 December 2011), who were 'self referrals' to hospital, less than 15 years of age, and assigned triage category 1 and 2 on presentation. Results There were 1047 presentations to Starship identified that met inclusion criteria. Of these, 256 of the 341 triage one presentations (75.1%) and 217 of the 706 triage two presentations (30.7%) were transported by ambulance.Ambulance use was higher among older children ( P < 0.001). Severity of illness or injury, as estimated by admission rates (56.7% vs. 43.3%, P = 0.21) and length of hospital stay (median = 1 day, P = 0.92), did not differ significantly by mode of transportation. There was no observed relationship with gender, ethnicity or area deprivation index score. Conclusion A significant proportion of acutely unwell children presenting to hospital were not transported by ambulance, particularly those aged less than 1 year. This has the potential to result in worse health outcomes. There were no identified associations with patient demographics, and further research is required to better understand this problem and develop solutions. [ABSTRACT FROM AUTHOR]

Indicators measuring aspects of performance to assess quality of care are often chosen arbitrarily. The present study aimed to determine what should be considered when selecting healthcare quality indicators, particularly focusing on the application to emergency medicine. Structured searches of electronic databases were supplemented by website searches of quality of care and benchmarking organisations, citation searches and discussions with experts. Candidate attributes of 'good' healthcare indicators were extracted independently by two authors. The validity of each attribute was independently assessed by 16 experts in quality of care and emergency medicine. Valid and reliable attributes were included in a critical appraisal tool for healthcare quality indicators, which was piloted by emergency medicine specialists. Twenty-three attributes were identified, and all were rated moderate to extremely important by an expert panel. The reliability was high: alpha = 0.98. Twelve existing tools explicitly stated a median (range) of 14 (8-17) attributes. A critical appraisal tool incorporating all the attributes was developed. This was piloted by four emergency medicine specialists who were asked to appraise and rank a set of six candidate indicators. Although using the tool took more time than implicit gestalt decision making: median (interquartile range) 190 (43-352) min versus 17.5 (3-34) min, their rankings changed after using the tool. To inform the appraisal of quality improvement indicators for emergency medicine, a comprehensive list of indicator attributes was identified, validated, developed into a tool and piloted. Although expert consensus is still required, this tool provides an explicit basis for discussions around indicator selection. [ABSTRACT FROM AUTHOR]

Abstract: Recent research highlights the paradoxical importance of students’ being able to check their understanding with teachers and of teachers’ constraining student participation. Using quantitative discourse analysis, this paper examines third graders’ discursive strategies in initiating such checks and teachers’ strategies in constraining them. The results show students regularly raise hands outside teacher-led discussions, presumably to initiate interactions, but teachers seldom acknowledge them and, when they do, often use discursive strategies that constrain student contributions. However, although teachers ignore most unauthorized utterances, they respond favorably to called-out requests and repairs, thus enabling students to check their understanding without teachers’ having to call on them outside controlled discussions. Some students seem ill disposed to call out, though, which may impede their ability to check their understanding, thus hindering their learning. Evaluation of various alternatives shows none is sufficient by itself. Offering students multiple ways of checking their understanding is recommended. [Copyright &y& Elsevier]

To update and extend research on teachers’ expectations of students of different sociocultural groups, 57 Black, White, Asian, and Hispanic teachers were asked to evaluate responses spoken by Black, White, and Hispanic 2nd- and 3rd-grade boys and girls. The results show that responses perceived as spoken by minority boys, minority girls, and White boys were evaluated less favorably than identically worded responses perceived as spoken by White girls. This suggests that teachers hold relatively low expectations of minority students and of boys. Teachers of all sociocultural groups evidenced such expectations, but Black and Hispanic teachers more strongly. [ABSTRACT FROM PUBLISHER]

To meet future requirements, space telescopes are envisioned to require primary mirrors that will be on the scale of ≥ 10 m in diameter. Packaging restrictions of current and foreseeable launch vehicles prohibit the use of a single rigid monolithic mirror of that size. Membrane-optics research seeks to create large-diameter apertures out of thin flexible filmlike reflective material. In this analysis, structures with embedded in-plane-actuated piezoelectric elements for active surface shape control were examined. By analyzing the nondimensional form of the governing differential equation, relative effects of linear and nonlinear terms are apparent. Then, through a series of MSC Nastran finite element models, scalability issues are explored to include the effects of nonlinear terms, existing membrane pretension, and unimorph-versus-bimorph actuation. Results show that although small-scale (existing) test articles may respond in accordance with linear models, they may mask the nonlinear characteristics that dominate large lull-scale membrane optics in the proposed applications. [ABSTRACT FROM AUTHOR]

Driveway runover injuries are a frequent cause of paediatric mortality and morbidity throughout the world. Driveway runovers occur as a result of an interaction between human factors (child and driver), vehicle factors (visibility) and environmental factors (driveway design and surroundings). This study investigates the environmental factors involved in these injuries. Case control study, Auckland, New Zealand. Cases were the properties where paediatric driveway injuries (age < 7 years) requiring hospital admission had occurred. Control properties were selected from the addresses of children presenting to the emergency department with a non-driveway injury. Blinded assessment of properties was completed using satellite images, site visits and searches of council records. Analysis was completed on 88 case properties and 181 controls. The risk of injury was increased by a driveway length greater than 12m (OR = 1.8, 95%CI = 1.1-3.0), exiting the driveway onto a local road (OR = 5.5, 95%CI = 2.7-11.2) and the driveway exiting onto a cul-de-sac (OR = 2.3, 95%CI = 1.4-3.9). The risk of driveway injury was increased when more parking areas were on the property (accessed from the driveway) (OR = 3.0, 95%CI = 1.6-5.4) and when the driveway runs along the property boundary (OR = 2.9, 95%CI = 1.6-5.2). A separate pedestrian pathway on the property was associated with a lower risk of injury (OR = 0.4, 95%CI = 0.2-0.9). A number of built environment features contribute to driveway runover injuries. This information should be used by those within the design and building community to reduce the risk of further driveway runover injury. [ABSTRACT FROM AUTHOR]

Paediatric limb fracture is a common injury that presents frequently to the ED. The primary objective of the present study was to determine whether ibuprofen provides better analgesia than paracetamol for paediatric patients discharged with acute limb fractures. A prospective, randomized controlled study was conducted in a children's ED. Children aged 5–14 years with an acute limb fracture were randomized to be prescribed paracetamol 15 mg/kg/dose every 4 h or ibuprofen 10 mg/kg/dose every 8 h. Objective (child-reported) pain scores using the ‘Faces’ pain scale were measured over a 48 h period. Child-reported pain did not differ significantly between the paracetamol and ibuprofen groups (mean pain score paracetamol 2.8 [95% CI 2.4–3.4] vs 2.7 [95% CI 2.1–3.3], P= 0.73). Parent-reported sleep quality did not differ between the two groups ( P= 0.78). Child-reported pain score decreased over the 48 h of measurement ( P < 0.0001). There were no significant differences in side-effects detected between the two groups. The present study shows that in the outpatient paediatric population, ibuprofen does not provide better analgesia than paracetamol. Pain from an acute fracture can be managed by regular simple oral analgesia and immobilization. [ABSTRACT FROM AUTHOR]

The primary objective of the present study was to determine the effectiveness of intranasal fentanyl analgesia in children aged 1–3 years with acute moderate to severe pain presenting to the ED. We also aimed to gather information on the safety and acceptability of intranasal fentanyl in this age group. Two paediatric ED enrolled children aged 1–3 years, with acute moderate or severe pain. Intranasal fentanyl was administered (1.5 µg/kg) via a mucosal atomiser device using a 50 µg/mL solution of fentanyl. Physiological parameters (heart rate, respiratory rate, oxygen saturations and level of consciousness) were measured at regular intervals. Objective pain assessment was completed using the Faces, Legs, Arms, Cry, Consolability (FLACC) score. Forty-six children presenting with acute moderate to severe pain were included. The median FLACC score before intranasal fentanyl administration was 8 (interquartile range [IQR] 5–10), decreasing to 2 (IQR 0–4) 10 min post fentanyl ( P < 0.0001) and 0 (IQR 0–2) 30 min post fentanyl ( P < 0.0001). A clinically significant decrease in FLACC scores was seen in 93% of children 10 min post fentanyl administration and 98% of children 30 min post fentanyl. Intranasal fentanyl delivery using a mucosal atomiser was well tolerated by all children. There were no adverse drug reactions or adverse events detected. Intranasal fentanyl is an effective, safe and well-tolerated mode of analgesia for children aged 1–3 years with moderate to severe pain. [ABSTRACT FROM AUTHOR]

The standard grammars for Biblical Aramaic treat the verb primarily in terms of tense and Aktionsart. The theory of H.B. Rosen, which is based on a distinction between point aspect verbs and linear aspect verbs, constitutes the one significant alternative to the standard view. The present article interacts with these two proposals and suggests a new approach — distributional analysis. Such analysis has been applied with great success in Hebrew studies, but not in research on the verb in Biblical Aramaic. The thesis here is that Biblical Aramaic has a primary verbal form for narrative (qetal) and a primary verbal form for discourse (yiqtul). [ABSTRACT FROM AUTHOR]

Future space telescopes may use large-diameter, flexible, lightweight membrane mirrors to overcome current launch weight and packaging limitations. In-plane actuated tensioned membrane mirrors may be a possible solution to maintaining the precise surface required of a telescope mirror. For this experiment a 0.127-m diam in-plane actuated deformable tensioned membrane mirror was constructed and tested. The research presented herein implements control algorithms based on the results of a nonlinear finite element MSC.Nastran model. The control method used a least-squares approach to create an influence function matrix which was implemented as a proportional plus integral controller. Precision shaping of the test article's mirror surface, expressed in terms of a Zernike coefficient basis set obtained from an optics-based Shack-Hartmann wave front sensor, was demonstrated in a series of quasi-static closed-loop control tests. Micron-level sinusoidal control inputs representing the defocus Zernike coefficient were successfully tracked with an average absolute accuracy of 0.16 µm. For multimode tracking, commanded tip, tilt, and defocus modes were tracked with an absolute average error of 0.14, 0.09, and 0.18 µm, respectively, indicating that increasing the dimension of the control system did not significantly degrade its performance. This experimental demonstration illustrates the use of optics-based precision surface control for in-plane actuated membrane mirrors, however, significant technological challenges still exist which may impede the use of this technology for large space-based telescope applications. [ABSTRACT FROM AUTHOR]

A correction to the article "Exit Strategy: Career Concerns and Revolving Doors in Congress," published in an earlier edition of the journal, is presented.

The article investigates the origin of the phrase, son of man, in the Book of Daniel, Chapter 7, Verse 13. The problems posed by the messianic interpretation of the phrase for understanding the relationship between the Book of Daniel and the New Testament are examined. The article also analyzes the composition of Daniel 7. The interpretation of the phrase in the Book of Daniel as an individual and messianic figure is explained.

Objective To explore the process of public involvement in planning primary health care. Background Recent policy in the UK promotes public involvement in planning health but there have been difficulties in engaging communities in the process. Surveys of health service organizations have found that there has been a failure to adapt to new approaches. It has become important to understand why this has occurred if policy initiatives to encourage involvement are to succeed. Design Qualitative study. Data collected through individual interviews and focus groups. Setting Two new primary healthcare developments in deprived areas in Bristol and Weston-Super-Mare. Participants Thirty-six professionals and 23 local residents in Bristol; six professionals and three local residents in Weston-Super-Mare. Results Three themes were identified: process, partnership and power. The main findings were that exceptional people with a shared commitment to public involvement were necessary to motivate others and develop partnerships. Local people were drawn into the process and with increased confidence became powerful advocates for their community. Creative and varied methods to involve the public were important in achieving balance between professionals and lay people. However, conflicts over practical decisions arose from a lack of clarity over who had power to influence decisions. Conclusion Most of the participants were enthusiastic about their experience of public involvement in planning primary health care. Features crucial to sustainable involvement included a commitment from leaders within statutory agencies, support over a long period to build the confidence of local people, willingness to use informal approaches that are in tune with local culture, and a recognition of the concerns of both service users and providers. [ABSTRACT FROM AUTHOR]

Objective: To highlight the injuries that result from lap-belt use and make recommendations for prevention, the recent experience of a regional paediatric trauma centre was reviewed. Methods: Retrospective review of admissions to Starship Children's Hospital from 1996 to 2003, with significant injury following involvement in a motor vehicle crash, while wearing a lap-belt. Patients were identified from two prospectively collected databases and discharge coding data. Results: In total, 19 patients were identified over the 7 year period. The morbidity sustained includes 15 patients with hollow viscus injury, 13 laparotomies, 7 spinal fractures, 2 paraplegia and 1 fatality. A total of 11 patients required laparotomy with a median delay of 24 h. Of patients in the present series, 58% were aged less than 8 years and thus were inappropriately restrained. Conclusions: Lap-belt use can result in a range of life-threatening injuries or permanent disability in the paediatric population. The incidence of serious lap-belt injury does not appear to be decreasing. Morbidity and mortality could be reduced by the use of three-point restraints, age appropriate restraints and booster seats. [ABSTRACT FROM AUTHOR]

Over the last decade support for increasing public participation in decisions regarding the planning and delivery of health services has become a familiar feature of the policy agenda for the UK National Health Service. This paper reviews current Labour policy towards public participation and reports on the response of primary care groups (PCGs) to recent Labour directives to make patient and public involvement an integral part of the way they work, presenting the findings of a survey conducted in one English health region. The experience of these PCGs suggests that, despite the diverse backgrounds of board members, there is marked consensus between local and central decision makers as to their understanding of public participation. Whilst academic debates have tended to conceptualize participation in dualist terms as a form of consumerism or of citizenship, the survey data suggest that in the context of local implementation public participation is framed within a new public management perspective which values it as an aid to organizational learning. The findings of this study highlight obstacles to securing effective public participation, including a lack of substantive guidance regarding policy implementation that produces uncertainty amongst local decision makers as to how best to proceed. The inherent limitations of public participation within the new public management paradigm suggest that democratic renewal, one of the goals of the government's modernization agenda, is unlikely to be achieved. [ABSTRACT FROM AUTHOR]

Evaluates user preference for personal editions versus community editions of on-line news. Creation of a personalized edition of a local newspaper for each subject based on an elliptical model; Variation of emphasis given to user and community profiles; Preference of users to coarse-grained community filters over fine-grained personalized filters.

Focuses on several medical related topics. Partnership of medicine and religion; Grief of losing love ones in a distant places; Life and works of Professor Archie Cochrane.

Discusses the primary care of patients with mental disorder in the community in Great Britain. Role of institutional care in the community; Concerns of community psychiatrists on the extramural fate and management of patients with mental disabilities; Provision of community care for the mentally ill.

Presents evidence suggesting that female corn buntings do not settle according to a compensation model but settle randomly with respect to males within the confines of available nesting habits. Details of methods; Results and discussion; General discussion.

Presents an evaluation of a method of accessing nonindexed textual data files where the mode of access is determined by the user, based on the intent of the information task at hand. DalText prototype system; Essential views considered in the DalText system; Validation of results; Background and effective search strategy; Number of steps taken before adopting the effective strategy; User preference.

Focuses on the importance of mental disorders in promotion of research as a means of understanding the causation and treatment; Clinical science of psychiatry; Operational approach to psychiatric research; Provision of incentives through the creation of research institute; Direction of research training.

Focuses on the assessment of psychotherapy versus placebo studies in Great Britain. Effectivity of placebo; Discussions on registration of psychotherapist; Function of placebo in medical therapeutics.

The article discusses the study conducted to determine the medical care and attention given to mentally ill patients in Great Britain. The study found that most mental disorder is identified and treated by primary care physicians rather than by psychiatric specialists. The study also established that 14-15 percent of the respondents are at risk over a 12-month period and consulted their physicians only once. The situations reported are associated with a high demand for general medical care and due to unsatisfactory result of medico-social management of mental health cases. It is inferred that psychiatric agencies do not focus on requirements to improve mental health services. In addition, further studies from conducted by other countries confirmed the findings.

The article discusses several opinions from clinicians and epidemiologists concerning the relation of psychiatric epidemiology to clinical psychiatry. During the 1949 Milbank Memorial Fund conference on the Epidemiology of Mental Disorders, several practicing psychiatrists questioned the relevance of clinical psychiatry including epidemiologist John Gordon, who emphasized that the study of the clinical case of mental disease is an artificial grouping of many morbid entities. Thomas Francis points that epidemiology is dependent on the accuracy of diagnosis and aims to draw psychiatrists into the epidemiological viewpoint.

Focuses on the scientific context of dreams. Mechanisms of death; Theory of dream sleep; Description of rapid eye movement sleep.

Profiles psychiatrist Aubrey Lewis. Family life; Background in psychiatry; Career highlights.

Aim: Traumatic brain injury (TBI) in childhood can impose a significant threat to life and longer-term disability. This study investigated the extent to which the documentation of key indicators of healthcare quality in the emergency department (ED) setting was consistent with clinical guidelines for the management of children with mild TBI (MTBI). Methods: The clinical records of a random sample of 60 children (stratified by ethnicity and age group), who were seen and discharged from a large metropolitan paediatric hospital ED following a head injury, were systematically reviewed to examine the processes of care and follow-up. Results: Based on the documentation in clinical records, processes designed to identify and manage potentially life-threatening acute complications (e.g. computed tomography scanning to identify intracranial haemorrhage) were consistent with best practice standards. However gaps existed between current and best practice for some aspects of care that could minimise risks of longer-term disability from MTBI. For example, relevant clinical criteria were well documented, but this information did not appear to be applied systematically to identify and to follow up children with definite or possible MTBI. Conclusion: The apparent absence of a systematic approach to the diagnosis and follow-up of MTBI in children presenting to ED suggests a missed opportunity to minimise the risk of disability following these injuries. Greater attention to an integrated care pathway that improves the identification, documentation, and follow-up of children with MTBI presenting to ED is required. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper is to explore variations in lay perceptions of user involvement in clinical governance. Context The English National Health Service has sought to build a dependable health service through enhanced effectiveness, responsiveness and consistency. Clinical governance, a policy for improving service quality, is a key pillar of these reforms. It is a statutory duty of primary care organizations to ensure that users are involved in all service planning and decision making, including clinical governance. Yet surveys indicated that user involvement in clinical governance was underdeveloped and underutilized. Design Focus groups were conducted with different types of lay people to explore their perceptions around public involvement in different aspects of clinical governance policy. Results Content analysis of the transcripts reveals that different groups of lay people varied in their desired role perspective and preferred type of involvement in different aspects of clinical governance policy. Drawing upon existing models of user involvement, we identified three role perspectives that lay people could take in user involvement – consumer, advocate and citizen. We compared our findings regarding the desired type of involvement with existing models of user involvement, and identified a new type of involvement, overseeing, that is relevant to clinical governance policy. Conclusions These findings suggest that to facilitate user involvement in clinical governance, it would be necessary to use different strategies to accommodate the differing role perspectives and types of involvement desired by different groups of lay people. [ABSTRACT FROM AUTHOR]

Previous studies have examined various aspects of user behavior on the Web, including general information-seeking patterns, search engine use, and revisitation habits. Little research has been conducted to study how users navigate and interact with their Web browser across different information-seeking tasks. We have conducted a field study of 21 participants, in which we logged detailed Web usage and asked participants to provide task categorizations of their Web usage based on the following categories: Fact Finding, Information Gathering, Browsing, and Transactions. We used implicit measures logged during each task session to provide usage measures such as dwell time, number of pages viewed, and the use of specific browser navigation mechanisms. We also report on differences in how participants interacted with their Web browser across the range of information-seeking tasks. Within each type of task, we found several distinguishing characteristics. In particular, Information Gathering tasks were the most complex; participants spent more time completing this task, viewed more pages, and used the Web browser functions most heavily during this task. The results of this analysis have been used to provide implications for future support of information seeking on the Web as well as direction for future research in this area. [ABSTRACT FROM AUTHOR]

Objective Accurate diagnosis, treatment and follow up of children suffering mild traumatic brain injury ( MTBI) is important as post-concussive symptoms and long-term disability might occur. This research explored the decisions clinicians make in their assessment and management of children with MTBI in acute care settings, and identified barriers and enablers to the delivery of best-practice care. Methods A purposeful sample of 29 clinicians employed in two metropolitan paediatric EDs and one Urgent Care clinic was surveyed using a vignette-based questionnaire that also included domains of guideline awareness, attitudes to MTBI care, use of clinical decision support systems, and knowledge and skills for practising evidence-based healthcare. Results Overall, the evaluation and management of children presenting acutely with MTBI generally followed best-practice guidelines, particularly in relation to identifying intracranial injuries that might require surgical intervention, observation for potential deterioration, adequate pain management and the provision of written head injury advice on discharge. Larger variation emerged in regard to follow-up care and referral pathways. Potential barriers to best- practice were lack of guideline awareness, attitudes to MTBI, and lack of time or other priorities. Conclusions Opportunities exist to improve care for children who present in acute care settings following mild traumatic brain injury. These include having up-to-date guidelines that are consistent across acute care settings; providing clearer pathways for referral and follow up; targeting continuing medical education towards potential complications; and providing computerised decision support so that assessment and management are conducted systematically. [ABSTRACT FROM AUTHOR]

This paper explores the use of health impact assessment (HIA) as a means of facilitating community engagement in spatial planning. The paper discusses the background to the development of HIA as a tool for assessing the likely impact of policies and wider changes on health with a view to building those into planning and decision-making, and describes the evolution of HIA into more participatory forms. It then goes on to describe a case-study of plans for a waste incinerator in an inner-city area in the UK, where HIA was used in response to community concerns about the development as a means of building in the views of local people to the decision-making around the plan. We describe in detail how the HIA was conducted and additional research undertaken within a timescale set by the planning processes. We discuss the difficulties involved in conducting any kind of research-based HIA so rapidly and in a situation of multiple, competing stakeholder interests. We argue that although the HIA failed to influence the final decisions in this particular instance it does, nonetheless, provide a model for how to create ‘knowledge spaces’ in which different perspectives and information can be brought around the table to create more democratic approaches to planning for waste. [ABSTRACT FROM PUBLISHER]

This paper reports the findings of a literature review of the health, social care and housing needs of older lesbian, gay, bisexual and transgender (LGBT) adults undertaken in 2006 for the Welsh Assembly Government. Peer-reviewed literature was identified through database searches of BNI, PubMed, CINAHL, DARE, ASSIA and PsychInfo. Follow-up searches were conducted using references to key papers and journals as well as specific authors who had published key papers. A total of 187 papers or chapters were retrieved, of which 66 were included in the study; major themes were identified and the findings synthesised using a meta-narrative approach. The main themes that emerged from the review were isolation, health behaviours, mental health and sexual health behaviours. The literature indicates that the health, social care and housing needs of LGBT older people is influenced by a number of forms of discrimination which may impact upon the provision of, access to and take up of health, social care and housing services. Understanding of the health, social care and housing needs of older LGBT people is limited and research in this area is scarce. The research which exists has been criticised for using small samples and for tending to exclude participants from less affluent backgrounds. The focus of research tends to be on gay men and lesbians; consequently, the needs of bisexual and transgender people remain largely unknown. Additionally, research which does exist tends to focus on a narrow range of health issues, often related to the health needs of younger LGBT people. Discrimination in various forms has a major impact on needs and experiences, leading to marginalisation of LGBT people both in the provision of health and social care services and neglect of these groups in public health research. [ABSTRACT FROM AUTHOR]

Examines the participation of the public in health care decision making. Distribution of health care resources through the market system; Mechanisms used in determining the pattern of health care provision; Role of the public in health care resources distribution.

Examines the factors influencing the provision of health care in Great Britain. Accounts on the ethical basis of health care rationing; Comparison between the views of health care providers and patients on health care rationing; Details on the views of the National Health Service on the rationing of health care.