"Are you otherwise fit and well?": Past medical history questions in UK paediatric consultations.

Accurate diagnosis and treatment depend upon detailed knowledge of both the child's presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. OBJECTIVE: To examine the function of the question "are you otherwise fit and well?" to elicit a child's general medical history in UK paediatric allergy outpatient consultations. METHODS: Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question's micro-design elements and their consequences for the consultation's trajectory. RESULTS: Asking "Are you otherwise fit and well?" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of "fitness" and "wellness"; negotiating opportunities for children's participation; and importantly, a shift towards discussing more general wellbeing. CONCLUSION: Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. PRACTICE IMPLICATIONS: Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question 'Are you otherwise fit and well' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.

Understanding mixed emotions in organized helping through emotionography.

Introduction: Emotionography studies emotion: (a) as it occurs naturally in display, reception, attribution, and avowal; (b) within and across diverse stretches of interaction and varied institutional contexts; (c) grounded purposefully in the perspectives of the interactants as those perspectives are displayed in real-time through unfolding talk; (d) using materials that are recorded and transcribed in sufficient precision to capture the granularity consequential for the interactants. We overview contemporary research on "mixed emotion" highlighting theoretical and methodological issues and explore the potential of emotionography as a generative alternative. Methods: The analysis will use contemporary conversation analysis and discursive psychology to illuminate the workings of organized helping using a collection of recordings from a child protection helpline all of which include laughter alongside crying. Results: Analysis shows, on the one hand, how crying and upset display the caller's stance on the trouble being reported, and mark its action-relevant severity; on the other, how laughter manages ongoing parallel issues such as advice resistance. We show that the "mixture" is public and pragmatic, displaying different concerns and stances, and dealing with different issues; all is in the service of action. Discussion: When analyzing the specifics of interaction, the concept of "mixed emotion" loses clarity, and it is more accurate to observe competing pragmatic endeavors being pursued in an intricately coordinated fashion. These practices would not be captured by conventional emotion measurement tools such as scales, vignettes, or retrospective interviews. Broader implications for theories of emotion and methods of emotion research are discussed.

Long-Term Stability of MFM-300(Al) toward Toxic Air Pollutants.

Temperature- or pressure-swing sorption in porous metal-organic framework (MOF) materials has been proposed for new gas separation technologies. The high tunability of MOFs toward particular adsorbates and the relatively low energy penalty for system regeneration indicate that reversible physisorption in MOFs has the potential to create economic and environmental benefits compared with state-of-the-art chemisorption systems. However, for MOF-based sorbents to be commercialized, they have to show long-term stability under the conditions imposed by the application. Here, we demonstrate the structural stability of MFM-300(Al) in the presence of a series of industrially relevant toxic and corrosive gases, including SO2, NO2, and NH3, over 4 years using long-duration synchrotron X-ray powder diffraction. Full structural analysis of gas-loaded MFM-300(Al) confirms the retention of these toxic gas molecules within the porous framework for up to 200 weeks, and cycling adsorption experiments verified the reusability of MFM-300(Al) for the capture of these toxic air pollutants.

Shaming interrogatives: Admonishments, the social psychology of emotion, and discursive practices of behaviour modification in family mealtimes.

This paper contributes to the study of admonishments, the operation of shaming in family interaction, and more broadly presses the virtue of a discursive psychological reconsideration of the social psychology of emotion. It examines the methodological basis of contemporary research on shame in experimental and qualitative social psychology, illustrated through the Test of Self-Conscious Affect (TOSCA) and qualitative work using shame narratives. Doubts are raised about how these methods can throw light on shaming practices in natural situations. The study uses a collection of video recordings of family mealtimes, focusing on admonishment sequences in which parents address the interrogatives 'what are you doing' or 'what did I say' to a 'misbehaving' child. Despite the interrogative syntax, rather than soliciting information we show that these interrogative forms pursue behaviour change by publicly highlighting both the problem behaviour and the child's active and intentional production of that behaviour. This is the sense in which the practice can be understood as shaming. Although this practice prosecutes shaming, ways in which the children can ignore, push back, or rework parents' actions are highlighted. This study contributes to a broader consideration of how enduring behavioural change can be approached as a parents' project.

A slow-cooling-rate in situ cell for long-duration studies of mineral precipitation in cold aqueous environments on Earth and other planetary bodies.

Liquid oceans and ice caps, along with ice crusts, have long been considered defining features of the Earth, but space missions and observations have shown that they are in fact common features among many of the solar system's outer planets and their satellites. Interactions with rock-forming materials have produced saline oceans not dissimilar in many respects to those on Earth, where mineral precipitation within frozen seawater plays a significant role in both determining global properties and regulating the environment in which a complex ecosystem of extremophiles exists. Since water is considered an essential ingredient for life, the presence of oceans and ice on other solar system bodies is of great astrobiological interest. However, the details surrounding mineral precipitation in freezing environments are still poorly constrained, owing to the difficulties of sampling and ex situ preservation for laboratory analysis, meaning that predictive models have limited empirical underpinnings. To address this, the design and performance characterization of a transmission-geometry sample cell for use in long-duration synchrotron X-ray powder diffraction studies of in situ mineral precipitation from aqueous ice-brine systems are presented. The cell is capable of very slow cooling rates (e.g. 0.3°C per day or less), and its performance is demonstrated with the results from a year-long study of the precipitation of the hydrated magnesium sulfate phase meridianiite (MgSO4·11H2O) from the MgSO4-H2O system. Evidence from the Mars Rover mission suggests that this hydrated phase is widespread on the present-day surface of Mars. However, as well as the predicted hexagonal ice and meridianiite phases, an additional hydrated sulfate phase and a disordered phase are observed.

Action and representation - A comment on Batel and Castro 'Re-opening the dialogue between the theory of social representations and discursive psychology'.

Batel and Castro propose a reconciliation of social representation theory and discursive psychology. This comment highlights the continuing relevance of long-standing critiques of social representation theory from discursive psychologists as well as their central focus on both how representations are built to appear factual and the role of representations in practices. It suggests that the analytic approaches proposed by Batel and Castro (e.g., focus groups and thematic analysis) are not sufficient to the analytic task. The proposed 'Pragmatic Discourse Analysis' falls short on its central task of identifying pragmatics. The virtues of working with naturalistic data using methods that attend to the action orientation of talk and text are pressed.

Stepwise observation and quantification and mixed matrix membrane separation of CO2 within a hydroxy-decorated porous host.

The identification of preferred binding domains within a host structure provides important insights into the function of materials. State-of-the-art reports mostly focus on crystallographic studies of empty and single component guest-loaded host structures to determine the location of guests. However, measurements of material properties (e.g., adsorption and breakthrough of substrates) are usually performed for a wide range of pressure (guest coverage) and/or using multi-component gas mixtures. Here we report the development of a multifunctional gas dosing system for use in X-ray powder diffraction studies on Beamline I11 at Diamond Light Source. This facility is fully automated and enables in situ crystallographic studies of host structures under (i) unlimited target gas loadings and (ii) loading of multi-component gas mixtures. A proof-of-concept study was conducted on a hydroxyl-decorated porous material MFM-300(VIII) under (i) five different CO2 pressures covering the isotherm range and (ii) the loading of equimolar mixtures of CO2/N2. The study has successfully captured the structural dynamics underpinning CO2 uptake as a function of surface coverage. Moreover, MFM-300(VIII) was incorporated in a mixed matrix membrane (MMM) with PIM-1 in order to evaluate the CO2/N2 separation potential of this material. Gas permeation measurements on the MMM show a great improvement over the bare PIM-1 polymer for CO2/N2 separation based on the ideal selectivity.

New synchrotron powder diffraction facility for long-duration experiments.

A new synchrotron X-ray powder diffraction instrument has been built and commissioned for long-duration experiments on beamline I11 at Diamond Light Source. The concept is unique, with design features to house multiple experiments running in parallel, in particular with specific stages for sample environments to study slow kinetic systems or processes. The instrument benefits from a high-brightness X-ray beam and a large area detector. Diffraction data from the commissioning work have shown that the objectives and criteria are met. Supported by two case studies, the results from months of measurements have demonstrated the viability of this large-scale instrument, which is the world's first dedicated facility for long-term studies (weeks to years) using synchrotron radiation.

A compact and versatile dynamic flow cryostat for photon science.

We have developed a helium gas flow cryostat for use on synchrotron tender to hard X-ray beamlines. Very efficient sample cooling is achieved because the sample is placed directly in the cooling helium flow on a removable sample holder. The cryostat is compact and easy to operate; samples can be changed in less than 5 min at any temperature. The cryostat has a temperature range of 2.5-325 K with temperature stability better than 0.1 K. The very wide optical angle and the ability to operate in any orientation mean that the cryostat can easily be adapted for different X-ray techniques. It is already in use on different beamlines at the European Synchrotron Radiation Facility (ESRF), ALBA Synchrotron Light Facility (ALBA), and Diamond Light Source (DLS) for inelastic X-ray scattering, powder diffraction, and X-ray absorption spectroscopy. Results obtained at these beamlines are presented here.

Black Carbon Contribution to Organic Carbon Stocks in Urban Soil.

Soil holds 75% of the total organic carbon (TOC) stock in terrestrial ecosystems. This comprises ecosystem-derived organic carbon (OC) and black carbon (BC), a recalcitrant product of the incomplete combustion of fossil fuels and biomass. Urban topsoils are often enriched in BC from historical emissions of soot and have high TOC concentrations, but the contribution of BC to TOC throughout the urban soil profile, at a regional scale is unknown. We sampled 55 urban soil profiles across the North East of England, a region with a history of coal burning and heavy industry. Through combined elemental and thermogravimetic analyses, we found very large total soil OC stocks (31-65 kg m(-2) to 1 m), exceeding typical values reported for UK woodland soils. BC contributed 28-39% of the TOC stocks, up to 23 kg C m(-2) to 1 m, and was affected by soil texture. The proportional contribution of the BC-rich fraction to TOC increased with soil depth, and was enriched in topsoil under trees when compared to grassland. Our findings establish the importance of urban ecosystems in storing large amounts of OC in soils and that these soils also capture a large proportion of BC particulates emitted within urban areas.

Urban tree effects on soil organic carbon.

Urban trees sequester carbon into biomass and provide many ecosystem service benefits aboveground leading to worldwide tree planting schemes. Since soils hold ∼75% of ecosystem organic carbon, understanding the effect of urban trees on soil organic carbon (SOC) and soil properties that underpin belowground ecosystem services is vital. We use an observational study to investigate effects of three important tree genera and mixed-species woodlands on soil properties (to 1 m depth) compared to adjacent urban grasslands. Aboveground biomass and belowground ecosystem service provision by urban trees are found not to be directly coupled. Indeed, SOC enhancement relative to urban grasslands is genus-specific being highest under Fraxinus excelsior and Acer spp., but similar to grasslands under Quercus robur and mixed woodland. Tree cover type does not influence soil bulk density or C∶N ratio, properties which indicate the ability of soils to provide regulating ecosystem services such as nutrient cycling and flood mitigation. The trends observed in this study suggest that genus selection is important to maximise long-term SOC storage under urban trees, but emerging threats from genus-specific pathogens must also be considered.

High-utility conserved avian microsatellite markers enable parentage and population studies across a wide range of species.

BACKGROUND: Microsatellites are widely used for many genetic studies. In contrast to single nucleotide polymorphism (SNP) and genotyping-by-sequencing methods, they are readily typed in samples of low DNA quality/concentration (e.g. museum/non-invasive samples), and enable the quick, cheap identification of species, hybrids, clones and ploidy. Microsatellites also have the highest cross-species utility of all types of markers used for genotyping, but, despite this, when isolated from a single species, only a relatively small proportion will be of utility. Marker development of any type requires skill and time. The availability of sufficient "off-the-shelf" markers that are suitable for genotyping a wide range of species would not only save resources but also uniquely enable new comparisons of diversity among taxa at the same set of loci. No other marker types are capable of enabling this. We therefore developed a set of avian microsatellite markers with enhanced cross-species utility. RESULTS: We selected highly-conserved sequences with a high number of repeat units in both of two genetically distant species. Twenty-four primer sets were designed from homologous sequences that possessed at least eight repeat units in both the zebra finch (Taeniopygia guttata) and chicken (Gallus gallus). Each primer sequence was a complete match to zebra finch and, after accounting for degenerate bases, at least 86% similar to chicken. We assessed primer-set utility by genotyping individuals belonging to eight passerine and four non-passerine species. The majority of the new Conserved Avian Microsatellite (CAM) markers amplified in all 12 species tested (on average, 94% in passerines and 95% in non-passerines). This new marker set is of especially high utility in passerines, with a mean 68% of loci polymorphic per species, compared with 42% in non-passerine species. CONCLUSIONS: When combined with previously described conserved loci, this new set of conserved markers will not only reduce the necessity and expense of microsatellite isolation for a wide range of genetic studies, including avian parentage and population analyses, but will also now enable comparisons of genetic diversity among different species (and populations) at the same set of loci, with no or reduced bias. Finally, the approach used here can be applied to other taxa in which appropriate genome sequences are available.

What happens to COPD patients before an admission with exacerbation?

AIM: To obtain patient-generated data relating to the management of their chronic obstructive pulmonary disease (COPD) in Primary Care before hospitalisation with exacerbation. BACKGROUND: Previous audits of COPD have shown high rates of hospital admission and readmission. There is significant interest in understanding the reasons so that useful preventative strategies may be developed. As part of the 2008 UK COPD audit, which comprised 9716 cases of COPD admission across 97% of acute units, we obtained a sample of patient-generated data to assess understanding of COPD, use of healthcare resources, access to care and self-management in Primary Care prior to hospitalisation with exacerbation. We anticipated the data would provide useful insight for directing improvement strategies. METHOD: A paper-based, anonymised survey was completed by patients identified as having exacerbation by participating hospital teams. Response rate was an estimated 46%. FINDINGS: Understanding and awareness of COPD was very variable. Patients noticed symptoms of COPD exacerbation, particularly change in sputum, for some time prior to hospitalisation but tended not to react promptly to these changes. A minority had self-care plans, many bypassed Primary Care Services and there was variable access to a named health professional or advice. Patients using home oxygen and nebulisers were at particular risk of admission. CONCLUSION: We conclude these sick patients use a lot of resources and the data suggest a need to support and educate them in the proactive management of exacerbation. There needs to be better 'exacerbation planning' so patients know how to recognise and treat flare-up but also whom to contact in the event of decline. Targetted support should be considered for the most vulnerable, particularly those using home oxygen and nebulisers, who have very high rates of hospitalisation.

Managing patients with COPD exacerbation: does age matter?

INTRODUCTION: there is little information about the relationship between age and management of COPD exacerbation (AECOPD), although older persons are known to be at a greater risk of hospital admission. METHODS: we have investigated responses from the clinical and patient questionnaire elements of the 2008 UK COPD audit, splitting the data into age decile. RESULTS: age ranged from 27 to 102. Patient-reported data suggested older patients had inferior knowledge of COPD, undertook less self-care and were less likely to recognise symptoms of exacerbation prior to hospitalisation. Clinician-reported data showed that although older patients had severe disease and symptoms, greater co-morbidity at presentation and higher mortality, fewer were seen in hospital or followed up subsequently by respiratory specialists. Older patients were more likely to have a DNR order signed within 24 h of admission, irrespective of co-morbidities or performance status. The observations were particularly applicable to those aged 80 or above. CONCLUSIONS: clinicians should consider increasing age as a specific risk factor in the management of COPD. Acute units and community teams should review carefully their protocols and pathways for how they assess, manage, discharge and follow-up older patients with COPD exacerbation.

A randomized trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project: three-year evaluation.

RATIONALE: Peer review has been widely used within the National Health Service to facilitate health quality improvement but evaluation has been limited particularly over the longer-term. Change within the National Health Service (NHS) can take a prolonged period--1-2 years--to occur. We report here a 3-year evaluation of the largest randomized trial of peer review ever conducted in the UK. AIM: To evaluate whether targeted mutual peer review of respiratory units brings about improvements in services for chronic obstructive pulmonary disease (COPD) over 3 years. METHODS: The peer review intervention was a reciprocal supportive exercise that included clinicians, hospital management, commissioners and patients, which focused on the quality of the provision of four specific evidence-based aspects of COPD care. RESULTS: Follow-up at 36 months demonstrated limited significant quantitative differences in the quality of services offered in the two groups but a strong trend in favour of intervention sites. Qualitative data suggested many benefits of peer review in most but not all intervention units and some control teams. The data identify factors that promote and obstruct change. CONCLUSION: The findings demonstrate significant change in service provision over 3 years in both control and intervention sites with great variability in both groups. The combined quantitative and qualitative findings indicate that targeted mutual peer review is associated with improved quality of care, improvements in service delivery and with changes within departments that promote and are precursors to quality improvement. The generic findings of this study have potential implications for the application of peer review throughout the NHS.

Re-reading Discourse and Social Psychology: transforming social psychology.

This paper considers one theme in the contemporary legacy of Potter and Wetherell's (1987) Discourse and Social Psychology. It overviews the context that led to that book and considers a series of critical responses from both experimental and critical/qualitative social psychologists. It refutes criticisms and corrects confusions. Focusing on contemporary discursive psychology, it highlights (a) its rigorous use of records of actual behaviour; (b) its systematic focus on normative practices. In methodological terms, it (a) highlights limitations in the use of open-ended interviews; (b) considers the way naturalistic materials provide access to participants' own orientations and displays; (c) builds a distinctive logic of sampling and generalization. In theoretical terms, it (a) highlights the way discourse work can identify foundational psychological matters; (b) offers a novel approach to emotion and embodiment; (c) starts to build a matrix of dimensions which are central to the constructing and recognizing of different kinds of social actions. It now offers a fully formed alternative social psychology which coordinates theory and method and a growing body of empirical work.

The National Falls and Bone Health Audit: implications for UK emergency care.

INTRODUCTION: The National Clinical Audit of Falls and Bone Health, coordinated by the Royal College of Physicians, assesses progress in implementing integrated falls services across the UK against national standards and enables benchmarking between service providers. Nationally, falls are a leading contributor towards mortality and morbidity in older people and account for 700,000 visits to emergency departments and 4 million annual bed days in England alone. METHODS: Two rounds of national organisational audit in 2005 and 2008 and one national clinical audit in 2006 were carried out based on indicators developed by a multidisciplinary group. RESULTS: These showed that management of falls and bone health in older people remains suboptimal in emergency departments and minor injury units and opportunities are being missed in carrying out evidence-based risk assessment and management. CONCLUSIONS: Older people attending emergency departments in the UK following a fall are receiving a poor deal. There is an urgent need to ensure more effective assessment and management to prevent further falls and fractures.

Commissioning health care in England: an evolving story.

The general election in the United Kingdom in May 2010 resulted in the election of a new government, a coalition between Conservative and Liberal Democrat parties. Six weeks after the election, a white paper, "Equity and Excellence: Liberating the NHS," that proposed profound changes to the structure and organization of the health service was published. The change that generated the most discussion was the proposal that general practitioners be placed at the center of the system and given control of about 80% of the National Health Service's £100 billion budget. The proposals were greeted with considerable concern by many health care professionals, patient representatives, and the media. In response, the government organized an independent review, and proposals have been altered in response. This article outlines the current organization of the National Health Service, the rationale for change, and government proposals.

Fast X-ray powder diffraction on I11 at Diamond.

The commissioning and performance characterization of a position-sensitive detector designed for fast X-ray powder diffraction experiments on beamline I11 at Diamond Light Source are described. The detecting elements comprise 18 detector-readout modules of MYTHEN-II silicon strip technology tiled to provide 90° coverage in 2θ. The modules are located in a rigid housing custom designed at Diamond with control of the device fully integrated into the beamline data acquisition environment. The detector is mounted on the I11 three-circle powder diffractometer to provide an intrinsic resolution of Δ2θ approximately equal to 0.004°. The results of commissioning and performance measurements using reference samples (Si and AgI) are presented, along with new results from scientific experiments selected to demonstrate the suitability of this facility for powder diffraction experiments where conventional angle scanning is too slow to capture rapid structural changes. The real-time dehydrogenation of MgH(2), a potential hydrogen storage compound, is investigated along with ultrafast high-throughput measurements to determine the crystallite quality of different samples of the metastable carbonate phase vaterite (CaCO(3)) precipitated and stabilized in the presence of amino acid molecules in a biomimetic synthesis process.

Is urinary continence considered in the assessment of older people after a fall in England and Wales? Cross-sectional clinical audit results.

OBJECTIVES: To investigate adherence to the urinary function assessments of the national falls guidelines for England and Wales. STUDY DESIGN: Secondary data analysis of the 2006 National Clinical Audit of Falls and Bone Health. SETTING: Acute hospitals in the UK. PARTICIPANTS: Patients aged 65 years and older with a fragility fracture as a result of a fall. MAIN OUTCOME MEASURES: Data were analysed to determine whether patients with fragility fractures received an assessment of urinary function including continence status; whether impairment was detected and if action was taken to prevent continence related falls. RESULTS: 63% (2009) of 3184 patients were assessed for urinary continence following a hip fracture and 41% (817) of these identified a problem. 21% (1187) of 5642 patients with nonhip fragility fractures were assessed and a problem was found in 27% (316). Hip fracture patients were more likely (p<0.0001) to receive a continence assessment and have problems detected. Only about half of those with problems had any intervention or a referral to a continence service. Admission to hospital for nonhip fracture patients was a strong predictor of being assessed (p<0.0001). CONCLUSION: Rates of assessment and action for those with who fall and have continence problems are low despite current national guidelines.