Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation

Objective: To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design: Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting: 2 GP practices in Devon and Warwickshire, UK. Participants: 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure: Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results: A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions: Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage

Statistics of anomalously localized states at the center of band E=0 in the one-dimensional Anderson localization model

We consider the distribution function $P(|\psi|^{2})$ of the eigenfunction amplitude at the center-of-band (E=0) anomaly in the one-dimensional tight-binding chain with weak uncorrelated on-site disorder (the one-dimensional Anderson model). The special emphasis is on the probability of the anomalously localized states (ALS) with $|\psi|^{2}$ much larger than the inverse typical localization length $\ell_{0}$. Using the solution to the generating function $\Phi_{an}(u,\phi)$ found recently in our works we find the ALS probability distribution $P(|\psi|^{2})$ at $|\psi|^{2}\ell_{0} >> 1$. As an auxiliary preliminary step we found the asymptotic form of the generating function $\Phi_{an}(u,\phi)$ at $u >> 1$ which can be used to compute other statistical properties at the center-of-band anomaly. We show that at moderately large values of $|\psi|^{2}\ell_{0}$, the probability of ALS at E=0 is smaller than at energies away from the anomaly. However, at very large values of $|\psi|^{2}\ell_{0}$, the tendency is inverted: it is exponentially easier to create a very strongly localized state at E=0 than at energies away from the anomaly. We also found the leading term in the behavior of $P(|\psi|^{2})$ at small $|\psi|^{2}<< \ell_{0}^{-1}$ and show that it is consistent with the exponential localization corresponding to the Lyapunov exponent found earlier by Kappus and Wegner and Derrida and Gardner.Comment: 25 pages, 9 figure

Effective action for Dirac fields in a constant electromagnetic background

We obtain, through zeta function methods, the one-loop effective action for massive Dirac fields in the presence of a uniform, but otherwise general, electromagnetic background. We show the agreement of our result with previous ones, concerning particular limit cases

A three-loop check of the 'a - maximization' in SQCD with adjoint(s)

The 'a - maximization' was introduced by K. Inrtiligator and B. Wecht for finding anomalous dimensions of chiral superfields at the IR fixed points of the RG flow. Using known explicit calculations of anomalous dimensions in the perturbation theory of SQCD (with one or two additional adjoint fields), it is checked here at the three-loop level.Comment: 5 pages; the title changed, the text improved and expande

Magic Numbers for the Photoelectron Anisotropy in Li-Doped Dimethyl Ether Clusters

Photoelectron velocity map imaging of Li(CH$_3$OCH$_3$)$_n$ clusters (1 $\leq$ n $\leq$ 175) is used to search for magic numbers related to the photoelectron anisotropy. Comparison with density functional calculations reveals magic numbers at n=4, 5, and 6, resulting from the symmetric charge distribution with high s-character of the highest occupied molecular orbital. Since each of these three cluster sizes correspond to the completion of a first coordination shell, they can be considered as 'isomeric motifs of the first coordination shell'. Differences in the photoelectron anisotropy, the vertical ionization energies and the enthalpies of vaporization between Li(CH$_3$OCH$_3$)$_n$ and Na(CH$_3$OCH$_3$)$_n$ can be rationalized in terms of differences in their solvation shells, atomic ionization energies, polarizabilities, metal-oxygen bonds, ligand-ligand interactions, and by cooperative effects

Abnormal negative feedback processing in first episode schizophrenia: evidence from an oculomotor rule switching task

Background. Previous studies have shown that patients with schizophrenia are impaired on executive tasks, where positive and negative feedbacks are used to update task rules or switch attention. However, research to date using saccadic tasks has not revealed clear deficits in task switching in these patients. The present study used an oculomotor ‘ rule switching ’ task to investigate the use of negative feedback when switching between task rules in people with schizophrenia. Method. A total of 50 patients with first episode schizophrenia and 25 healthy controls performed a task in which the association between a centrally presented visual cue and the direction of a saccade could change from trial to trial. Rule changes were heralded by an unexpected negative feedback, indicating that the cue-response mapping had reversed. Results. Schizophrenia patients were found to make increased errors following a rule switch, but these were almost entirely the result of executing saccades away from the location at which the negative feedback had been presented on the preceding trial. This impairment in negative feedback processing was independent of IQ. Conclusions. The results not only confirm the existence of a basic deficit in stimulus–response rule switching in schizophrenia, but also suggest that this arises from aberrant processing of response outcomes, resulting in a failure to appropriately update rules. The findings are discussed in the context of neurological and pharmacological abnormalities in the conditions that may disrupt prediction error signalling in schizophrenia

Bi-layer splitting in overdoped high TcT_{c} cuprates

Recent angle-resolved photoemission data for overdoped Bi2212 are explained. Of the peak-dip-hump structure, the peak corresponds the $\vec q =0$ component of a hole condensate which appears at $T_c$. The fluctuating part of this same condensate produces the hump. The bilayer splitting is large enough to produce a bonding hole and an electron antibonding quasiparticle Fermi surface. Smaller bilayer splittings observed in some experiments reflect the interaction of the peak structure with quasiparticle states near, but not at, the Fermi surface.Comment: 4 pages with 2 figures - published versio

First record of verticillium wilt (Verticillium longisporum) in winter oilseed rape in the UK

Verticillium longisporum is an important pathogen of oilseed rape (OSR) and vegetable brassicas in several European countries, but has not been reported previously in the UK (Karapapa et al., 1997; Steventon et al., 2002). In 2007, Verticillium wilt was suspected in UK crops of winter OSR (W-OSR) on cv. Castille in Romney Marsh, Kent and on cv. Barrel near Hereford. At these two locations, 32 and 10% of the plants, respectively, appeared to be affected, but the presence of stem canker may have masked some infections. Symptoms were first seen as the crops began to ripen (seeds green-brown to brown, Growth Stage: 6,4-6,5) and included brown and dark grey vertical bands on the stems from soil level into the branches, and premature ripening of some branches (Fig. 1). Microsclerotia were observed on stem samples collected in the field (Fig. 2), suggesting V. longisporum as the causal agent. Cultures were prepared from field samples by immersing stem pieces in 5% sodium hypochlorite solution for one minute, washing twice in sterile distilled water and plating onto potato dextrose agar containing 25 mg/l streptomycin sulphate. Isolates from three plants per outbreak were identified morphologically as V. longisporum. Mean conidial dimensions (25 spores per isolate) were 8.80-9.65 μm (length) and 2.50-2.85 μm (width) and all isolates produced elongated microsclerotia, characters typical of V. longisporum (Karapapa et al., 1997). The identity was confirmed by PCR using species-specific primers (Steventon et al., 2002) and, as a member of the α sub-group, by direct sequencing of the amplicons from primer pairs ITS4-ITS5 and DB19-DB22 (Collins et al., 2003; 2005). Sequences for isolate 003 from Kent were deposited in GenBank (Accession Nos. HQ702376 and HQ702377). All isolates tested from 2008 and 2009 were identical with previously deposited sequences for European OSR isolates (e.g. AF363992 and AF363246 respectively). Pathogenicity was confirmed by inoculating three OSR cv. Castille seedlings per isolate using the root dip technique with 1 x 106 spores/ml (Karapapa et al., 1997) under heated glasshouse conditions at 19°C. Leaf yellowing and blackening of the leaf veins were found 26 days after inoculation (Fig. 3). Yellowing affecting the three oldest leaves increased for seven to nine days. After five weeks the final mean leaf area affected was 63-78% with no differences between isolates. No leaf yellowing occurred in the controls. After five weeks, V. longisporum was re-isolated from all the inoculated seedlings, but not from the non-inoculated controls. In June 2008, infection of W-OSR crops in different fields on the same farms was found on cv. Es Astrid in Kent (56% incidence) and on cv. Lioness in Hereford (15% incidence). The Kent farm had been growing W-OSR alternating with winter wheat for at least 10 years whilst the Hereford farm had grown W-OSR one year in four. These short rotations of OSR may be contributing to the appearance of this disease. This study confirms the identification of V. longisporum on any host in the UK, through molecular studies and detailed spore measurements that were not reported in an earlier review (Gladders, 2009). This pathogen occurs in several European countries and, since OSR may be traded freely, following a Defra consultation, no statutory plant health action is to be taken