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

EOS: A project to investigate the design and construction of real-time distributed embedded operating systems

The EOS project is investigating the design and construction of a family of real-time distributed embedded operating systems for reliable, distributed aerospace applications. Using the real-time programming techniques developed in co-operation with NASA in earlier research, the project staff is building a kernel for a multiple processor networked system. The first six months of the grant included a study of scheduling in an object-oriented system, the design philosophy of the kernel, and the architectural overview of the operating system. In this report, the operating system and kernel concepts are described. An environment for the experiments has been built and several of the key concepts of the system have been prototyped. The kernel and operating system is intended to support future experimental studies in multiprocessing, load-balancing, routing, software fault-tolerance, distributed data base design, and real-time processing

Kink-antikink interactions in the double sine-Gordon equation and the problem of resonance frequencies

We studied the kink-antikink collision process for the "double sine-Gordon" (DSG) equation in 1+1 dimensions at different values of the potential parameter $R>0$. For small values of $R$ we discuss the problem of resonance frequencies. We give qualitative explanation of the frequency shift in comparison with the frequency of the discrete level in the potential well of isolated kink. We show that in this region of the parameter $R$ the effective long-range interaction between kink and antikink takes place.Comment: 9 pages, LaTeX, 4 figures (eps

Demographic growth and the distribution of language sizes

It is argued that the present log-normal distribution of language sizes is, to a large extent, a consequence of demographic dynamics within the population of speakers of each language. A two-parameter stochastic multiplicative process is proposed as a model for the population dynamics of individual languages, and applied over a period spanning the last ten centuries. The model disregards language birth and death. A straightforward fitting of the two parameters, which statistically characterize the population growth rate, predicts a distribution of language sizes in excellent agreement with empirical data. Numerical simulations, and the study of the size distribution within language families, validate the assumptions at the basis of the model.Comment: To appear in Int. J. Mod. Phys. C (2008

Development and application of a non-Gaussian atmospheric turbulence model for use in flight simulators

A method is described for generating time histories which model the frequency content and certain non-Gaussian probability characteristics of atmospheric turbulence including the large gusts and patchy nature of turbulence. Methods for time histories using either analog or digital computation are described. A STOL airplane was programmed into a 6-degree-of-freedom flight simulator, and turbulence time histories from several atmospheric turbulence models were introduced. The pilots' reactions are described