Doctor and practice characteristics associated with differences in patient evaluations of general practice

BACKGROUND: Variation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context. However, the extent to which differences in patients' evaluation of the GPs are associated with differences in GP and practice characteristics must also be ascertained in order to facilitate comparison of adjusted patient evaluations between GPs. The aim of this study was to determine such associations in a setting where GPs serve a list of patients and act as gatekeepers. METHODS: We carried out a patient evaluation survey among voluntarily participating GPs using the EUROPEP questionnaire, which produced 28,260 patient evaluations (response rate 77.3%) of 365 GPs. In our analyses we compared the prevalence of positive evaluations in groups of GPs. RESULTS: Our principal finding was a negative association between the GP's age and the evaluation of all aspects, except accessibility. We also found an association between the way the practice was organised and the patients' evaluation of accessibility, with GPs in single-handed practices getting far the most positive evaluations. Long weekly working hours were associated with more positive evaluations of all dimensions except accessibility, whereas more than 0.5 full-time employees per GP, a higher number of listed patients per GP and working in a training practice were associated with negative evaluation of accessibility. CONCLUSION: GP characteristics are mainly associated with patients' experience of interpersonal aspects of care, while practice characteristics are associated with evaluation of accessibility. These differences need to be accounted for when comparing patient evaluations of different practices

Nd:YVO4 high-power master oscillator power amplifier laser system for second-generation gravitational wave detectors

Ultrastable high-power laser systems are essential components of the long baseline interferometers that detected the first gravitational waves from merging black holes and neutron stars. One way to further increase the sensitivity of current generation gravitational wave detectors (GWDs) is to increase the laser power injected into the interferometers. In this Letter, we describe and characterize a 72 W and a 114 W linearly polarized, single-frequency laser system at a wavelength of 1064 nm, each based on single-pass Nd:YVO4 power amplifiers. Both systems have low power and frequency noise and very high spatial purity with less than 10.7% and 2.9% higher order mode content, respectively. We demonstrate the simple integration of these amplifiers into the laser stabilization environment of operating GWDs and show stable low-noise operation of one of the amplifier systems in such an environment for more than 45 days

The Causal Structure of Emotions in Aristotle: Hylomorphism, Causal Interaction between Mind and Body, and Intentionality

Recently, a strong hylomorphic reading of Aristotelian emotions has been put forward, one that allegedly eliminates the problem of causal interaction between soul and body. Taking the presentation of emotions in de An. I 1 as a starting point and basic thread, but relying also on the discussion of Rh. II, I will argue that this reading only takes into account two of the four causes of emotions, and that, if all four of them are included into the picture, then a causal interaction of mind and body remains within Aristotelian emotions, independent of how strongly their hylomorphism is understood. Beyond the discussion with this recent reading, the analysis proposed of the fourfold causal structure of emotions is also intended as a hermeneutical starting point for a comprehensive analysis of particular emotions in Aristotle. Through the different causes Aristotle seems to account for many aspects of the complex phenomenon of emotion, including its physiological causes, its mental causes, and its intentional object

Reconfiguration of Multilevel Inverter with Trapezoidal Pulse Width Modulation

This paper presents different multi-carrier unipolar trapezoidal pulse width modulation strategies for a reduced switch asymmetrical multilevel inverter. The different strategies are phase disposition, alternative phase opposition and disposition, and carrier overlapping and variable frequency that involve triangular waves as carriers with a unipolar trapezoidal wave as a reference. The reduced switch, asymmetrical multilevel inverter operation was examined for generating the seven-level output voltage using Matlab/Simulink 2009b and the results were verified with a real-time laboratory-based experimental setup using a field-programmable gate array. Different parameter analyses, such as total harmonic distortion, fundamental root mean square voltage, and distortion factor, were analyzed with different modulation indices to investigate the performance of the selected topology. Unipolar trapezoidal pulse width modulation provides a higher root mean square voltage value.publishedVersio

NFKB1 regulates human NK cell maturation and effector functions

12siopenopenLougaris, Vassilios; Patrizi, Ornella; Baronio, Manuela; Tabellini, Giovanna; Tampella, Giacomo; Damiati, Eufemia; Frede, Natalie; van der Meer, Jos W.M.; Fliegauf, Manfred; Grimbacher, Bodo; Parolini, Silvia; Plebani, AlessandroLougaris, Vassilios; Patrizi, Ornella; Baronio, Manuela; Tabellini, Giovanna; Tampella, Giacomo; Damiati, Eufemia; Frede, Natalie; van der Meer, Jos W. M.; Fliegauf, Manfred; Grimbacher, Bodo; Parolini, Silvia; Plebani, Alessandr

A Review of Current Research Trends in Power-Electronic Innovations in Cyber-Physical Systems.

In this paper, a broad overview of the current research trends in power-electronic innovations in cyber-physical systems (CPSs) is presented. The recent advances in semiconductor device technologies, control architectures, and communication methodologies have enabled researchers to develop integrated smart CPSs that can cater to the emerging requirements of smart grids, renewable energy, electric vehicles, trains, ships, internet of things (IoTs), etc. The topics presented in this paper include novel power-distribution architectures, protection techniques considering large renewable integration in smart grids, wireless charging in electric vehicles, simultaneous power and information transmission, multi-hop network-based coordination, power technologies for renewable energy and smart transformer, CPS reliability, transactive smart railway grid, and real-time simulation of shipboard power systems. It is anticipated that the research trends presented in this paper will provide a timely and useful overview to the power-electronics researchers with broad applications in CPSs.post-print2.019 K

Reduction of predictive uncertainty in estimating irrigation water requirement through multi-model ensembles and ensemble averaging

Irrigation agriculture plays an increasingly important role in food supply. Many evapotranspiration models are used today to estimate the water demand for irrigation. They consider different stages of crop growth by empirical crop coefficients to adapt evapotranspiration throughout the vegetation period. We investigate the importance of the model structural versus model parametric uncertainty for irrigation simulations by considering six evapotranspiration models and five crop coefficient sets to estimate irrigation water requirements for growing wheat in the Murray–Darling Basin, Australia. The study is carried out using the spatial decision support system SPARE:WATER. We find that structural model uncertainty among reference ET is far more important than model parametric uncertainty introduced by crop coefficients. These crop coefficients are used to estimate irrigation water requirement following the single crop coefficient approach. Using the reliability ensemble averaging (REA) technique, we are able to reduce the overall predictive model uncertainty by more than 10%. The exceedance probability curve of irrigation water requirements shows that a certain threshold, e.g. an irrigation water limit due to water right of 400 mm, would be less frequently exceeded in case of the REA ensemble average (45%) in comparison to the equally weighted ensemble average (66%). We conclude that multi-model ensemble predictions and sophisticated model averaging techniques are helpful in predicting irrigation demand and provide relevant information for decision making