Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation

Ultrasonic inspection and self-healing of Ge and 3C-SiC semiconductor membranes

Knowledge of the mechanical properties and stability of thin film structures is important for device operation. Potential failures related to crack initiation and growth must be identified early, to enable healing through e.g. annealing. Here, three square suspended membranes, formed from a thin layer of cubic silicon carbide (3C-SiC) or germanium (Ge) on a silicon substrate, were characterised by their response to ultrasonic excitation. The resonant frequencies and mode shapes were measured during thermal cycling over a temperature range of 20--100~$^\circ$C. The influence of temperature on the stress was explored by comparison with predictions from a model of thermal expansion of the combined membrane and substrate. For an ideal, non-cracked sample the stress and Q-factor behaved as predicted. In contrast, for a 3C-SiC and a Ge membrane that had undergone vibration and thermal cycling to simulate extended use, measurements of the stress and Q-factor showed the presence of damage, with the 3C-SiC membrane subsequently breaking. However, the damaged Ge sample showed an improvement to the resonant behaviour on subsequent heating. Scanning electron microscopy showed that this was due to a self-healing of sub-micrometer cracks, caused by expansion of the germanium layer to form bridges over the cracked regions, with the effect also observable in the ultrasonic inspection

Rotationally induced vortices in optical cavity modes

We show that vortices appear in the modes of an astigmatic optical cavity when it is put into rotation about its optical axis. We study the properties of these vortices and discuss numerical results for a specific realization of such a set-up. Our method is exact up to first order in the time-dependent paraxial approximation and involves bosonic ladder operators in the spirit of the quantum-mechanical harmonic oscillator.Comment: 8 pages, 5 figures. Accepted for publication in a special issue (singular optics 2008) of Journal of Optics A: Pure and Applied Optic

Saturation of front propagation in a reaction-diffusion process describing plasma damage in porous low-k materials

We propose a three-component reaction-diffusion system yielding an asymptotic logarithmic time-dependence for a moving interface. This is naturally related to a Stefan-problem for which both one-sided Dirichlet-type and von Neumann-type boundary conditions are considered. We integrate the dependence of the interface motion on diffusion and reaction parameters and we observe a change from transport behavior and interface motion \sim t^1/2 to logarithmic behavior \sim ln t as a function of time. We apply our theoretical findings to the propagation of carbon depletion in porous dielectrics exposed to a low temperature plasma. This diffusion saturation is reached after about 1 minute in typical experimental situations of plasma damage in microelectronic fabrication. We predict the general dependencies on porosity and reaction rates.Comment: Accepted for publication in Phys. Rev.

Modulation of the extraordinary optical transmission by surface acoustic waves

International audienceThe numerical study of periodically nanostructured metallic films exhibiting extraordinary optical transmission (EOT) deposited onto the top of a piezoelectric material is reported. Surface acoustic waves are generated in the piezoelectric substrate and their influence in the transmission spectrum of the EOT structure is studied. It is shown that low frequency acoustic waves can significantly tune the resonance frequency of the EOT structure

Radiological data of brachial plexus avulsion injury associated spinal cord herniation (BPAI-SCH) and comparison to anterior thoracic spinal cord herniation (ATSCH).

Spinal cord herniation (SCH) is a rare cause of myelopathy. When reported, SCH has most commonly been described as occurring spontaneously in the thoracic spine, and being idiopathic in nature (anterior thoracic spinal cord herniation, ATSCH) [1-3]. Several theories have been proposed to explain its occurrence, including congenital, inflammatory, and traumatic etiologies alike [1-4]. Even more rarely, SCH has been described to occur in the cervical spine in association with brachial plexus avulsion injuries (BPAI-SCH). In our accompanying article, Late Cervical Spinal Cord Herniation Resulting from Post-Traumatic Brachial Plexus Avulsion Injury, two cases of BPAI-SCH are presented and discussed in the context of the reviewed literature [5]. Here, pertinent accompanying follow-up data was collected and is presented for the cases, including postoperative radiographic outcome imaging. Furthermore, a table is presented comparing and contrasting ATSCH to BPAI-SCH. Although the two phenomena have been previously grouped together, this table highlights ATSCH and BPAI-SCH as distinct entities; more specifically, BPAI-SCH is a separate, long-term complicating feature of BPAI. This supplementary data helps treating physicians by increasing awareness and knowledge of BPAI-SCH as a distinct entity from ATSCH and cause of delayed neurological deterioration

Measurement of the Beam Asymmetry Sigma and the Target Asymmetry T in the Photoproduction of Omega Mesons off the Proton Using CLAS at Jefferson Laboratory

The photoproduction of omega mesons off the proton has been studied in the reaction γp -\u3e pω using the CEBAF Large Acceptance Spectrometer (CLAS) and the frozen-spin target in Hall B at the Thomas Jefferson National Accelerator Facility. For the first time, the target asymmetry T has been measured in photoproduction from the decay ω -\u3e π+π-π0, using a transversely polarized target with energies ranging from just above the reaction threshold up to 2.8 GeV. Significant nonzero values are observed for these asymmetries, reaching about 30-40% in the third-resonance region. New measurements for the photon-beam asymmetry Σ are also presented, which agree well with previous CLAS results and extend the world database up to 2.1 GeV. These data and additional ω photoproduction observables from CLAS were included in a partial-wave analysis within the Bonn-Gatchina framework. Significant contributions from s-channel resonance production were found in addition to t-channel exchange processes

Design of a complex virtual reality simulation to train finger motion for persons with hemiparesis: a proof of concept study

<p>Abstract</p> <p>Background</p> <p>Current neuroscience has identified rehabilitation approaches with the potential to stimulate adaptive changes in the brains of persons with hemiparesis. These approaches include, intensive task-oriented training, bimanual activities and balancing proximal and distal upper extremity interventions to reduce competition between these segments for neural territory.</p> <p>Methods</p> <p>This paper describes the design and feasibility testing of a robotic/virtual environment system designed to train the hand and arm of persons with hemiparesis. The system employs a simulated piano that presents visual, auditory and tactile feedback comparable to an actual piano. Arm tracking allows patients to train both the arm and hand as a coordinated unit, emphasizing the integration of both transport and manipulation phases. The piano trainer includes songs and scales that can be performed with one or both hands. Adaptable haptic assistance is available for more involved subjects. An algorithm adjusts task difficulty in proportion to subject performance. A proof of concept study was performed on four subjects with upper extremity hemiparesis secondary to chronic stroke to establish: a) the safety and feasibility of this system and b) the concurrent validity of robotically measured kinematic and performance measures to behavioral measures of upper extremity function.</p> <p>Results</p> <p>None of the subjects experienced adverse events or responses during or after training. As a group, the subjects improved in both performance time and key press accuracy. Three of the four subjects demonstrated improvements in fractionation, the ability to move each finger individually. Two subjects improved their aggregate time on the Jebsen Test of Hand Function and three of the four subjects improved in Wolf Motor Function Test aggregate time.</p> <p>Conclusion</p> <p>The system designed in this paper has proven to be safe and feasible for the training of hand function for persons with hemiparesis. It features a flexible design that allows for the use and further study of adjustments in point of view, bilateral and unimanual treatment modes, adaptive training algorithms and haptically rendered collisions in the context of rehabilitation of the hemiparetic hand.</p

Dislocation Free Island Formation in Heteroepitaxial Growth: An Equilibrium Study

We investigate the equilibrium properties of strained heteroepitaxial systems, incorporating the formation and the growth of a wetting film, dislocation free island formation, and ripening. The derived phase diagram provides a detailed characterization of the possible growth modes in terms of the island density, equilibrium island size, and wetting layer thickness. Comparing our predictions with experimental results we discuss the growth conditions that can lead to stable islands as well as ripening.Comment: 4 pages, LaTeX, 3 ps figure