General practice cooperatives: long waiting times for home visits due to long distances?

BACKGROUND: The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. METHODS: Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. RESULTS: The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minuts decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). DISCUSSION AND CONCLUSION: Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance

Tube Width Fluctuations in F-Actin Solutions

We determine the statistics of the local tube width in F-actin solutions, beyond the usually reported mean value. Our experimental observations are explained by a segment fluid theory based on the binary collision approximation (BCA). In this systematic generalization of the standard mean-field approach effective polymer segments interact via a potential representing the topological constraints. The analytically predicted universal tube width distribution with a stretched tail is in good agreement with the data.Comment: Final version, 5 pages, 4 figure

Comparison of the meteorology and surface energy balance at Storbreen and Midtdalsbreen, two glaciers in southern Norway

We compare 5 years of meteorological records from automatic weather stations (AWSs) on Storbreen and Midtdalsbreen, two glaciers in southern Norway, located approximately 120 km apart. The records are obtained from identical AWSs with an altitude difference of 120 m and cover the period September 2001 to September 2006. Air temperature at the AWS locations is found to be highly correlated, even with the seasonal cycle removed. The most striking difference between the two sites is the difference in wind climate. Midtdalsbreen is much more under influence of the large-scale circulation with wind speeds on average a factor 1.75 higher. On Storbreen, weaker katabatic winds are dominant. The main melt season is from May to September at both locations. During the melt season, incoming and net solar radiation are larger on Midtdalsbreen, whereas incoming and net longwave radiation are larger on Storbreen, primarily caused by thicker clouds on the latter. The turbulent fluxes are a factor 1.7 larger on Midtdalsbreen, mainly due to the higher wind speeds. Inter-daily fluctuations in the surface energy fluxes are very similar at the AWS sites. On average, melt energy is a factor 1.3 larger on Midtdalsbreen, a result of both larger net radiation and larger turbulent fluxes. The relative contribution of net radiation to surface melt is larger on Storbreen (76%) than on Midtdalsbreen (66%). As winter snow depth at the two locations is comparable in most years, the larger amount of melt energy results in an earlier disappearance of the snowpack on Midtdalsbreen and 70% more ice melt than on Storbreen. We compare the relative and absolute values of the energy fluxes on Storbreen and Midtdalsbreen with reported values for glaciers at similar latitudes. Furthermore, a comparison is made with meteorological variables measured at two nearby weather stations, showing that on-site measurements are essential for an accurate calculation of the surface energy balance and melt rate

Out-of-hours care in western countries: assessment of different organizational models

Contains fulltext : 81655.pdf (publisher's version ) (Open Access)BACKGROUND: Internationally, different organizational models are used for providing out-of-hours care. The aim of this study was to assess prevailing models in order to identify their potential strengths and weaknesses. METHODS: An international web-based survey was done in 2007 in a sample of purposefully selected key informants from 25 western countries. The questions concerned prevailing organizational models for out-of-hours care, the most dominant model in each country, perceived weaknesses, and national plans for changes in out-of-hours care. RESULTS: A total of 71 key informants from 25 countries provided answers. In most countries several different models existed alongside each other. The Accident and Emergency department was the organizational model most frequently used. Perceived weaknesses of this model concerned the coordination and continuity of care, its efficiency and accessibility. In about a third of the countries, the rota group was the most dominant organizational model for out-of-hours care. A perceived weakness of this model was lowered job satisfaction of physicians. The GP cooperative existed in a majority of the participating countries; no weaknesses were mentioned with respect to this model. Most of the countries had plans to change the out-of-hours care, mainly toward large scale organizations. CONCLUSION: GP cooperatives combine size of scale advantages with organizational features of strong primary care, such as high accessibility, continuity and coordination of care. While specific patients require other organizational models, the co-existence of different organizational models for out-of-hours care in a country may be less efficient for health systems

The Effects of Next-Nearest-Neighbor Interactions on the Orientation Dependence of Step Stiffness: Reconciling Theory with Experiment for Cu(001)

Within the solid-on-solid (SOS) approximation, we carry out a calculation of the orientational dependence of the step stiffness on a square lattice with nearest and next-nearest neighbor interactions. At low temperature our result reduces to a simple, transparent expression. The effect of the strongest trio (three-site, non pairwise) interaction can easily be incorporated by modifying the interpretation of the two pairwise energies. The work is motivated by a calculation based on nearest neighbors that underestimates the stiffness by a factor of 4 in directions away from close-packed directions, and a subsequent estimate of the stiffness in the two high-symmetry directions alone that suggested that inclusion of next-nearest-neighbor attractions could fully explain the discrepancy. As in these earlier papers, the discussion focuses on Cu(001).Comment: 8 pages, 3 figures, submitted to Phys. Rev.

Competing mechanisms for step meandering in unstable growth

The meander instability of a vicinal surface growing under step flow conditions is studied within a solid-on-solid model. In the absence of edge diffusion the selected meander wavelength agrees quantitatively with the continuum linear stability analysis of Bales and Zangwill [Phys. Rev. B {\bf 41}, 4400 (1990)]. In the presence of edge diffusion a local instability mechanism related to kink rounding barriers dominates, and the meander wavelength is set by one-dimensional nucleation. The long-time behavior of the meander amplitude differs in the two cases, and disagrees with the predictions of a nonlinear step evolution equation [O. Pierre-Louis et al., Phys. Rev. Lett. {\bf 80}, 4221 (1998)]. The variation of the meander wavelength with the deposition flux and with the activation barriers for step adatom detachment and step crossing (the Ehrlich-Schwoebel barrier) is studied in detail. The interpretation of recent experiments on surfaces vicinal to Cu(100) [T. Maroutian et al., Phys. Rev. B {\bf 64}, 165401 (2001)] in the light of our results yields an estimate for the kink barrier at the close packed steps.Comment: 8 pages, 7 .eps figures. Final version. Some errors in chapter V correcte

Pervasive cold ice within a temperate glacier-implications for glacier thermal regimes, sediment transport and foreland geomorphology

© Author(s) 2019. Published by Copernicus Publications on behalf of the European Geosciences Union.This study suggests that cold-ice processes may be more widespread than previously assumed, even within temperate glacial systems. We present the first systematic mapping of cold ice at the snout of the temperate glacier Midtdalsbreen, an outlet of the Hardangerjøkulen icefield (Norway), from 43 line kilometres of ground-penetrating radar data. Results show a 40 m wide cold-ice zone within the majority of the glacier snout, where ice thickness is <10 m. We interpret ice to be cold-based across this zone, consistent with basal freeze-on processes involved in the deposition of moraines. We also find at least two zones of cold ice up to 15 m thick within the ablation area, occasionally extending to the glacier bed. There are two further zones of cold ice up to 30 m thick in the accumulation area, also extending to the glacier bed. Cold-ice zones in the ablation area tend to correspond to areas of the glacier that are covered by late-lying seasonal snow patches that reoccur over multiple years. Subglacial topography and the location of the freezing isotherm within the glacier and underlying subglacial strata likely influence the transport and supply of supraglacial debris and formation of controlled moraines. The wider implication of this study is the possibility that, with continued climate warming, temperate environments with primarily temperate glaciers could become polythermal in forthcoming decades with (i) persisting thinning and (ii) retreat to higher altitudes where subglacial permafrost could be and/or become more widespread. Adversely, the number and size of late-lying snow patches in ablation areas may decrease and thereby reduce the extent of cold ice, reinforcing the postulated change in the thermal regime.Peer reviewedFinal Published versio