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

Comparative methane estimation from cattle based on total CO₂ production using different techniques

The objective of this study was to compare the precision of CH4 estimates using calculated CO2 (HP) by the CO2 method (CO2T) and measured CO2 in the respiration chamber (CO2R). The CO2R and CO2T study was conducted as a 3 × 3 Latin square design where 3 Dexter heifers were allocated to metabolic cages for 3 periods. Each period consisted of 2 weeks of adaptation followed by 1 week of measurement with the CO2R and CO2T. The average body weight of the heifer was 226 ± 11 kg (means ± SD). They were fed a total mixed ration, twice daily, with 1 of 3 supplements: wheat (W), molasses (M), or molasses mixed with sodium bicarbonate (Mbic). The dry mater intake (DMI; kg/day) was significantly greater (P < 0.001) in the metabolic cage compared with that in the respiration chamber. The daily CH4 (L/day) emission was strongly correlated (r = 0.78) between CO2T and CO2R. The daily CH4 (L/kg DMI) emission by the CO2T was in the same magnitude as by the CO2R. The measured CO2 (L/day) production in the respiration chamber was not different (P = 0.39) from the calculated CO2 production using the CO2T. This result concludes a reasonable accuracy and precision of CH4 estimation by the CO2T compared with the CO2R

Predicting Habitat Properties Using Remote Sensing Data: Soil pH and Moisture, and Ground Vegetation Cover

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Remote sensing data comprise a valuable information source for many ecological landscape studies that may be under-utilized because of an overwhelming amount of processing methods and derived variables. These complexities, combined with a scarcity of quality control studies, make the selection of appropriate remote sensed variables challenging. Quality control studies are necessary to evaluate the predictive power of remote sensing data and to develop parsimonious models underpinned by functional variables, i.e., cause rather than solely correlation. Cause-based models yield superior model transferability across different landscapes and ecological settings. We propose two basic guidelines for conducting such quality control studies that increase transferability and predictive power. The first is to favour predictors that are causally related to the response. The second is to include additional variables controlling variation in the property of interest and testing for optimum processing method and/or scale. Here, we evaluated these principles in predicting ground vegetation cover, soil moisture and pH under challenging conditions with forest canopies hindering direct remote sensing of the ground. Our model using lidar data combined with natural resource maps explained most of the observed variation in soil pH and moisture, and somewhat less variation of ground vegetation cover. Soil pH was best predicted by topographic position, sediment type and site index (R 2 = 0.90). Soil moisture was best predicted by topographic position, radiation load, sediment type and site index (R 2 = 0.83). The best model for predicting ground vegetation cover was a combination of lidar-based estimates for light availability below canopy and forest type, including an interaction between these two variables (R 2 = 0.65).publishedVersio

«Begynn i det små!» «Hvordan bruker barnehagelærere musikk for å skape tilknytning?»

Sammendrag Gjennom barnehagelærer studiet har vi undret oss over hvordan musikk blir tatt i bruk for å skape tilknytning. Ut ifra teori og empiri vil vi belyse problemstillingen: Hvordan bruker barnehagelærere musikk for å skape tilknytning? Musikk kan ha en viktig betydning i overganger og situasjoner som kan være utfordrende for barn. I løpet av denne prosessen har vi fått erfare barnehagelærere som brenner for å bruke musikk i barnehagehverdagen. Under intervjuene kom det frem at det var naturlig for informantene å ta i bruk musikk for å skape tilknytning med barna, og at musikken kunne være med på å skape glede og lykkehormonet øker. Frykten for å ta i bruk sin egen stemme kan være en utfordring for mange som jobber i barnehagen, og dette var også noe vi ønsket å finne mer ut av. Ved å ta i bruk sang og musikk kan det være med på å skape et fellesskap, og som våre informanter la det frem kan det beskrives som en «vi-følelse». Hvordan barnehagelærere bruker musikk for å skape tilknytning er forskjellig. Det er ikke alltid man trenger å tenke så stort, men at det handler om å begynne i det små

Reversible antibiotic tolerance induced in <i>Staphylococcus aureus</i> by concurrent drug exposure

ABSTRACT   Resistance of Staphylococcus aureus to beta-lactam antibiotics has led to increasing use of the glycopeptide antibiotic vancomycin as a life-saving treatment for major S. aureus infections. Coinfection by an unrelated bacterial species may necessitate concurrent treatment with a second antibiotic that targets the coinfecting pathogen. While investigating factors that affect bacterial antibiotic sensitivity, we discovered that susceptibility of S. aureus to vancomycin is reduced by concurrent exposure to colistin, a cationic peptide antimicrobial employed to treat infections by Gram-negative pathogens. We show that colistin-induced vancomycin tolerance persists only as long as the inducer is present and is accompanied by gene expression changes similar to those resulting from mutations that produce stably inherited reduction of vancomycin sensitivity (vancomycin-intermediate S. aureus [VISA] strains). As colistin-induced vancomycin tolerance is reversible, it may not be detected by routine sensitivity testing and may be responsible for treatment failure at vancomycin doses expected to be clinically effective based on such routine testing. IMPORTANCE   Commonly, antibiotic resistance is associated with permanent genetic changes, such as point mutations or acquisition of resistance genes. We show that phenotypic resistance can arise where changes in gene expression result in tolerance to an antibiotic without any accompanying genetic changes. Specifically, methicillin-resistant Staphylococcus aureus (MRSA) behaves like vancomycin-intermediate S. aureus (VISA) upon exposure to colistin, which is currently used against infections by Gram-negative bacteria. Vancomycin is a last-resort drug for treatment of serious S. aureus infections, and VISA is associated with poor clinical prognosis. Phenotypic and reversible resistance will not be revealed by standard susceptibility testing and may underlie treatment failure