10,307 research outputs found

    Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

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    Objectives To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers.Design Cost consequences study alongside randomised controlled trial.Setting Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales.Participants 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments.Main outcome measures NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction.Results Overall six month costs were greater for the virtual outreach consultations (pound724 per patient) than for conventional outpatient appointments (pound625): difference in means pound99 ($162; is not an element of138) (95% confidence interval pound10 to pound187, P=0.03). if the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means pound108 (pound73 to pound142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost 8 pound (5 pound to 10 pound, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost pound11 (pound10 to pound12, P < 0.0001).Condusion The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported

    Enforcing RFID data visibility restrictions using XACML security policies

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    Radio Frequency Identification (RFID) technology allows automatic data capture from tagged objects moving in a supply chain. This data can be very useful if it is used to answer traceability queries, however it is distributed across many different repositories, owned by different companies. Discovery Services (DS) are designed to assist in retrieving the RFID data relevant for traceability queries while enforcing sharing policies that are defined and required by participating companies to prevent sensitive data from being exposed. In this paper we define an interface for Supply Chain Authorization (SC-Az) and describe the implementation of two visibility restriction mechanisms based on Access Control Lists (ACLs) and Capabilities. Both approaches were converted to the standard eXtensible Access Control Markup Language (XACML) and their correctness and performance was evaluated for supply chains with increasing size

    Phase Mixing of Alfvén Waves Near a 2D Magnetic Null Point

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    The propagation of linear Alfvén wave pulses in an inhomogeneous plasma near a 2D coronal null point is investigated. When a uniform plasma density is considered, it is seen that an initially planar Alfvén wavefront remains planar, despite the varying equilibrium Alfvén speed, and that all the wave collects at the separatrices. Thus, in the non-ideal case, these Alfvénic disturbances preferentially dissipate their energy at these locations. For a non-uniform equilibrium density, it is found that the Alfvén wavefront is significantly distorted away from the initially planar geometry, inviting the possibility of dissipation due to phase mixing. Despite this however, we conclude that for the Alfvén wave, current density accumulation and preferential heating still primarily occur at the separatrices, even when an extremely non-uniform density profile is considered

    The perceptions of undertaking a higher degree alongside orthodontic speciality training: a cross-sectional survey of British Orthodontic Society members

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    Introduction: In the UK, orthodontic speciality training takes place over three years full-time. In addition to the clinical training, there is an expectation that trainees undertake a higher degree. Currently, there is little evidence regarding the impact of undertaking a higher degree on specialist orthodontists. Aims: Investigate UK orthodontists' perceptions of undertaking a higher degree alongside speciality training. Materials and methods: A cross-sectional research study involving the distribution of an anonymous, descriptive, online, questionnaire-based survey between May and June 2021 via the British Orthodontic Society. Data were obtained in relation to the impact of undertaking a higher degree on the completion of speciality training, research skills, delivery of patient care and career opportunities. Results: In total, 166 questionnaires were completed (approximately 13.3% response rate). Most respondents 'agreed' or 'strongly agreed' that undertaking a higher degree had improved their scientific (77.1%) and critical appraisal skills (80.7%), job prospects (60.2%) and career opportunities (63.9%). Most respondents felt the benefits of the higher degree outweighed the associated costs (65.1%) and was a worthwhile component of training (69.3%). Conclusions: Specialist orthodontists place a high value on undertaking a higher degree. The results of this questionnaire should be of importance to stakeholders involved in the development of the orthodontic curriculum

    Physical function assessment tools in pediatric rheumatology

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    Pediatric rheumatic diseases with predominant musculoskeletal involvement such as juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis(JDM) can cause considerable physical functional impairment and significantly affect the children's quality of life (QOL). Physical function, QOL, health-related QOL (HRQOL) and health status are personal constructs used as outcomes to estimate the impact of these diseases and often used as proxies for each other. The chronic, fluctuating nature of these diseases differs within and between patients, and complicates the measurement of these outcomes. In children, their growing needs and expectations, limited use of age-specific questionnaires, and the use of proxy respondents further influences this evaluation. This article will briefly review the different constructs inclusive of and related to physical function, and the scales used for measuring them. An understanding of these instruments will enable assessment of functional outcome in clinical studies of children with rheumatic diseases, measure the impact of the disease and treatments on their lives, and guide us in formulating appropriate interventions

    Near-sea-level langley calibration algorithm

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    As compared to other methods, measurement of aerosol optical depth (AOD) using sunphotometers offer several advantages. However, it suffers a drawback as calibration of the instrument required to be performed at high altitude due to temporal drifts in the atmospheric condition during the calibration. To solve this, a new Langley calibration algorithm has been designed for AOD measurement using spectroradiometer instrument. The key advantages of the proposed algorithm are its objectivity, computational efficiency and the ability to detect short intervals of cloud transits. It avoids travelling to high altitude mountain that the conventional calibration procedure always practiced for frequent calibration. Most importantly, neither it requires priori knowledge of the instrument calibration nor a collocated calibrated instrument for nominal calibration transfer to perform the cloud-screening procedure

    The cellular diversity of the pedunculopontine nucleus: relevance to behavior in health and aspects of Parkinson's disease

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    The pedunculopontine nucleus (PPN) is a rostral brainstem structure that has extensive connections with basal ganglia nuclei and the thalamus. Through these the PPN contributes to neural circuits that effect cortical and hippocampal activity. The PPN also has descending connections to nuclei of the pontine and medullary reticular formations, deep cerebellar nuclei, and the spinal cord. Interest in the PPN has increased dramatically since it was first suggested to be a novel target for treating patients with Parkinson’s disease who are refractory to medication. However, application of frequency-specific electrical stimulation of the PPN has produced inconsistent results. A central reason for this is that the PPN is not a heterogeneous structure. In this article, we review current knowledge of the neurochemical identity and topographical distribution of neurons within the PPN of both humans and experimental animals, focusing on studies that used neuronally selective targeting strategies to ascertain how the neurochemical heterogeneity of the PPN relates to its diverse functions in relation to movement and cognitive processes. If the therapeutic potential of the PPN is to be realized, it is critical to understand the complex structure-function relationships that exist here
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