2,090 research outputs found

    The impact of co-located NHS walk-in centres on emergency departments

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    Objectives: To determine the impact of establishing walk-in centres alongside emergency departments on attendance rates, visit duration, process, costs and outcome of care. Methods: Eight hospitals with co-located emergency departments and walk-in centres were compared with eight matched emergency departments without walk-in centres. Site visits were conducted. Routine data about attendance numbers and use of resources were analysed. A random sample of records of patients attending before and after walk-in centres opened were also assessed. Patients who had not been admitted to hospital were sent a postal questionnaire. Results: In most sites, the walk-in centres did not have a distinct identity and there were few differences in the way services were provided compared with control sites. Overall, there was no evidence of an increase in attendance at sites with walk-in centres, but considerable variability across sites. The proportion of patients managed within the four-hour NHS target improved at sites both with and without walk-in centres. There was no evidence of any difference in re-consultation rates, costs of care or patient outcomes at sites with or without walk-in centres. Conclusions: Most hospitals in this study implemented the walk-in centre concept to a very limited extent. Consequently there was no evidence of any impact on attendance rates, process, costs or outcome of care

    Investigating five key predictive text entry with combined distance and keystroke modelling

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    This paper investigates text entry on mobile devices using only five-keys. Primarily to support text entry on smaller devices than mobile phones, this method can also be used to maximise screen space on mobile phones. Reported combined Fitt's law and keystroke modelling predicts similar performance with bigram prediction using a five-key keypad as is currently achieved on standard mobile phones using unigram prediction. User studies reported here show similar user performance on five-key pads as found elsewhere for novice nine-key pad users

    Comparing care at walk-in centres and at accident and emergency departments: an exploration of patient choice, preference and satisfaction

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    Objectives: To explore the impact of establishing walk-in centres alongside emergency departments on patient choice, preference and satisfaction. Methods: A controlled, mixed-method study comparing eight emergency departments with co-located walk-in centres with the same number of ‘traditional’ emergency departments. This paper focuses on the results of a cross-sectional questionnaire survey of users. Results: Survey data demonstrated that patients were frequently unable to distinguish between being treated at a walk-in centre or an A&E department, and even where this was the case, opportunities to exercise choice about their preferred care provider were often limited. Few made an active choice to attend a co-located walk-in centre. Patients attending walk-in centres were just as likely to be satisfied overall with the care they received as their counterparts who were treated in the co-located A&E facility, although a small proportion of walk-in centre users did report greater satisfaction with some specific aspects of their care and consultation. Conclusions: Whilst one of the key policy goals underpinning the co-location of walk-in centres next to an A&E department was to provide patients with more options for accessing healthcare and greater choice, leading in turn to increased satisfaction, this evaluation was able to provide little evidence to support this. The high percentage of patients expressing a preference for care in an established emergency department compared to a new walk-in centre facility raises questions for future policy development. Further consideration should therefore be given to the role that A&E focused walk-in centres play in the Department of Health’s current policy agenda, as far as patient choice is concerned

    Night feeding to reduce bird predation in feedlots

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    During times of heavy infestations by birds, feedlots can have 25 to 30% increases in feed usage, thereby resulting in large economic losses. Because starlings, blackbirds, grackles, and other avian pests normally feed during daylight hours, we hypothesized that feeding cattle at night would minimize feed contamination and feed loss due to bird infestation. Crossbred beef heifers (n=96; 770 lb) were used to evaluate the effects of feeding at night on performance and carcass characteristics. Heifers were fed for 107 days during the months of November to March, when large bird populations were observed. Feed was delivered once daily at approximately 10:00 a.m. for heifers with continuous access to feed and 30 minutes before dusk for heifers that had access to feed only at night. Feed calls for heifers fed at night were managed so that no feed remained in the bunk at dawn, whereas the control heifers were allowed ad libitum access to feed. Daily feed deliveries per animal (21.51 vs. 18.15 lb for heifers fed continuously or only at night, respectively) were decreased by 16% (P<0.01) when cattle were provided access to feed only at night, but daily gain was not different. Feed efficiency was improved by 14% (P=0.05) with night time feeding, but carcass weights and dressing percentage remained similar. Overall, feeding cattle only during hours of darkness yielded similar growth performance compared to cattle fed continuously. However, feed efficiency was improved substantially, which we attribute to reduced theft by birds

    Getting Closer or Drifting Apart

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    Advances in communication and transportation technologies have the potential to bring people closer together and create a "global village." However, they also allow heterogeneous agents to segregate along special interests, which gives rise to communities fragmented by type rather than by geography. We show that lower communication costs should always decrease separation between individual agents even as group-based separation increases. Each measure of separation is pertinent for distinct types of social interaction. A group-based measure captures the diversity of group preferences that can have an impact on the provision of public goods. While an individual measure correlates with the speed of information transmission through the social network that affects, for example, learning about job opportunities and new technologies. We test the model by looking at coauthoring between academic economists before and during the rise of the Internet in the 1990s.Economic

    Use of bisulfite processing to generate high-β-O-4 content water-soluble lignosulfonates

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    This work was supported by EPSRC grants (EP/1518175), the Industrial Biotechnology Innovation Centre (IBioIC) (DMB Ph.D. studentship) and an EPSRC Doctoral Prize Fellowship (CSL).With lignin-first biorefineries likely to become a reality, controlled depolymerization of high-quality lignin streams to high value products has become a priority. Using bisulfite chemistry, access to a high-β-O-4 content water-soluble lignosulfonate has been achieved, allowing follow-on procedures in water to be conducted. We show that phenolic β-O-4 units preferential-ly react under acidic bisulfite conditions, whilst non-phenolic β-O-4 units react much more slowly. Exploiting this improved chemical understanding and inherent selectivity, a softwood lignosulfonate has been prepared in which phenolic β-O-4 α-sulfonation has occurred leaving significant native β-O-4 content. Use of an O-benzoylation protocol with lignin coupled with advanced 2D NMR methods has allowed detailed analysis of this and other commercial and industrial lignosulfonates. Conversion of the native β-O-4 to benzylic- oxidized β-O-4 units was followed by a selective reductive cleavage to give a premium aromatic monomer in pure form.Publisher PDFPeer reviewe

    Smoothed Particle Hydrodynamics Simulations of Apsidal and Nodal Superhumps

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    In recent years a handful of systems have been observed to show "negative" (nodal) superhumps, with periods slightly shorter than the orbital period. It has been suggested that these modes are a consequence of the slow retrograde precession of the line of nodes in a disk tilted with respect to the orbital plane. Our simulations confirm and refine this model: they suggest a roughly axisymmetric, retrogradely-precessing, tilted disk that is driven at a period slightly less than half the orbital period as the tidal field of the orbiting secondary encounters in turn the two halves of the disk above and below the midplane. Each of these passings leads to viscous dissipation on one face of an optically-thick disk -- observers on opposite sides of the disk would each observe one brightening per orbit, but 180 degrees out of phase with each other.Comment: 11 pages. Accepted for publication in The ApJ Letter

    An assessment of the strength of knots and splices used as eye terminations in a sailing environment

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    Research into knots, splices and other methods of forming an eye termination has been limited, despite the fact that they are essential and strongly affect the performance of a rope. The aim of this study was to carry out a comprehensive initial assessment of the breaking strength of eye terminations commonly used in a sailing environment, thereby providing direction for further work in the field. Supports for use in a regular tensile testing machine were specially developed to allow individual testing of each sample and a realistic spread of statistical data to be obtained. Over 180 break tests were carried out on four knots (the bowline, double bowline, figure-of-eight loop and perfection loop) and two splices (three-strand eye splice and braid-on-braid splice). The factors affecting their strength were investigated. A statistical approach to the analysis of the results was adopted. The type of knot was found to have a significant effect on the strength. This same effect was seen in both types of rope construction (three-strand and braid-on-braid). Conclusions were also drawn as to the effect of splice length, eye size, manufacturer and rope diameter on the breaking strength of splices. Areas of development and further investigation were identified

    Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

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    Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes
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