The disappearance of the "revolving door" patient in Scottish general practice: successful policies

<b>Background</b> We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.<p></p> <b>Methods</b> A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with "revolving door" patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of "revolving door" patients identified from 1999 to 2005 in Scotland.<p></p> <b>Results</b> A "revolving door" patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of "revolving door" patients during the course of the study.<p></p> <b>Conclusions</b> "Revolving door" patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS

Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials.

ObjectiveThe goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.MethodsIntervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.ResultsThe intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.ConclusionsWeight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients

Photosynthetic maximum quantum yield increases are an essential component of the Southern Ocean phytoplankton response to iron

It is well established that an increase in iron supply causes an increase in total oceanic primary production in many regions, but the physiological mechanism driving the observed increases has not been clearly identified. The Southern Ocean iron enrichment experiment, an iron fertilization experiment in the waters closest to Antarctica, resulted in a 9-fold increase in chlorophyll (Chl) concentration and a 5-fold increase in integrated primary production. Upon iron addition, the maximum quantum yield of photosynthesis (phi(m)) rapidly doubled, from 0.011 to 0.025 mol C.mol quanta(-1). Paradoxically, this increase in light-limited productivity was not accompanied by a significant increase in light-saturated productivity (P-max(b)). P-max(b) maximum Chl normalized productivity, was 1.34 mg C.mg Chl(-1).h(-1) outside and 1.49 mg C.mg Chl(-1)-h(-1) inside the iron-enriched patch. The importance of phi(m) as compared with P-max(b) in controlling the biological response to iron addition has vast implications for understanding the ecological response to iron. We show that an iron-driven increase in phi(m) is the proximate physiological mechanism affected by iron addition and can account for most of the increases in primary production. The relative importance of phi(m) over P-max(b) in this iron-fertilized bloom highlights the limitations of often-used primary productivity algorithms that are driven by estimates of P-max(b) but largely ignore variability in phi(m) and light-limited productivity. To use primary productivity models that include variability in iron supply in prediction or forecasting, the variability of light-limited productivity must be resolved

Milling plant and soil material in plastic tubes over-estimates carbon and under-estimates nitrogen concentrations

Peer reviewedPostprin

Stability Analysis of Frame Slotted Aloha Protocol

Frame Slotted Aloha (FSA) protocol has been widely applied in Radio Frequency Identification (RFID) systems as the de facto standard in tag identification. However, very limited work has been done on the stability of FSA despite its fundamental importance both on the theoretical characterisation of FSA performance and its effective operation in practical systems. In order to bridge this gap, we devote this paper to investigating the stability properties of FSA by focusing on two physical layer models of practical importance, the models with single packet reception and multipacket reception capabilities. Technically, we model the FSA system backlog as a Markov chain with its states being backlog size at the beginning of each frame. The objective is to analyze the ergodicity of the Markov chain and demonstrate its properties in different regions, particularly the instability region. By employing drift analysis, we obtain the closed-form conditions for the stability of FSA and show that the stability region is maximised when the frame length equals the backlog size in the single packet reception model and when the ratio of the backlog size to frame length equals in order of magnitude the maximum multipacket reception capacity in the multipacket reception model. Furthermore, to characterise system behavior in the instability region, we mathematically demonstrate the existence of transience of the backlog Markov chain.Comment: 14 pages, submitted to IEEE Transaction on Information Theor

Identifying critically important vascular access outcomes for trials in haemodialysis : an international survey with patients, caregivers and health professionals

BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD

Reaction Time and Mortality from the Major Causes of Death:The NHANES-III Study

Studies examining the relation of information processing speed, as measured by reaction time, with mortality are scarce. We explored these associations in a representative sample of the US population

The Role of Local Intrinsic Dimensionality in Benchmarking Nearest Neighbor Search

This paper reconsiders common benchmarking approaches to nearest neighbor search. It is shown that the concept of local intrinsic dimensionality (LID) allows to choose query sets of a wide range of difficulty for real-world datasets. Moreover, the effect of different LID distributions on the running time performance of implementations is empirically studied. To this end, different visualization concepts are introduced that allow to get a more fine-grained overview of the inner workings of nearest neighbor search principles. The paper closes with remarks about the diversity of datasets commonly used for nearest neighbor search benchmarking. It is shown that such real-world datasets are not diverse: results on a single dataset predict results on all other datasets well.Comment: Preprint of the paper accepted at SISAP 201