Nurse telephone triage in out of hours primary care: a pilot study

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Accretion dynamics in neutron star black hole binaries

We perform three-dimensional, Newtonian hydrodynamic simulations with a nuclear equation of state to investigate the accretion dynamics in neutron star black hole systems. We find as a general result that non-spinning donor stars yield larger circularization radii than corotating donors. Therefore, the matter from a neutron star without spin will more likely settle into an accretion disk outside the Schwarzschild radius. With the used stiff equation of state we find it hard to form an accretion disk that is promising to launch a gamma-ray burst. In all relevant cases the core of the neutron star survives and keeps orbiting the black hole as a mini neutron star for the rest of the simulation time (up to several hundred dynamical neutron star times scales). The existence of this mini neutron star leaves a clear imprint on the gravitational wave signal which thus can be used to probe the physics at supra-nuclear densities.Comment: submitted to MNRAS, 23 pages, 16 figure

Emergency and on-demand health care: modelling a large complex system

This paper describes how system dynamics was used as a central part of a whole-system review of emergency and on-demand health care in Nottingham, England. Based on interviews with 30 key individuals across health and social care, a 'conceptual map' of the system was developed, showing potential patient pathways through the system. This was used to construct a stock-flow model, populated with current activity data, in order to simulate patient flows and to identify system bottle-necks. Without intervention, assuming current trends continue, Nottingham hospitals are unlikely to reach elective admission targets or achieve the government target of 82% bed occupancy. Admissions from general practice had the greatest influence on occupancy rates. Preventing a small number of emergency admissions in elderly patients showed a substantial effect, reducing bed occupancy by 1% per annum over 5 years. Modelling indicated a range of undesirable outcomes associated with continued growth in demand for emergency care, but also considerable potential to intervene to alleviate these problems, in particular by increasing the care options available in the community

Hyperons and massive neutron stars: vector repulsion and SU(3) symmetry

With the discovery of massive neutron stars such as PSR J1614-2230, the question has arisen whether exotic matter such as hyperons can exist in the neutron star core. We examine the conditions under which hyperons can exist in massive neutron stars. We consistently investigate the vector meson-hyperon coupling, going from SU(6) quark model to a broader SU(3) symmetry. We propose that the maximum neutron star mass decreases linearly with the strangeness content f_s of the neutron star core as M_max(f_s) = M_max(0) - 0.6 M_solar (f_s/0.1), which seems to be independent of the underlying nuclear equation of state and the vector baryon-meson coupling scheme. Thus, pulsar mass measurements can be used to constrain the hyperon fraction in neutron stars.Comment: 13 pages, 10 figure

Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation