Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation

Objective: To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design: Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting: 2 GP practices in Devon and Warwickshire, UK. Participants: 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure: Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results: A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions: Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage

Shear-free radiating collapse and conformal flatness

Here we study some general properties of spherical shear-free collapse. Its general solution when imposing conformal flatness is reobtained [1,2] and matched to the outgoing Vaidya spacetime. We propose a simple model satisfying these conditions and study its physical consequences. Special attention deserve, the role played by relaxational processes and the conspicuous link betweeen dissipation and density inhomogeneity.Comment: 13 pages Latex. Some misprints in eqs.(17), (30) and (35) have been correcte

Strange matter in rotating compact stars

We have constructed equations of state involving various exotic forms of matter with large strangeness fraction such as hyperon matter, Bose-Einstein condensates of antikaons and strange quark matter. First order phase transitions from hadronic to antikaon condensed and quark matter are considered here. The hadronic phase is described by the relativistic field theoretical model. Later those equations of state are exploited to investigate models of uniformly rotating compact stars. The effect of rotation on the third family branch for the equation of state involving only antikaon condensates is investigated. We also discuss the back bending phenomenon due to a first order phase transition from $K^-$ condensed to quark matter.Comment: 8 pages, 4 figures; Plenary talk delivered at Strangeness in Quark Matter (SQM) 2004 held in Cape Town, South Africa from 15-20 September; Accepted for publication in the proceedings in Journal of Physics

A uniform treatment of the orbital effects due to a violation of the Strong Equivalence Principle in the gravitational Stark-like limit

We analytically work out several effects which a violation of the Strong Equivalence Principle (SEP) induces on the orbital motion of a binary system constituted of self-gravitating bodies immersed in a constant and uniform external field. We do not restrict to the small eccentricity limit. Moreover, we do not select any specific spatial orientation of the external polarizing field. We explicitly calculate the SEP-induced mean rates of change of all the osculating Keplerian orbital elements of the binary, the perturbation of the projection of the binary orbit onto the line-of-sight, the shift of the radial velocity, and the range and range-rate signatures and as well. We find that the ratio of the SEP precessions of the node and the inclination of the binary depends only on and the pericenter of the binary itself, being independent on both the magnitude and the orientation of the polarizing field, and on the semimajor axis, the eccentricity and the node of the binary. Our results, which do not depend on any particular SEP-violating theoretical scheme, can be applied to quite general astronomical and astrophysical scenarios. They can be used to better interpret present and future SEP experiments, especially when several theoretical SEP mechanisms may be involved, and to suitably design new dedicated tests.Comment: LaTex2e, 14 pages, no figures, no tables, 42 references. To appear in Classical and Quantum Gravity (CQG

Improved Models of Stellar Core Collapse and Still no Explosions: What is Missing?

Two-dimensional hydrodynamic simulations of stellar core-collapse with and without rotation are presented which for the first time were performed by solving the Boltzmann equation for the neutrino transport including a state-of-the-art description of neutrino interactions. Although convection develops below the neutrinosphere and in the neutrino-heated region behind the supernova shock, the models do not explode. This suggests missing physics, possibly with respect to the nuclear equation of state and weak interactions in the subnuclear regime. However, it might also indicate a fundamental problem of the neutrino-driven explosion mechanism.Comment: PRL submitted; 3 eps figures, 1 colored, high-quality available upon reques

Radiating Shear-Free Gravitational Collapse with Charge

We present a new shear free model for the gravitational collapse of a spherically symmetric charged body. We propose a dissipative contraction with radiation emitted outwards. The Einstein field equations, using the junction conditions and an ansatz, are integrated numerically. A check of the energy conditions is also performed. We obtain that the charge delays the black hole formation and it can even halt the collapse.Comment: 22 pages, 9 figures. It has been corrected several typos and included several references. Accepted for publication in GR

Isospin-rich nuclei in neutron star matter

Stability of nuclei beyond the drip lines in the presence of an enveloping gas of nucleons and electrons, as prevailing in the inner crust of a neutron star, is studied in the temperature-dependent Thomas-Fermi framework. A limiting asymmetry in the isospin space beyond which nuclei cannot exist emerges from the calculations. The ambient conditions like temperature, baryon density and neutrino concentration under which these exotic nuclear systems can be formed are studied in some detail.Comment: Submitted to Phy. Rev. C: Revtex version of manuscript 22 pages and 10 PS-files for figure

Isospin-rich nuclei in neutron star matter

Stability of nuclei beyond the drip lines in the presence of an enveloping gas of nucleons and electrons, as prevailing in the inner crust of a neutron star, is studied in the temperature-dependent Thomas-Fermi framework. A limiting asymmetry in the isospin space beyond which nuclei cannot exist emerges from the calculations. The ambient conditions like temperature, baryon density and neutrino concentration under which these exotic nuclear systems can be formed are studied in some detail.Comment: Submitted to Phy. Rev. C: Revtex version of manuscript 22 pages and 10 PS-files for figure

The Tolman VII solution, trapped null orbits and w - modes

The Tolman VII solution is an exact static spherically symmetric perfect fluid solution of Einstein's equations that exhibits a surprisingly good approximation to a neutron star. We show that this solution exhibits trapped null orbits in a causal region even for a tenuity (total radius to mass ratio) $> 3$. In this region the dynamical part of the potential for axial w - modes dominates over the centrifugal part.Comment: 5 pages revtex. 10 figures png. Further information at http://grtensor.phy.queensu.ca/tolmanvii

New Supernova Constraints on Sterile Neutrino Production

We consider the possibility that a light sterile-neutrino species $\nu_S$ can be produced by $\nu_e$ scattering during the cooling of a proto-neutron star. If we parameterize the sterile neutrino production cross-section by a parameter $A$ as $\sigma (\nu_e X\rightarrow \nu_S X) = A \sigma(\nu_e X\rightarrow \nu_e X)$, where $X$ is an electron, neutron or proton, we show that $A$ is constrained by limits to the conversion of $\nu_e$ to $\nu_S$ in the region between the sterile-neutrino trapping region and the electron-neutrino trapping region. This consideration excludes values of $A$ in the range between 10^{-4} \la A \la 10^{-1}.Comment: 12 pages; Late