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

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

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

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

Factors Affecting Retention of Undergraduate Students in Fisheries and Wildlife Programs

Undergraduate enrollment in agriculture and natural resources‐related programs has steadily declined for the past decade or more. College administrators and faculty struggle to separate the real causes of this decline from the superficial and often mythical factors. How programs should address this decline is of similar concern. Rather than speculate on why students do not pursue a degree in a natural resources field, specifically fisheries and wildlife (FW), we decided to investigate the question of FW student retention from the perspective of the students themselves. Specifically, we wanted to know: (a) Why do students say they chose to leave the FW program at MSU? (b) Why did students who persisted in program say they chose to stay? and (c) What reasons did transfer students give for choosing FW as a major? We conducted a series of face‐to‐face interviews with these three groups of students, and asked them a series of 10‐14 questions related to their experiences in the Department of Fisheries and Wildlife at Michigan State University in an effort to better understand student reasons for leaving, persisting, and immigrating into the program. Although our project is just beginning, preliminary results offer some interesting insights into the departure puzzle. Specific, but limited, findings from interviewees include: (a) the importance of job prospects and earnings potential, (b) a general reluctance to pursue postgraduate education, (c) a degree of disillusionment at the relative lack of outdoor experiences offered by the program in classroom and extracurricular activities, and (d) a desire for more active participation and field experiences in the undergraduate program. Several students in this study told us that they selected FW out of a desire to spend more time in the field, and were disappointed this was frequently not the case. Some students expressed a general feeling of deception at the realities of the departmental curriculum, although these were poorly defined and may be the product of other issues such as unrealistic program expectations. This ongoing study has the potential to inform natural resource programs on techniques to attract, retain, and educate undergraduate students

Hazard Detection Software for Lunar Landing

The Autonomous Landing and Hazard Avoidance Technology (ALHAT) Project is developing a system for safe and precise manned lunar landing that involves novel sensors, but also specific algorithms. ALHAT has selected imaging LIDAR (light detection and ranging) as the sensing modality for onboard hazard detection because imaging LIDARs can rapidly generate direct measurements of the lunar surface elevation from high altitude. Then, starting with the LIDAR-based Hazard Detection and Avoidance (HDA) algorithm developed for Mars Landing, JPL has developed a mature set of HDA software for the manned lunar landing problem. Landing hazards exist everywhere on the Moon, and many of the more desirable landing sites are near the most hazardous terrain, so HDA is needed to autonomously and safely land payloads over much of the lunar surface. The HDA requirements used in the ALHAT project are to detect hazards that are 0.3 m tall or higher and slopes that are 5 or greater. Steep slopes, rocks, cliffs, and gullies are all hazards for landing and, by computing the local slope and roughness in an elevation map, all of these hazards can be detected. The algorithm in this innovation is used to measure slope and roughness hazards. In addition to detecting these hazards, the HDA capability also is able to find a safe landing site free of these hazards for a lunar lander with diameter .15 m over most of the lunar surface. This software includes an implementation of the HDA algorithm, software for generating simulated lunar terrain maps for testing, hazard detection performance analysis tools, and associated documentation. The HDA software has been deployed to Langley Research Center and integrated into the POST II Monte Carlo simulation environment. The high-fidelity Monte Carlo simulations determine the required ground spacing between LIDAR samples (ground sample distances) and the noise on the LIDAR range measurement. This simulation has also been used to determine the effect of viewing on hazard detection performance. The software has also been deployed to Johnson Space Center and integrated into the ALHAT real-time Hardware-in-the-Loop testbed

A census with ROSAT of low-luminosity X-ray sources in globular clusters

I analyze 101 observations from the ROSAT archive to search for X-ray sources in or near 55 globular clusters. New sources are found in the cores of NGC362 (a double source), NGC6121 (marginally significant), NGC6139, and NGC6266; and outside the cores of NGC6205, NGC6352 and NGC6388. More accurate positions are determined for the X-ray sources in some ten clusters. The improved position for the source in NGC6341 excludes the suggested ultraviolet counterpart. It is shown that one of the two sources reported near the core NGC6626 is spurious, as is the detection of a pulsar period in the PSPC data of this cluster; the central source is resolved in three sources. One source reported previously in NGC6304 is demoted to an upper limit. For 20 cluster cores better upper limits to the X-ray luminosity are obtained. From a statistical analysis I argue that several sources outside the cluster cores may well belong to the clusters. All spectral energy distributions observed so far are relatively soft, with bremsstrahlung temperatures =~0.9keV; there is evidence however that bremsstrahlung spectra do not correctly describe the spectra. The X-ray luminosity per unit mass for the cluster as a whole does not depend on the concentration; the luminosity per unit mass for the core may increase with the cluster concentration.Comment: 24 pages, 8 figures, 5 tables, accepted for publication in Astronomy and Astrophysic

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

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

Risk of Nosocomial Transmission of Nipah Virus in a Bangladesh Hospital

We conducted a seroprevalence study and exposure survey of healthcare workers to assess the risk of nosocomial transmission of Nipah virus during an outbreak in Bangladesh in 2004. No evidence of recent Nipah virus infection was detected despite substantial exposures and minimal use of personal protective equipmen

Biological, clinical and population relevance of 95 loci for blood lipids.

Plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides are among the most important risk factors for coronary artery disease (CAD) and are targets for therapeutic intervention. We screened the genome for common variants associated with plasma lipids in >100,000 individuals of European ancestry. Here we report 95 significantly associated loci (P < 5 x 10(-8)), with 59 showing genome-wide significant association with lipid traits for the first time. The newly reported associations include single nucleotide polymorphisms (SNPs) near known lipid regulators (for example, CYP7A1, NPC1L1 and SCARB1) as well as in scores of loci not previously implicated in lipoprotein metabolism. The 95 loci contribute not only to normal variation in lipid traits but also to extreme lipid phenotypes and have an impact on lipid traits in three non-European populations (East Asians, South Asians and African Americans). Our results identify several novel loci associated with plasma lipids that are also associated with CAD. Finally, we validated three of the novel genes-GALNT2, PPP1R3B and TTC39B-with experiments in mouse models. Taken together, our findings provide the foundation to develop a broader biological understanding of lipoprotein metabolism and to identify new therapeutic opportunities for the prevention of CAD