DIETARY PATTERNS IN STREAM- AND LAKE-DWELLING POPULATIONS OF AUSTROPOTAMOBIUS PALLIPES

White-clawed crayfish (Austropotamobius pallipes) are widespread in Ireland in both running and standing water, although stream-dwelling in much of their range elsewhere. A detailed comparative study of a lake and a stream population demonstrated that diets changed with crayfish size from feeding on entomostracans to a predominance of aquatic macrophytes and terrestrial vegetation. However, carnivory remained important at all sizes: Gammarids were a significant component in larger lake crayfish and in all sizes of stream crayfish. Fish increased in importance with crayfish size. A. pallipes thus appears more carnivorous than some other European and American crayfish. The extent to which this is related to habitat is discussed

Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine’s Sentinel Site Survey data

Introduction Avoidable attendances (AAs; defined as non-urgent, self-referred patients who could be managed more effectively and efficiently by other services) have been identified as a contributor to ED crowding. Internationally, AAs have been estimated to constitute 10%–90% of ED attendances, with the UK 2013 Urgent and Emergency Care Review suggesting a figure of 40%. Methods This pilot study used data from the Royal College of Emergency Medicine’s Sentinel Site Survey to estimate the proportion of AAs in 12 EDs across England on a standard day (20 March 2014). AAs were defined by an expert panel using questions from the survey. All patients attending the EDs were recorded with details of investigations and treatments received, and the proportion of patients meeting criteria for AA was calculated. Results Visits for 3044 patients were included. Based on these criteria, a mean of 19.4% (95% CI 18.0% to 20.8%) of attendances could be deemed avoidable. The lowest proportion of AAs reported was 10.7%, while the highest was 44.3%. Younger age was a significant predictor of AA with mean age of 38.6 years for all patients attending compared with 24.6 years for patients attending avoidably (p≤0.001). Discussion The proportion of AAs in this study was lower than many estimates in the literature, including that reported by the 2013 Urgent and Emergency Care Review. This suggests the ED is the most appropriate healthcare setting for many patients due to comprehensive investigations, treatments and capability for urgent referrals. The proportion of AAs is dependent on the defining criteria used, highlighting the need for a standardised, universal definition of an appropriate/avoidable ED attendance. This is essential to understanding how AAs contribute to the overall issue of crowding

Education for collaboration: the influence of the third space on professional boundaries

The delivery of integrated care requires the establishment of effective professional relationships that foster collaborative working across health systems. Evidence for how to prepare practitioners to work in those settings is limited. By exploring an innovative postgraduate Programme for Integrated Child Health (PICH) this article highlights the conditions by which effective collaboration can be encouraged. Our qualitative evaluation of PICH involved one-to-one semi-structured interviews with 23 postgraduate general practice and paediatric trainees and their mentors. We analysed the data using the concept of the ‘third space’, where multiple discourses between individuals with diverse professional backgrounds occur, enabling creative exploration of tensions inherent in new ways of working in order to identify enablers and barriers to collaboration. Our analysis identified three themes that enabled collaboration: effective communication, boundary work and educational spaces; and four themes that were barriers: traditional hierarchical professional identities, curriculum design, financial systems and workplace spaces. PICH demonstrated the value of educational spaces and their role in enabling collaborative practice, as participants explored their professional identities and those of other disciplines. Structural factors in the workplace which inhibit collaborative practice were also evident. We conclude by proposing a model for collaborative learning in third spaces based upon the recognition that, while educational programmes alone will not lead to change, they have the potential to inform the development of productive workplace spaces that will be required if collaborative practice in healthcare is to become a reality

Tight-Binding Theory of Manganese and Iron Oxides

The electronic structure is found to be understandable in terms of free-atom term values and universal interorbital coupling parameters, since self-consistent tight-binding calculations indicate that Coulomb shifts of the d-state energies are small. Special-point averages over the bands are seen to be equivalent to treatment of local octahedral clusters. The cohesive energy per manganese for MnO, Mn2O3, and MnO2, in which manganese exists in valence states Mn2+, Mn3+, and Mn4+, is very nearly the same and dominated by the transfer of manganese s electrons to oxygen p states. There are small corrections, one eV per Mn in all cases, from couplings of minority-spin states. Transferring one majority-spin electron from an upper cluster state to a nonbonding oxygen state adds 1.67 eV to the cohesion for Mn2O3, and two transfers adds twice that for MnO2 . The electronic and magnetic properties are consistent with this description and appear to be understandable in terms of the same parameters.Comment: Submitting to Phys. Rev.

EUV ionization of pure He nanodroplets: Mass-correlated photoelectron imaging, Penning ionization and electron energy-loss spectra

The ionization dynamics of pure He nanodroplets irradiated by EUV radiation is studied using Velocity-Map Imaging PhotoElectron-PhotoIon COincidence (VMI-PEPICO) spectroscopy. We present photoelectron energy spectra and angular distributions measured in coincidence with the most abundant ions He+, He2+, and He3+. Surprisingly, below the autoionization threshold of He droplets we find indications for multiple excitation and subsequent ionization of the droplets by a Penning-like process. At high photon energies we evidence inelastic collisions of photoelectrons with the surrounding He atoms in the droplets

Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

BACKGROUND: To evaluate NHS England London region's approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice. METHODS: A pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation. RESULTS: The central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer's practice by providing an 'outsider perspective'. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement. CONCLUSIONS: Responsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective

Structural Relationships Among Mental Boundaries, Childhood Imaginary Companions, Creative Experiences, and Entity Encounters

This study investigated relationships between thin mental boundary functioning, creativity, imaginary companions (ICs), and anomalous ‘(entity) encounter experiences.’ A convenience sample of 389 respondents completed the Revised Transliminality Scale, Oxford-Liverpool Inventory of Feelings and Experiences, Creative Experiences Questionnaire, Survey of Strange Events, and a measure of Childhood Imaginary Companions. Competing testing with path analysis found that the best-fitting model was consistent with the causal chain of ‘Thin Boundaries (transliminality and schizotypy) → Creative Experiences → ICs → (Entity) Encounter Experiences.’ These results suggest that deep-types of ICs (i.e., showing apparent independent agency) are perhaps most accurately characterized as syncretic cognitions versus hallucination-like experiences. The authors examine these findings relative to study limitations, as well as discussing the need for future research that approaches ICs as a special mental state that can facilitate allied altered-anomalous experiences. In this context, this study furthered understanding of relationships between conscious states related to mental boundaries, childhood imaginary companions, creative experiences, and entity encounters

An analysis of NHS 111 demand for primary care services: a retrospective cohort study

The NHS 111 service triages over 16,650,745 calls per year and approximately 48% of callers are triaged to a primary care disposition, such as a telephone appointment with a general practitioner (GP). However, there has been little assessment of the ability of primary care services to meet this demand. If a timely service cannot be provided to patients, it could result in patients calling 999 or attending emergency departments (ED) instead. This study aimed to explore the patient journey for callers who were triaged to a primary care disposition, and the ability of primary care services to meet this demand. We obtained routine, retrospective data from the Connected Yorkshire research database, and identified all 111 calls between the 1st January 2021 and 31st December 2021 for callers registered with a GP in the Bradford or Airedale region of West Yorkshire, who were triaged to a primary care disposition. Subsequent healthcare system access (111, 999, primary and secondary care) in the 72 hours following the index 111 call was identified, and a descriptive analysis of the healthcare trajectory of patients was undertaken. There were 56,102 index 111 calls, and a primary care service was the first interaction in 26,690/56,102 (47.6%) of cases, with 15,470/26,690 (58%) commenced within the specified triage time frame. Calls to 999 were higher in the cohort who had no prior contact with primary care (58% vs 42%) as were ED attendances (58.2% vs 41.8), although the proportion of avoidable ED attendances was similar (10.5% vs 11.8%). Less than half of 111 callers triaged to a primary care disposition make contact with a primary care service, and even when they do, call triage time frames are frequently not met, suggesting that current primary care provision cannot meet the demand from 111