Roles of fire history and rewetting in peatland restoration and vegetation recovery on the Merang peat dome, South Sumatra, Indonesia

In the restoration of drained and degraded tropical peat swamp forest (PSF) it is not well understood whether fire suppression on its own is sufficient to facilitate regeneration, or if rewetting plays a key role. We attempt to answer this question in the Merang area, a 23,000-ha peatland located in South Sumatra province, Indonesia. As with more than 90 % of PSF in Southeast Asia, the area has been largely degraded by logging and drainage canals, along with multiple fires. It has been designated and managed as an ecosystem restoration area since 2016, by which time only a single 254 ha patch of original PSF habitat remained. However, scattered remnant PSF trees ( 4 fires), while Macaranga pruinosa, Melicope glabra and Melicope lunu-ankenda dominate in regenerating areas that have experienced 12 fires. While fire suppression is essential to prevent further loss of vegetation, effective rewetting is required before woody vegetation can recover

Carbon chemistry in Galactic Bulge Planetary Nebulae

Galactic Bulge Planetary Nebulae show evidence of mixed chemistry with emission from both silicate dust and PAHs. This mixed chemistry is unlikely to be related to carbon dredge up, as third dredge-up is not expected to occur in the low mass Bulge stars. We show that the phenomenon is widespread, and is seen in 30 nebulae out of 40 of our sample, selected on the basis of their infrared flux. HST images and UVES spectra show that the mixed chemistry is not related to the presence of emission-line stars, as it is in the Galactic disk population. We also rule out interaction with the ISM as origin of the PAHs. Instead, a strong correlation is found with morphology, and the presence of a dense torus. A chemical model is presented which shows that hydrocarbon chains can form within oxygen-rich gas through gas-phase chemical reactions. The model predicts two layers, one at $A_V\sim 1.5$ where small hydrocarbons form from reactions with C$^+$, and one at $A_V\sim 4$, where larger chains (and by implication, PAHs) form from reactions with neutral, atomic carbon. These reactions take place in a mini-PDR. We conclude that the mixed chemistry phenomenon occurring in the Galactic Bulge Planetary Nebulae is best explained through hydrocarbon chemistry in an UV-irradiated, dense torus.Comment: 13 pages, 10 figue

Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

<p>Abstract</p> <p>Background</p> <p>Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP) on call or the ED.</p> <p>Methods</p> <p>Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services.</p> <p>Results</p> <p>1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African) nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women.</p> <p>Conclusions</p> <p>Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.</p

The Lamb shift in muonic hydrogen 1

Abstract: The long quest for a measurement of the Lamb shift in muonic hydrogen is over. Last year we measured the energy splitting (Pohl et al., Nature, 466, 213 (2010)) in mp with an experimental accuracy of 15 ppm, twice better than our proposed goal. Using current QED calculations of the fine, hyperfine, QED, and finite size contributions, we obtain a rootmean-square proton charge radius of r p = 0.841 84 (67) fm. This value is 10 times more precise, but 5 standard deviations smaller, than the 2006 CODATA value of r p . The origin of this discrepancy is not known. Our measurement, together with precise measurements of the 1S-2S transition in regular hydrogen and deuterium, gives improved values of the Rydberg constant, R ? = 10 973 731.568 16

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

Association between general practice characteristics and use of out-of-hours GP cooperatives

Contains fulltext : 154585.pdf (publisher's version ) (Open Access)BACKGROUND: The use of out-of-hours healthcare services for non-urgent health problems is believed to be related to the organisation of daytime primary care but insight into underlying mechanisms is limited. Our objective was to examine the association between daytime general practice characteristics and the use of out-of-hours care GP cooperatives. METHODS: A cross-sectional observational study in 100 general practices in the Netherlands, connected to five GP cooperatives. In each GP cooperative, we took a purposeful sample of the 10 general practices with the highest use of out-of-hours care and the 10 practices with the lowest use. Practice and population characteristics were obtained by questionnaires, interviews, data extraction from patient registration systems and telephone accessibility measurements. To examine which aspects of practice organisation were associated with patients' use of out-of-hours care, we performed logistic regression analyses (low versus high out-of-hours care use), correcting for population characteristics. RESULTS: The mean out-of-hours care use in the high use group of general practices was 1.8 times higher than in the low use group. Day time primary care practices with more young children and foreigners in their patient populations and with a shorter distance to the GP cooperative had higher out-of-hours primary care use. In addition, longer telephone waiting times and lower personal availability for palliative patients in daily practice were associated with higher use of out-of-hours care. Moreover, out-of-hours care use was higher when practices performed more diagnostic tests and therapeutic procedures and had more assistant employment hours per 1000 patients. Several other aspects of practice management showed some non-significant trends: high utilising general practices tended to have longer waiting times for non-urgent appointments, lower availability of a telephone consulting hour, lower availability for consultations after 5 p.m., and less frequent holiday openings. CONCLUSIONS: Besides patient population characteristics, organisational characteristics of general practices are associated with lower use of out-of-hours care. Improving accessibility and availability of day time primary day care might be a potential effective way to improve the efficient use of out-of-hours care services

The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

Contains fulltext : 109803.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. DESIGN: A quasi experimental study is undertaken at one "general practitioner cooperative" to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. METHODS: Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators. DISCUSSION: The study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT01388374

Patient safety in out-of-hours primary care: a review of patient records.

Contains fulltext : 89812.pdf (publisher's version ) (Open Access)BACKGROUND: Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. METHODS: A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. RESULTS: In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%). The most frequent incident type was treatment (56%). All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%). Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%). Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04). CONCLUSION: Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety

Urinary tract infections in young children: High guideline adherence of triage nurses at general practice co-operatives

Background: Urinary tract infection (UTI) is one of the most common bacterial infections among children, and it can have serious consequences including renal failure. Triage nurses at general practice (GP) co-operatives play an important role in identifying UTI in young children, but diagnosis is difficult because the symptoms tend to be non-specific. Aim: The aim of this study was to determine what triage nurses at GP co-operatives do when UTI in a child is suspected, or when a feverish child is presented. Methods: A survey study of triage nurses at Dutch GP co-operatives based on four vignettes was carried out. The information in the vignettes consisted of data about one 5-year-old child with suspected UTI, and three children with fever without focus (a 14-month-old boy with a 3-day fever, a 2-month-old girl with a 2-day fever, and a 4-year-old child with a 5-day fever). Results: A total of 145 questionnaires (59% response rate) were returned. If UTI was suspected, all triage nurses requested the parents to provide a sample of the child's urine, but only 70% gave instructions on how to collect the urine. More than 90% of the triage nurses requested the feverish children aged 2 months and 4 years to appear at the GP co-operative. Eighty per cent also requested the 14-month-old boy with fever without focus to appear, even though there was no direct need for this request. In most cases, the triage nurses did not think UTI was likely, mainly because they thought another focus was more likely. Discussion: More than 90% of triage nurses at GP co-operatives acted according to the guidelines if UTI was suspected. Even though UTI was not the first focus a triage nurse thought of when a child with fever without focus was presented, she requested the child to be brought to the GP co-operative almost every time. Possible interventions to improve the detection of children's UTIs could focus on the importance of the timeliness of detection, while over-diagnosis should be prevented