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

Project management in the Apollo program Interim report

Project management in Apollo progra

Manned space flight in transition

A study was conducted to analyze the reorientation of NASA programs in the post-Apollo period. The study is an external view of NASA by unbiased observers as an input to and aid in the decision making process concerning near and long term planning. The subjects discussed are: (1) the near-term NASA scenario; (2) organization of field centers; (3) planning activities; and (4) operational activities. A summary of the recommendations arising as a result of the study is presented

Determination for the modal age level for the grades IV and VI of the difficulty of the principal: The more rapid the vibrations of a body, the higher is the pitch of the note emitted by it

This item was digitized by the Internet Archive. Thesis (Ed.M.)--Boston Universityhttps://archive.org/details/determinationfor00poo

Cost Comparisons for White-Tailed Deer Live Capture Techniques

During March 13 - July 16, 1996, we captured 75 white-tailed deer (Odocoileus virginianus) using dart guns, rocket nets, and Clover traps on the Seneca Army Depot in Romulus, New York. We compared the labor and cost efficiency of these trapping techniques and reported on mortalities. Darting from a vehicle ($196/deer), and rocket-netting ($172/deer) were similar in time and cost efficiency. Darting from a blind was more costly ($358/deer) due to minimal time devoted to the technique and a high initial material investment. Clover traps were relatively inefficient (15.2 hours/deer) and costly ($895/deer), primarily due to a lack of snow. Materials comprised most of the total cost for all methods. Darting from a vehicle had the highest mortality (9.5%, n=2 of 21). Cost efficiency for all trapping techniques was poorly represented in the literature

Enlightening dynamic functions in molecular systems by intrinsically chiral light-driven molecular motors

Chirality is a fundamental property which plays a major role in chemistry, physics, biological systems and materials science. Chiroptical artificial molecular motors (AMMs) are a class of molecules which can convert light energy input into mechanical work, and they hold great potential in the transformation from simple molecules to dynamic systems and responsive materials. Taking distinct advantages of the intrinsic chirality in these structures and the unique opportunity to modulate the chirality on demand, chiral AMMs have been designed for the development of light-responsive dynamic processes including switchable asymmetric catalysis, chiral self-assembly, stereoselective recognition, transmission of chirality, control of spin selectivity and biosystems as well as integration of unidirectional motion with specific mechanical functions. This review focuses on the recently developed strategies for chirality-led applications by the class of intrinsically chiral AMMs. Finally, some limitations in current design and challenges associated with recent systems are discussed and perspectives towards promising candidates for responsive and smart molecular systems and future applications are presented.</p

Controlling rotary motion of molecular motors based on oxindole

Molecular motors are essential components of artificial molecular machines, which can be used to manipulate and amplify mechanical motion at the nanoscale to create machine-like function. Since the discovery of light-driven rotary molecular motors, the field has been widely developed, including the introduction of molecular motors based on oxindole by our group in 2019. The rotational properties of molecular motors, e.g. absorption wavelength, quantum yield and rotation speed, often critically depend on substituent effects. Up to now, the substituent effects of oxindole-based molecular motors have not yet been investigated. Herein, we present a family of oxindole-based molecular motors functionalised at three different positions on the motor core, with either CN or OMe groups. The motors prepared in this work retain the favourable features of oxindole-based motors, i.e. simple synthesis and visible light addressability. We find that functionalisation has substantial effects on the absorption wavelength of the motors, meanwhile the rotation speed is unaffected. Furthermore, we found that functionalisation of the oxindole molecular motors increases their quantum efficiency considerably in comparison to previous motors of their class

Designing light-driven rotary molecular motors

The ability to induce and amplify motion at the molecular scale has seen tremendous progress ranging from simple molecular rotors to responsive materials. In the two decades since the discovery of light-driven rotary molecular motors, the development of these molecules has been extensive; moving from the realm of molecular chemistry to integration into dynamic molecular systems. They have been identified as actuators holding great potential to precisely control the dynamics of nanoscale devices, but integrating molecular motors effectively into evermore complex artificial molecular machinery is not trivial. Maximising efficiency without compromising function requires conscious and judicious selection of the structures used. In this perspective, we focus on the key aspects of motor design and discuss how to manipulate these properties without impeding motor integrity. Herein, we describe these principles in the context of molecular rotary motors featuring a central double bond axle and emphasise the strengths and weaknesses of each design, providing a comprehensive evaluation of all artificial light-driven rotary motor scaffolds currently present in the literature. Based on this discussion, we will explore the trajectory of research into the field of molecular motors in the coming years, including challenges to be addressed, potential applications, and future prospects.</p

Designing light-driven rotary molecular motors

The ability to induce and amplify motion at the molecular scale has seen tremendous progress ranging from simple molecular rotors to responsive materials. In the two decades since the discovery of light-driven rotary molecular motors, the development of these molecules has been extensive; moving from the realm of molecular chemistry to integration into dynamic molecular systems. They have been identified as actuators holding great potential to precisely control the dynamics of nanoscale devices, but integrating molecular motors effectively into evermore complex artificial molecular machinery is not trivial. Maximising efficiency without compromising function requires conscious and judicious selection of the structures used. In this perspective, we focus on the key aspects of motor design and discuss how to manipulate these properties without impeding motor integrity. Herein, we describe these principles in the context of molecular rotary motors featuring a central double bond axle and emphasise the strengths and weaknesses of each design, providing a comprehensive evaluation of all artificial light-driven rotary motor scaffolds currently present in the literature. Based on this discussion, we will explore the trajectory of research into the field of molecular motors in the coming years, including challenges to be addressed, potential applications, and future prospects

Evaluations of Livestock Protection Dogs for Deterring Deer and Cattle Interactions

Bovine Tuberculosis (bovine TB) in northern Michigan has proven a dilemma necessitating aggressive measures including depopulation of livestock operations, culling of wildlife, banning the feeding of wildlife, and fencing livestock feed with high fences. Bovine TB is believed to be transmitted from white-tailed deer (Odocoileus virginianus) to domestic cattle through feces, urine, saliva, and nasal secretions on contaminated feed (indirect transmission) and from animal to animal (direct transmission). Effective methods for excluding deer from cattle enclosures would minimize the potential for indirect and direct transmission of bovine TB between infected deer and cattle. We combined an idea used historically in Europe to control predation on sheep with the concept of modem frightening devices that often fall short when the motivation of offending species is high. The use of livestock protection dogs (LPDs) seemed like an ideal solution in controlling the transmission of bovine TB from white-tailed deer to cattle. We felt LPDs raised and bonded with cattle would reduce use of cattle pastures and cattle feed by deer and minimize contact between deer and cattle, thereby reducing the potential for the transmission of bovine TB. We evaluated 4 LPDs over a 5-month period utilizing 2 primary data collection methods (direct observations and motion-activated video) on farmed deer facilities in Michigan. Following the initial evaluation of the LPDs, we relocated the dogs to working livestock operations in Michigan for further evaluation to gain an understanding of their practicality and long-term efficacy. Pastures protected by dogs had fewer intrusions by deer, fewer contacts (within 5m) between deer and cattle, and lower use of cattle feed by deer. Overall, we successfully decreased the potential for disease transmission with 66% fewer intrusions by deer into protected pastures, 96% fewer contacts (within 5m) between deer and cattle, and 100% lower use of cattle feed by deer (based of observation data). Livestock protection dogs were more effective in protecting animals and their immediate surroundings than excluding animals from entire study pastures. We found a strong treatment effect within the High Density Site; while within the Very High Density Site, we had high variability within intrusion rates at protected pastures and relatively low use of unprotected pastures resulting in no significant treatment effect. In conclusion, when properly trained and confined with the protected animals, LPDs minimize the potential for livestock to contract bovine TB from infected deer