1,015 research outputs found
Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs
OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. Participants: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments
No Evidence Supporting Flare Driven High-Frequency Global Oscillations
The underlying physics that generates the excitations in the global
low-frequency, < 5.3 mHz, solar acoustic power spectrum is a well known process
that is attributed to solar convection; However, a definitive explanation as to
what causes excitations in the high-frequency regime, > 5.3 mHz, has yet to be
found. Karoff and Kjeldsen (Astrophys. J. 678, 73-76, 2008) concluded that
there is a correlation between solar flares and the global high-frequency solar
acoustic waves. We have used the Global Oscillations Network Group (GONG)
helioseismic data in an attempt to verify Karoff and Kjeldsen (2008) results as
well as compare the post-flare acoustic power spectrum to the pre-flare
acoustic power spectrum for 31 solar flares. Among the 31 flares analyzed, we
observe that a decrease in acoustic power after the solar flare is just as
likely as an increase. Furthermore, while we do observe variations in acoustic
power that are most likely associated with the usual p-modes associated with
solar convection, these variations do not show any significant temporal
association with flares. We find no evidence that consistently supports flare
driven high-frequency waves.Comment: 20 pages, 9 figures, Accepted for publication in Solar Physic
Accessing elite nurses for research: reflections on the theoretical and practical issues of telephone interviewing
Elite groups are interesting as they frequently are powerful (in terms of position, knowledge and influence) and enjoy considerable authority. It is important, therefore, to involve them in research concerned with understanding social contexts and processes. This is particularly pertinent in healthcare, where considerable strategic development and change are features of everyday practice that may be guided or perceived as being guided, by elites.
This paper evolved from a study investigating the availability and role of nurses whose remit involved leading nursing research and development within acute NHS Trusts in two health regions in Southern England. The study design included telephone interviews with Directors of Nursing Services during which time the researchers engaged in a reflective analysis of their experiences of conducting research with an `elite' group. Important issues identified were the role of gatekeepers, engagement with elites and the use of the telephone interview method in this context. The paper examines these issues and makes a case for involving executive nurses in further research. The paper also offers strategies to help researchers design and implement telephone interview studies successfully to maximise access to the views and experiences of `hard to reach groups', such as elites, while minimising the associated disruption
Recent Developments of NEMO: Detection of Solar Eruptions Characteristics
The recent developments in space instrumentation for solar observations and
telemetry have caused the necessity of advanced pattern recognition tools for
the different classes of solar events. The Extreme ultraviolet Imaging
Telescope (EIT) of solar corona on-board SOHO spacecraft has uncovered a new
class of eruptive events which are often identified as signatures of Coronal
Mass Ejection (CME) initiations on solar disk. It is evident that a crucial
task is the development of an automatic detection tool of CMEs precursors. The
Novel EIT wave Machine Observing (NEMO) (http://sidc.be/nemo) code is an
operational tool that detects automatically solar eruptions using EIT image
sequences. NEMO applies techniques based on the general statistical properties
of the underlying physical mechanisms of eruptive events on the solar disc. In
this work, the most recent updates of NEMO code - that have resulted to the
increase of the recognition efficiency of solar eruptions linked to CMEs - are
presented. These updates provide calculations of the surface of the dimming
region, implement novel clustering technique for the dimmings and set new
criteria to flag the eruptive dimmings based on their complex characteristics.
The efficiency of NEMO has been increased significantly resulting to the
extraction of dimmings observed near the solar limb and to the detection of
small-scale events as well. As a consequence, the detection efficiency of CMEs
precursors and the forecasts of CMEs have been drastically improved.
Furthermore, the catalogues of solar eruptive events that can be constructed by
NEMO may include larger number of physical parameters associated to the dimming
regions.Comment: 12 Pages, 5 figures, submitted to Solar Physic
Discrete molecular dynamics simulations of peptide aggregation
We study the aggregation of peptides using the discrete molecular dynamics
simulations. At temperatures above the alpha-helix melting temperature of a
single peptide, the model peptides aggregate into a multi-layer parallel
beta-sheet structure. This structure has an inter-strand distance of 0.48 nm
and an inter-sheet distance of 1.0 nm, which agree with experimental
observations. In this model, the hydrogen bond interactions give rise to the
inter-strand spacing in beta-sheets, while the Go interactions among side
chains make beta-strands parallel to each other and allow beta-sheets to pack
into layers. The aggregates also contain free edges which may allow for further
aggregation of model peptides to form elongated fibrils.Comment: 15 pages, 8 figure
Association between Reimbursement Incentives and Physician Practice in Oncology: A Systematic Review
Importance: Significant controversy exists regarding whether physicians factor personal financial considerations into their clinical decision making. Within oncology, several reimbursement policies may incentivize physicians to increase health care use. Objective: To evaluate whether the financial incentives presented by oncology reimbursement policies affect physician practice patterns. Evidence Review: Studies evaluating an association between reimbursement incentives and changes in reimbursement policy on oncology care delivery were reviewed. Articles were identified systematically by searching PubMed/MEDLINE, Web of Science, Proquest Health Management, Econlit, and Business Source Premier. English-language articles focused on the US health care system that made empirical estimates of the association between a measurement of physician reimbursement/compensation and a measurement of delivery of cancer treatment services were included. The Risk of Bias in Non-Randomized Studies of Interventions tool was used to assess risk of bias. There were no date restrictions on the publications, and literature searches were finalized on February 14, 2018. Findings: Eighteen studies were included. All were observational cohort studies, and most had a moderate risk of bias. Heterogeneity of reimbursement policies and outcomes precluded meta-analysis; therefore, a qualitative synthesis was performed. Most studies (15 of 18 [83%]) reported an association between reimbursement and care delivery consistent with physician responsiveness to financial incentives, although such an association was not identified in all studies. Findings consistently suggested that self-referral arrangements may increase use of radiotherapy and that profitability of systemic anticancer agents may affect physicians' choice of drug. Findings were less conclusive as to whether profitability of systemic anticancer therapy affects the decision of whether to use any systemic therapy. Conclusions and Relevance: To date, this study is the first systematic review of reimbursement policy and clinical care delivery in oncology. The findings suggest that some oncologists may, in certain circumstances, alter treatment recommendations based on personal revenue considerations. An implication of this finding is that value-based reimbursement policies may be a useful tool to better align physician incentives with patient need and increase the value of oncology care
The Saffman-Taylor problem on a sphere
The Saffman-Taylor problem addresses the morphological instability of an
interface separating two immiscible, viscous fluids when they move in a narrow
gap between two flat parallel plates (Hele-Shaw cell). In this work, we extend
the classic Saffman-Taylor situation, by considering the flow between two
curved, closely spaced, concentric spheres (spherical Hele-Shaw cell). We
derive the mode-coupling differential equation for the interface perturbation
amplitudes and study both linear and nonlinear flow regimes. The effect of the
spherical cell (positive) spatial curvature on the shape of the interfacial
patterns is investigated. We show that stability properties of the fluid-fluid
interface are sensitive to the curvature of the surface. In particular, it is
found that positive spatial curvature inhibits finger tip-splitting. Hele-Shaw
flow on weakly negative, curved surfaces is briefly discussed.Comment: 26 pages, 4 figures, RevTex, accepted for publication in Phys. Rev.
Expansion in perfect groups
Let Ga be a subgroup of GL_d(Q) generated by a finite symmetric set S. For an
integer q, denote by Ga_q the subgroup of Ga consisting of the elements that
project to the unit element mod q. We prove that the Cayley graphs of Ga/Ga_q
with respect to the generating set S form a family of expanders when q ranges
over square-free integers with large prime divisors if and only if the
connected component of the Zariski-closure of Ga is perfect.Comment: 62 pages, no figures, revision based on referee's comments: new ideas
are explained in more details in the introduction, typos corrected, results
and proofs unchange
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