Response to requests for general practice out of hours: geographical analysis in north west England

The organisation of out of hours general practice (GP) in the UK has changed rapidly in recent years as practice based rotas and deputising services have given way to GP cooperatives in many areas. At the same time, the proportion of patients contacting an out of hours service who receive telephone advice only, rather than a face to face consultation, has risen substantially, although patients continue to express strong preferences for personal contact with a doctor out of hours. We examined the effect of the distance of the patient from the primary care centre on the doctor’s decision to see the patient face to face

A comparison of methods for calculating general practice level socioeconomic deprivation

Background: A measure of the socioeconomic deprivation experienced by the registered patient population of a general practice is of interest because it can be used to explore the association between deprivation and a wide range of other variables measured at practice level. If patient level geographical data are available a population weighted mean area-based deprivation score can be calculated for each practice. In the absence of these data, an area-based deprivation score linked to the practice postcode can be used as an estimate of the socioeconomic deprivation of the practice population. This study explores the correlation between Index of Multiple Deprivation 2004 (IMD) scores linked to general practice postcodes (main surgery address alone and main surgery plus any branch surgeries), practice population weighted mean IMD scores, and practice level mortality (aged 1 to 75 years, all causes) for 38 practices in Rotherham UK. Results: Population weighted deprivation scores correlated with practice postcode based scores (main surgery only, Pearson r = 0.74, 95% CI 0.54 to 0.85; main plus branch surgeries, r = 0.79, 95% CI 0.63 to 0.89). All cause mortality aged 1 to 75 correlated with deprivation (main surgery postcode based measure, r = 0.50, 95% CI 0.22 to 0.71; main plus branch surgery based score, r = 0.55, 95% CI 0.28 to 0.74); population weighted measure, r = 0.66, 95% CI 0.43 to 0.81). Conclusion: Practice postcode linked IMD scores provide a valid proxy for a population weighted measure in the absence of patient level data. However, by using them, the strength of association between mortality and deprivation may be underestimated

Acute effects of aircraft noise on cardiovascular admissions - an interrupted time-series analysis of a six-day closure of London Heathrow Airport caused by volcanic ash

Acute noise exposure may acutely increase blood pressure but the hypothesis that acute exposure to aircraft noise may trigger cardiovascular events has not been investigated. This study took advantage of a six-day closure of a major airport in April 2010 caused by volcanic ash to examine if there was a decrease in emergency cardiovascular hospital admissions during or immediately after the closure period, using an interrupted daily time-series study design. The population living within the 55 dB(A) noise contour was substantial at 0.7 million. The average daily admission count was 13.9 (SD 4.4). After adjustment for covariates, there was no evidence of a decreased risk of hospital admission from cardiovascular disease during the closure period (relative risk 0.97 (95% CI 0.75–1.26)). Using lags of 1–7 days gave similar results. Further studies are needed to investigate if transient aircraft noise exposure can trigger acute cardiovascular events

Magnetic Rotator Winds and Keplerian Disks of Hot Stars

We consider rotating magnetic stars with winds and disks. We establish a theorem that relates the angular velocity of a disk region with no meridional motion to the angular velocity of the star. Also, we show that for a given value of the magnetic field strength, if the rotation rate is too high or the flow velocity into the shock boundary is too low, a Keplerian disk region will not be formed. We develop a model for the formation of disks in magnetic rotators through the processes of fill-up and diffusion into Keplerian orbits. At the end of the fill-up stage the density of the disk increases significantly and the magnetic force in the disk becomes negligible. We derive analytical expressions for the inner and outer radii of Keplerian disks in terms of the stellar rotation rate. A disk can form if the meridional component Bm of the field at the stellar surface is larger than a minimum value. The radial extent of the Keplerian region becomes larger for larger values of Bm and is largest when Bm equals an optimal value. The strengths of the minimum fields required for Keplerian disk formation in B-type stars varies from order 1G to 10G. In O-type stars they must be of order 500G. Also, we suggest that the stellar magnetic fields may be affected by rotationally driven meridional circulation leading to some of the the observed variations of disks with time.Comment: 44 pages, 1 figure, accepted by Ap

Intra annual Variability of the Arabian Sea high salinity water mass in the South Eastern Arabian Sea during 2016 17

Intra-annual variability of the Arabian Sea high salinity water mass (ASHSW) in the South Eastern Arabian Sea (SEAS) and Gulf of Mannar (GoM) are addressed in this paper by utilisng the monthly missions carried out onboard INS Sagardhwani during 2016-17. Our observations revealed that the ASHSW was evident along the SEAS irrespective of seasons, whereas in the GoM the presence of ASHSW was observed during winter. The processes such as downwelling/up-welling, coastal currents, intrusion of low saline waters, stratification are clearly affects the spreading of the ASHSW. The characteristics such as core salinity value, depth and thickness of ASHSW exhibited remarkable spatio-temporal variability. Lateral mixing with the low saline waters in the region during winter reduces its core salinity. The intrusion of low saline waters was clearly seen upto 15 ON but the intrusion of low saline waters is not flowing through the GoM. The interface between the ASHSW and the prevailing low saline waters showed strong horizontal gradients of salinity. The presence of the ASHSW makes difference in the SLD and the below layer gradient which is sufficient to complicate or influence sound transmission. The spatio temporal variability of the ASHSW and its acoustic relevance are documented in this paper

Air Pollution and Subtypes, Severity and Vulnerability to Ischemic Stroke—A Population Based Case-Crossover Study

Few studies have examined the association between air pollutants and ischemic stroke subtypes. We examined acute effects of outdoor air pollutants (PM10, NO2, O3, CO, SO2) on subtypes and severity of incident ischemic stroke and investigated if pre-existing risk factors increased susceptibility.We used a time stratified case-crossover study and stroke cases from the South London Stroke Register set up to capture all incident cases of first ever stroke occurring amongst residents in a geographically defined area. The Oxford clinical and TOAST etiological classifications were used to classify subtypes. A pragmatic clinical classification system was used to assess severity. Air pollution concentrations from the nearest background air pollution monitoring stations to patients' residential postcode centroids were used. Lags from 0 to 6 days were investigated.There were 2590 incident cases of ischemic stroke (1995-2006). While there were associations at various lag times with several pollutants, overall, there was no consistent pattern between exposure and risk of ischemic stroke subtypes or severity. The possible exception was the association between NO2 exposure and small vessel disease stroke-adjusted odds ratio of 1.51 (1.12-2.02) associated with an inter-quartile range increase in the lag 0-6 day average for NO2. There were no clear associations in relation to pre-existing risk factors.Overall, we found little consistent evidence of association between air pollutants and ischemic stroke subtypes and severity. There was however a suggestion that increasing NO2 exposure might be associated with higher risk of stroke caused by cerebrovascular small vessel disease

An Intelligent Method for Predictive Monitoring of Patient Health Parameters using Data Mining Techniques

Now a day Internet of Things is suddenly increasing technology. IOT is the network of physical object or things embedded with software sensors, electronics and network connectivity. IOT is used to collect information and exchange data. In this paper, we are developing a system which will automatically monitor the industrial applications. IOT has given a powerful way to build industrial system by using wireless devices, and sensors. IOT concept is to monitor and control the industry. In phase I the hard ware was designed successfully using IOT. The input from sensor and data output can be displayed in the LCD (16*2).microcontroller (PIC16F887) which is used to collect data from sensors and displayed in LCD. The displayed data can be seen by server using IOT. The performances are verified experimentally using IOT. In Phase II the data from the server can be monitor through personal computer .The industrial data can be viewed through URL

Investigation of the Association Between Alcohol Outlet Density and Alcohol-Related Hospital Admission Rates in England: Study Protocol.

BACKGROUND: Availability of alcohol is a major policy issue for governments, and one of the availability factors is the density of alcohol outlets within geographic areas. OBJECTIVE: The aim of this study is to investigate the association between alcohol outlet density and hospital admissions for alcohol-related conditions in a national (English) small area level ecological study. METHODS: This project will employ ecological correlation and cross-sectional time series study designs to examine spatial and temporal relationships between alcohol outlet density and hospital admissions. Census units to be used in the analysis will include all Lower and Middle Super-Output Areas (LSOAs and MSOAs) in England (53 million total population; 32,482 LSOAs and 6781 MSOAs). LSOAs (approximately 1500 people per LSOA) will support investigation at a fine spatial resolution. Spatio-temporal associations will be investigated using MSOAs (approximately 7500 people per MSOA). The project will use comprehensive coverage data on alcohol outlets in England (from 2003, 2007, 2010, and 2013) from a commercial source, which has estimated that the database includes 98% of all alcohol outlets in England. Alcohol outlets may be classified into two broad groups: on-trade outlets, comprising outlets from which alcohol can be purchased and consumed on the premises (eg, pubs); and off-trade outlets, in which alcohol can be purchased but not consumed on the premises (eg, off-licenses). In the 2010 dataset, there are 132,989 on-trade and 51,975 off-trade outlets. The longitudinal data series will allow us to examine associations between changes in outlet density and changes in hospital admission rates. The project will use anonymized data on alcohol-related hospital admissions in England from 2003 to 2013 and investigate associations with acute (eg, admissions for injuries) and chronic (eg, admissions for alcoholic liver disease) harms. The investigation will include the examination of conditions that are wholly and partially attributable to alcohol, using internationally standardized alcohol-attributable fractions. RESULTS: The project is currently in progress. Results are expected in 2017. CONCLUSIONS: The results of this study will provide a national evidence base to inform policy decisions regarding the licensing of alcohol sales outlets

Computational Markets to Regulate Mobile-Agent Systems

Mobile-agent systems allow applications to distribute their resource consumption across the network. By prioritizing applications and publishing the cost of actions, it is possible for applications to achieve faster performance than in an environment where resources are evenly shared. We enforce the costs of actions through markets where user applications bid for computation from host machines. \par We represent applications as collections of mobile agents and introduce a distributed mechanism for allocating general computational priority to mobile agents. We derive a bidding strategy for an agent that plans expenditures given a budget and a series of tasks to complete. We also show that a unique Nash equilibrium exists between the agents under our allocation policy. We present simulation results to show that the use of our resource-allocation mechanism and expenditure-planning algorithm results in shorter mean job completion times compared to traditional mobile-agent resource allocation. We also observe that our resource-allocation policy adapts favorably to allocate overloaded resources to higher priority agents, and that agents are able to effectively plan expenditures even when faced with network delay and job-size estimation error

Antioxidant, In-vitro Antibacterial and DNA-cleavage activities of Nickel (II) Complex derived from N, N'-(1, 2 Phenylenebis (Methanylylidene)) bis(4-Nitroaniline)

New mononuclear Nickel (II) complex with Schiff base derived from the condensation of o-phthalaldehyde with p-nitroaniline were synthesized. The ligand and its complex were characterized by elemental analysis, molar conductivity, magnetic moment, IR, 1H NMR, and electronic spectra. The conductivity data confirmed the non-electrolytic nature of the complex. The spectral and analytical data suggested a distorted octahedral geometry for Ni(II) complex. The synthesized complex with ligand have been screened for antimicrobial activity against two gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis) and two gram-negative bacteria (Escherichia coli and klebsiella pneumoniae). The obtained results showed that Ni(II) complex is more potent than free ligand. DNA cleavage studies of Ni(II) complex have been investigated by gel electrophoresis using super coiled pUC18DNA. The experimental results revealed that the Ni(II) complex cleaved pUC18DNA. in an efficient manner than the parent ligand. In addition, the antioxidant activity of the ligand and its metal complex were investigated through scavenging effects for DPPH radical indicating that the compound show stronger antioxidant activity than free ligand but lower when compared to standard oxidants such as vitamin C. Keywords: Mononuclear, Antimicrobial studies and DNA cleavage