Senior doctor triage (SDT), a qualitative study of clinicians' views on senior doctors' involvement in triage and early assessment of emergency patients

INTRODUCTION: Despite the focus during the last decade on introducing interventions such as senior doctor initial assessment or senior doctor triage (SDT) to reduce emergency department (ED) crowding, there has been little attempt to identify the views of emergency healthcare professionals on such interventions. The aim of this study was to gain an understanding of SDT from the perspective of emergency hospital staff. A secondary aim of this study was to develop a definition of SDT based on the interview findings and the available literature on this process. METHODS: Qualitative semi-structured telephone interviews were conducted with participants of different backgrounds including senior doctors, nurses, paramedics and ED managers. Textual data were analysed using a template analysis approach. RESULTS: 27 participants from 13 EDs across England were interviewed. SDT was viewed as a safety mechanism and a measure to control patient flow. The most prominent positive aspect was the ability to initiate early investigations and treatment. Various shortcomings of SDT were described such as the lack of standardisation of the process and its cost implications. Participants identified a number of barriers to this process including insufficient resources and exit block, and called for solutions focused on these issues. A proposed definition of an 'ideal' SDT was developed where it is described as a systematic brief assessment of patients arriving at the ED by a senior doctor-led team, which takes place in a dedicated unit. The aim of this assessment is to facilitate early investigation and management of patients, early patient disposition and guide junior staff to deliver safe and high-quality clinical care. CONCLUSION: This is the first national study to explore the opinions of various emergency and managerial staff on the SDT model. It revealed variable interpretations of this model and what it can and cannot offer. This has led to a standard definition of the SDT process, which can be useful for clinicians and researchers in emergency care

Supernovae as a probe of particle physics and cosmology

It has very recently been demonstrated by Csaki, Kaloper and Terning (CKT) that the faintness of supernovae at high redshift can be accommodated by mixing of a light axion with the photon in the presence of an intergalactic magnetic field, as opposed to the usual explanation of an accelerating universe by a dark energy component. In this paper we analyze further aspects of the CKT mechanism and its generalizations. The CKT mechanism also passes various cosmological constraints from the fluctuations of the CMB and the formation of structure at large scales, without requiring an accelerating phase in the expansion of the Universe. We investigate the statistical significance of current supernova data for pinning down the different components of the cosmological energy-momentum tensor and for probing physics beyond the standard models.Comment: 17 pages, LaTeX, 4 figures; v2: typos corrected, minor changes, references added; v3: updated figures, details regarding fits include

Bingham sealing and application in vacuum clamping

Vacuum clamping is extensively used in shell machining. In this paper a Bingham Sealing (BS) is presented and formulized based on Bingham plastic performance. The sealing capability of BS is evaluated in various cases. A new Bingham plastic is developed and the yield stress is measured. The performances of "O"ring sealing and BS with the developed Bingham plastic are compared to the static experiment. In this experiment the same vacuum is achieved and the distortion of the blade with BS is better than that with "O" ring sealing

Gravitomagnetic Effects in the Propagation of Electromagnetic Waves in Variable Gravitational Fields of Arbitrary-Moving and Spinning Bodies

Propagation of light in the gravitational field of self-gravitating spinning bodies moving with arbitrary velocities is discussed. The gravitational field is assumed to be "weak" everywhere. Equations of motion of a light ray are solved in the first post-Minkowskian approximation that is linear with respect to the universal gravitational constant $G$. We do not restrict ourselves with the approximation of gravitational lens so that the solution of light geodesics is applicable for arbitrary locations of source of light and observer. This formalism is applied for studying corrections to the Shapiro time delay in binary pulsars caused by the rotation of pulsar and its companion. We also derive the correction to the light deflection angle caused by rotation of gravitating bodies in the solar system (Sun, planets) or a gravitational lens. The gravitational shift of frequency due to the combined translational and rotational motions of light-ray-deflecting bodies is analyzed as well. We give a general derivation of the formula describing the relativistic rotation of the plane of polarization of electromagnetic waves (Skrotskii effect). This formula is valid for arbitrary translational and rotational motion of gravitating bodies and greatly extends the results of previous researchers. Finally, we discuss the Skrotskii effect for gravitational waves emitted by localized sources such as a binary system. The theoretical results of this paper can be applied for studying various relativistic effects in microarcsecond space astrometry and developing corresponding algorithms for data processing in space astrometric missions such as FAME, SIM, and GAIA.Comment: 36 pages, 1 figure, submitted to Phys. Rev.

Problems and possibilities in fine-tuning of the Cepheid P-L relationship

Factors contributing to the scatter around the ridge-line period-luminosity relationship are listed, followed by a discussion how to eliminate the adverse effects of these factors (mode of pulsation, crossing number, temperature range, reddening, binarity, metallicity, non-linearity of the relationship, blending), in order to reduce the dispersion of the P-L relationship.Comment: 7 pages, 8 figures; accepted for publication in Astrophysics & Space Scienc

Axion Dissipation Through the Mixing of Goldstone Bosons

By coupling axions strongly to a hidden sector, the energy density in coherent axions may be converted to radiative degrees of freedom, alleviating the ``axion energy crisis''. The strong coupling is achieved by mixing the axion and some other Goldstone boson through their kinetic energy terms, in a manner reminiscent of paraphoton models. Even with the strong coupling it proves difficult to relax the axion energy density through particle absorption, due to the derivative nature of Goldstone boson couplings and the effect of back reactions on the evolution of the axion number density. However, the distribution of other particle species in the hidden sector will be driven from equilibrium by the axion field oscillations. Restoration of thermal equilibrium results in energy being transferred from the axions to massless particles, where it can redshift harmlessly without causing any cosmological problems.Comment: 20 pages, Latex, (3 uuencoded compressed tarred postscript figures attached

Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: A systematic review and critical appraisal of time and motion studies

Background: Optimising the efficiency and productivity of senior doctors is critical to ED function and delivery of safe patient care. Time and motion studies (TMS) can allow quantification of how these doctors spend their working time, identify inefficiencies in the current work processes and provide insights into improving working conditions, and enhancing productivity. Three questions were addressed: (1) How do senior emergency doctors spend their time in the ED? (2) How much of their time is spent on multitasking? (3) What is the number of tasks completed per hour? Methods: The literature was systematically searched for TMS of senior emergency doctors. We searched for articles published in peer-reviewed journals in English language from 1998 to 2018 in the following databases: MEDLINE, EMBASE, Scopus, Web of Science and Cochrane. Studies were assessed for methodological quality using evidence-based quality criteria relevant for TMS including duration of observation, observer bias, Hawthorne effect and whether the task classification acknowledged any previous existing schemes. A narrative synthesis approach was followed. Results: Fourteen TMS were included. The studies were liable to several biases including observer and Hawthorne bias. Overall, the time spent on direct face-to-face contact with the patient accounted for at least around 25%-40% of the senior doctors' time. The remaining time was mostly spent on indirect clinical care such as communication (8%-44%), documentation (10%-28%) and administrative tasks (2%-20%). The proportion of time spent on multitasking ranged from 10% to 23%. When reported, the number of tasks performed per hour was generally high. Conclusion: The review revealed that senior doctors spent a large percentage of their time on direct face-to-face contact with patients. The review findings provided a grounded understanding of how senior doctors spent their time in the ED and could be useful in implementing improvements to the emergency care system

Finite-temperature scalar fields and the cosmological constant in an Einstein universe

We study the back reaction effect of massless minimally coupled scalar field at finite temperatures in the background of Einstein universe. Substituting for the vacuum expectation value of the components of the energy-momentum tensor on the RHS of the Einstein equation, we deduce a relationship between the radius of the universe and its temperature. This relationship exhibit a maximum temperature, below the Planck scale, at which the system changes its behaviour drastically. The results are compared with the case of a conformally coupled field. An investigation into the values of the cosmological constant exhibit a remarkable difference between the conformally coupled case and the minimally coupled one.Comment: 7 pages, 2 figure