NHS Direct: consistency of triage outcomes

OBJECTIVES: To examine the consistency of triage outcomes by nurses using four types of computerised decision support software in NHS Direct. METHODS: 119 scenarios were constructed based on calls to ambulance services that had been assigned the lowest priority category by the emergency medical dispatch systems in use. These scenarios were presented to nurses working in four NHS Direct call centres using different computerised decision support software, including the NHS Clinical Assessment System. RESULTS: The overall level of agreement between the nurses using the four systems was “fair” rather than “moderate” or “good” (k=0.375, 95% CI: 0.34 to 0.41). For example, the proportion of calls triaged to accident and emergency departments varied from 22% (26 of 119) to 44% (53 of 119). Between 21% (25 of 119) and 31% (37 of 119) of these low priority ambulance calls were triaged back to the 999 ambulance service. No system had both high sensitivity and specificity for referral to accident and emergency services. CONCLUSIONS: There were large differences in outcome between nurses using different software systems to triage the same calls. If the variation is primarily attributable to the software then standardising on a single system will obviously eliminate this. As the calls were originally made to ambulance services and given the lowest priority, this study also suggests that if, in the future, ambulance services pass such calls to NHS Direct then at least a fifth of these may be passed back unless greater sensitivity in the selection of calls can be achieved

Interplanetary MeV electrons of Jovian origin

Observations of low energy electron increases observed in interplanetary space on Pioneer 10 are reported as it approached Jupiter. These discrete bursts were several hundred times the normal quiet-time electron flux, and became more frequent as one approached Jupiter resulting in the quasi-continuous presence of large fluxes of these electrons in interplanetary space. It is noted that the integrated flux from quiet-time electrons is comparable to the integrated ambient electron flux itself. In addition, the spectrum of electrons observed in Jupiter's magnetosphere, on Pioneer 10 in interplanetary space near Jupiter, for the quiet-time increases near the earth, and for the ambient electron spectrum are all remarkably similar. These two lines of evidence suggest the possibility that Jupiter could be the source of most of the ambient electrons at low energies

Jovian protons and electrons: Pioneer 11

A preliminary account of the Pioneer 11 passage through the Jovian magnetosphere as viewed by particle detector systems is presented. Emphasis is placed on the region well within the Jovian magnetosphere using data from the LET-II telescope, which measured the proton flux from 0.2 to 21.2 MeV in seven energy intervals and electrons from 0.1 to 2 MeV in four energy intervals. The relative trajectories of Pioneer 10 and 11 are discussed and indicate that Pioneer 11 was exposed to a much lower total radiation dose than Pioneer 10, largely as a result of the retrograde trajectory which approached and exited the inner region of the magnetosphere at high latitudes. Angular distributions, calculations from Pioneer 11 magnetic field data, and the low-energy nucleon component are included in the discussion

A Second Edition of Webber\u27s “Appendix to the Catalogue of the Flora Of Nebraska. With a Supplementary List of Recently Reported Species

PREFATORY NOTE. The importance to Nebraska botanical students of the paper entitled an Appendix to the Catalogue of the Flora of Nebraska, prepared by Mr. Herbert J . Webber, M. A., formerly assistant in botany in the University of Nebraska, now assistant in the Shaw School of Botany, St. Louis, warrants its republication by the University. It was published originally in the Transactions of the Academy of Science of St. Louis (Vol. VI., No. 1, March 12, 1892.) The present edition differs from the first only in the correction of a few minor errors, and the rearrangement of the index. In his preface to the first edition Mr. Webber explains that the names of those reporting species follow in every case the name of the species reported as it occurs in the Appendix. The collector whose name follows the species, it must be understood, is to be taken as authority for its occurrence, as in many cases I have not had the opportunity to examine the specimens. Thus specimens here reported must be understood to be preserved in the herbaria of those reporting the species, or in the Herbarium of the University of Nebraska.\u27\u27 The Supplementary List (p. 45 et seq.) includes all the species of plants added since Mr. Webber\u27s paper went to press. It consists mainly of the additions made by Mr. P. A. Rydberg, a graduate student, in his collecting tour through the western counties in the summer of 1891, with others made by members of the University Botanical department, and Dr. H. Hapeman of Minden, and Rev. J. M. Bates of Valentine. Specimens of nearly all the species reported in both lists, are deposited in the University Herbarium. It is hoped that the periodical publication of accessions to the flora of the state will stimulate botanical students to a closer study of our native plants, and encourage them to deposit specimens of newly discovered species in the University Herbarium. To this end correspondence is solicited by the Department of Botany. Address, DEPARTMENT OF BOTANY, UNIVERSITY OF NEBRASKA, LINCOLN, NEBR. May 25, 1892

Reflections on Running a critLIS Reading Group

In this chapter we offer our reflections, developed through a collaborative autoethnography, on our experience of running a face-to-face Critical Librarianship and Information Studies (critLIS) reading group in an Information School (iSchool) in the United Kingdom (UK)