Reasons for variations in the use of open access gastroscopy by general practitioners

This study aimed to investigate the wide variation between general practitioners (GPs) in their use of open access gastroscopy by assessing (i) their partnership share, workload, and the aggregated practice request rate; (ii) correlations with their professional and practice characteristics; and (iii) a comparison with referral rates to medicine, surgery, and all specialties. All 145 GPs and their practice managers were sent a questionnaire and hospital held data on all requests for open access gastroscopy over one year were reviewed. During the year, the 145 GPs made 1210 requests for open access gastroscopy, varying from one to 44 per GP. There were 987,880 practice consultations altogether, an average of 22,451 per practice or 7127 per whole time practitioner. Requests for open access gastroscopy formed 2.4% of all referrals, an average of one per 1000 consultations, or eight per GP. Of a total of 49,123 referrals to all specialties (371 per GP) 4218 (8.5%) were to medicine, and 6444 to surgery (13.1%). The following factors did not correlate with requests: vocational training, a concurrent hospital post, length of service, or receipt of the deprivation allowance by the practice. When the open access gastroscopy referral rate was aggregated for each practice the variation between practices was narrowed to essentially twofold. Requests for open access gastroscopy form a small proportion of all referrals (2.4%). Aggregated practice request rates are relatively uniform compared with the wide variation between individual GPs, suggesting a disproportionate gastroenterology workload between partners. The open access gastroscopy service does not seem to be subject to misuse from most GPs if a variation in practice usage is used as a measure

A description of a sleep restriction program to reduce bedtime disturbances and night waking.

The authors describe a behavioral intervention designed to reduce sleep problems without increasing disruption at bedtime or throughout the evening. Sleep restriction was used to reduce the bedtime and nighttime sleep problems of two children, a 4-year-old girl with autism and a 4-year-old girl with developmental delay. Sleep restriction involved reducing the number of hours each child slept while maintaining a consistent bedtime and awake time. Once the program was successful, the amount of sleep was faded back to an age-appropriate level. The sleep-restriction programs appeared to result in the elimination of bedtime disturbances and the reduction of nighttime awakenings. The authors discuss the effectiveness of this behavioral intervention for the treatment of sleep disturbances in children with developmental disabilities

Efficient Implementation of Smoothness-Increasing Accuracy-Conserving (SIAC) Filters for Discontinuous Galerkin Solutions

The discontinuous Galerkin (DG) methods provide a high-order extension of the finite volume method in much the same way as high-order or spectral/hp elements extend standard finite elements. However, lack of inter-element continuity is often contrary to the smoothness assumptions upon which many post-processing algorithms such as those used in visualization are based. Smoothness-increasing accuracy-conserving (SIAC) filters were proposed as a means of ameliorating the challenges introduced by the lack of regularity at element interfaces by eliminating the discontinuity between elements in a way that is consistent with the DG methodology; in particular, high-order accuracy is preserved and in many cases increased. The goal of this paper is to explicitly define the steps to efficient computation of this filtering technique as applied to both structured triangular and quadrilateral meshes. Furthermore, as the SIAC filter is a good candidate for parallelization, we provide, for the first time, results that confirm anticipated performance scaling when parallelized on a shared-memory multi-processor machine.Delft Institute of Applied MathematicsElectrical Engineering, Mathematics and Computer Scienc