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

Improving measurements of SF6 for the study of atmospheric transport and emissions

Sulfur hexafluoride (SF6) is a potent greenhouse gas and useful atmospheric tracer. Measurements of SF6 on global and regional scales are necessary to estimate emissions and to verify or examine the performance of atmospheric transport models. Typical precision for common gas chromatographic methods with electron capture detection (GC-ECD) is 1–2%. We have modified a common GC-ECD method to achieve measurement precision of 0.5% or better. Global mean SF6 measurements were used to examine changes in the growth rate of SF6 and corresponding SF6 emissions. Global emissions and mixing ratios from 2000–2008 are consistent with recently published work. More recent observations show a 10% decline in SF6 emissions in 2008–2009, which seems to coincide with a decrease in world economic output. This decline was short-lived, as the global SF6 growth rate has recently increased to near its 2007–2008 maximum value of 0.30±0.03 pmol mol−1 (ppt) yr−1 (95% C.L.)

Application of Advanced Reservoir Characterization, Simulation, and Production Optimization Strategies to Maximize Recovery in Slope and Basin Clastic Reservoirs, West Texas (Delaware Basin)

The objective of this Class III project is to demonstrate that detailed reservoir characterization of clastic reservoirs in basinal sandstones of the Delaware Mountain Group in the Delaware Basin of West Texas and New Mexico is a cost-effective way to recover more of the original oil in place by strategic infill-well placement and geologically based field development. Reservoirs in the Delaware Mountain Group have low producibility (average recovery <14 percent of the original oil in place) because of a high degree of vertical and lateral heterogeneity caused by depositional processes and post-depositional diagenetic modification. Detailed correlations of the Ramsey sandstone reservoirs in Geraldine Ford field suggest that lateral sandstone continuity is less than interpreted by previous studies. The degree of lateral heterogeneity in the reservoir sandstones suggests that they were deposited by eolian-derived turbidites. According to the eolian-derived turbidite model, sand dunes migrated across the exposed shelf to the shelf break during sea-level lowstands and provided well-sorted sand for turbidity currents or grain flows into the deep basin. Cyclic changes in sea level were an important cause of vertical heterogeneity in the reservoir interval at Geraldine Ford field. Ramsey sandstones were deposited during periods of relative sea-level fall in high-order cycles. Laterally continuous organic-rich siltstones, which were deposited in periods of relative sea-level rise during the high-order cycles, create vertical flow barriers within the reservoir. The sealing facies above the Ramsey sandstone is interpreted to be a particularly effective trap because it was deposited at a time of sea-level rise at three scales of cyclicity.Bureau of Economic Geolog

Theoretical X-Ray Absorption Debye-Waller Factors

An approach is presented for theoretical calculations of the Debye-Waller factors in x-ray absorption spectra. These factors are represented in terms of the cumulant expansion up to third order. They account respectively for the net thermal expansion $\sigma^{(1)}(T)$, the mean-square relative displacements $\sigma^2(T)$, and the asymmetry of the pair distribution function $\sigma^{(3)}(T)$. Similarly, we obtain Debye-Waller factors for x-ray and neutron scattering in terms of the mean-square vibrational amplitudes $u^2(T)$. Our method is based on density functional theory calculations of the dynamical matrix, together with an efficient Lanczos algorithm for projected phonon spectra within the quasi-harmonic approximation. Due to anharmonicity in the interatomic forces, the results are highly sensitive to variations in the equilibrium lattice constants, and hence to the choice of exchange-correlation potential. In order to treat this sensitivity, we introduce two prescriptions: one based on the local density approximation, and a second based on a modified generalized gradient approximation. Illustrative results for the leading cumulants are presented for several materials and compared with experiment and with correlated Einstein and Debye models. We also obtain Born-von Karman parameters and corrections due to perpendicular vibrations.Comment: 11 pages, 8 figure

Electromagnetically induced transparency in superconducting quantum circuits : Effects of decoherence, tunneling and multi-level cross-talk

We explore theoretically electromagnetically-induced transparency (EIT) in a superconducting quantum circuit (SQC). The system is a persistent-current flux qubit biased in a $\Lambda$ configuration. Previously [Phys. Rev. Lett. 93, 087003 (2004)], we showed that an ideally-prepared EIT system provides a sensitive means to probe decoherence. Here, we extend this work by exploring the effects of imperfect dark-state preparation and specific decoherence mechanisms (population loss via tunneling, pure dephasing, and incoherent population exchange). We find an initial, rapid population loss from the $\Lambda$ system for an imperfectly prepared dark state. This is followed by a slower population loss due to both the detuning of the microwave fields from the EIT resonance and the existing decoherence mechanisms. We find analytic expressions for the slow loss rate, with coefficients that depend on the particular decoherence mechanisms, thereby providing a means to probe, identify, and quantify various sources of decoherence with EIT. We go beyond the rotating wave approximation to consider how strong microwave fields can induce additional off-resonant transitions in the SQC, and we show how these effects can be mitigated by compensation of the resulting AC Stark shifts

Formation of shock waves in a Bose-Einstein condensate

We consider propagation of density wave packets in a Bose-Einstein condensate. We show that the shape of initially broad, laser-induced, density perturbation changes in the course of free time evolution so that a shock wave front finally forms. Our results are well beyond predictions of commonly used zero-amplitude approach, so they can be useful in extraction of a speed of sound from experimental data. We discuss a simple experimental setup for shock propagation and point out possible limitations of the mean-field approach for description of shock phenomena in a BEC.Comment: 8 pages & 6 figures, minor changes, more references, to appear in Phys. Rev.

The Myth of the Stupid Believer: The Negative Religiousness–IQ Nexus is Not on General Intelligence (g) and is Likely a Product of the Relations Between IQ and Autism Spectrum Traits

Numerous studies have found a negative relationship between religiousness and IQ. It is in the region of −0.2, according to meta-analyses. The reasons for this relationship are, however, unknown. It has been suggested that higher intelligence leads to greater attraction to science, or that it helps to override evolved cognitive dispositions such as for religiousness. Either way, such explanations assume that the religion–IQ nexus is on general intelligence (g), rather than some subset of specialized cognitive abilities. In other words, they assume it is a Jensen efect. Two large datasets comparing groups with diferent levels of religiousness show that their IQ diferences are not on g and must, therefore, be attributed to specialized abilities. An analysis of the specialized abilities on which the religious and non-religious groups difer reveals no clear pattern. We cautiously suggest that this may be explicable in terms of autism spectrum disorder traits among people with high IQ scores, because such traits are negatively associated with religiousness

mockrobiota: a Public Resource for Microbiome Bioinformatics Benchmarking.

Mock communities are an important tool for validating, optimizing, and comparing bioinformatics methods for microbial community analysis. We present mockrobiota, a public resource for sharing, validating, and documenting mock community data resources, available at http://caporaso-lab.github.io/mockrobiota/. The materials contained in mockrobiota include data set and sample metadata, expected composition data (taxonomy or gene annotations or reference sequences for mock community members), and links to raw data (e.g., raw sequence data) for each mock community data set. mockrobiota does not supply physical sample materials directly, but the data set metadata included for each mock community indicate whether physical sample materials are available. At the time of this writing, mockrobiota contains 11 mock community data sets with known species compositions, including bacterial, archaeal, and eukaryotic mock communities, analyzed by high-throughput marker gene sequencing. IMPORTANCE The availability of standard and public mock community data will facilitate ongoing method optimizations, comparisons across studies that share source data, and greater transparency and access and eliminate redundancy. These are also valuable resources for bioinformatics teaching and training. This dynamic resource is intended to expand and evolve to meet the changing needs of the omics community

Displaced but not replaced: the impact of e-learning on academic identities in higher education.

Challenges facing universities are leading many to implement institutional strategies to incorporate e-learning rather than leaving its adoption up to enthusiastic individuals. Although there is growing understanding about the impact of e-learning on the student experience, there is less understanding of academics’ perceptions of e-learning and its impact on their identities. This paper explores the changing nature of academic identities revealed through case study research into the implementation of e-learning at one UK university. By providing insight into the lived experiences of academics in a university in which technology is not only transforming access to knowledge but also influencing the balance of power between academic and student in knowledge production and use, it is suggested that academics may experience a jolt to their ‘trajectory of self’ when engaging with e-learning. The potential for e-learning to prompt loss of teacher presence and displacement as knowledge expert may appear to undermine the ontological security of their academic identity