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

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

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

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

A system-wide approach to explaining variation in potentially avoidable emergency admissions: national ecological study

Background Some emergency admissions can be avoided if acute exacerbations of health problems are managed by the range of health services providing emergency and urgent care. Aim To identify system-wide factors explaining variation in age sex adjusted admission rates for conditions rich in avoidable admissions. Design National ecological study. Setting 152 emergency and urgent care systems in England. Methods Hospital Episode Statistics data on emergency admissions were used to calculate an age sex adjusted admission rate for conditions rich in avoidable admissions for each emergency and urgent care system in England for 2008–2011. Results There were 3 273 395 relevant admissions in 2008–2011, accounting for 22% of all emergency admissions. The mean age sex adjusted admission rate was 2258 per year per 100 000 population, with a 3.4-fold variation between systems (1268 and 4359). Factors beyond the control of health services explained the majority of variation: unemployment rates explained 72%, with urban/rural status explaining further variation (R2=75%). Factors related to emergency departments, hospitals, emergency ambulance services and general practice explained further variation (R2=85%): the attendance rate at emergency departments, percentage of emergency department attendances converted to admissions, percentage of emergency admissions staying less than a day, percentage of emergency ambulance calls not transported to hospital and perceived access to general practice within 48 h. Conclusions Interventions to reduce avoidable admissions should be targeted at deprived communities. Better use of emergency departments, ambulance services and primary care could further reduce avoidable emergency admissions

Volume–outcome relationships in open and endovascular repair of abdominal aortic aneurysm : administrative data 2006–2018

Background The aim of this study was to use recent evidence to investigate and update volume–outcome relationships after open surgical repair (OSR) and endovascular repair (EVAR) of abdominal aortic aneurysm in England. Methods Hospital Episode Statistics (HES) data from April 2006 to March 2018 were obtained. The primary outcome was in‐hospital death. Other outcomes included duration of hospital stay, readmissions within 30 days, and critical care requirements. Case‐mix adjustment included age, sex, HES year, deprivation index, weekend admission, mode of admission, type of procedure and co‐morbidities. Results Annual volume of all repairs combined appeared to be an appropriate measure of volume. After case‐mix adjustment, a significant relationship between volume and in‐hospital mortality was seen for OSR (P < 0·001) but not for EVAR (P = 0·169 for emergency and P = 0·363 for elective). The effect appeared to extend beyond 60 repairs per year to volumes above 100 repairs per year. There was no significant relationship between volume and duration of hospital stay or 30‐day readmissions. In patients receiving emergency OSR, higher volume was associated with longer stay in critical care. Conclusion Higher annual all‐procedure volumes were associated with significantly lower in‐hospital mortality for OSR, but such a relationship was not significant for EVAR. There was not enough evidence for a volume effect on other outcomes

Socioeconomic disparities in surgery for carotid artery disease in England

Background Carotid artery disease and stroke are more prevalent in socioeconomically deprived areas. The aim was to investigate socioeconomic disparities in carotid artery disease surgery rates and in outcomes following surgery. Methods The study used population-based ecological and cohort study designs, 31 672 census areas in England, hospital admissions from April 2006 to March 2018, the Index of Multiple Deprivation 2010 as the area-level deprivation indicator, and Poisson, logistic, and Cox regression. Results A total of 54 377 patients (67 per cent men) from a population aged 55 years and older of 14.7 million had carotid artery disease procedures (95 per cent carotid endarterectomy). Carotid endarterectomy rates were 116 per cent (95% c.i. 101 to 132) higher in men and 180 per cent (95% c.i. 155 to 207) higher in women aged 55–64 years in the most compared with the least socioeconomically deprived areas by quintile. However, this difference diminished and appeared to reverse with increasing age, with 24 per cent (95% c.i. 14 to 33) and 12 per cent (95% c.i. −3 to 24) lower carotid endarterectomy rates respectively in men and women aged 85 years and older in the most deprived areas. Patients in deprived areas having carotid endarterectomy were more likely to have been admitted as symptomatic emergency carotid artery disease admissions. Mortality, and a combined outcome of mortality or stroke-related re-admission, were both worse in patients living in more deprived areas and were only partially accounted for by the higher prevalence of co-morbidities. There was, however, no clear pattern of association between deprivation and elective waiting time for carotid endarterectomy. Conclusions These results provide evidence of socioeconomic disparities in surgery for carotid artery disease. Clear policies are needed to address these disparities