Twenty four hour care in inner cities: two years' out of hours workload in east London general practice.

Two inner city general practices in east London jointly provide care outside normal working hours without using deputising services for about 14,000 patients. The statistics on workload were reviewed for 1987 and 1988. An overall rate of face to face consultations of 4.1 per patient per year was recorded, there being 115,965 consultations over two years for a mean list size of 14,174 patients. Four per cent (4737) of such consultations were outside normal working hours. The annual rate of visiting outside normal hours was 128.1 per 1000 patients in 1987 (1793 visits) and 131.5 per 1000 in 1988 (1888 visits). The rates of night visiting were 18.8 (262 visits) and 18.9 (271 visits) per 1000 patients in 1987 and 1988 respectively. Only 24% of all the requests for medical help out of hours (1483/6220) were dealt with by advice given on the telephone. The high rates of consultation outside normal working hours with only a small proportion being dealt with on the telephone alone may be explained by indices of deprivation. Local rotas for out of hours work are a good compromise between meeting the needs of patients and doctors in deprived areas, but there are financial implications for inner cities.     

Characteristics of white-tailed deer visits to cattle farms: implications for disease transmission at the wildlife–livestock interface

Bovine tuberculosis (bTB) is endemic in free-ranging white-tailed deer (Odocoileus virginianus) in MI, USA. Currently, the rates of farm visitation by deer and co-use of forage resources by cattle and deer are poorly understood. To evaluate the extent deer and livestock may share forage resources, we investigated farm, yard, and cattle-use area visitation by white-tailed deer and compared visitation with common livestock management practices. We fitted 25 female white-tailed deer near the bTB-infected zone in Michigan’s Lower Peninsula with global positioning system collars. Livestock management practices associated with farm visitation included presence of confined feeding pastures, number of cattle water sources, and the number of cattle pastures. Fewer farm visits occurred at night than during the day. A higher proportion of nighttime visits occurred between midnight and sunrise. Visitation to yards and cattle-use areas were similar: a higher proportion of visits occurred at night, and a higher proportion of nighttime visits occurred between midnight and sunrise. Multiple visits during the same day were common. Visitation increased through spring and peaked during the fawning season. Results suggest that mitigation and control efforts to guard against potential transmission of bTB should include the season and time of day during which deer visitation occurs. Furthermore, specific livestock management practices may contribute to farm visitation by deer. Deer visiting multiple farms may contribute to local area spread of bTB. Focusing risk mitigation efforts on individual deer that are most likely to visit farms may reduce potential bTB transmission.     

B.M.A. Deputizing Service in Sheffield, 1970

Seventy-four per cent. of Sheffield general practitioners and 78% of those in Nottingham used a deputizing service in 1970. In each city the deputizing service was used by about 80% of single-handed general practitioners, 90% of doctors in two-doctor practices, and 60% of those in partnerships of three or more.The Sheffield deputizing service handled 15,988 new calls in the year, an average of 106 per subscribing doctor, and in addition made 339 revisits. The median number of calls handled for single-handed doctors was 98, for those in two-doctor practices 95, and for those in partnerships of three or more 75. The growth of group practice has not eliminated the demand for deputizing services.Sixty-six per cent. of consultations were with deputies who were primarily hospital doctors, 20% with a full-time deputy, 11% with deputies who were primarily general practitioners, and 3% with the switchboard staff, who were also trained nurses. The deputies had been qualified, on average, for eight years. Seventy-two per cent. of patients attended were seen within one hour of receipt of the call.Calls handled by the deputizing service represented approximately 1% of all the subscribers'' consultations, 5% of their home visits, and half their calls between midnight and 07.00 hours. At this level of activity the concept of “personal doctoring” was not threatened.     

Out of hours service: the Danish solution examined.

In Denmark the provision of out of hours care by general practitioners came under increasing pressure in the 1980s because of growing demand for services by the public and increasing complaints from rural doctors about their heavy workload and disproportionately low remuneration in comparison with urban doctors. As a result, the out of hours service was reformed at the start of 1992: locally negotiated rota systems were replaced with county based services. Each county now has a coordination centre, where all patients'' calls are received by a team of doctors. The doctors may give a telephone consultation, advise the patient to attend one of the emergency clinics strategically placed about the county, or arrange for a home visit. Doctors on home visiting duty are located at bases throughout the county and keep in touch with the coordination centre with mobile telephones. Graded fees mean that doctors are encouraged to give telephone consultations rather than arrange for clinic consultations or home visits. The reforms have reduced doctors'' out of hours workload and the number of home visits made and have proved acceptable to patients, doctors, and administrators.     

Using videotaping to validate the use of spraints as an index of Eurasian otter (Lutra lutra) activity

Eurasian Otter (Lutra lutra) surveys are commonly based on spraints (otter faeces) as an index of use intensity, habitat preference, and to a certain degree, population density. We were interested to know: (1) Does the number of fresh spraints correlate to the number of visits? (2) Can spraints be indicative of activity levels? (3) Is the absence of fresh spraints indicative of no visits? We used videotaping that provided a true picture of otter nocturnal activity at marking sites and compared our findings with the number of fresh spraints the following morning. This enabled us to correlate the number of spraints with the number of otter visits during the night and assess the validity of spraints as an activity index. We carried out a total of 59 videotaping nights and counted spraints in 29 sprainting sites between September 2002 and March 2004. We found a positive correlation between the proportion of nights a latrine was visited and the proportion of nights fresh spraints were deposited. The number of fresh spraints/night/site was positively correlated with the number of otter visits/night/site. Latrines visited on more nights had a higher number of fresh spraints per night visited. However, in about half the nights where no spraints were found, visits were recorded. Spraints are generally a good indicator of use intensity of a specific latrine and consequently a possible indicator of activity level and habitat preference. Understanding what determines scent-marking behaviour and its relationship to actual activity and presence can improve our ability to assess otter populations and design management protocols.     

Twelve months of deputising: 100 000 patient contacts with eighteen services.

An analysis of a 1-in-5 sample of nearly 500 000 patients contacts with 18 deputising services showed considerable variation in the way cells were handled. Telephonists, usually work on shifts including at least one operator who was a trained nurse handled, without sending a deputy, between 3% of new calls at one service and 19% at another. In one service, 19% of visits were made by deputies who were general practitioners; in another, 78%. At least 42% of patients visited by one service were apparently seen within one hour; 74% by another service. The proportions referred to hospital varied from 9% to 16%. The use of deputising services continues to grow; there is as yet no substantiated evidence of shortcomings in the care they provide. The possibility of reviewing the activity of the services, with the use of such indices as those described, might enable present limitations on their use to be lifted.     

Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register.

OBJECTIVE: To assess longitudinal trends in admissions, management, and inpatient mortality from acute myocardial infarction over 10 years. DESIGN: Retrospective analysis based on the Nottingham heart attack register. SETTING: Two district general hospitals serving a defined urban and rural population. SUBJECTS: All patients admitted with a confirmed acute myocardial infarction during 1982-4 and 1989-92 (excluding 1991, when data were not collected). MAIN OUTCOME MEASURES: Numbers of patients, background characteristics, time from onset of symptoms to admission, ward of admission, treatment, and inpatient mortality. RESULTS: Admissions with acute myocardial infarction increased from 719 cases in 1982 to 960 in 1992. The mean age increased from 62.1 years to 66.6 years (P < 0.001), the duration of stay fell from 8.7 days to 7.2 days (P < 0.001), and the proportion of patients aged 75 years and over admitted to a coronary care unit increased significantly from 29.1% to 61.2%. A higher proportion of patients were admitted to hospital within 6 hours of onset of their symptoms in 1989-92 than in 1982-4, but 15% were still admitted after the time window for thrombolysis. Use of beta blockers increased threefold between 1982 and 1992, aspirin was used in over 70% of patients after 1989, and thrombolytic use increased 1.3-fold between 1989 and 1992. Age and sex adjusted odds ratios for inpatient mortality remained unchanged over the study period. CONCLUSIONS: Despite an increasing uptake of the "proved" treatments, inpatient mortality from myocardial infarction did not change between 1982 and 1992.     

PREY TAKEN BY TAWNY OWLS DURING THE BREEDING SEASON

The diet of Tawny Owls during the breeding seasons 1949-52 in Wytham Woods, near Oxford, was determined (a) from analysis of pellets collected, (b) from observation at night, by the use of a red floodlight, of prey brought to the nest and (c) from records of prey left in the nest made during daily visits to weigh the young.
Analysis of pellets showed an increase in the proportion of moles and beetles (mainly cockchafen) in the diet after the first week of May (the time when, on average, the young owls are about half grown) and a decrease in the proportion of mice and voles.
These changes were confirmed in a more emphatic way from observations of food being brought to the nest and from records of prey left in the nest.
This greater emphasis suggests that tho food brought to the young may differ from that which the adults eat themselves.
The fact that no moles were observed being brought to nests at night, wherean many were recorded as surplus prey in the nest, showed that diurnal hunting is regular during the breeding reaaon.
A true assessment of prey taken by Tawny Owls during the breeding season should be based both on analyeis of pellets cast by the adults and on records of food brought to the nest throughout 24 hours. Such records could best be obtained with an automatic camera and flash and a design of nest-box which is described.     

Organisation of primary care services outside normal working hours.

OBJECTIVE--To determine the use and organisation of out of hours services in primary care. DESIGN--Telephone survey. SETTING--Family health services authorities in England and Wales. MAIN OUTCOME MEASURES--Rate of use of out of hours care, methods of provision, and role of authorities. RESULTS--12-25% of authorities were unable to answer one or more key questions in the survey because of insufficient information. The mean number of night visits made per unrestricted principal per 1000 patients per year was 35.3. 13 of the 19 authorities with averages above 40 covered large towns or cities. 81 authorities had at least one commercial deputising service. In 46 metropolitan districts and one other district over 75% of general practitioners had consent to use a deputising service, although not all did so. Information on cooperation between practices was limited. 22 cooperatives were recognised by the authorities, nine were not officially recognised, and a further 13 were nearing institution. Only two cooperatives were in areas with extensive use of deputising services. CONCLUSION--Methods of providing out of hours care are changing, and without good information systems family health services authorities will not be able to monitor the effect on quality and cost effectiveness of care.     

Equal and Opposite Effects of Floral Offer and Spatial Distribution on Fruit Production and Predispersal Seed Predation in Xanthosoma daguense (Araceae)1

Inflorescences of the terrestrial aroid Xanthosoma daguense in the Andes of Colombia are visited by Dinastinae and Nitidulidae beetles. Plants produce one inflorescence at a time, which is pollinated during the first night of opening. Dynastine beetles act as pollinators, whereas Nitidulids lay eggs in the inflorescence and the larvae damage the seeds. We explored the effects of floral offer and distance among inflorescences on the number of pollinator visits, fruit production, and predispersal seed predation. Number of Dynastine visits per inflorescence tended to increase with increasing distances among inflorescences, but fruit predation increased when inflorescences were more clumped. Both pollinator visitation rates and predispersal seed predation were low at high floral offer. Fruit set increased when inflorescences were visited by two or more Dynastines, but the proportion of fruits damaged by Nitidulid larvae was equivalent to the increase in fruit production due to more Dinastine visits. The net result was a similar number of undamaged fruits in all infructescences produced, independent of the number of Dinastine visits. Our results revealed that both pollinators and predators responded to the number of available inflorescences and their spatial distribution, but they had opposing effects on the infructescences. Thus, our study suggests that the interaction of two ecological processes, pollination and predispersal seed predation, may cancel each other's effects under natural conditions.     

Which physicians make home visits and why? A survey

BACKGROUND: Recent changes in the North American health care system and certain demographic factors have led to increases in home care services. Little information is available to identify the strategies that could facilitate this transformation in medical practice and ensure that such changes respond adequately to patients'' needs. As a first step, the authors attempted to identify the major factors influencing physicians'' home care practices in the Quebec City area. METHODS: A self-administered questionnaire was sent by mail to all 696 general practitioners working in the Quebec City area. The questionnaire was intended to gather information on physicians'' personal and professional characteristics, as well as their home care practice (practice volume, characteristics of both clients and home visits, and methods of patient assessment and follow-up). RESULTS: A total of 487 physicians (70.0%) responded to the questionnaire, 283 (58.1%) of whom reported making home visits. Of these, 119 (42.0%) made fewer than 5 home visits per week, and 88 (31.1%) dedicated 3 hours or less each week to this activity. Physicians in private practice made more home visits than their counterparts in family medicine units and CLSCs (centres locaux des services communautaires [community centres for social and health services]) (mean 11.5 v. 5.8 visits per week), although the 2 groups reported spending about the same amount of time on this type of work (mean 5.6 v. 5.0 hours per week). The proportion of visits to patients in residential facilities or other private residences was greater for private practitioners than for physicians from family medicine units and CLSCs (29.7% v. 18.9% of visits), as were the proportions of visits made at the patient''s request (28.0% v. 14.2% of visits) and resulting from an acute condition (21.4% v. 16.0% of visits). The proportion of physicians making home visits at the request of a CLSC was greater for those in family medicine units and CLSCs than for those in private practice (44.0% v. 11.3% of physicians), as was the proportion of physicians making home visits at the request of a colleague (18.0% v. 4.5%) or at the request of hospitals (30.0% v. 6.8%). Physicians in family medicine units and CLSCs did more follow-ups at a frequency of less than once per month than private practitioners (50.9% v. 37.1% of patients), and they treated a greater proportion of patients with cognitive disorders (17.2% v. 12.6% of patients) and palliative care needs (13.7% v. 8.6% of patients). Private practitioners made less use of CLSC resources to assess home patients or follow them. Male private practitioners made more home visits than their female counterparts (mean 12.8 v. 8.3 per week), although they spent an almost equal amount of time on this activity (mean 5.7 v. 5.2 hours per week). INTERPRETATION: These results suggest that practice patterns for home care vary according to the physician''s practice setting and sex. Because of foreseeable increases in the numbers of patients needing home care, further research is required to evaluate how physicians'' practices can be adapted to patients'' needs in this area.     

Ectoparasites: are they the proximate cause of cleaning interactions?

We tested the importance of ectoparasites in cleaning symbioses by comparing the activity of Caribbean cleaning gobies ( Elacatinus evelynae ) and of their clients during three daily periods (early morning, midday and late afternoon) in which ectoparasite availability varied naturally. Emergence from the benthos of gnathiid isopod larvae, the main target of cleaning goby predation, was higher at night, when cleaners are inactive, than during the day. Overall ectoparasite loads also tended to be higher on clients in the morning. This coincided with higher rates of visits to cleaning stations by client fish in the morning than at midday, but high rates of client visits were also recorded in the late afternoon. Clients were more likely to adopt stereotypical incitation poses, which increase the likelihood of being cleaned, in the morning than later in the day. Inspection bouts by cleaning gobies were longest in the morning. Cleaner and client behaviours therefore change predictably in response to natural diurnal variation in ectoparasite availability. These results add to a growing number of studies supporting the idea that cleaning symbioses are mutualisms dependent on ectoparasite removal.     

Diurnal patterns in the spatial relationships between saithe, Pollachius virens, schooling in the wild

Six saithe, length 35 to 43 cm, were tagged with acoustic transmitters and individuals tracked for between 9 and 508 h during May 1989. The tagged fish were members of a schooling group and during the study, pairs of tagged fish were tracked simultaneously for periods ranging from 9 to 139 h. These data have been used to investigate the spatial relationships between individuals schooling in the wild. Distances between individuals showed a distinct diel pattern. Tagged fish were generally closer together during the day, than either at night or the periods of dawn and dusk. Those circumstances under which pairs of tagged fish could be shown to school together were investigated by analysing the differences in their swimming directions. Schooling was generally evident during the hours of daylight, although the degree to which fish schooled varied between pairs. The degree to which the fish schooled was also dependent upon distance between the tagged individuals. Schooling could be demonstrated for saithe within 20 m of each other during the day and within 10 m in two out of three pairs at night.     

气象因子对江苏省水稻单产的影响

全球气候变暖作为一个不争的客观事实,不可避免地对农业生产产生影响。针对传统多元线性回归分析方法,不能直接分析气象因子与水稻气象单产时序关系,根据1978—2010年间江苏省水稻单产数据和同期气象时序数据,研究了水稻单产的影响因素,提取了水稻气象单产;利用连续小波变换方法研究了水稻气象单产、水稻营养生长与生殖生长期间的日照时数、降水和气温等气象因子的时序变化特征;利用交叉小波和相干小波变换方法,研究了水稻营养生长与生殖生长期间气象因子与水稻气象单产间的相互影响关系。结果显示:(1)近33 a间,江苏省水稻气象单产占实际单产的比重逐渐减小,水稻生产抵御气象灾害能力逐渐增强。(2)水稻气象单产与日照时数、降水量和气温等气象因子有几乎一致的特征周期。(3)在水稻分蘖期、孕穗期与开花结实期,气象单产与日照时数、降水量和气温间的相位差关系较为复杂。水稻分蘖期日照时数的增多有利于水稻单产的增加,降水的增多导致水稻单产的下降。水稻开花结实期日照时数的增强、昼夜温差的变大有利于水稻单产的增加,夜间最低气温的上升会导致水稻单产的下降。为了应对全球气候变暖,需要进一步改变水稻种植方式,加强土地利用监管,积极开展农村土地综合整治,加强高标准基本农田建设,加大农田水利设施建设,调整作物播种期,加强气象灾害应对防范体系建设,更好地发挥生物技术在适应气候变化中的作用。     

Family doctors and change in practice strategy since 1986.

OBJECTIVES--To investigate the changes in practice strategy that have taken place since 1986. DESIGN--Comparison of practices in 1986 and 1992. SETTING--93% of group practices (26 practices) in a single family health services authority. MAIN OUTCOME MEASURES--Changes in staffing, premises, equipment, clinic services, and incomes between 1986 and 1992. RESULTS--In 1986, 28% of practices employed a nurse; in 1992, 92% did so. Between 1986 and 1992, 14 cost-rent schemes costing more than 10,000 pounds had been started. Certain practices, designated innovators, were more likely to possess specified items of equipment than other practices. Computer ownership was widespread: 77% of practices had a computer, compared with 36% in 1986. In 1992, 16 practices had a manager, compared with 10 in 1986. Clinic services provided by more than half of practices were well established services (antenatal, for example), new services for which a payment had been introduced (such as diabetes, asthma, minor surgery), or the more readily provided "new" clinic services (diet, smoking cessation). Gross income increased, but so did practice costs, especially for innovators. Practices in the more affluent area of the family health services authority were still more likely to invest in their premises and staff, and to provide more services than those in the declining area. In the more affluent area, practices had higher costs but also higher incomes. CONCLUSION--Between 1986 and 1992, practices in this area invested heavily in equipment and services, but differences remain, depending on the location of the practice. Investment has increased, particularly in the more deprived part of the area, so that the inconsistency in standards has been much reduced. Practice incomes have risen, but so also have workload and costs.     

Diel emergence patterns of chironomids

The diel emergence patterns of 16 chironomid species from a Berkshire lake are characterized. A study of these patterns and those described previously in the literature indicate that the diel pattern for any chironomid species can often be predicted on the basis of the Tribe to which it belongs. Chironomini spp. usually emerge at dusk or at night. Macropelopiini spp. and Metrioenemini spp. characteristically emerge during daylight but the former peak in the morning and the latter peak in the afternoon. Orthocladiini and Tanytarsini spp. exhibit more varied patterns although bimodalism is a frequent feature. The phylogenetic conservatism in the diel patterns displayed implies that these patterns became established early during chironomid evolution, and are, therefore, plesiomorphic.     

Activity patterns of pipistrelle bats (Pipistrellus pipistrellus) in Oxfordshire

A maternity colony of pipistrelle bats ( Pipisfrellus pipistrellus ), in Oxfordshire, was monitored between 1 March 1989 and 6 October 1989. An infra-red 'automatic bat counter' was installed at the roost, to record the number of bats entering and leaving each minute throughout the night. Air temperature, light intensity at sunset, cloud cover, wind speed and rain were recorded on each night of monitoring. Insect abundance was estimated on 18 nights.
The nightly activity pattern was found to be unimodal in pregnancy, bimodal during lactation and unimodal post-weaning. The mean time that each bat spent outside the roost ranged from 103–483 min, with a mean of 321 min.
Ambient air temperature and length of night were significant factors affecting mean time spent outside the roost. The percentage of the night which the bats spent away from the roost ranged from 22 to 88%, with a mean of 64%. There was a significant positive correlation between ambient air temperature and percentage of the night spent away from the roost. Insect abundance showed no significant correlation with the time that bats spent outside the roost. Wind and rain had no apparent effect on time spent outside the roost.     

Compensation for Unfavorable Characteristics of Irregular Individual Shift Rotas

Some employees of TV companies, such as those who produce remote TV programs, have to cope with very irregular rotas and many short‐term schedule deviations. Many of these employees complain about the negative effects of such on their wellbeing and private life. Therefore, a working group of employers, council representatives, and researchers developed a so‐called bonus system. Based on the criteria of the BESIAK system, the following list of criteria for the ergonomic assessment of irregular shift systems was developed: proportion of night hours worked between 22∶00 and 01∶00 h and between 06∶00 and 07∶00 h, proportion of night hours worked between 01∶00 and 06∶00 h, number of successive night shifts, number of successive working days, number of shifts longer than 9 h, proportion of phase advances, off hours on weekends, work hours between 17∶00 and 23∶00 h from Monday to Friday, number of working days with leisure time at remote places, and sudden deviations from the planned shift rota. Each individual rota was evaluated in retrospect. If pre‐defined thresholds of criteria were surpassed, bonus points were added to the worker's account. In general, more bonus points add up to more free time. Only in particular cases was monetary compensation possible for some criteria. The bonus point system, which was implemented in the year 2002 for about 850 employees of the TV company, has the advantages of more transparency concerning the unfavorable characteristics of working‐time arrangements, incentive for superiors to design “good” rosters that avoid the bonus point thresholds (to reduce costs), positive short‐term effects on the employee social life, and expected positive long‐term effects on the employee health. In general, the most promising approach to cope with the problems of shift workers in irregular and flexible shift systems seems to be to increase their influence on the arrangement of working times. If this is not possible, bonus point systems may help to achieve greater transparency and fairness in the distribution of unfavorable working‐time arrangements within a team, and even reduce the unnecessary unfavorable aspects of shift systems.     

Compensation for unfavorable characteristics of irregular individual shift rotas

Some employees of TV companies, such as those who produce remote TV programs, have to cope with very irregular rotas and many short-term schedule deviations. Many of these employees complain about the negative effects of such on their wellbeing and private life. Therefore, a working group of employers, council representatives, and researchers developed a so-called bonus system. Based on the criteria of the BESIAK system, the following list of criteria for the ergonomic assessment of irregular shift systems was developed: proportion of night hours worked between 22:00 and 01:00 h and between 06:00 and 07:00 h, proportion of night hours worked between 01:00 and 06:00 h, number of successive night shifts, number of successive working days, number of shifts longer than 9 h, proportion of phase advances, off hours on weekends, work hours between 17:00 and 23:00 h from Monday to Friday, number of working days with leisure time at remote places, and sudden deviations from the planned shift rota. Each individual rota was evaluated in retrospect. If pre-defined thresholds of criteria were surpassed, bonus points were added to the worker's account. In general, more bonus points add up to more free time. Only in particular cases was monetary compensation possible for some criteria. The bonus point system, which was implemented in the year 2002 for about 850 employees of the TV company, has the advantages of more transparency concerning the unfavorable characteristics of working-time arrangements, incentive for superiors to design “good” rosters that avoid the bonus point thresholds (to reduce costs), positive short-term effects on the employee social life, and expected positive long-term effects on the employee health. In general, the most promising approach to cope with the problems of shift workers in irregular and flexible shift systems seems to be to increase their influence on the arrangement of working times. If this is not possible, bonus point systems may help to achieve greater transparency and fairness in the distribution of unfavorable working-time arrangements within a team, and even reduce the unnecessary unfavorable aspects of shift systems.