How easy is it to contact the duty medical doctor responsible for acute admissions?

OBJECTIVE--To ascertain ease or difficulty of contacting duty junior doctors responsible for acute medical admissions by telephone. DESIGN--Telephone survey of hospitals in six health regions in England and Wales. SETTING--70 Randomly selected hospitals, 15 of which were excluded because of non-acceptance of acute medical admissions. PARTICIPANTS--71 Duty doctors (duty house physicians, senior house officers, or registrars responsible for acute medical admissions) in 48 hospitals; seven duty doctors in seven hospitals were excluded (four declined to participate and three required a written explanation of the survey). 67 Doctors gave full information to all questions. MAIN OUTCOME MEASURES--Time taken for hospital switchboards and duty doctors to reply to telephone call, diagnoses of patients recently admitted, and on call rotas and hours of sleep of duty doctors. RESULTS--Hospital switchboards responded within 30 seconds in 87 (74%) calls, and in 76 calls (64%) the duty doctor requested was contacted within a further two minutes. Chest pain, possibly due to myocardial infarction, was the most common reason for acute medical admissions. Nearly half (48%) of the duty doctors in larger hospitals reported having 4-5 hours sleep or less on their nights on call. Most (30) were on a one in three rota; two were on a one in two rota. CONCLUSIONS--Despite impressions to the contrary contacting the duty medical team by telephone seemed fairly easy. Although most junior doctors were on a rota of one in three or better, insufficient recognition may be given to their deprivation of sleep during nights on duty.     

Improving compliance with requirements on junior doctors' hours

Problem Compliance with UK regulations on junior doctors'' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed.Design Audit of change.Setting Paediatric night rota in large children''s hospital.Key measures for improvement Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through critical incident reports.Strategies for change Development of new staff roles, followed by change from a partial shift rota comprising 11 doctors and one senior nurse, to a full shift night team comprising three middle grade doctors and two senior nurses.Effects of change Compliance with regulations on working hours increased from 33% to 77%. Workload changed little and was well within the capacity of the new night team. The effect on patient care and on medical staff requires further evaluation.Lessons learnt Reduction of junior doctors'' working hours requires changes to roles, processes, and practices throughout the organisation.     

Reducing night shift exposure: a pilot study of rota, night shift and age effects on sleepiness and fatigue

The reduction of exposure to longer runs of successive night duties is often one of the aims of 'best practice' intervention. The objective of this pilot study was to examine the effects of a change in rota upon sleepiness and fatigue, and potential age-related issues in relation to the change. Participants were 102 police officers, mean age 33.60 (sd 6.11), mean shiftwork experience = 10.56 years (sd 6.84). Testing occurred at least one month before the change from the existing 'Ottawa' system to a new rota that split a run of 7 consecutive night shifts into blocks of 3 and 4 within the rota cycle, and 6 months after the change. Measures of critical flicker fusion, subjective fatigue and sleepiness, and stimulant intake were taken in relation to selected night shifts on both rotas. Older officers tended to report higher fatigue and sleepiness, and higher caffeine intake than the younger shiftworkers irrespective of rota or shift. The findings tend to suggest that the change of rota had little effect but that age may play a substantial role in responses to night work.     

Introduction of a partial shift system for house officers in a teaching hospital.

OBJECTIVES--(1) To introduce a partial shift system to reduce the hours of work of preregistration house surgeons to an average of 64 a week to comply with the New Deal for junior doctors; (2) to test linking the partial shift concept to an existing structure of "on call" firms. DESIGN--Formal assessment after three months of a pilot partial shift system for eight house surgeons on three firms instituted on 1 November 1991, followed by questionnaire and interview evaluation at three and six months of a revised system implemented on 1 February 1992. SETTING--Department of general surgery at St Bartholomew''s Hospital, London. SUBJECTS--24 house surgeons attached to three surgical firms. RESULTS--In eight weeks each house surgeon worked one week (five shifts) of night duty, one week of "cover" (afternoon and evening) duty, and six weeks of normal daytime hours. Each weekday a house surgeon from the firm on call worked an extended daytime on call shift until 10 pm. Weekend duties were split between two house surgeons from the firm on call. A computer generated graphical display of the rota was used to facilitate leave planning. Average working hours were reduced to below 64 per week, including prospective cover, without detriment to patient care and educational standards. Within the shift system individual house surgeons could be on call with their own firm by day and at weekends. Opinions were equally divided among junior staff as to their preference for either on call or partial shift systems. CONCLUSIONS--The principles of this partial shift system are generally applicable and the model can readily be adopted by district general hospitals.     

Junior doctors' on call activities: differences in workload and work patterns among grades.

OBJECTIVE--To examine the workload and work patterns of junior doctors of all grades while on call. DESIGN--Pilot study of activity data self recorded by junior doctors, with the help of students during busy periods. SETTING--A general surgical firm and a general medical firm based at University Hospital, Nottingham. SUBJECTS--Four registrars, three senior house officers, and five preregistration house officers. RESULTS--Senior house officers and preregistration house officers spent nearly half of all their on call duty time working, but less than half of that time was spent in direct contact with patients. Registrars were on call more often than the house officers but spent less than one fifth of their on call duty time working, and almost two thirds of that time was spent in direct contact with patients. CONCLUSIONS--Workload while on duty is excessive for both senior and preregistration house officers. Changes in some administrative procedures and employment of more non-medical staff during on call periods might reduce the time spent on non-clinical activities, thereby reducing the overall workload and allowing more time for patient contact.     

Pre-hospital Coronary Care Service

The Dublin cardiac ambulance service operates two specially-equipped ambulances from a private ambulance station; five metropolitan hospitals provide coronary care beds on a rota system. The service covers an area of 450 square miles (1,165 sq km) and a population of 800,000. The ambulances are staffed solely by trained ambulance personnel. During the first three years 1,973 patients were transported to hospital. Primary ventricular fibrillation was encountered in 20 patients and successfully treated in 17. No deaths occurred in the ambulance.Over 98% of the patients were transferred uneventfully to hospital, so a medical team from the hospital on duty was called on 30 occasions only. A feature of the Dublin service is the low cost of a standard ambulance call, at about £7·50.     

Early Carboniferous radiolarians from north-west Thailand: palaeogeographical implications

Moderately well-preserved radiolarian assemblages are described from bedded cherts south of Mae Hong Son, north-west Thailand. Twenty species and subspecies are identified, including one new species ( Archocyrtium sashidai Feng sp. nov.). The assemblages belong to the middle Early Carboniferous Albaillella indensis and Eostylodictya rota zones. The new data suggest that there was a pelagic basin between the Shan-Thai terrane and Gondwana during the Early Carboniferous. This implies, contrary to previous interpretations, that the Shan-Thai terrane had already rifted apart from Gondwana during the Early Carboniferous.     

A proposal for a new definition of the axial rotation angle of the shoulder joint.

The Euler/Cardan angles are commonly used to define the motions of the upper arm with respect to the trunk. This definition, however, has a problem in that the angles of both the horizontal flexion/extension and the axial rotation of the shoulder joint become unstable at the gimbal-lock positions. In this paper, a new definition of the axial rotation angle was proposed. The proposed angle was stable over the entire range of the shoulder motion. With the new definition, the neutral position of the axial rotation agreed with that in the conventional anatomy. The advantage of the new definition was demonstrated by measuring actual complex motions of the shoulder with a three-dimensional motion capture system.     

The effect of input DNA copy number on genotype call and characterising SNP markers in the humpback whale genome using a nanofluidic array

Recent advances in nanofluidic technologies have enabled the use of Integrated Fluidic Circuits (IFCs) for high-throughput Single Nucleotide Polymorphism (SNP) genotyping (GT). In this study, we implemented and validated a relatively low cost nanofluidic system for SNP-GT with and without Specific Target Amplification (STA). As proof of principle, we first validated the effect of input DNA copy number on genotype call rate using well characterised, digital PCR (dPCR) quantified human genomic DNA samples and then implemented the validated method to genotype 45 SNPs in the humpback whale, Megaptera novaeangliae, nuclear genome. When STA was not incorporated, for a homozygous human DNA sample, reaction chambers containing, on average 9 to 97 copies, showed 100% call rate and accuracy. Below 9 copies, the call rate decreased, and at one copy it was 40%. For a heterozygous human DNA sample, the call rate decreased from 100% to 21% when predicted copies per reaction chamber decreased from 38 copies to one copy. The tightness of genotype clusters on a scatter plot also decreased. In contrast, when the same samples were subjected to STA prior to genotyping a call rate and a call accuracy of 100% were achieved. Our results demonstrate that low input DNA copy number affects the quality of data generated, in particular for a heterozygous sample. Similar to human genomic DNA, a call rate and a call accuracy of 100% was achieved with whale genomic DNA samples following multiplex STA using either 15 or 45 SNP-GT assays. These calls were 100% concordant with their true genotypes determined by an independent method, suggesting that the nanofluidic system is a reliable platform for executing call rates with high accuracy and concordance in genomic sequences derived from biological tissue.     

高级护师综合评价指标体系研究

目的:结合当前我国护理事业发展规划纲要、人事制度改革、岗位评聘的需要,构建科学合理、实用性强的高级护师综合评价指标体系,实现对高级护师科学化的综合评价。方法:运用文献分析法及专家访谈法建立备选评价指标,据此对39名专家仅进行三轮专家咨询。通过德尔菲法对拟定的指标进行筛选和补充,通过层次分析法对指标权重进行明确。结果:经过三轮专家咨询及数理统计分析,构建了一套科学的三级甲等综合性医院高级护师综合评价指标体系。该指标体系包括职业素质、学识水平、业务能力、工作业绩4个一级指标及其延伸的12项二级指标和47项三级指标。结论:本研究构建了科学、实用的高级护师综合评价指标体系,该指标体系层次分明、指标数量适中、指标权重明确,有利于正确反映高级护师实际能力和综合素质,能够对高级护师进行科学的的综合评价。     

Primary classification and phylogeny of the Polemoniaceae, with comments on molecular cladistics

The system of classification of the Polemoniaceae currently in use was published by Grant in 1959. Much new evidence concerning relationships in the family has been obtained by numerous workers since 1959, and the old system is in need of revision. A revised system down to the genus level, based on conventional and unconventional characters, including molecular evidence, is presented here. Nineteen genera are grouped into eight tribes and two subfamilies. Three new tribes are described: Acanthogilieae, Loeselieae, and Leptodactyloneae. Several genera are transferred to new groups. The phylogeny of the family is discussed in the light of both the older and new evidence. The approach used in constructing both the 1959 and new systems is that of evolutionary systematics. Two recent (1996, 1997) family-wide surveys of cpDNA and rDNA use cladistic methods of analysis to arrive at sets of major groups. Some of this molecular evidence has been adopted for the present revised system. However, much incongruence still exists between the new sets of clades, on the one hand, and the present revised system or the still-viable parts of the 1959 system on the other hand. The incongruences call for an examination and comparison of the contrasting methods of evolutionary systematics and molecular cladistics. A fundamental flaw in the 1996 and 1997 treatments is the attempt to classify plants on the basis of single-gene gene trees.     

Identities and provenance of the gelechioid moths originally described by Francis Walker from 'unknown countries'

Abstract. The taxonomic placement and possible type-localities of twelve species and one genus of Gelechioidea described by Francis Walker from 'unknown countries' are discussed. Opisina arenosella Walker is the senior synonym of Nephantis serinopa Meyrick and Opisina Walker is the senior synonym of Nephantis serinopa Meyrick and Opisina Walker the senior synonym of Nephantis Meyrick; Aroga compositella (Walker), new combination, is the senior synonym of A.coloradensis (Busck); Cryptolechia metaphaeella Walker is a junior synonym of Antaeotricha schlaegeri (Zeller); A.albulella (Walker), new combination, is the senior synonym of A.vestalis (Zeller), and A.spurcatella (Walker), new combination, is the senior synonym of A.chloromis (Meyrick). A lectotype for C.metaphaeella Walker is designated.     

The vocal systems of two nocturnal burrowing petrels, the White-chinned Procellaria aequinoctialis and the Grey P. cinerea

I studied the calls of White-chinned Petrels Procellaria aequinoctialis and Grey Petrels P. cinerea at the Prince Edward Islands in the Southern Ocean. White-chinned Petrels gave two calls. One, the Wheezy call, was usually given from within breeding burrows, was given in response to playback of strange (= non-mate) calls, and probably served a burrow defence function. The other call, the Rattle call, was uttered roughly as often on the ground as from within the burrow. This call was mostly given by males and probably served as sexual advertisement. The one identified call type of the Grey Petrel was given in the same circumstances as the Wheezy call of the White-chinned Petrel.
In both species there was evidence of mate recognition of calls. Birds tended to remain silent to the playback of the mate's call, whereas they responded vocally to strange calls.
This vocal system, where both sexes share two call types but where sexual dimorphism in call is absent, has not been described before for petrels. Possible reasons for the variation in petrel vocal systems are discussed.     

Effects of crop rotation and reduced nitrogen fertilisation on Apera spica-venti populations in a long-term experiment

Apera spica-venti is one of the most serious annual grass weeds in Germany and may cause considerably yield losses in untreated fields. A long-term field experiment was conducted investigating the effects of crop rotation and nitrogen fertiliser use on A. spica-venti populations. A six-field cash-crop rotation with 67% winter cereals and a six-field fodder crop rotation with 50% winter cereals were studied. The rate of tillering was in the fodder crop rotation significantly higher than in the cash crop rotation. The halving of nitrogen fertilizer dose caused a significant increase in the tillering rate. Most plants of A. spica-venti emerged in winter wheat. There was an increase of emerged A. spica-venti in winter wheat from year to year.     

Cervical screening in an inner city area: response to a call system in general practice.

To determine whether a cervical screening call system based in general practice in a deprived inner city area would increase the numbers of women who came forward for cervical smears the response to letters of invitation for screening was monitored for one year in one general practice in the Paddington and North Kensington district of London. Women aged 20-64 were identified from the computerised age-sex register. Only 16% of these women had had a smear test. A total of 750 call letters was sent out. Initially the response was poor (57 women; 22%), and 85 (32%) letters were returned marked "address unknown." After the age-sex register was updated the response to call was 330 women (44%). The response of women aged over 35 was better than the response of women aged 35 and under (229 (53%) v 101 (32%)). In the year of the study the number of women aged 20-64 on the revised register who had been screened rose by 330 (14%). A general practice based call system can improve uptake of cervical screening even in a highly mobile, socially underprivileged population.     

Definitions and standardization of a new grading scheme for eyelid contour abnormalities after trichiasis surgery

Background

Clear definitions of outcomes following trichiasis surgery are critical for planning program evaluations and for identifying ways to improve trichiasis surgery. Eyelid contour abnormality is an important adverse outcome of surgery; however, no standard method has been described to categorize eyelid contour abnormalities.

Methodology/Principal Findings

A classification system for eyelid contour abnormalities following surgery for trachomatous trichiasis was developed. To determine whether the grading was reproducible using the classification system, six-week postoperative photographs were reviewed by two senior graders to characterize severity of contour abnormalities. Sample photographs defining each contour abnormality category were compiled and used to train four new graders. All six graders independently graded a Standardization Set of 75 eyelids, which included a roughly equal distribution across the severity scale, and weighted kappa scores were calculated. Two hundred forty six-week postoperative photographs from an ongoing clinical trial were randomly selected for evaluating agreement across graders. Two months after initial grading, one grader regraded a subset of the 240 photographs to measure longer-term intra-observer agreement. The weighted kappa for agreement between the two senior graders was 0.80 (95% CI: 0.71–0.89). Among the Standardization Set, agreement between the senior graders and the 4 new graders showed weighted kappa scores ranging from 0.60–0.80. Among 240 eyes comprising the clinical trial dataset, agreement ranged from weighted kappa 0.70–0.71. Longer-term intra-observer agreement was weighted kappa 0.86 (95% CI: 0.80–0.92).

Conclusions/Significance

The standard eyelid contour grading system we developed reproducibly delineates differing levels of contour abnormality. This grading system could be useful both for helping to evaluate trichiasis surgery outcomes in clinical trials and for evaluating trichiasis surgery programs.     

Genetic control and evolution of acoustic signals in planthoppers (Homoptera: Delphacidae)

Acoustic signals are part of the specific mate recognition system of planthoppers. The genetic control of acoustic signal characters was studied in the planthopperRibautodelphax imitans. Artificial selection for interpulse interval in the female call revealed a large additive genetic component for this polygenic character. Other female call characters showed a correlated response. Some male call characters also appeared to be genetically correlated with the female character selected for, despite the rather different structure of male and female calls. Parent-offspring regression provided significant heritability estimates for those male call characters that also responded to artificial selection in the female call, one of which appeared to be influenced by sex-linked genes. It is argued that the differentiation of this mate recognition system in planthopper populations and species could be the result of founder effects, enabled by the genetic plasticity of the call characters and the existence of a wing length dimorphism in these animals.     

Construction of an associative memory using unstable periodic orbits of a chaotic attractor

Unstable periodic orbits are the skeleton of a chaotic attractor. We constructed an associative memory based on the chaotic attractor of an artificial neural network, which associates input patterns to unstable periodic orbits. By processing an input, the system is driven out of the ground state to one of the pre-defined disjunctive areas of the attractor. Each of these areas is associated with a different unstable periodic orbit. We call an input pattern learned if the control mechanism keeps the system on the unstable periodic orbit during the response. Otherwise, the system relaxes back to the ground state on a chaotic trajectory. The major benefits of this memory device are its high capacity and low-energy consumption. In addition, new information can be simply added by linking a new input to a new unstable periodic orbit.     

Individual Male Calling Pattern and Male Mating Success in the European Treefrog (Hyla arborea): Is there Evidence for Directional or Stabilizing Selection on Male Calling Behaviour?

In anurans, call properties are commonly classified based on within‐male variability as being either static or dynamic. Numerous playback experiments in the laboratory have indicated that female preferences based on dynamic call properties are usually strongly directional, while female preferences based on static call properties are often stabilizing or weakly directional. However, there are only few studies demonstrating that female preferences for high values of dynamic call properties indeed exert directional selection on male calling behaviour in natural populations. Moreover, field studies investigating whether female preferences for values of static call properties around the mean of the population lead to currently operating stabilizing selection on male calling patterns in natural populations are completely lacking. Here I investigate for two consecutive breeding seasons male calling patterns and male mating success in a population of individually marked European treefrogs (Hyla arborea), a hylid frog with prolonged breeding season and a lek mating system. Individual male calling pattern as analysed in terms of seven temporal and spectral call properties did not differ between males that survived from one breeding season to the next and those not surviving. None of the seven call properties investigated differed significantly between mated and unmated males, indicating that there is no strong directional selection on male calling behaviour in the study population. However, in one study season males that produced calls with a number of pulses around the mean of the population were significantly more likely to obtain matings than males that produced calls with a number of pulses at the low or high end of the distribution. Thus, this study provides preliminary evidence for the operation of stabilizing selection on a static call property (i.e. the number of pulses per call) in a natural population of an anuran amphibian.