Out-of-hours visits in a group practice.

In one year 1644 out-of-hours calls were undertaken by a partnership of eight doctors working in a deprived inner urban area and a deprived large council housing estate; of these calls 332 were performed between the hours of 11 pm and 7 am. The number of calls required in the housing estate, 1077, was about twice as many as in the inner urban area, although the same doctors were using the same criteria for a visit. The rate of visits of 107 per 1000 patients in the housing estate was much higher than in other published series. The reasons for this difference appeared to be related to the comparative youth of parents and the number of young children.     

When is a patient's use of primary care services unwarranted? Some answers from physicians.

To explore physicians'' perceptions of what constitutes unwarranted use of their services, examples of patient-initiated encounters considered unwarranted were contributed by physicians and categorized as requests for unnecessary services, inappropriately timed encounters or inconsiderate requests. A random sample of family and general practitioners in Ontario was surveyed with a questionnaire derived from these examples. Although there was no unanimity, examples of missed appointments, requests for further, unnecessary investigations, consultations or admissions to hospital, duplication of services, visits prompted by a desire to obtain free samples of over-the-counter drugs, some out-of-hours calls, and visits of healthy workers to obtain notes regarding fitness for work were seen as unwarranted by 70% or more of the respondents.     

Is the emergency ambulance service abused?

Analysis of 1000 consecutive patients brought to the accident and emergency department of a busy district general hospital by ambulance after emergency "999" telephone calls showed that 51.7% of these journeys were unnecessary. Medical cases accounted for a greater percentage of necessary calls than did trauma and surgical cases. Medical education of the public is essential if the number of these calls is to be cut.     

Physiological resonance between mates through calls as possible evidence of empathic processes in songbirds

Physiological resonance – where the physiological state of a subject generates the same state in a perceiver – has been proposed as a proximate mechanism facilitating pro-social behaviours. While mainly described in mammals, state matching in physiology and behaviour could be a phylogenetically shared trait among social vertebrates. Birds show complex social lives and cognitive abilities, and their monogamous pair-bond is a highly coordinated partnership, therefore we hypothesised that birds express state matching between mates. We show that calls of male zebra finches Taeniopygia guttata produced during corticosterone treatment (after oral administration of exogenous corticosterone and during visual separation from the partner) provoke both an increase in corticosterone concentrations and behavioural changes in their female partner compared to control calls (regular calls emitted by the same male during visual separation from the partner only), whereas calls produced during corticosterone treatment by unfamiliar males have no such effect. Irrespective of the caller status (mate/non-mate), calls' acoustic properties were predictive of female corticosterone concentration after playback, but the identity of mate calls was necessary to fully explain female responses. Female responses were unlikely due to a failure of the call-based mate recognition system: in a discrimination task, females perceive calls produced during corticosterone treatment as being more similar to the control calls of the same male than to control calls of other males, even after taking acoustical differences into account. These results constitute the first evidence of physiological resonance solely on acoustic cues in birds, and support the presence of empathic processes.     

Follow-up of emergency ambulance calls in Nottingham: implications for coronary ambulance servie.

Information about patients in ambulance service records has been linked to that in the patients'' hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack.     

Cultural transmission of vocalizations in ravens, Corvus corax

As ravens have pronounced learning capabilities, especially in the vocal domain, cultural transmission might be a relevant factor affecting the composition of their vocal repertoires. We investigated how important cultural transmission is in establishing a raven's vocal repertoire and whether there are different pathways of transmission. We studied individually known free-ranging breeding pairs whose vocalizations were recorded during interactions with a caged pair. The mean repertoire size of these vocalizations was 12 call types per individual (from 79 types recorded from 74 individuals), with no difference between the sexes. In 81% of individuals the repertoire was composed entirely of calls also used by other individuals. Analysis of the distribution of call types among individuals regarding sex, partnership and neighbourhood and aspects of the geographical distribution of calls showed that the main pathway of cultural transmission was within the sexes. In addition, transmission occurred between pair partners, as well as between neighbouring and more distant pairs. About 40% of the calls in a raven's repertoire were transmitted within a sex and 10% between pair partners. Any two given birds in the population shared on average 20% (0-77%) of their calls. Cultural transmission within the sexes led to a pronounced sexual dimorphism in vocal behaviour. Copyright 2002 The Association for the Study of Animal Behaviour. Published by Elsevier Science Ltd. All rights reserved.      

Through-ice communication by Weddell seals may not be practicable

Possible communication between territorial male Weddell seals (Leptonychotes weddellii) under the ice with females on the ice was investigated. In-air and underwater recordings of underwater calls were made at three locations near Davis, Antarctica. Most underwater calls were not detectable in air, often because of wind noise. In-air call amplitudes of detectable calls ranged from 32–74 dB re. 20 Pa at 86 Hz down to 4–38 dB re. 20 Pa at 3.6 kHz. Most of these would be audible to humans. Only 26 of 582 amplitude measurements (from 230 calls) ranged from 5 dB to a maximum of 15 dB above the minimum harbour-seal (Phoca vitulina) in-air detection threshold. Seals on the ice could likely hear a few very loud underwater calls but only if the caller was nearby and there were no wind noises. The low detectability of underwater calls in air likely precludes effective communication between underwater seals and those on the ice.     

Begging signals in a mobile feeding system: the evolution of different call types

In some species, dependent offspring join foraging providers and beg for food. Mobile offspring might benefit from evolving begging signals adapted to the different situations they are exposed to, but this possibility has been ignored. In cooperatively breeding meerkats (Suricata suricatta), dependent offspring use a repertoire of several begging calls when joining foraging adults. We found that these calls can be differentiated on the basis of their acoustic structure and that pups adjusted the use of specific call types according to the social context. Pups continuously gave "repeat" calls when they accompanied foraging adults, and playback of these calls increased provisioning by the adults. When pups saw adults with food, they switched from repeat calls to vigorous "high-pitched" calls; adults also preferred to "feed" loudspeakers broadcasting high-pitched calls rather then loudspeakers broadcasting repeat calls. The elaboration of different begging calls might reflect an adaptation to a situation where dependent young must solicit food from potential feeders while at the same time directing feeders to bring the prey item to themselves and not to another begging pup. Here we show that mobile but dependent offspring adapt to different contexts in a mobile feeding system by using a repertoire of begging calls.     

Effects of male call pitch on female behaviour and mate fidelity in little penguins

Playback experiments with two loudspeakers were conducted to examine how female little penguins (Eudyptula minor) respond to bray calls of males that varied in (1) dominant frequency (low vs high) and (2) familiarity (current partner vs stranger). In the first experiment, there was no statistically significant difference in the number of approaching females between low- and high-pitch calls. In the second experiment, using calls from the current partner and a stranger, females were more likely to approach closer to their own partners calls, regardless of the pitch of the strangers call. We conclude that female little penguins may recognize their partners calls (or at least familiar male calls) and appear to maintain mate fidelity even when larger, potentially more successful, strangers are on offer.     

Responses to natural and synthetic phee calls by common marmosets (Callithrix jacchus)

Captive adult common marmosets (Callithrix jacchus) produce whistlelike “phee” calls in two contexts: in the home cage, where phee calls may function as part of territorial marking behavior, and when separated from social companions, where phee calls may function to reunite conspecifics. Natural and synthesized calls representing the acoustic structure of male and female calls in each context were presented to adult marmosets in a playback paradigm. Marmosets demonstrated discriminative abilities according to the context of the call and the caller's sex. Vocal and behavioral responses indicated increased vigilance and territorial behavior, following playbacks of naturally produced calls as well as synthetic calls. All animals scanned more frequently following produced calls as well as synthetic calls. All animals scanned more frequently following natural home cage as well as isolation calls, but only increased contact behavior (trills) in response to home cage calls. The responses were dimorphic according to the sex of the caller, where adult males scanned more following male calls, and adult females were more aggressive following male and female calls. The differential behavioral responses to playbacks of marmoset phee calls suggest a biological relevance to subtle differences found in the acoustic parameters of the phee call. © 1994 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, in the public domain in the United States of America.

     

Ring chromosome 13 syndrome characterized by high resolution array based comparative genomic hybridization in patient with 47, XYY syndrome: a case report

Introduction

Percutaneous or endocavitory drainage of a diverticular abscess under radiological guidance often enables one to perform a one-staged resection and anastomosis (without stoma formation) instead of a two-staged procedure. It reduces the significant postoperative morbidity and mortality associated with the conventional emergency surgical management. However, radiological guidance is not always available due to limited resources during out-of-hours.

Case presentation

A 78-year-old Caucasian woman underwent transrectal drainage of a diverticular abscess performed with a pigtail catheter without radiological guidance. Technical details of the procedure are described and alternative options discussed.

Conclusion

In carefully selected patients, per-rectal drainage using a pigtail catheter can be performed without radiological guidance and the procedure offers a simple and effective way of controlling sepsis.     

Power, blame, and accountability: Medicaid managed care for mental health services in New Mexico

I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize the public-private "partnership" between the state and its managed care contractors to illuminate the complexities of exacting state oversight in a medically underserved, rural setting. Second, I discuss the strategic deployment of accountability discourse by members of this partnership to limit use of expensive services by Medicaid recipients. Third, I focus on transportation for Medicaid recipients to show how market triumphalism drives patient care decisions. Providers and patients with the least amount of formal authority and power are typically blamed for system deficiencies.     

A South African Public-Private Partnership HIV Treatment Model: Viability and Success Factors

Introduction

The increasing number of people requiring HIV treatment in South Africa calls for efficient use of its human resources for health in order to ensure optimum treatment coverage and outcomes. This paper describes an innovative public-private partnership model which uses private sector doctors to treat public sector patients and ascertains the model’s ability to maintain treatment outcomes over time.

Methods

The study used a retrospective design based on the electronic records of patients who were down-referred from government hospitals to selected private general medical practitioners (GPs) between November 2005 and October 2012. In total, 2535 unique patient records from 40 GPs were reviewed. The survival functions for mortality and attrition were calculated. Cumulative incidence of mortality for different time cohorts (defined by year of treatment initiation) was also established.

Results

The median number of patients per GP was 143 (IQR: 66–246). At the time of down-referral to private GPs, 13.8% of the patients had CD4 count <200 cell/mm³, this proportion reduced to 6.6% at 12 months and 4.1% at 48 months. Similarly, 88.4% of the patients had suppressed viral load (defined as HIV-1 RNA <400 copies/ml) at 48 months. The patients’ probability of survival at 12 and 48 months was 99.0% (95% CI: 98.4%–99.3%) and 89.0% (95% CI: 87.1%–90.0%) respectively. Patient retention at 48 months remained high at 94.3% (95% CI: 93.0%–95.7%).

Conclusions

The study findings demonstrate the ability of the GPs to effectively maintain patient treatment outcomes and potentially contribute to HIV treatment scale-up with the relevant support mechanism. The model demonstrates how an assisted private sector based programme can be effectively and efficiently used to either target specific health concerns, key populations or serve as a stop-gap measure to meet urgent health needs.     

VOCAL INDIVIDUALITY OF IN-AIR WEDDELL SEAL (LEPTONYCHOTES WEDDELLII) PUP "PRIMARY" CALLS

As a result of selective pressures faced during lactation, vocal recognition may play a crucial role in maintaining the phocid mother–pup bond during the period of dependence. To investigate this possibility, we examined whether Weddell seal ( Leptonychotes weddellii ) pups produce individually distinctive "primary" calls. One temporal, nine fundamental frequency features, and two spectral characteristics were measured. A discriminant function analysis (DFA) of 15 Vestfold Hills pups correctly classified 52% of calls, while the cross-validation procedure classified 29% of calls to the correct pup. A second DFA of 10 known-age McMurdo Sound pups correctly classified 44% of "test" calls. For novel calls, the probabilities of attaining such classification rates by chance are low. The relationship between age and call stereotypy indicated that pups 2 wk and older may be more vocally distinctive. Overall, findings suggest that Weddell seal pup "primary" calls are moderately distinctive and only exhibit sufficient stereotypy to aid maternal recognition by approximately two weeks of age.     

Differences in preference for species-specific female calls between acoustically experienced and acoustically naive maleRibautodelphax planthoppers (Homoptera: Delphacidae)

Males of the planthopper Ribautodelphax imitanswere exposed to playbacks of either conspecific or heterospecific (R. imitantoides)female calls during their development from egg to adult, and thereafter these, as well as naive males,were offered a two- way choice between these calls. Males of all treatments approached the conspecific call significantly more often. However, males primed by the conspecific call chose the heterospecific call almost four times less often than did males primed by heterospecific calls or naive males, thus showing that the preference for conspecific calls can be partly learned. Males primed by heterospecific calls performed very similarly to completely naive males, suggesting that the signal recognition mechanism is much less sensitive to heterospecific calls than to conspecific calls. Males with experience of the conspecific female call tended to take more time to reach the call source in the trials than both other types of males. The evolutionary implications of these findings are discussed.     

Improving outcomes for ill and injured children in emergency departments: protocol for a program in pediatric emergency medicine and knowledge translation science

Background

Implementation of evidence-based mental health assessment and intervention in community public health practice is a high priority for multiple stakeholders. Academic-community partnerships can assist in the implementation of efficacious treatments in community settings; yet, little is known about the processes by which these collaborations are developed. In this paper, we discuss our application of community-based participatory research (CBPR) approach to implementation, and we present six lessons we have learned from the establishment of an academic-community partnership.

Methods

With older adults with psychosis as a focus, we have developed a partnership between a university research center and a public mental health service system based on CBPR. The long-term goal of the partnership is to collaboratively establish an evidence-based implementation network that is sustainable within the public mental healthcare system.

Results

In building a sustainable partnership, we found that the following lessons were instrumental: changing attitudes; sharing staff; expecting obstacles and formalizing solutions; monitoring and evaluating; adapting and adjusting; and taking advantage of emerging opportunities. Some of these lessons were previously known principles that were modified as the result of the CBPR process, while some lessons derived directly from the interactive process of forming the partnership.

Conclusion

The process of forming of academic-public partnerships is challenging and time consuming, yet crucial for the development and implementation of state-of-the-art approaches to assessment and interventions to improve the functioning and quality of life for persons with serious mental illnesses. These partnerships provide necessary organizational support to facilitate the implementation of clinical research findings in community practice benefiting consumers, researchers, and providers.     

Calls during agonistic interactions vary with arousal and raise audience attention in ravens

Background

Acoustic properties of vocalizations can vary with the internal state of the caller, and may serve as reliable indicators for a caller’s emotional state, for example to prevent conflicts. Thus, individuals may associate distinct characteristics in acoustic signals of conspecifics with specific social contexts, and adjust their behaviour accordingly to prevent escalation of conflicts. Common ravens (Corvus corax) crowd-forage with individuals of different age classes, sex, and rank, assemble at feeding sites, and engage in agonistic interactions of varying intensity. Attacked individuals frequently utter defensive calls in order to appease the aggressor. Here, we investigated if acoustic properties of defensive calls change with varying levels of aggression, and if bystanders respond to these changes.

Results

Individuals were more likely to utter defensive calls when the attack involved contact aggression, and when the attacker was higher in rank than the victim. Defensive calls produced during intense conflicts were longer and uttered at higher rates, and showed higher fundamental frequency- and amplitude-related measures than calls uttered during low-intensity aggression, indicating arousal-based changes in defensive calls. Playback experiments showed that ravens were more likely to react in response to defensive calls with higher fundamental frequency by orientating towards the speakers as compared to original calls and calls manipulated in duration.

Conclusions

Arousal-based changes are encoded in acoustic parameters of defensive calls in attacked ravens, and bystanders in the audience pay attention to the degree of arousal in attacked conspecifics. Our findings imply that common ravens can regulate conflicts with conspecifics by means of vocalizations, and are able to gather social knowledge from conspecific calls.

     

Substrate-gleaning versus aerial-hawking: plasticity in the foraging and echolocation behaviour of the long-eared bat,Myotis evotis

The foraging and echolocation behaviour of Myotis evotis was investigated during substrate-gleaning and aerial-hawking attacks. Bats gleaned moths from both the ground and a bark-covered trellis, however, they were equally adept at capturing flying moths. The calls emitted by M. evotis during substrate-gleaning sequences were short, broadband, and frequency-modulated (FM). Three behavioural phases were identified: search, hover, and attack. Gleaning search calls were significantly longer in duration, lower in highest frequency, and larger in bandwidth than hover/attack calls. Calls were detected in only 68% of gleaning sequences, and when they were emitted, bats ceased calling 200 ms before attacking. Terminal feeding buzzes, the rapid increase in pulse repetition rate associated with an attempted prey capture, were never recorded during gleaning attacks. The echolocation calls uttered by M. evotis during aerial-hawking foraging sequences were also short duration, high frequency, FM calls. Two distinct acoustic phases were identified: approach and terminal. Approach calls were significantly different from terminal calls in all variables measured. Calls were detected in 100% of aerial-hawking attacks and terminal feeding buzzes were invariably produced. Gleaning hover/attack calls were spectrally similar to aerial approach calls, but were shorter in duration and emitted at a significantly lower (but constant) repetition rate than aerial signals. Although the foraging environment (flight cage contents) remained unchanged between tasks (substrate-gleaning vs. aerial-hawking), bats emitted significantly lower amplitude calls while gleaning. We conclude that M. evotis adjusts its echolocation behaviour to meet the perceptual demands (acoustical constraints) imposed by each foraging situations.Abbreviations BW bandwidth - CF constant frequency - dB SPL decibels sound pressure level - FM frequency modulated - HF highest frequency - LF lowest frequency - PF peak frequency Presented at the meeting Acoustic Images in Bat Sonar, a conference on FM echolocation honoring Donald R. Griffin's contributions to experimental biology (June 14–16, Brown University, Providence RI).     

The ontogeny of acoustic individuality in the nasal calls of captive goitred gazelles, Gazella subgutturosa

Individualistic voices are important for establishing personalized relationships among individuals. In young animals, individual vocal identity is affected by permanent changes of the acoustics due to the growth of their vocal apparatus. Different acoustic variables change uncoordinatedly, so vocal individuality should be repeatedly upgraded along development. We compared classifying accuracy of individuals and sexes by nasal calls in fast-growing goitred gazelles Gazella subgutturosa at two ontogenetic stages, juvenile (3-6 weeks of age) and adolescent (23-26 weeks of age). Juvenile "spring" nasal calls and adolescent "fall" nasal calls were examined in the same 35 calves (18 males, 17 females), wild-born in May and then hand-raised. Discriminate function analysis based on four formants, fundamental frequency, duration and three power quartiles, revealed an equally high potential of spring and fall calls to encode sex. The individuality was very high in both ages but significantly higher in fall calls. Classifying calls to individuals was based on the same three acoustic variables (fundamental frequency and third and fourth formants) in both ages, although their actual values changed uncoordinatedly from spring to fall in most subjects. Our results suggest updating acoustic individuality in nasal calls of adolescent goitred gazelles accordingly to the newly emerged acoustic variation.     

Acoustic characteristics of eight common Chinese anurans during the breeding season

Anurans often have species-specific vocalizations. To quantify and compare the characteristics of anuran calls in Gutianshan National Nature Reserve, Zhejiang Province, we recorded the advertisement calls of eight species belonging to four families (Ranidae, Microhylidae, Megophryidae and Bufonidae) from June to September 2012 using Sony ICD-FX8 IC recorders. All recordings were analyzed using the "Praat" software. Five acoustics parameters were measured, including temporal traits (call duration, number of notes or pulse number/call) and spectral traits (fundamental frequency, the first three formants and dominant frequency). The characteristic parameters of Microhyla ornate and Fejervarya limnocharis calls were different as were the calls of some populations of the same species recorded in different regions. The advertisement calls of the eight species were specific. Our study has provided a useful reference for identifying the calls of some common Chinese anurans.