1,721,006 research outputs found
A national evaluation of specialists' clinics in primary care settings
No full textBackground: Encouraged by the increased purchasing power of general (practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this trend.Aim: To evaluate the costs processes, and benefits of specialists' outreach clinics held in GPs' surgeries compared with hospital outpatient clinics. Design of Study: A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with matched outpatient control clinics.Setting: Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls covering 14 hospital trust areas across EnglandMethod: Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also given to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and trust accountants (process and costs questionnaire). Evaluation of the costs, processes, and benefits of specialist outreach clinics versus hospital outpatient clinics was carried our by comparing questionnaire responses.Results: In comparison with outpatients outreach clinic patients spent less rime on the waiting lists for appointments to see the specialist, they had shorter waiting times in clinics, fewer follow-up appointments, and were more likely to he completely discharged after the sampled attendance. Outreach patients were more satisfied than outpatients with the range of clinic process items asked about. Most doctors felt that the outreach clinic was 'worthwhile'. While patients' personal costs were lower in outreach than in outpatients clinics, NHS costs were more expensive per patient in outreach. The benefits of outreach clinics on patients 'health status at six months' follow-up were relatively small.Conclusions: Outreach clinics are a means of improving access to specialist services for patients in addition to improving the efficiency and quality of health care. Most results were similar across specialties and areas. The benefits of the outreach service need to be weighed against their substantially higher NHS costs, in comparison with outpatients clinics Outreach clinics are unlikely to be financially justifiable for NHS funding given that the impact on patients' health status was small
Combinatorial and Fourier analytic L\ub2 methods for Buffon's needle problem
Get PDFFor interpretation of the references to color in this and all other figures, the reader is referred to the electronic version of this thesis.}\end{figure}In recent years, progress has been made on Buffon's needle problem, in which one considers a subset of the plane and asks how likely "Buffon's needle" - a long, straight needle with independent, uniform distributions on its position and orientation - is to intersect said set. The case in which the set is a small neighborhood of a one-dimensional unrectifiable Cantor-like set has been considered in recent years, and progress has been made, motivated in part by connections to analytic capacity.Call the set E, the radius of the neighborhood ε, and the neighborhood Eε. Then in some special cases, it has been confirmed that Buffon's needle intersects Eε with probability at most C|logε|-p, for p>0 small enough, C>0 large enough. In the special case of the so-called "four corner" Cantor set and Sierpinski's gasket, the lower bound C*log|logε|/|logε| is known, replacing the previously-known lower bound C/|logε| which is good for more general one-dimensional self-similar sets.In addition, the stronger lower bounds are still good if one "bends the needle" into the shape of a long circular arc, or "Buffon's noodle." The radius one uses can be as small as |logε|ε0$, for any ε0, with the constant C depending on ε0. It is unknown whether this condition or anything like it is necessary.Work continues on generalizing the upper bound results.Thesis (Ph. D.)--Michigan State University. Mathematics, 2011Includes bibliographical references (pages 77-78
Evaluation of specialists' outreach clinics in general practice in England: Process and acceptability to patients, specialists, and general practitioners
No full textObjectives - The wider study aimed to evaluate specialists) outreach clinics in relation to their costs, processes, and effectiveness, including patients' and professionals' attitudes. The data on processes and attitudes are presented here.Design - Self administered questionnaires were drawn up for patients, their general practitioners (GPs) and specialists, and managers in the practice. Information was sought from hospital trusts. The study formed a pilot phase prior to a wider evaluation.Setting - Nine outreach clinics in general practices in England, each with a hospital outpatient department as a control clinic were studied.Subjects - The specialties included were ear, nose, and throat surgery; rheumatology; and gynaecology. The subjects were the patients who attended either the outreach clinics or hospital outpatients clinics during the study period, the outreach patients' GPs, the outreach patients' and outpatients' specialists, the managers in the practices, and the NHS trusts which employed the specialists.Main outcome measures - Process items included waiting Lists, waiting times in clinics, number of follow up visits, investigations and procedures performed, treatment, health status, patients' and specialists' travelling times, and patients' and doctors' attitudes to, and satisfaction with, the clinic.Results - There was no difference in the health status of patients in relation to the clinic site tie, outreach and hospital outpatients' clinics) at baseline, and all but one of the specialists said there were no differences in casemix between their outreach and outpatients' clinics. Patients preferred, and were more satisfied with, care in specialists' outreach clinics in general practice, in comparison with outpatients' clinics. The outreach clinics were rated as more convenient than outpatients) clinics in relation to journey times; those outreach patients in work lost less time away from work than outpatients' clinic patients due to the clinic attendance. Length of time on the waiting list was significantly reduced for gynaecology patients; waiting times in clinics were lower for outreach patients than outpatients across all specialties. In addition, outreach patients were more Likely to be first rather than follow up attenders; rheumatology outreach patients were more likely than hospital outpatients to receive therapy. GPs' referrals to hospital outpatients' clinics were greatly reduced by the availability of outreach clinics. Both specialists and GPs saw the main advantages of outreach clinics in relation to the greater convenience and better access to care for patients. Few of the specialists and GPs in the outreach practices held formal training and education sessions in the outreach clinic, although over half of the GPs felt that their skills/expertise had broadened as a result of the outreach clinic.Conclusions - The processes of care (waiting times, patient satisfaction, convenience to patients, follow up attendances) were better in outreach than in outpatients' clinics. However, waiting Lists were only significantly reduced for gynaecology patients, despite both GPs and consultants reporting reduced waiting lists for patients as one of the main advantages of outreach. Whether these improvements merit the increased cost to the specialists (in terms of their increased travelling times and time spent away from their hospital base) and whether the development of what is, in effect, two standards of care between practices with and without outreach can be stemmed and the standard of care raised in all practices leg, by sharing outreach clinics between GPs in an area) remain the subject of debate. As the data were based on the pilot study, the results should be viewed with some caution, although statistical power was adequate for comparisons of sites if not specialties
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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