HSV-1 has become the most common cause of newly diagnosed genital herpes infections in this population of college students and reflects a reversal of the usual HSV-1/HSV-2 ratio.

Objectives-To describe the relationship between patient satisfaction with out of hours care provided by deputising and practice doctors in four urban areas in England and characteristics of the service provided and patients, the care given, and health outcomes. Setting-Fourteen general practices in four urban areas in England. Participants-People who requested out of hours care. Design-Analysis of data from a study of out of hours care. Patients were interviewed within 5 days of their request for out of hours care. Data on the service provided were obtained from medical records and all other data were collected at interview. Satisfaction was measured using a valid reliable instrument. Results-2152 patients were recruited to the study and 1466 were interviewed. Satisfaction data were available on 1402 patients. "Overall satisfaction" was associated with age, doctor type, lack of access to a car at the time of the request, and health outcome. The relationships between satisfaction subscales and patient characteristics (age, sex, ethnicity, and access to a car at the time of the request), service characteristics (doctor type and delay between the request and visit), whether a prescription was given, and health outcome were variable. If an expected home visit was not received, "overall satisfaction" and satisfaction with "communication and management", "doctor's attitude", and "initial contact person" were reduced. Conclusion-Patient satisfaction is dependent on many factors. Mismatch between patient expectation and the service received is related to decreased satisfaction. This may increase as general practitioners delegate more out of hours care to cooperatives and deputising services.

Objective: To evaluate an out of hours cooperative of general practitioners compared with a deputising service. Design: Observational study of two services in overlapping geographical areas. Setting: A general practice cooperative in Kensington, Chelsea, and Westminster and a deputising service operating in that area and the neighbouring area of Brent and Harrow. Subjects: All patients contacting a doctor at either service in an eight week period beginning 1 September 1995. Main outcome measures: Patients' age and sex; rates of home visiting, telephone advice, and attendance at a primary centre; hospital admission rates; prescribing rates; times of patient calls; and response times. Results: Data were collected on 5812 patient contacts. Doctors from the cooperative visited 32.0% (1253/ 3920) of patients, offered telephone advice to 57.8% (2267), and saw 7.1% (278) of patients at the primary care centre. By contrast, the deputising service visited 76.3% (1444/1892) of patients and gave telephone advice to 19.3% (365). Doctors from the cooperative prescribed drugs to fewer patients (37.6%; 1473/3915) than did the deputising service (51.7%; 941/1821) (odds ratio 0.56 (95% confidence interval 0.50 to 0.63) adjusted for age and sex) and admitted 8.7% (339/ 3888) of patients to hospital compared with 6.8% (128/1889) from the deputising service (odds ratio 1.30 (1.05 to 1.61) adjusted for age and sex). Response times for the deputising service were faster (median time to visit 65 minutes) than for the cooperative (median time to visit 75 minutes) but the time to first contact with a doctor was shorter for the cooperative because most people initially received telephone advice. Conclusions: The cooperative in this study dealt with patient contacts very differently from the way the deputising service dealt with contacts, fewer patients being visited and fewer receiving prescriptions. The data presented enable other out of hours services to compare their own performance using a standard data collection and analysis program.

Successful fisheries management practices developed for one ecosystem can often be used in similar ecosystems. We developed a flexible lake classification framework in collaboration with ~100 fisheries biologists for improved fisheries conservation management in Wisconsin, USA. In total, 5,950 lakes were classified into 15 lake classes using a two‐tiered approach. In tier‐one, lakes were clustered into “simple” and “complex” sportfish assemblages. In tier‐two, lakes were further clustered using accumulated degree days, water clarity, and special cases. We focus on temperature and clarity because these factors often drive fisheries change over time—thus a lake's class can change over time. Lake class assignments were refined through a vetting process where fisheries biologists with expert knowledge provided feedback. Relative abundance, size‐structure, and growth rates of fishes varied significantly across classes. Biologists are encouraged to utilize class interquartile ranges in fisheries metrics to make improved fisheries assessments. We highlight hard‐won lessons from our effort including: (1) the importance of co‐developing classification frameworks alongside fisheries biologists; and (2) encouraging frameworks where lakes can shift classes and fisheries expectations over time due to factors like climate change and eutrophication.

College health centers are important sources for Pap and STI test data. Pap tests frequently yield low-grade abnormalities, and screening tests for chlamydia and especially gonorrhea are infrequently positive. Rates of HIV and syphilis in this population are low, raising concerns about positive predictive value when screening low-risk students. A majority of genital herpes infections are caused by HSV-1.