Can guidelines improve referral to elective surgical specialties for adults? A systematic review

Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving prereferral investigation and treatment, but there is no strong evidence in favour of other beneficial effects

The Origin of Episodic Accretion Bursts in the Early Stages of Star Formation

We study numerically the evolution of rotating cloud cores, from the collapse of a magnetically supercritical core to the formation of a protostar and the development of a protostellar disk during the main accretion phase. We find that the disk quickly becomes unstable to the development of a spiral structure similar to that observed recently in AB Aurigae. A continuous infall of matter from the protostellar envelope makes the protostellar disk unstable, leading to spiral arms and the formation of dense protostellar/protoplanetary clumps within them. The growing strength of spiral arms and ensuing redistribution of mass and angular momentum creates a strong centrifugal disbalance in the disk and triggers bursts of mass accretion during which the dense protostellar/protoplanetary clumps fall onto the central protostar. These episodes of clump infall may manifest themselves as episodes of vigorous accretion rate (\ge 10^{-4} M_sun/yr) as is observed in FU Orionis variables. Between these accretion bursts, the protostar is characterized by a low accretion rate (< 10^{-6} M_sun/yr). During the phase of episodic accretion, the mass of the protostellar disk remains less than or comparable to the mass of the protostar.Comment: 5 pages, 2 figures, accepted for publication in ApJ

Low Frequency VLA Observations of Abell 754: Evidence for a Cluster Radio Halo and Possible Radio Relics

We present 74 MHz and 330 MHz VLA observations of Abell 754. Diffuse, halo-like emission is detected from the center of the cluster at both frequencies. At 330 MHz the resolution of 90'' distinguishes this extended emission from previously known point sources. In addition to the halo and at a much lower level, outlying steep-spectrum emission regions straddle the cluster center and are seen only at 74 MHz. The location, morphology and spectrum of this emission are all highly suggestive of at least one, and possibly two cluster radio relics. Easily obtained higher resolution, higher sensitivity VLA observations at both frequencies are required to confirm the extended nature of the halo-like emission and the 74 MHz relic detections. However, since there is prior evidence that this cluster is or has recently been in the process of a major merger event, the possible discovery of relics in this system is of great interest in light of recent observational and theoretical evidence in favor of a merger-relic connection. We discuss the possible role the merger shock waves, which are seen in the X-ray emission, may have played in the formation of the halo and radio relics in A754.Comment: 15 pages including 4 figures. Accepted for publication by Ap

Filling the Organ Donor Pool by Giving Priority

Context: Many of the alternatives for procuring donor organs are considered either ineffective, unethical, or illegal. One possibility that may not face such challenges is a priority system whereby individuals who register as an organ donor are given priority to receive an organ over those who have not registered. However, providing extrinsic rewards can sometimes paradoxically reduce the target behavior, especially for those who are more altruistically motivated. Methods: Two behavioral experiments were employed and data were analyzed using regressions as well as examining open-ended responses. Findings: The results suggest that giving priority to receive an organ to those who register to donate postmortem could increase overall registration rates. Further, the effect of providing priority appears to work by inducing anticipated regret, which can be used to overcome common obstacles to registration. Finally, it was found that a priority system is most effective in increasing donor rates for those individuals who are less altruistically motivated and does not reduce registration rates for those who are more altruistically motivated. Conclusions: Given the unabated shortage of transplant organs, the finding that a priority system could increase the willingness to register as a donor without crowding out altruistically motivated individuals is highly encouraging

Hyperopic Cops and Robbers

We introduce a new variant of the game of Cops and Robbers played on graphs, where the robber is invisible unless outside the neighbor set of a cop. The hyperopic cop number is the corresponding analogue of the cop number, and we investigate bounds and other properties of this parameter. We characterize the cop-win graphs for this variant, along with graphs with the largest possible hyperopic cop number. We analyze the cases of graphs with diameter 2 or at least 3, focusing on when the hyperopic cop number is at most one greater than the cop number. We show that for planar graphs, as with the usual cop number, the hyperopic cop number is at most 3. The hyperopic cop number is considered for countable graphs, and it is shown that for connected chains of graphs, the hyperopic cop density can be any real number in $[0,1/2].

Three-centre cluster structure in 11C and 11B

Studies of the 16O(9Be,alpha 7Be)14C, 7Li(9Be,alpha 7Li)5He and 7Li(9Be,alpha alpha t)5He reactions at E(beam)=70 and 55 MeV have been performed using resonant particle spectroscopy techniques. The 11C excited states decaying into alpha+7Be(gs) are observed between 8.5 and 13.5 MeV. The alpha+7Li(gs), alpha+7Li*(4.652 MeV) and t+8Be(gs) decays of 11B excited states between 9 and 19 MeV are observed. The decay processes are used to indicate the possible three-centre 2alpha+3He (2alpha+3H) cluster structure of observed states. This cluster structure is more prominent in the positive-parity states, where two rotational bands with large deformations are suggested. Excitations of some of the observed T=1/2 resonances coincide with the energies of previously measured T=3/2 isobaric analogs of the 11Be states,indicating that these states may have mixed isospin.Comment: Contribution for the proceedings of the NUSTAR'05: NUclear STructure, Astrophysics and Reactions, University of Surrey, Guildford, UK; accepted for publication in Journal of Physics