Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. Participants: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments

Properties of the Strange Axial Mesons in the Relativized Quark Model

We studied properties of the strange axial mesons in the relativized quark model. We calculated the $K_1$ decay constant in the quark model and showed how it can be used to extract the $K_1 (^3P_1) - K_1 (^1P_1)$ mixing angle ($\theta_K$) from the weak decay $\tau \to K_1 \nu_\tau$. The ratio $BR(\tau \to \nu_\tau K_1 (1270))/BR(\tau\to \nu_\tau K_1(1400))$ is the most sensitive measurement and also the most reliable since the largest of the theoretical uncertainties factor out. However the current bounds extracted from the TPC/Two-Gamma collaboration measurements are rather weak: we typically obtain $-30^o \lesssim \theta_K \lesssim 50^o$ at 68\% C.L. We also calculated the strong OZI-allowed decays in the pseudoscalar emission model and the flux-tube breaking model and extracted a $^3P_1 - ^1P_1$ mixing angle of $\theta_K \simeq 45^o$. Our analysis also indicates that the heavy quark limit does not give a good description of the strange mesons.Comment: Revised version to be published in Phys. Rev. D. Minor changes. Latex file uses revtex version 3 and epsfig, 4 postcript figures are attached. The full postcript version with embedded figures is available at ftp://ftp.physics.carleton.ca/pub/theory/godfrey/ocipc9512.ps.

Scaling in Plasticity-Induced Cell-Boundary Microstructure: Fragmentation and Rotational Diffusion

We develop a simple computational model for cell boundary evolution in plastic deformation. We study the cell boundary size distribution and cell boundary misorientation distribution that experimentally have been found to have scaling forms that are largely material independent. The cell division acts as a source term in the misorientation distribution which significantly alters the scaling form, giving it a linear slope at small misorientation angles as observed in the experiments. We compare the results of our simulation to two closely related exactly solvable models which exhibit scaling behavior at late times: (i) fragmentation theory and (ii) a random walk in rotation space with a source term. We find that the scaling exponents in our simulation agree with those of the theories, and that the scaling collapses obey the same equations, but that the shape of the scaling functions depend upon the methods used to measure sizes and to weight averages and histograms

Gravity and Random Surfaces on the Lattice - A Review

We review recent work in the lattice approach to random surfaces and quantum gravity. Our task is made somewhat easier by some very interesting results, particularly in four dimensions, that have appeared recently and which are reported elsewhere in these proceedings. Inevitably, given the scope of the review and the limitations of space, the presentation will omit work of importance and be telegraphic in discussing work that is included, for which apologies are offered in advance. After the customary brief historical introduction we work our way in dimensional order from one up to four dimensions before closing with some remarks on the relation, if any, between the various lattice models and ``real'' 4D gravity.Comment: 13 pages with 8 embedded eps figures, Latex+espcrc2.sty (included). Plenary review talk at Lattice96 rendered, more or less, into written English. Now with a minor typo in last section fixe

I=3/2 KπK \pi Scattering in the Nonrelativisitic Quark Potential Model

We study $I=3/2$ elastic $K\pi$ scattering to Born order using nonrelativistic quark wavefunctions in a constituent-exchange model. This channel is ideal for the study of nonresonant meson-meson scattering amplitudes since s-channel resonances do not contribute significantly. Standard quark model parameters yield good agreement with the measured S- and P-wave phase shifts and with PCAC calculations of the scattering length. The P-wave phase shift is especially interesting because it is nonzero solely due to $SU(3)_f$ symmetry breaking effects, and is found to be in good agreement with experiment given conventional values for the strange and nonstrange constituent quark masses.Comment: 12 pages + 2 postscript figures, Revtex, MIT-CTP-210

Study of the Process e+ e- --> omega pi0 --> pi0 pi0 gamma in c.m. Energy Range 920--1380 MeV at CMD-2

The cross section of the process e+ e- --> omega pi0 --> pi0 pi0 gamma has been measured in the c.m. energy range 920-1380 MeV with the CMD-2 detector. Its energy dependence is well described by the interference of the rho(770) and rho'(1450) mesons decaying to omega pi0. Upper limits for the cross sections of the direct processes e+ e- --> pi0 pi0 gamma, eta pi0 gamma have been set.Comment: Accepted for publication in PL

Towards Noncommutative Fuzzy QED

We study in one-loop perturbation theory noncommutative fuzzy quenched QED_4. We write down the effective action on fuzzy S**2 x S**2 and show the existence of a gauge-invariant UV-IR mixing in the model in the large N planar limit. We also give a derivation of the beta function and comment on the limit of large mass of the normal scalar fields. We also discuss topology change in this 4 fuzzy dimensions arising from the interaction of fields (matrices) with spacetime through its noncommutativity.Comment: 33 page

NN Core Interactions and Differential Cross Sections from One Gluon Exchange

We derive nonstrange baryon-baryon scattering amplitudes in the nonrelativistic quark model using the ``quark Born diagram" formalism. This approach describes the scattering as a single interaction, here the one-gluon-exchange (OGE) spin-spin term followed by constituent interchange, with external nonrelativistic baryon wavefunctions attached to the scattering diagrams to incorporate higher-twist wavefunction effects. The short-range repulsive core in the NN interaction has previously been attributed to this spin-spin interaction in the literature; we find that these perturbative constituent-interchange diagrams do indeed predict repulsive interactions in all I,S channels of the nucleon-nucleon system, and we compare our results for the equivalent short-range potentials to the core potentials found by other authors using nonperturbative methods. We also apply our perturbative techniques to the N$\Delta$ and $\Delta\Delta$ systems: Some $\Delta\Delta$ channels are found to have attractive core potentials and may accommodate ``molecular" bound states near threshold. Finally we use our Born formalism to calculate the NN differential cross section, which we compare with experimental results for unpolarised proton-proton elastic scattering. We find that several familiar features of the experimental differential cross section are reproduced by our Born-order result.Comment: 27 pages, figures available from the authors, revtex, CEBAF-TH-93-04, MIT-CTP-2187, ORNL-CCIP-93-0

Eureka and beyond: mining's impact on African urbanisation

This collection brings separate literatures on mining and urbanisation together at a time when both artisanal and large-scale mining are expanding in many African economies. While much has been written about contestation over land and mineral rights, the impact of mining on settlement, notably its catalytic and fluctuating effects on migration and urban growth, has been largely ignored. African nation-states’ urbanisation trends have shown considerable variation over the past half century. The current surge in ‘new’ mining countries and the slow-down in ‘old’ mining countries are generating some remarkable settlement patterns and welfare outcomes. Presently, the African continent is a laboratory of national mining experiences. This special issue on African mining and urbanisation encompasses a wide cross-section of country case studies: beginning with the historical experiences of mining in Southern Africa (South Africa, Zambia, Zimbabwe), followed by more recent mineralizing trends in comparatively new mineral-producing countries (Tanzania) and an established West African gold producer (Ghana), before turning to the influence of conflict minerals (Angola, the Democratic Republic of Congo and Sierra Leone)

Constraints on Dark Matter Annihilation in Clusters of Galaxies with the Fermi Large Area Telescope

Nearby clusters and groups of galaxies are potentially bright sources of high-energy gamma-ray emission resulting from the pair-annihilation of dark matter particles. However, no significant gamma-ray emission has been detected so far from clusters in the first 11 months of observations with the Fermi Large Area Telescope. We interpret this non-detection in terms of constraints on dark matter particle properties. In particular for leptonic annihilation final states and particle masses greater than ~200 GeV, gamma-ray emission from inverse Compton scattering of CMB photons is expected to dominate the dark matter annihilation signal from clusters, and our gamma-ray limits exclude large regions of the parameter space that would give a good fit to the recent anomalous Pamela and Fermi-LAT electron-positron measurements. We also present constraints on the annihilation of more standard dark matter candidates, such as the lightest neutralino of supersymmetric models. The constraints are particularly strong when including the fact that clusters are known to contain substructure at least on galaxy scales, increasing the expected gamma-ray flux by a factor of ~5 over a smooth-halo assumption. We also explore the effect of uncertainties in cluster dark matter density profiles, finding a systematic uncertainty in the constraints of roughly a factor of two, but similar overall conclusions. In this work, we focus on deriving limits on dark matter models; a more general consideration of the Fermi-LAT data on clusters and clusters as gamma-ray sources is forthcoming.Comment: accepted to JCAP, Corresponding authors: T.E. Jeltema and S. Profumo, minor revisions to be consistent with accepted versio