A point mass in an isotropic universe: III. The region R≤2mR\leq 2m

McVittie's solution of Einstein's field equations, representing a point mass embedded into an isotropic universe, possesses a scalar curvature singularity at proper radius $R=2m$. The singularity is space-like and precedes, in the expanding case, all other events in the space-time. It is shown here that this singularity is gravitationally weak, and the possible structure of the region $R\leq 2m$ is investigated. A characterization of this solution which does not involve asymptotics is given.Comment: Revtex, 11pp. To appear in Class.Quant.Grav. Paper II appeared as Class. Quant. Grav. 16 (1999) 122

A note on behaviour at an isotropic singularity

The behaviour of Jacobi fields along a time-like geodesic running into an isotropic singularity is studied. It is shown that the Jacobi fields are crushed to zero length at a rate which is the same in every direction orthogonal to the geodesic. We show by means of a counter-example that this crushing effect depends crucially on a technicality of the definition of isotropic singularities, and not just on the uniform degeneracy of the metric at the singularity.Comment: 13 pp. plain latex. To appear in Classical and Quantum Gravit

A Characterisation of Strong Wave Tails in Curved Space-Times

A characterisation of when wave tails are strong is proposed. The existence of a curvature induced tail (i.e. a Green's function term whose support includes the interior of the light-cone) is commonly understood to cause backscattering of the field governed by the relevant wave equation. Strong tails are characterised as those for which the purely radiative part of the field is backscattered. With this definition, it is shown that electromagnetic waves in asymptotically flat space-times and fields governed by tail-free propagation have weak tails, but minimally coupled scalar fields in a cosmological scenario have strong tails.Comment: 17 pages, Revtex, to appear in Classical and Quantum Gravit

Development of the Carers’ Alert Thermometer (CAT) to identify family carers struggling with caring for someone dying at home: a mixed method consensus study

Background: There is an increasing international policy direction to promote home death for dying patients which will impact on the demands placed on family carers. The early identification of carer needs and appropriate intervention can help avoid crisis situations for the carer and avoidable hospital admissions which are reported to be a global concern. The aim of the study was to explore what professionals and carers of patients with cancer and advanced progressive illness, in their last year of life, find burdensome and to develop an alert system for use by non-specialist staff. Methods: A mixed-method, multi-phased, consensus study sequentially utilising qualitative and quantitative data to develop and pilot the Carers’ Alert Thermometer (CAT). 245 people (117 carers and 128 professionals) participated in the study across a range of health and social care settings in the North West of England (2011–2014). Results: A number of key domains were identified and prioritised by consensus for inclusion in the CAT. The 8 domains fit within two overarching themes of the reported carer experience; the support needed by the carer to provide care and the support needed for the carer’s own health and well-being. The resultant CAT is an evidence-based alert thermometer consisting of 10 questions, guidance on the possible actions for each alert and space for an action plan to be jointly agreed by the assessor and carer. Preliminary piloting of the CAT has shown it to be valued, fit for purpose and it can be administered by a range of personnel. Conclusions: The CAT enables the identification of current and potential future needs so a proactive approach can be taken to supporting the carer as their role develops over time, with a view to enhancing their well-being and preventing avoidable hospital admissions; ultimately supporting patient choice to remain in their own home

Rituximab monitoring and redosing in pediatric neuromyelitis optica spectrum disorder.

Abstract OBJECTIVE: To study rituximab in pediatric neuromyelitis optica (NMO)/NMO spectrum disorders (NMOSD) and the relationship between rituximab, B cell repopulation, and relapses in order to improve rituximab monitoring and redosing. METHODS: Multicenter retrospective study of 16 children with NMO/NMOSD receiving 652 rituximab courses. According to CD19 counts, events during rituximab were categorized as "repopulation," "depletion," or "depletion failure" relapses (repopulation threshold CD19 6510 7 10(6) cells/L). RESULTS: The 16 patients (14 girls; mean age 9.6 years, range 1.8-15.3) had a mean of 6.1 events (range 1-11) during a mean follow-up of 6.1 years (range 1.6-13.6) and received a total of 76 rituximab courses (mean 4.7, range 2-9) in 42.6-year cohort treatment. Before rituximab, 62.5% had received azathioprine, mycophenolate mofetil, or cyclophosphamide. Mean time from rituximab to last documented B cell depletion and first repopulation was 4.5 and 6.8 months, respectively, with large interpatient variability. Earliest repopulations occurred with the lowest doses. Significant reduction between pre- and post-rituximab annualized relapse rate (ARR) was observed (p = 0.003). During rituximab, 6 patients were relapse-free, although 21 relapses occurred in 10 patients, including 13 "repopulation," 3 "depletion," and 4 "depletion failure" relapses. Of the 13 "repopulation" relapses, 4 had CD19 10-50 7 10(6) cells/L, 10 had inadequate monitoring ( 641 CD19 in the 4 months before relapses), and 5 had delayed redosing after repopulation detection. CONCLUSION: Rituximab is effective in relapse prevention, but B cell repopulation creates a risk of relapse. Redosing before B cell repopulation could reduce the relapse risk further. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that rituximab significantly reduces ARR in pediatric NMO/NMOSD. This study also demonstrates a relationship between B cell repopulation and relapses

General properties of cosmological models with an Isotropic Singularity

Much of the published work regarding the Isotropic Singularity is performed under the assumption that the matter source for the cosmological model is a barotropic perfect fluid, or even a perfect fluid with a $\gamma$-law equation of state. There are, however, some general properties of cosmological models which admit an Isotropic Singularity, irrespective of the matter source. In particular, we show that the Isotropic Singularity is a point-like singularity and that vacuum space-times cannot admit an Isotropic Singularity. The relationships between the Isotropic Singularity, and the energy conditions, and the Hubble parameter is explored. A review of work by the authors, regarding the Isotropic Singularity, is presented.Comment: 18 pages, 1 figur

On the existence of dyons and dyonic black holes in Einstein-Yang-Mills theory

We study dyonic soliton and black hole solutions of the ${\mathfrak {su}}(2)$ Einstein-Yang-Mills equations in asymptotically anti-de Sitter space. We prove the existence of non-trivial dyonic soliton and black hole solutions in a neighbourhood of the trivial solution. For these solutions the magnetic gauge field function has no zeros and we conjecture that at least some of these non-trivial solutions will be stable. The global existence proof uses local existence results and a non-linear perturbation argument based on the (Banach space) implicit function theorem.Comment: 23 pages, 2 figures. Minor revisions; references adde

Working with Children with Learning Disabilities and/or who Communicate Non-verbally: Research experiences and their implications for social work education, increased participation and social inclusion

Social exclusion, although much debated in the UK, frequently focuses on children as a key 'at risk' group. However, some groups, such as disabled children, receive less consideration. Similarly, despite both UK and international policy and guidance encouraging the involvement of disabled children and their right to participate in decision-making arenas, they are frequently denied this right. UK based evidence suggests that disabled children's participation lags behind that of their non-disabled peers, often due to social work practitioners' lack of skills, expertise and knowledge on how to facilitate participation. The exclusion of disabled children from decision-making in social care processes echoes their exclusion from participation in society. This paper seeks to begin to address this situation, and to provide some examples of tools that social work educators can introduce into pre- and post-qualifying training programmes, as well as in-service training. The paper draws on the experiences of researchers using non-traditional qualitative research methods, especially non-verbal methods, and describes two research projects, focusing on the methods employed to communicate with and involve disabled children, the barriers encountered and lessons learnt. Some of the ways in which these methods of communication can inform social work education are explored alongside wider issues of how and if increased communication can facilitate greater social inclusion