What to do about poor clinical performance in clinical trials

The performance of individual clinicians is being monitored as never before. Su Mason and colleagues discuss the implications of this for clinical trials and recommend what should happen if during a trial the performance of one clinician or one centre is identified as being particularly poor. Tom Treasure, a surgeon, wants the monitoring to be done fairly and to take account of the complexities of clinical practice; and Heather Goodare, a patient, wants to be told when things go wrong. The Department of Health in England has issued guidelines for research governance stating that healthcare organisations remain responsible for the quality of all aspects of patients' care whether or not some aspects of the care are part of a research study.1 We discuss how this obligation can be met in multicentre trials, given that data on the performance of clinicians are held by the trial management team, not by the host organisation

From 2D Integrable Systems to Self-Dual Gravity

We explain how to construct solutions to the self-dual Einstein vacuum equations from solutions of various two-dimensional integrable systems by exploiting the fact that the Lax formulations of both systems can be embedded in that of the self-dual Yang--Mills equations. We illustrate this by constructing explicit self-dual vacuum metrics on $\R^2\times \Sigma$, where $\Sigma$ is a homogeneous space for a real subgroup of SL(2, \C) associated with the two-dimensional system.Comment: 9 pages, LaTex, no figure

Remote sensing of intertidal morphological change in Morecambe Bay, U.K., between 1991 and 2007

Tidal Flats are important examples of extensive areas of natural environment that remain relatively unaffected by man. Monitoring of tidal flats is required for a variety of purposes. Remote sensing has become an established technique for the measurement of topography over tidal flats. A further requirement is to measure topographic changes in order to measure sediment budgets. To date there have been few attempts to make quantitative estimates of morphological change over tidal flat areas. This paper illustrates the use of remote sensing to measure quantitative and qualitative changes in the tidal flats of Morecambe Bay during the relatively long period 1991–2007. An understanding of the patterns of sediment transport within the Bay is of considerable interest for coastal management and defence purposes. Tidal asymmetry is considered to be the dominant cause of morphological change in the Bay, with the higher currents associated with the flood tide being the main agency moulding the channel system. Quantitative changes were measured by comparing a Digital Elevation Model (DEM) of the intertidal zone formed using the waterline technique applied to satellite Synthetic Aperture Radar (SAR) images from 1991–1994, to a second DEM constructed from airborne laser altimetry data acquired in 2005. Qualitative changes were studied using additional SAR images acquired since 2003. A significant movement of sediment from below Mean Sea Level (MSL) to above MSL was detected by comparing the two Digital Elevation Models, though the proportion of this change that could be ascribed to seasonal effects was not clear. Between 1991 and 2004 there was a migration of the Ulverston channel of the river Leven north-east by about 5 km, followed by the development of a straighter channel to the west, leaving the previous channel decoupled from the river. This is thought to be due to independent tidal and fluvial forcing mechanisms acting on the channel. The results demonstrate the effectiveness of remote sensing for measurement of long-term morphological change in tidal flat areas. An alternative use of waterlines as partial bathymetry for assimilation into a morphodynamic model of the coastal zone is also discussed

Collapsible reflector Patent

Self erecting parabolic reflector design for use in spac

The effects of uncertainty on optimal consumption

When marginal utility is convex and there is pure labour income uncertainty, certain results are well-known. Asset return uncertainty is often assumed to have qualitatively similar effects; see e.g. Skinner (1988). We show that this assumption is not correct. Asset return uncertainty gives rise to an additional term in the Euler equation, which by introducing a role for current cash-in-hand, may work in the opposite direction to the precautionary motive, leading to ambiguity in the slope of the expected consumption time profile. We present a linearised version of the Euler equation, and an associated closed form solution, in order to provide intuition for these results. Numerical analysis indicates that the approximation is reasonable for empirically plausible estimates of the variances of the underlying disturbances

Stability Criteria for SIS Epidemiological Models under Switching Policies

We study the spread of disease in an SIS model. The model considered is a time-varying, switched model, in which the parameters of the SIS model are subject to abrupt change. We show that the joint spectral radius can be used as a threshold parameter for this model in the spirit of the basic reproduction number for time-invariant models. We also present conditions for persistence and the existence of periodic orbits for the switched model and results for a stochastic switched model

∗\ast-SDYM fields and heavenly spaces: II. Reductions of the ∗\ast-SDYM system

Reductions of self-dual Yang-Mills (SDYM) system for $\ast$-bracket Lie algebra to the Husain-Park (HP) heavenly equation and to sl(N,{\boldmath{C}) SDYM equation are given. An example of a sequence of $su(N)$ chiral fields ($N\geq 2$) tending for $N\to\infty$ to a curved heavenly space is found.Comment: 18 page

The measurement errors in the Swift-UVOT and XMM-OM

The probability of photon measurement in some photon counting instrumentation, such as the Optical Monitor on the XMM-Newton satellite, and the UVOT on the Swift satellite, does not follow a Poisson distribution due to the detector characteristics, but a Binomial distribution. For a single-pixel approximation, an expression was derived for the incident countrate as a function of the measured count rate by Fordham, Moorhead and Galbraith (2000). We show that the measured countrate error is binomial, and extend their formalism to derive the error in the incident count rate. The error on the incident count rate at large count rates is larger than the Poisson-error of the incident count rate.Comment: 4 pages, 2 postscript figures, submitted to MNRA

Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial

Objective: To assess the cost effectiveness of laparoscopic hysterectomy compared with conventional hysterectomy (abdominal or vaginal). Design: Cost effectiveness analysis based on two parallel trials: laparoscopic (n = 324) compared with vaginal hysterectomy (n = 163); and laparoscopic (n = 573) compared with abdominal hysterectomy (n = 286). Participants: 1346 women requiring a hysterectomy for reasons other than malignancy. Main outcome measure: One year costs estimated from NHS perspective. Health outcomes expressed in terms of QALYs based on women's responses to the EQ-5D at baseline and at three points during up to 52 weeks' follow up. Results: Laparoscopic hysterectomy cost an average of pound401 ($708; C571) more (95$471789; E380 437). The, probability that laparoscopic hysterectomy is cost effective was below 50% for a large range of values of willingness to pay for an additional QALY. Laparoscopic hysterectomy cost an average of pound186 ($328; E265) more than abdominal hysterectomy, although 95$46 893; E37 813). If the NHS is willing to pay pound30 0 00 for an additional QALY, the probability that laparoscopic hysterectomy is cost effective is 56%. Conclusions: Laparoscopic hysterectomy is not cost effective relative to vaginal hysterectomy. Its cost effectiveness relative to the abdominal procedure is finely balanced