Design and performance of a multicentre, randomized controlled trial of teleconsulting.

We have designed and performed a multicentre, randomized controlled trial of teleconsulting. The trial investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing as an alternative to general practitioner referral to a hospital specialist. The participating general practitioners referred a total of 3170 patients who satisfied the entry criteria. Of these, 1040 (33%) failed to provide consent or otherwise refused to participate in the trial. Of the patients recruited to the trial, a total of 1902 (91%) completed and returned the baseline questionnaire. Although the trial was successful in recruiting sufficient patients and in obtaining high questionnaire response rates, the findings will require careful interpretation to take account of the limits which the protocol placed on the ability of general practitioners to select patients for referral

Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial.

BACKGROUND: The current model of general practitioner referral of patients to hospital specialists in the UK is sometimes associated with unnecessary duplication of investigations and treatments. We aimed to compare joint teleconsultations between general practitioners, specialists, and patients (virtual outreach) with standard outpatient referral. METHODS: Virtual outreach services were established in London and Shrewsbury. The general practitioners referred 3170 patients, of whom 2094 consented to participate in the study and were eligible for inclusion. 1051 patients were randomly assigned virtual outreach, and 1043 standard outpatient appointments. We followed up the patients for 6 months after their index consultation. The primary outcome measure was the offer of a follow-up outpatient appointment. Analysis was by intention to treat. FINDINGS: More patients in the virtual outreach group than the standard group were offered a follow-up appointment (502 [52%] vs 400 [41%], odds ratio 1.52 [95% CI 1.27-1.82], p<0.0001). Significant differences in effects were observed between the two sites (p=0.009) and across different specialties (p<0.0001). Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ear, nose, and throat surgery and orthopaedics than in the other specialties. Fewer tests and investigations were ordered in the virtual outreach group by an average of 0.79 per patient (0.37-1.21, p=0.0002). Patients' satisfaction (analysed per protocol) was greater after a virtual outreach consultation than after a standard outpatient consultation (mean difference 0.33 scale points [95% CI 0.23-0.43], p<0.0001), with no heterogeneity between specialties or sites. INTERPRETATION: The trial showed that allocation of patients to virtual outreach consultations is variably associated with increased offers of follow-up appointments according to site and specialty, but leads to significant increases in patients' satisfaction and substantial reductions in tests and investigations. Efficient operation of such services will require appropriate selection of patients, significant service reorganisation, and provision of logistical support

New times, new politics: history and memory during the final years of the CPGB

This article examines the relationship between collective memory, historical interpretation and political identity. It focuses on the dissolution of the Communist Party of Great Britain (CPGB) as constructed through collective narrative memory, and on Marxist interpretations of history. The divisions within the party and the wider Marxist community, stretching from 1956 until 1991, were often framed around questions of historical interpretation. The events of 1989–1991 created an historical and mnemonic crisis for CPGB members who struggled to reconcile their past identities with their present situation. Unlike the outward-facing revisionism of other political parties, this was an intensely personal affair. The solution for many was to emphasise the need to find new ways to progress socialist aims, without relying on a discredited grand narrative. In contrast, other Communist parties, such as the Communist Party of Britain, which had been established (or ‘re-established’) in 1988, fared rather better. By adhering to the international party line of renewal and continued struggle, the party was able to hold its narrative together, condemning the excesses of totalitarian regimes, while reaffirming the need for international class struggle

Anomalous translational velocity of vortex ring with finite-amplitude Kelvin waves

We consider finite-amplitude Kelvin waves on an inviscid vortex assuming that the vortex core has infinitesimal thickness. By numerically solving the governing Biot-Savart equation of motion, we study how the frequency of the Kelvin waves and the velocity of the perturbed ring depend on the Kelvin wave amplitude. In particular, we show that, if the amplitude of the Kelvin waves is sufficiently large, the perturbed vortex ring moves backwards.Comment: 6 pages, 5 figures, v2: minor changes, v3: typos correcte

Deuterium fractionation in the Horsehead edge

Deuterium fractionation is known to enhance the [DCO+]/[HCO+] abundance ratio over the D/H elemental ratio of about 1e-5 in the cold and dense gas typically found in pre-stellar cores. We report the first detection and mapping of very bright DCO+ J=3-2 and J=2-1 lines (3 and 4 K respectively) towards the Horsehead photodissociation region (PDR) observed with the IRAM-30m telescope. The DCO+ emission peaks close to the illuminated warm edge of the nebula (< 50" or about 0.1 pc away). Detailed nonlocal, non-LTE excitation and radiative transfer analyses have been used to determine the prevailing physical conditions and to estimate the DCO+ and H13CO+ abundances from their line intensities. A large [DCO+]/[HCO+] abundance ratio (>= 0.02) is inferred at the DCO+ emission peak, a condensation shielded from the illuminating far-UV radiation field where the gas must be cold (10-20 K) and dense (>= 2x10^5 cm-3). DCO+ is not detected in the warmer photodissociation front, implying a lower [DCO+]/[HCO+] ratio (< 1e-3). According to our gas phase chemical predictions, such a high deuterium fractionation of HCO+ can only be explained if the gas temperature is below 20 K, in good agreement with DCO+ excitation calculations.Comment: 4 pages, 3 PostScript figures. Accepted for publication in Astronomy & Astrophysics in the letter section. Uses aa LaTeX macro

Microscopic Dynamics in a Strongly Interacting Bose-Einstein Condensate

An initially stable 85Rb Bose-Einstein condensate (BEC) was subjected to a carefully controlled magnetic field pulse in the vicinity of a Feshbach resonance. This pulse probed the strongly interacting regime for the condensate, with calculated values for the diluteness parameter (na^3) ranging from 0.01 to 0.5. The field pulse was observed to cause loss of atoms from the condensate on remarkably short time scales (>=10 microsec). The dependence of this loss on magnetic field pulse shape and amplitude was measured. For triangular pulses shorter than 1 ms, decreasing the pulse length actually increased the loss, until extremely short time scales (a few tens of microseconds) were reached. Such time scales and dependencies are very different from those expected in traditional condensate inelastic loss processes, suggesting the presence of new microscopic BEC physics.Comment: 4 pages in latex2E, 4 eps figures; revised Fig.1, revised scatt.lengths, added discussion, new refs., resubmitted to PR

EGRET Spectral Index and the Low-Energy Peak Position in the Spectral Energy Distribution of EGRET-Detected Blazars

In current theoretical models of the blazar subclass of active galaxies, the broadband emission consists of two components: a low-frequency synchrotron component with a peak in the IR to X-ray band, and a high-frequency inverse Compton component with a peak in the gamma-ray band. In such models, the gamma-ray spectral index should be correlated with the location of the low-energy peak, with flatter gamma-ray spectra expected for blazars with synchrotron peaks at higher photon energies and vice versa. Using the EGRET-detected blazars as a sample, we examine this correlation and possible uncertainties in its construction.Comment: 17 pages including 1 figure, accepted for publication in The Astrophysical Journa

The geomorphology of Svínafellsjökull and Virkisjökull-Falljökull glacier forelands, southeast Iceland

A detailed, 1:10,500-scale, surficial geology and glacial geomorphology map of Svínafellsjökull and Virkisjökull-Falljökull glacier forelands in southeast Iceland depicts the landsystem imprint of Holocene glacier fluctuations, volcanogenic outburst floods and recent (post-1990) climate-induced rapid ice-front retreat. The map is based on field survey data in combination with 2012 airborne LiDAR data, 2009–2012 terrestrial LiDAR data and 2007 colour aerial photography. The base digital elevation model (DEM) is compiled from an ice-cap wide airborne LiDAR dataset. The mapped glacial landforms are dominated by sequences of recessional moraines laid down in the mid-Holocene, the Little Ice Age, and the last ∼100 years; the state of landform preservation generally decreasing with age. Interspersed with glaciofluvial sedimentation associated with typical ice-marginal retreat sequences is key geomorphological evidence of high-magnitude volcanogenic outburst floods (jökulhlaups) associated with the eruptions of Öraefajökull in 1362 and 1727 CE. Ice-front retreat has accelerated since c.2005 leaving a rapidly evolving buried-ice landscape in front of Virkisjökull-Falljökull – including an ice-cored esker, a large ice-floored (supraglacial) lake, and numerous actively forming kettle holes and ice caverns. This map could act as a ‘reference frame’ for geomorphologists studying the temporal evolution of glacial landform-sediment assemblages undergoing rapid change