The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study

Extent: 11p.Objectives: To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. Design: A retrospective cohort analysis of linked data. Setting: A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. Participants: 407 CRC patients who had a colonoscopy followed by surgery. Primary outcome measures: Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. Results: Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). Conclusions: Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management.David Goldsbury, Mark Harris, Shane Pascoe, Michael Barton, Ian Olver, Allan Spigelman, Justin Beilby, Craig Veitch, David Weller, Dianne L O'Connel

Planning research in the area of launch vehicle and propulsion programs Progress report, 1-31 Mar. 1968

Program and report reviews on launch vehicle upper stages and propulsion of advanced reentry spacecraf

Learning across business sectors: knowledge sharing between aerospace and construction

This report addresses the extent that managerial practices can be shared between the aerospace and construction sectors. Current recipes for learning from other industries tend to be oversimplistic and often fail to recognise the embedded and contextual nature of managerial knowledge. Knowledge sharing between business sectors is best understood as an essential source of innovation. The process of comparison challenges assumptions and better equips managers to cope with future change. Comparisons between the aerospace and construction sectors are especially useful because they are so different. The two sectors differ hugely in terms of their institutional context, structure and technological intensity. The aerospace sector has experienced extensive consolidation and is dominated by a small number of global companies. Aerospace companies operate within complex networks of global interdependency such that collaborative working is a commercial imperative. In contrast, the construction sector remains highly fragmented and is characterised by a continued reliance on small firms. The vast majority of construction firms compete within localised markets that are too often characterised by opportunistic behaviour. Comparing construction to aerospace highlights the unique characteristics of both sectors and helps explain how managerial practices are mediated by context. Detailed comparisons between the two sectors are made in a range of areas and guidance is provided for the implementation of knowledge sharing strategies within and across organisations. The commonly accepted notion of ‘best practice’ is exposed as a myth. Indeed, universal models of best practice can be detrimental to performance by deflecting from the need to adapt continuously to changing circumstances. Competitiveness in the construction sector too often rests on efficiency in managing contracts, with a particular emphasis on the allocation of risk. Innovation in construction tends to be problem-driven and is rarely shared from project to project. In aerospace, the dominant model of competitiveness means that firms have little choice other than to invest in continuous innovation, despite difficult trading conditions. Research and development (R&D) expenditure in aerospace continues to rise as a percentage of turnovers. A sustained capacity for innovation within the aerospace sector depends crucially upon stability and continuity of work. In the construction sector, the emergence of the ‘hollowed-out’ firm has undermined the industry’s capacity for innovation. Integrated procurement contexts such as prime contracting in construction potentially provide a more supportive climate for an innovation-based model of competitiveness. However, investment in new ways of working depends upon a shift in thinking not only amongst construction contractors, but also amongst the industry’s major clients

Opportunities for future supernova studies of cosmic acceleration

We investigate the potential of a future supernova dataset, as might be obtained by the proposed SNAP satellite, to discriminate among different ``dark energy'' theories that describe an accelerating Universe. We find that many such models can be distinguished with a fit to the effective pressure-to-density ratio, $w$, of this energy. More models can be distinguished when the effective slope, $dw/dz$, of a changing $w$ is also fit, but only if our knowledge of the current mass density, $\Omega_m$, is improved. We investigate the use of ``fitting functions'' to interpret luminosity distance data from supernova searches, and argue in favor of a particular preferred method, which we use in our analysis.Comment: Four pages including figures. Final published version. No significant changes from v

Stable ultrahigh-density magneto-optical recordings using introduced linear defects

The stability of data bits in magnetic recording media at ultrahigh densities is compromised by thermal `flips' -- magnetic spin reversals -- of nano-sized spin domains, which erase the stored information. Media that are magnetized perpendicular to the plane of the film, such as ultrathin cobalt films or multilayered structures, are more stable against thermal self-erasure than conventional memory devices. In this context, magneto-optical memories seem particularly promising for ultrahigh-density recording on portable disks, and bit densities of $\sim$100 Gbit inch$^{-2}$ have been demonstrated using recent advances in the bit writing and reading techniques. But the roughness and mobility of the magnetic domain walls prevents closer packing of the magnetic bits, and therefore presents a challenge to reaching even higher bit densities. Here we report that the strain imposed by a linear defect in a magnetic thin film can smooth rough domain walls over regions hundreds of micrometers in size, and halt their motion. A scaling analysis of this process, based on the generic physics of disorder-controlled elastic lines, points to a simple way by which magnetic media might be prepared that can store data at densities in excess of 1 Tbit inch$^{-2}$.Comment: 5 pages, 4 figures, see also an article in TRN News at http://www.trnmag.com/Stories/041801/Defects_boost_disc_capacity_041801.htm

Discrimination, labour markets and the Labour Market Prospects of Older Workers: What Can a Legal Case Teach us?

As governments become increasingly concerned about the fiscal implications of the ageing population, labour market policies have sought to encourage mature workers to remain in the labour force. The ‘human capital’ discourses motivating these policies rest on the assumption that older workers armed with motivation and vocational skills will be able to return to fulfilling work. This paper uses the post-redundancy recruitment experiences of former Ansett Airlines flight attendants to develop a critique of these expectations. It suggests that policies to increase older workers’ labour market participation will not succeed while persistent socially constructed age- and gender- typing shape labour demand. The conclusion argues for policies sensitive to the institutional structures that shape employer preferences, the competitive rationality of discriminatory practices, and the irresolvable tension between workers’ human rights and employers’ property rights

The solar system boron abundance

The concentrations of B in seven carbonaceous chondritic meteorites have been determined by the use of two different analytical techniques. The data correspond to a B/H ratio of about 10^(-9) compared to the value of 10^(-8) previously proposed by Cameron, Colgate, and Grossman. However, the meteoritic abundance remains at least a factor of 2-10 higher than various estimates of the solar photosphere abundance. We conclude that both meteoritic and photospheric B and Be abundances must be considered in comparisons with nucleosynthesis calculations. Using our revised B abundances and assuming ^7Li was synthesized in the big bang, we find that the residual ^6Li/1°B, ^9Be/^(10)B, and ^(11)B/^(10)B abundance ratios are well matched by the production rates for bombardment of a CNO mixture of solar proportions by protons and a-particles with a kinetic energy per nucleon spectrum of the form E^(-1.8)

Characterising sand and gravel deposits using electrical resistivity tomography (ERT) : case histories from England and Wales

Electrical Resistivity Tomography (ERT) is a rapidly developing geophysical imaging technique that is now widely used to visualise subsurface geological structure, groundwater and lithological variations. It is being increasingly used in environmental and engineering site investigations, but despite its suitability and potential benefits, ERT has yet to be routinely applied by the minerals industry to sand and gravel deposit assessment and quarry planning. The principal advantages of ERT for this application are that it is a cost-effective non-invasive method, which can provide 2D or 3D spatial models of the subsurface throughout the full region of interest. This complements intrusive sampling methods, which typically provide information only at discrete locations. Provided that suitable resistivity contrasts are present, ERT has the potential to reveal mineral and overburden thickness and quality variations within the body of the deposit. Here we present a number of case studies from the UK illustrating the use of 2D and 3D ERT for sand and gravel deposit investigation in a variety of geological settings. We use these case studies to evaluate the performance of ERT, and to illustrate good practice in the application of ERT to deposit investigation. We propose an integrated approach to site investigation and quarry planning incorporating both conventional intrusive methods and ERT

Separate Universes Do Not Constrain Primordial Black Hole Formation

Carr and Hawking showed that the proper size of a spherical overdense region surrounded by a flat FRW universe cannot be arbitrarily large as otherwise the region would close up on itself and become a separate universe. From this result they derived a condition connecting size and density of the overdense region ensuring that it is part of our universe. Carr used this condition to obtain an upper bound for the density fluctuation amplitude with the property that for smaller amplitudes the formation of a primordial black hole is possible, while larger ones indicate a separate universe. In contrast, we find that the appearance of a maximum is not a consequence of avoiding separate universes but arises naturally from the geometry of the chosen slicing. Using instead of density a volume fluctuation variable reveals that a fluctuation is a separate universe iff this variable diverges on superhorizon scales. Hence Carr's and Hawking's condition does not pose a physical constraint on density fluctuations. The dynamics of primordial black hole formation with an initial curvature fluctuation amplitude larger than the one corresponding to the maximum density fluctuation amplitude was previously not considered in detail and so we compare it to the well-known case where the amplitude is smaller by presenting embedding and conformal diagrams of both types in dust spacetimes.Comment: Updated version corresponds to the published version 10.1103/PhysRevD.83.124025, 22 pages, 22 figure

Experimental and numerical investigation on coupled motion characteristics of a tunnel element suspended from a twin-barge

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordThe coupled motion characteristics of a tunnel element, which is suspended from a twin-barge and moored to the seabed during the installation process, has been investigated using a 1:50 scaled model. Response characteristics are obtained for multiple regular wave conditions and three different immersion depths. Experimental investigation includes studies to identify system properties of individual arrangements (tunnel, twin-barge) and for the coupled tunnel & twin-barge configuration. Investigation of motion characteristics includes i) experimental studies of the tunnel element from a fixed suspension point and barge, ii) experimental studies with and without a mooring arrangement from the tunnel element to the seabed, iii) experimental study of the fully coupled tunnel & twin-barge configuration, and iv) numerical investigation of the fully coupled tunnel & twin-barge configuration using a commercial fully dynamic mooring simulation software (OrcaFlex™). The experimental investigations were carried out in the State Key Laboratory of Coastal and Offshore Engineering at Dalian University of Technology (DUT), using the ‘6-D Measurement System’ (6D-UMS) to obtain six degree of motions for both the tunnel and twin-barge. For the numerical study hydrodynamic properties were obtained from the diffraction/radiation potential code WAMIT for simplified tunnel and twin-barge elements and used to derive fully coupled motion behavior using the time-domain mooring simulation software OrcaFlex™. The results are presented in order to provide insights into the motion characteristics for the different configurations studied. The main findings indicate that the sway and roll motions for the coupled tunnel & twin-barge configuration decrease with increasing wave incidence angle and immersion depths. The use of additional mooring lines to restrain the tunnel element to the seabed played a further role in reducing the motions of the tunnel element, particularly when subjected to large amplitude and long period waves.The study is supported by the National Natural Science Foundation of China (Grant No.11272079) and the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (Grant No. 51221961) and the China Scholarship Council (award to Yang Can for 1 year's study abroad at the University of Exeter). The corresponding author has been partly funded through EPSRC grant EP/R007519/1