The Impact of Commissioning for Rhinosinusitis in England

Objectives: To assess the compliance of clinical commissioning groups (CCG) in England with the ENT-UK Rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence. We also aimed to assess the ease of accessibility of data from CCG’s. Design:Audit of compliance of English CCG’s with the ENT-UK rhinosinusitis commissioning guide. Setting: CCG’s in England Participants: 58 of the 221 CCG’s in England were included, chosen because they were the first CCG’s authorised by NHS England or alternately, the CCG’s forecast to have a deficit in their first year of operation.Their websites were reviewed; when information was not easily accessibly, a freedom of information request was submitted to the relevant CCG. Main outcome measures: Compliance with commissioning guidelines for rhinosinusitis. Results: 13% of CCG’s had restrictive referral criteria in place,largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanningwithin primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice. Conclusions: Restricting access to surgerymay contribute to poorer outcomes and a decrease in the patient’s quality of life. This is against the NHS constitution and open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care

Psychopathology in Williams syndrome: the effect of individual differences across the lifespan

The present research aimed to comprehensively explore psychopathology in Williams syndrome (WS) across the lifespan and evaluate the relationship between psychopathology and age category (child or adult), gender and cognitive ability. The parents of 50 participants with WS, aged 6-50 years, were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL). The prevalence of a wide range of Axis I DSM-IV disorders was assessed. In addition to high rates of anxiety and Attention Deficit Hyperactivity Disorder (ADHD) (38% and 20% respectively), 14% of our sample met criteria for a depressive disorder and 42% of participants were not experiencing any significant psychopathological difficulties. There was some evidence for different patterns of psychopathology between children and adults with WS and between males and females. These relationships were largely in keeping with those found in the typically developing population, thus supporting the validity of applying theory and treatment approaches for psychopathology in the typically developing population to WS

Association of Use of an Integrated Specialty Pharmacy With Total Medical Expenditures Among Members of an Accountable Care Organization

This cohort study examines the association of integrated specialty pharmacy use among members of a university hospital accountable care organization (ACO) with total medical expenditure

A spatial and temporal correlation analysis of aggregate wind power in an ideally interconnected Europe

Studies have shown that a large geographic spread of installed capacity can reduce wind power variability and smooth production. This could be achieved by using electricity interconnections and storage systems. However, interconnections and storage are not totally flexible, so it is essential to understand the wind power correlation in order to address power system constraints in systems with large and growing wind power penetrations. In this study the spatial and temporal correlation of wind power generation across several European Union countries was examined to understand how wind ‘travels’ across Europe. Three years of historical hourly wind power generation data from ten countries were analysed. The results of the analysis were then compared with two other studies focused on the Nordic region and the United States of America. The findings show that similar general correlation characteristics do exist between European country pairs. This is of particular importance when planning and operating interconnector flows, storage optimisation and cross-border power trading

Phenomenological Model and Phase Behavior of Saturated and Unsaturated Lipids and Cholesterol

We present a phenomenological theory for the phase behavior of ternary mixtures of cholesterol and saturated and unsaturated lipids, one which describes both liquid and gel phases, and illuminates the mechanism of the behavior. In a binary system of the lipids, the two phase separate when the saturated chains are well ordered, as in the gel phase, simply due to packing effects. In the liquid phase the saturated ones are not sufficiently well ordered for separation to occur. The addition of cholesterol, however, increases the saturated lipid order to the point that phase separation is once again favorable. For the system above the main chain transition of the saturated lipid, we can obtain phase diagrams in which there is liquid-liquid phase separation in the ternary system but not in any of the binary ones, while below that temperature we obtain the more common phase diagram in which a gel phase, rich in saturated lipid, appears in addition to the two liquid phases.Comment: 16 pages, 2 figure

Baryon Number in Warped GUTs : Model Building and (Dark Matter Related) Phenomenology

In the past year, a new non-supersymmetric framework for electroweak symmetry breaking (with or without Higgs) involving SU(2)_L * SU(2)_R * U(1)_{B-L} in higher dimensional warped geometry has been suggested. In this work, we embed this gauge structure into a GUT such as SO(10) or Pati-Salam. We showed recently (in hep-ph/0403143) that in a warped GUT, a stable Kaluza-Klein fermion can arise as a consequence of imposing proton stability. Here, we specify a complete realistic model where this particle is a weakly interacting right-handed neutrino, and present a detailed study of this new dark matter candidate, providing relic density and detection predictions. We discuss phenomenological aspects associated with the existence of other light (<~ TeV) KK fermions (related to the neutrino), whose lightness is a direct consequence of the top quark's heaviness. The AdS/CFT interpretation of this construction is also presented. Most of our qualitative results do not depend on the nature of the breaking of the electroweak symmetry provided that it happens near the TeV brane.Comment: 61 pages, 12 figures; v2: minor changes; v3: Two additional diagrams in Fig. 10; a numerical factor corrected in section 16.1 (baryogenesis section), corresponding discussion slightly modified but qualitative results unchange

Top quark electric and chromo electric dipole moments in the general two Higgs Doublet model

We study the electric and chromo electric dipole moment of top quark in the general two Higgs Doublet model (model III). We analyse the dependency of this quantity to the new phases coming from the complex Yukawa couplings and masses of charged and neutral Higgs bosons. We observe that the electric and chromo elecric dipole moments of top quark are at the order of 10^{-21} e cm and 10^{-20} g_s cm, which are extremely large values compared to ones calculated in the SM and also two Higgs Doublet model with real Yukawa couplings.Comment: 9 pages,10 figure

Neutrino Masses and a Fourth Generation of Fermions

We study neutrino mass generation in models with four chiral families of leptons and quarks and four right handed neutrinos. Generically, in these models there are three different contributions to the light neutrino masses: the usual see-saw contribution, the tree-level contribution due to mixing of light neutrinos with neutrino of the fourth generation, and the two loop contribution due to the Majorana mass term of the fourth neutrino. We study properties of these contributions and their experimental bounds. The regions of the parameters (mixings of the fourth neutrino, masses of RH neutrino components, etc.) have been identified where various contributions dominate. New possibilities of a realization of the flavour symmetries in the four family context are explored. In particular, we consider applications of the smallest groups, e.g. SG(20,3), with irreducible representation 4.Comment: 33 pages, 4 figures; Eq. (18) corrected and thus corrections to Eqs. (21,26-28,41,42,44-46) and figures, the loop contribution reduced by 2 orders of magnitude; general conclusions unchanged; accepted by Nucl. Phys.

CHronic Rhinosinusitis Outcome MEasures (CHROME), developing a core outcome set for trials of interventions in chronic rhinosinusitis

Statement of Problem: Evaluating the effectiveness of treatments in chronic rhinosinusitis (CRS) have been limited by both a paucity of high quality randomised trials, and the heterogeneity of outcomes in those that have been reported. Core outcome sets (COS) are an agreed, standardized set of outcomes that should be measured and reported by future trials as a minimum and will facilitate future meta-analysis of trial results in systematic reviews (SRs). We set out to develop a core outcome set for interventions for adults with CRS. Method(s) of study: A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders’ views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed 110 patients and healthcare practitioners to individually rate the outcomes in terms of importance, on a Likert scale. Main Results: After 2 rounds of the iterative Delphi process, the 54 initial outcomes were distilled down to a final core-outcome set of 15 items, over 4 domains. Principal Conclusions: The authors hope inclusion of these core outcomes in future trials will increase the value of research on interventions for CRS in adults. It was felt important to make recommendations regarding how these outcomes should be measured, although additional work is now required to further develop and revalidate existing outcome measures