Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

Objectives To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers.Design Cost consequences study alongside randomised controlled trial.Setting Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales.Participants 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments.Main outcome measures NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction.Results Overall six month costs were greater for the virtual outreach consultations (pound724 per patient) than for conventional outpatient appointments (pound625): difference in means pound99 ($162; is not an element of138) (95% confidence interval pound10 to pound187, P=0.03). if the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means pound108 (pound73 to pound142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost 8 pound (5 pound to 10 pound, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost pound11 (pound10 to pound12, P < 0.0001).Condusion The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported

An Optical Counterpart to the Anomalous X-ray Pulsar 4U 0142+61

The energy source of the anomalous X-ray pulsars is not well understood, hence their designation as anomalous. Unlike binary X-ray pulsars, no companions are seen, so the energy cannot be supplied by accretion of matter from a companion star. The loss of rotational energy, which powers radio pulsars, is insufficient to power AXPs. Two models are generally considered: accretion from a large disk left over from the birth process, or decay of a very strong magnetic field (10^15 G) associated with a 'magnetar'. The lack of counterparts at other wavelengths has hampered progress in our understanding of these objects. Here, we present deep optical observations of the field around 4U 0142+61, which is the brightest AXP in X-rays. We find an object with peculiar optical colours at the position of the X-ray source, and argue that it is the optical counterpart. The optical emission is too faint to admit the presence of a large accretion disk, but may be consistent with magnetospheric emission from a magnetar.Comment: 16 pages, 3 figures, accepted by Nature. Press embargo until 1900 hrs London time (GMT) on 6 December 200

The structural invisibility of outsiders: the role of migrant labour in the meat-processing industry

This article examines the role of migrant workers in meat-processing factories in the UK. Drawing on materials from mixed methods research in a number of case study towns across Wales, we explore the structural and spatial processes that position migrant workers as outsiders. While state policy and immigration controls are often presented as a way of protecting migrant workers from work-based exploitation and ensuring jobs for British workers, our research highlights that the situation ‘on the ground’ is more complex. We argue that ‘self-exploitation’ among the migrant workforce is linked to the strategies of employers and the organisation of work, and that hyper-flexible work patterns have reinforced the spatial and social invisibilities of migrant workers in this sector. While this creates problems for migrant workers, we conclude that it is beneficial to supermarkets looking to supply consumers with the regular supply of cheap food to which they have become accustomed

Sexuality and Affection among Elderly German Men and Women in Long-Term Relationships: Results of a Prospective Population-Based Study

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The study was funded by the German Federal Ministry for Families, Senior Citizens, Women and Youth (AZ 314-1722-102/16; AZ 301-1720-295/2), the Ministry for Science, Research and Art Baden-Württemberg, and the University of Rostock (FORUN 989020; 889048)

Precursors and correlates of transient and persistent longitudinal profiles of psychotic experiences from late childhood through early adulthood

Background: Psychotic experiences are reported by 5–10% of young people, although only a minority persist and develop into psychotic disorders. It is unclear what characteristics differentiate those with transient psychotic experiences from those with persistent psychotic experiences that are more likely to be of clinical relevance. / Aims: To investigate how longitudinal profiles of psychotic experiences, created from assessments at three different time points, are influenced by early life and co-occurring factors. / Method: Using data from 8045 individuals from a birth cohort study, longitudinal profiles of psychotic experiences based on semi-structured interviews conducted at 12, 18 and 24 years were defined. Environmental, cognitive, psychopathological and genetic determinants of these profiles were investigated, along with concurrent changes in psychopathology and cognition. / Results: Following multiple imputations, the distribution of longitudinal profiles of psychotic experiences was none (65.7%), transient (24.1%), low-frequency persistent (8.4%) and high-frequency persistent (1.7%). Individuals with high-frequency persistent psychotic experiences were more likely to report traumatic experiences, other psychopathology, a more externalised locus of control, reduced emotional stability and conscientious personality traits in childhood, compared with those with transient psychotic experiences. These characteristics also differed between those who had any psychotic experiences and those who did not. / Conclusions: These findings indicate that the same risk factors are associated with incidence as with persistence of psychotic experiences. Thus, it might be that the severity of exposure, rather than the presence of specific disease-modifying factors, is most likely to determine whether psychotic experiences are transient or persist, and potentially develop into a clinical disorder over time

A computational analysis of abnormal belief-updating processes and their association with psychotic experiences and childhood trauma in a UK birth cohort

BACKGROUND: Psychotic experiences emerge from abnormalities in perception and belief formation, and occur more commonly in those experiencing childhood trauma. Yet, which precise aspects of belief formation are atypical in psychosis is not well understood. We used a computational modelling approach to characterise belief-updating in young adults in the general population, examine their relationship with psychotic outcomes and trauma, and the extent to which they mediate the trauma-psychosis relationship. METHODS: We used data from 3,360 individuals from the Avon Longitudinal Study of Parents and Children birth cohort who completed assessments for psychotic outcomes, depression, anxiety, and two belief-updating tasks at age 24, and had data available on traumatic events assessed from birth to late adolescence. Unadjusted and adjusted regression and counterfactual mediation methods were used for the analyses. RESULTS: Basic behavioural measures of belief-updating ('draws to decision' and 'disconfirmatory updating') were not associated with psychotic experiences. However, computational modelling revealed an association between increased decision noise with both psychotic experiences and trauma exposure, although <3% of the trauma-psychotic experience association was mediated by decision noise. Belief-updating measures were also associated with intelligence and socio-demographic characteristics, confounding most of the associations with psychotic experiences. There was little evidence that belief-updating parameters were differentially associated with delusions compared to hallucinations, or that they were differentially associated with psychotic outcomes compared to depression or anxiety. CONCLUSIONS: These findings challenge the hypothesis that atypical belief-updating mechanisms (as indexed by the computational models and behavioural measures we employed) underlie the development of psychotic phenomena

Animistic pragmatism and native ways of knowing: adaptive strategies for overcoming the struggle for food in the sub-Arctic

Background. Subsistence norms are part of the &#x201C;ecosophy&#x201D; or ecological philosophy of Alaska Native Peoples in the sub-Arctic, such as the Inupiat of Seward Peninsula. This kind of animistic pragmatism is a special source of practical wisdom that spans over thousands of years and which has been instrumental in the I&#xF1;upiat&#x2019;s struggle to survive and thrive in harsh and evolving environments. Objective. I hope to show how narrative in relationship to the &#x201C;ecosophy&#x201D; of Alaska Native peoples can help to promote a more ecological orientation to address food insecurity in rural communities in Alaska. Alaska Native ecosophy recommends central values and virtues necessary to help address concerns in Alaska&#x2019;s rural communities. Design. Here, I will tease out the nature of this &#x201C;ecosophy&#x201D; in terms of animistic pragmatism and then show why this form of pragmatism can be instrumental for problematizing multi-scalar, intergenerational, uncertain and complex environmental challenges like food security. Results. Native elders have been the embodiment of trans-generational distributed cognition,1 for example, collective memory, norms, information, knowledge, technical skills and experimental adaptive strategies. They are human &#x201C;supercomputers,&#x201D; historical epistemologists and moral philosophers of a sort who use narrative, a form of moral testimony, to help their communities face challenges and seize opportunities in the wake of an ever-changing landscape. Conclusions. The &#x201C;ecosophy&#x201D; of the I&#xF1;upiat of Seward Peninsula offers examples of &#x201C;focal practices&#x201D;, which are essential for environmental education. These focal practices instil key virtues, namely humility, gratitude, self-reliance, attentiveness, responsibility and responsiveness, that are necessary for subsistence living

Kinetic Characterisation of a Single Chain Antibody against the Hormone Abscisic Acid: Comparison with Its Parental Monoclonal

A single-chain Fv fragment antibody (scFv) specific for the plant hormone abscisic acid (ABA) has been expressed in the bacterium Escherichia coli as a fusion protein. The kinetics of ABA binding have been measured using surface plasmon resonance spectrometry (BIAcore 2000) using surface and solution assays. Care was taken to calculate the concentration of active protein in each sample using initial rate measurements under conditions of partial mass transport limitation. The fusion product, parental monoclonal antibody and the free scFv all have low nanomolar affinity constants, but there is a lower dissociation rate constant for the parental monoclonal resulting in a three-fold greater affinity. Analogue specificity was tested and structure-activity binding preferences measured. The biologically-active (+)-ABA enantiomer is recognised with an affinity three orders of magnitude higher than the inactive (-)-ABA. Metabolites of ABA including phaseic acid, dihydrophaseic acid and deoxy-ABA have affinities over 100-fold lower than that for (+)-ABA. These properties of the scFv make it suitable as a sensor domain in bioreporters specific for the naturally occurring form of ABA

On the Relationship Between Ultrasonic and Micro-Structural Properties of Imperfect Interfaces in Layered Solids

The interaction of ultrasonic waves with interfaces formed by two non-conforming, rough surfaces in contact has been the subject of numerous investigations [1–10]. The motivations behind these studies have been various: from the assessment of the real area of contact between two rough surfaces [1], to the modeling of crack closure near the tip of a fatigue crack [4]; from the identification of the nature of interfacial imperfections in kissing and partial bonds [6], to the generation of ultrasonic waves [8]. In most of these studies, the characterization of the interfacial properties has been attempted by studying the reflection of longitudinal and shears waves at normal incidence. Only recently, the problem concerning the interaction of ultrasonic waves with realistic complex systems such as that formed by two neighboring imperfect interfaces has been addressed. Lavrentyev and Rokhlin [9, 10] used ultrasonic spectroscopy to evaluate the interfacial conditions from the spectra of longitudinal and shear waves reflected normally from the interfaces