A review of patient choice in the NHS

By December 2005 National Health Service (NHS) patients who may require elective surgery will be offered a choice of four to five hospitals at the referral stage, as part of the government’s vision for a responsive, patient-centric health service. The Healthcare Management Research Group of Cranfield Postgraduate Medical School has been working with Bedford Hospital NHS Trust to evaluate the possible implications of patient choice, and this document provides an overview of the current situation and predicted changes. During February and March 2004 a number of meetings were held with key NHS stakeholders, including Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and General Practitioners (GPs) in Bedfordshire, Hertfordshire, Cambridgeshire, Huntingdonshire and Northamptonshire, and also the Department of Health in London. Conclusions from these interviews form the core of the research and are reinforced by a literature review of academic papers, news articles, books, government guidelines and opinion surveys. In particular, the process by which PCTs commission secondary care providers is assessed and the nine pilot schemes are evaluated. The Department of Health’s report on pilots also provides a valuable insight into the practicalities of offering choice. Lessons learned from healthcare systems around the world are compared with current policy in the NHS, and finally there is critique of the challenges to the implementation of ch

Asymptotic silence-breaking singularities

We discuss three complementary aspects of scalar curvature singularities: asymptotic causal properties, asymptotic Ricci and Weyl curvature, and asymptotic spatial properties. We divide scalar curvature singularities into two classes: so-called asymptotically silent singularities and non-generic singularities that break asymptotic silence. The emphasis in this paper is on the latter class which have not been previously discussed. We illustrate the above aspects and concepts by describing the singularities of a number of representative explicit perfect fluid solutions.Comment: 25 pages, 6 figure

Self-similar Bianchi models: I. Class A models

We present a study of Bianchi class A tilted cosmological models admitting a proper homothetic vector field together with the restrictions, both at the geometrical and dynamical level, imposed by the existence of the simply transitive similarity group. The general solution of the symmetry equations and the form of the homothetic vector field are given in terms of a set of arbitrary integration constants. We apply the geometrical results for tilted perfect fluids sources and give the general Bianchi II self-similar solution and the form of the similarity vector field. In addition we show that self-similar perfect fluid Bianchi VII$_0$ models and irrotational Bianchi VI$_0$ models do not exist.Comment: 14 pages, Latex; to appear in Classical and Quantum Gravit

A new proof of the Bianchi type IX attractor theorem

We consider the dynamics towards the initial singularity of Bianchi type IX vacuum and orthogonal perfect fluid models with a linear equation of state. The `Bianchi type IX attractor theorem' states that the past asymptotic behavior of generic type IX solutions is governed by Bianchi type I and II vacuum states (Mixmaster attractor). We give a comparatively short and self-contained new proof of this theorem. The proof we give is interesting in itself, but more importantly it illustrates and emphasizes that type IX is special, and to some extent misleading when one considers the broader context of generic models without symmetries.Comment: 26 pages, 5 figure

Particle Production of Vector Fields: Scale Invariance is Attractive

In a model of an Abelian vector boson with a Maxwell kinetic term and non-negative mass-squared it is demonstrated that, under fairly general conditions during inflation, a scale-invariant spectrum of perturbations for the components of a vector field, massive or not, whose kinetic function (and mass) is modulated by the inflaton field is an attractor solution. If the field is massless, or if it remains light until the end of inflation, this attractor solution also generates anisotropic stress, which can render inflation weakly anisotropic. The above two characteristics of the attractor solution can source (independently or combined together) significant statistical anisotropy in the curvature perturbation, which may well be observable in the near future

The flatness problem and Λ\Lambda

By way of a complete integration of the Friedmann equations, in terms of observables, it is shown that for the cosmological constant $\Lambda > 0$ there exist non-flat FLRW models for which the total density parameter $\Omega$ remains $\sim 1$ throughout the entire history of the universe. Further, it is shown that in a precise quantitative sense these models are not finely tuned. When observations are brought to bear on the theory, and in particular the WMAP observations, they confirm that we live in just such a universe. The conclusion holds when the classical notion of $\Lambda$ is extended to dark energy.Comment: Final form to appear in Physical Review Letters. Further information at http://grtensor.org/Robertson

Gravity Waves from a Cosmological Phase Transition: Gauge Artifacts and Daisy Resummations

The finite-temperature effective potential customarily employed to describe the physics of cosmological phase transitions often relies on specific gauge choices, and is manifestly not gauge-invariant at finite order in its perturbative expansion. As a result, quantities relevant for the calculation of the spectrum of stochastic gravity waves resulting from bubble collisions in first-order phase transitions are also not gauge-invariant. We assess the quantitative impact of this gauge-dependence on key quantities entering predictions for gravity waves from first order cosmological phase transitions. We resort to a simple abelian Higgs model, and discuss the case of R_xi gauges. By comparing with results obtained using a gauge-invariant Hamiltonian formalism, we show that the choice of gauge can have a dramatic effect on theoretical predictions for the normalization and shape of the expected gravity wave spectrum. We also analyze the impact of resumming higher-order contributions as needed to maintain the validity of the perturbative expansion, and show that doing so can suppress the amplitude of the spectrum by an order of magnitude or more. We comment on open issues and possible strategies for carrying out "daisy resummed" gauge invariant computations in non-Abelian models for which a gauge-invariant Hamiltonian formalism is not presently available.Comment: 25 pages, 10 figure

Bianchi VIII Empty Futures

Using a qualitative analysis based on the Hamiltonian formalism and the orthonormal frame representation we investigate whether the chaotic behaviour which occurs close to the initial singularity is still present in the far future of Bianchi VIII models. We describe some features of the vacuum Bianchi VIII models at late times which might be relevant for studying the nature of the future asymptote of the general vacuum inhomogeneous solution to the Einstein field equations.Comment: 22 pages, no figures, Latex fil