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

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

Fractured identities: injury and the balletic body

Social worlds shape human bodies and so it is inevitable that there are strong relationships between the body, professional dance and identity. In this article we draw on Bourdieu’s notions of habitus, and various forms of capital, as the main theoretical framework for our discussion. Our ethnography of the balletic body elicited dancers and ex-dancers’ perceptions of their bodies and sought to reveal some of the facets of their embodied habitus. The sheer physicality of their working lives - of feeling exhausted, sweaty and out of breath - is something dancers (like all athletes) become ‘addicted to’. Ageing and injury can reveal this compulsion to dance and so dancers invariably find it very difficult to, for example, give up class once they retire from the stage; or miss a performance if they have a ‘slight injury’. In other words, the vocational calling to dance is so overwhelming that their balletic body is their identity. In addition, there is an unremitting loop between individual habitus and institutional habitus (the ballet company), which affects both the meaning and management of injury. All our informants at the Royal Ballet (London: n = 20) had suffered dance injuries. The injured, dancing body is perceived as an inevitable part of a career in ballet. Everyone spoke of the improved athleticism of dancers, and of the expansion in facilities to maintain healthy dancers. However, most dancers can expect several major injuries during their careers. Such epiphanies force dancers to confront their embodiment, and their thoughts invariably turn to their body, career and self. Critical injuries threaten to terminate a dancer’s career and so endanger their embodied sense of self. On a more everyday level, dancing and performing with painful, niggling injuries is the norm

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

Gravitational Entropy and Quantum Cosmology

We investigate the evolution of different measures of ``Gravitational Entropy'' in Bianchi type I and Lema\^itre-Tolman universe models. A new quantity behaving in accordance with the second law of thermodynamics is introduced. We then go on and investigate whether a quantum calculation of initial conditions for the universe based upon the Wheeler-DeWitt equation supports Penrose's Weyl Curvature Conjecture, according to which the Ricci part of the curvature dominates over the Weyl part at the initial singularity of the universe. The theory is applied to the Bianchi type I universe models with dust and a cosmological constant and to the Lema\^itre-Tolman universe models. We investigate two different versions of the conjecture. First we investigate a local version which fails to support the conjecture. Thereafter we construct a non-local entity which shows more promising behaviour concerning the conjecture.Comment: 20 pages, 7 ps figure

Geographers out of place: institutions, (inter)disciplinarity and identity

Ten years ago, the decision was taken to close Brunel University’s Department of Geography and Earth Sciences and its undergraduate programmes. Since this time, most of the human geographers have remained at Brunel, but now work from beyond the boundaries of conventional academic Geography. In this paper we argue that this situation, which is not uncommon for geographers in the UK and elsewhere, has significant implications for both individuals and the discipline more broadly. Through our everyday experiences of interdisciplinary working, this paper reflects on what it means to be a geographer working outside of ‘Geography’. The paper examines the implications of this at three different yet related scales: the immediately personal scale in terms of identity and individual academic performance, the institutional scale and its organisation that can lead to the presence/ absence of academic subject areas, and then finally the disciplinary scale with its attendant spaces of knowledge generation, dissemination and protectionism. Our arguments are framed by neoliberal-led higher education changes and conceptualisations of institutions, (inter)disciplinarity and identity, and point to broader significances for the shape of the discipline

Tilted two-fluid Bianchi type I models

In this paper we investigate expanding Bianchi type I models with two tilted fluids with the same linear equation of state, characterized by the equation of state parameter w. Individually the fluids have non-zero energy fluxes w.r.t. the symmetry surfaces, but these cancel each other because of the Codazzi constraint. We prove that when w=0 the model isotropizes to the future. Using numerical simulations and a linear analysis we also find the asymptotic states of models with w>0. We find that future isotropization occurs if and only if $w \leq 1/3$. The results are compared to similar models investigated previously where the two fluids have different equation of state parameters.Comment: 14 pages, 3 figure

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

Cystic fibrosis mice carrying the missense mutation G551D replicate human genotype phenotype correlations

We have generated a mouse carrying the human G551D mutation in the cystic fibrosis transmembrane conductance regulator gene (CFTR) by a one-step gene targeting procedure. These mutant mice show cystic fibrosis pathology but have a reduced risk of fatal intestinal blockage compared with 'null' mutants, in keeping with the reduced incidence of meconium ileus in G551D patients. The G551D mutant mice show greatly reduced CFTR-related chloride transport, displaying activity intermediate between that of cftr(mlUNC) replacement ('null') and cftr(mlHGU) insertional (residual activity) mutants and equivalent to approximately 4% of wild-type CFTR activity. The long-term survival of these animals should provide an excellent model with which to study cystic fibrosis, and they illustrate the value of mouse models carrying relevant mutations for examining genotype-phenotype correlations

Graded Majorana spinors

In many mathematical and physical contexts spinors are treated as Grassmann odd valued fields. We show that it is possible to extend the classification of reality conditions on such spinors by a new type of Majorana condition. In order to define this graded Majorana condition we make use of pseudo-conjugation, a rather unfamiliar extension of complex conjugation to supernumbers. Like the symplectic Majorana condition, the graded Majorana condition may be imposed, for example, in spacetimes in which the standard Majorana condition is inconsistent. However, in contrast to the symplectic condition, which requires duplicating the number of spinor fields, the graded condition can be imposed on a single Dirac spinor. We illustrate how graded Majorana spinors can be applied to supersymmetry by constructing a globally supersymmetric field theory in three-dimensional Euclidean space, an example of a spacetime where standard Majorana spinors do not exist.Comment: 16 pages, version to appear in J. Phys. A; AFK previously published under the name A. F. Schunc