A randomised controlled trial to measure the effect of chest pain unit care upon anxiety, depression, and health-related quality of life [ISRCTN85078221]

Background The chest pain unit (CPU) has been developed to provide a rapid and accurate diagnostic assessment for patients attending hospital with acute, undifferentiated chest pain. We aimed to measure the effect of CPU assessment upon psychological symptoms and health-related quality of life. Methods We undertook a single-centre, cluster-randomised controlled trial. Days (N = 442) were randomised in equal numbers to CPU or routine care. Patients with acute chest pain, undiagnosed by clinical assessment, ECG and chest radiograph, were recruited and followed up with self-completed questionnaires (SF-36 and HADS) at two days and one month after hospital attendance. Results Patients receiving CPU assessment had significantly higher scores on the physical functioning (difference 5.1 points; 95% CI 1.1 to 9.0), vitality (4.6; 1.3 to 8.0), and general health (5.7; 2.3 to 9.2) dimensions of the SF-36 at two days, and significantly higher scores on all except the emotional role dimension at one month. They also had significantly lower depression scores on the HADS depression scale at two days (0.93; 0.34 to 1.51) and one month (1.0; 0.36 to 1.66). However, initially lower anxiety scores at two days (0.89; 0.21 to 1.56) were not maintained at one month (0.48; -0.26 to 1.23). CPU assessment was associated with reduced prevalence (OR 0.71; 95% CI 0.52 to 0.97) and severity (6.5 mm on 100 m visual analogue scale; 95% CI 2.2 to 10.8) of chest pain at one month, but no significant difference in the proportion of patients taking time off work (OR 0.82; 95% CI 0.54 to 1.04). Conclusion CPU assessment is associated with improvements in nearly all dimensions of quality of life and with reduced symptoms of depression

DWT/PCA face recognition using automatic coefficient selection

In PCA-based face recognition, there is often a trade-off between selecting the most relevant parts of a face image for recognition and not discarding information which may be useful. The work presented in this paper proposes a method to automatically determine the most discriminative coefficients in a DWT/PCA-based face recognition system, based on their inter-class and intra-class standard deviations. In addition, the eigenfaces used for recognition are generally chosen based on the value of their associated eigenvalues. However, the variance indicated by the eigenvalues may be due to factors such as variation in illumination levels between training set faces, rather than differences that are useful for identification. The work presented proposes a method to automatically determine the most discriminative eigenfaces, based on the inter-class and intra-class standard deviations of the training set eigenface weight vectors. The results obtained using the AT&T database show an improvement over existing DWT/PCA coefficient selection techniques

Perceptions of creativity amongst university design tutors

The possibility to suppress the nonperturbative effects choosing the vary high multiplicity final state is discussed. The theoretical uncertainties and the experimental observable consequence of this choice are discussed

The magnetar model for Type I superluminous supernovae I: Bayesian analysis of the full multicolour light curve sample with MOSFiT

We use the new Modular Open Source Fitter for Transients (MOSFiT) to model 38 hydrogen-poor superluminous supernovae (SLSNe). We fit their multicolour light curves with a magnetar spin-down model and present the posterior distributions of magnetar and ejecta parameters. The colour evolution can be well matched with a simple absorbed blackbody. We find the following medians (1$\sigma$ ranges): spin period 2.4 ms (1.2-4 ms); magnetic field $0.8\times 10^{14}$ G (0.2-1.8 $\times 10^{14}$ G); ejecta mass 4.8 Msun (2.2-12.9 Msun); kinetic energy $3.9\times 10^{51}$ erg (1.9-9.8 $\times 10^{51}$ erg). This significantly narrows the parameter space compared to our priors, showing that although the model is flexible, the parameter space relevant to SLSNe is well constrained by existing data. The requirement that the instantaneous engine power is $\sim 10^{44}$ erg at the light curve peak necessitates either a large rotational energy (P<2 ms), or more commonly that the spin-down and diffusion timescales be well-matched. We find no evidence for separate populations of fast- and slow-declining SLSNe, which instead form a continuum both in light curve widths and inferred parameters. Variations in the spectra are well explained through differences in spin-down power and photospheric radii at maximum-light. We find no correlations between any model parameters and the properties of SLSN host galaxies. Comparing our posteriors to stellar evolution models, we show that SLSNe require rapidly rotating (fastest 10%) massive stars (> 20 Msun), and that this is consistent with the observed SLSN rate. High mass, low metallicity, and likely binary interaction all serve to maintain rapid rotation essential for magnetar formation. By reproducing the full set of SLSN light curves, our posteriors can be used to inform photometric searches for SLSNe in future survey data

What to do about poor clinical performance in clinical trials

The performance of individual clinicians is being monitored as never before. Su Mason and colleagues discuss the implications of this for clinical trials and recommend what should happen if during a trial the performance of one clinician or one centre is identified as being particularly poor. Tom Treasure, a surgeon, wants the monitoring to be done fairly and to take account of the complexities of clinical practice; and Heather Goodare, a patient, wants to be told when things go wrong. The Department of Health in England has issued guidelines for research governance stating that healthcare organisations remain responsible for the quality of all aspects of patients' care whether or not some aspects of the care are part of a research study.1 We discuss how this obligation can be met in multicentre trials, given that data on the performance of clinicians are held by the trial management team, not by the host organisation

Systematic investigation of the fallback accretion powered model for hydrogen-poor superluminous supernovae

The energy liberated by fallback accretion has been suggested as a possible engine to power hydrogen-poor superluminous supernovae. We systematically investigate this model using the Bayesian light-curve fitting code MOSFiT (Modular Open Source Fitter for Transients), fitting the light curves of 37 hydrogen-poor superluminous supernovae assuming a fallback accretion central engine. We find that this model can yield good fits to their light curves, with a fit quality that rivals the popular magnetar engine models. Examining our derived parameters for the fallback model, we find the total energy requirements from the accretion disk are estimated to be 0.002 - 0.7 Msun c^2. If we adopt a typical conversion efficiency ~ 1e-3, the required mass to accrete is thus 2 - 700 Msun. Many superluminous supernovae, therefore, require an unrealistic accretion mass, and so only a fraction of these events could be powered by fallback accretion unless the true efficiency is much greater than our fiducial value. The superluminous supernovae that require the smallest amounts of fallback mass still remain to be the fallback accretion powered supernova candidates, but they are difficult to be distinguished solely by their light curve properties.Comment: 12 pages, 8 figures, 3 tables, accepted by The Astrophysical Journa

Allocating Yellowfin Tuna Between the Multispecies Purse Seine and Longline Fleets

Yellowfin tuna in the western Pacific are harvested as juveniles by purse seiners and as adults by longliners. The study presents estimates of the multi-species harvest technology of these two types of vessel operating in Papua New Guinea's Exclusive Economic Zone. The results, together with price and cost information and estimates of the impact of the purse seine catch on the catch rates of longline vessels are used to perform a benefit/cost analysis of a reallocation of juvenile yellowfin through a one percent decline in purse seine harvest in PNG's EEZ. The marginal benefit of investment in the yellowfin stock is found to exceed that of marginal cost, suggesting that there may be an economic case for a reallocation.resource sharing, multispecies fisheries, yellowfin tuna, Environmental Economics and Policy, International Development, International Relations/Trade, Resource /Energy Economics and Policy,

General practitioners' reasons for removing patients from their lists: postal survey in England and Wales

The removal of patients from doctors' lists causes con­ siderable public and political concern, with speculation that patients are removed for inappropriate, including financial, reasons. In 1999 the House of Commons Select Committee on Public Administration noted that little evidence was available on either the frequency of, or the reasons for, removal of patients. National statistics do not distinguish between patients removed after moving out of a practice area and those removed for other reasons. Two postal surveys have reported why general practitioners might, in general, remove patients, and one small study has described the reasons doctors give for particular removals. We therefore determined the current scale of, and doctors' reasons for, removal of patients from their lists in Eng­ land and Wales

Evaluation of NHS Direct ‘‘referral’’ to community pharmacists

OBJECTIVES: To evaluate a pilot scheme of referrals from a nurse-led telephone helpline (NHS Direct) to community pharmacists. METHODS: A multi-method approach, including analysis of routine data from NHS Direct, postal surveys of NHS Direct callers, analysis of anonymised transcripts of calls, a postal survey of callers referred to pharmacists, and face-to-face interviews with NHS Direct nurses. SETTING: Essex, Barking and Havering. KEY FINDINGS: During the first three months of the pilot scheme, 6% (1,995/31,674) of NHS Direct calls triaged by nurses were logged as referred to pharmacists. This built on an existing foundation of informal referral to pharmacists of 4%. There was no measurable change in callers’ views of the helpfulness of advice, enablement, or caller satisfaction associated with the scheme. Conditions sent to pharmacists included skin rash, cough, sore throat, stomach pain, and vomiting and/or diarrhoea. 86% (54/63) of callers referred to pharmacists during the scheme felt the referral was very or quite appropriate and 75% (48/64) attempted to contact a pharmacist. In general, those who did so found the experience a positive one: 65% (31/48) spoke to the pharmacist, and 80% (28/35) of people expressing an opinion were satisfied with the advice offered, but the lack of privacy in the pharmacy was of some concern. Although routine data indicated high usage of the scheme, nurse referral of callers to pharmacists declined over time. Their initial enthusiasm diminished due to concerns about the appropriateness of guidelines, their lack of understanding of the rationale behind some referrals, and the lack of feedback about the appropriateness of their referrals. CONCLUSIONS: The evaluation of the pilot scheme has generated a range of recommendations for the wider national roll-out of the scheme, including revision of the guidelines and review of NHS Direct nurse training for referral to pharmacy. NHS Direct and pharmacists should consider how to strengthen the system of pharmacist feedback to NHS Direct