Objective-To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms ofprocess, outcome, and comparative cost.Design-A randomised controlled trial. Setting-A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis.Patients-All new attenders categorised by the triage system as "semiurgent" or "delay acceptable." 66% ofall attenders were eligible for inclusion.Main outcome measures-Numbers of patients undergoing investigation, referral, or prescription; types of disposal; consultation satisfaction scores; reattendance to accident and emergency department within 30 days of index visit; health status at one month; comparative cost differences.Results-4684 patients participated. For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20%; 95% confidence interval 16% to 25%), referred to other hospital services less often (39%; 28% to 47%/6), admitted fewer patients (45%; 32% to 56%), and prescribed more often (41%; 30% to 54%/6). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit; 418 patients (18%) seen by accident and emergency staff similarly reattended. 435 patients (72% of those eligible) completed the consultation satisfaction questionnaire and 258 (59% of those eligible) provided health status information one month after consultation. There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction questionnaire scores or health status. For all patients seen by general practitioners during the study, estimated marginal and total savings were £Ir1427 and £Ir117 005 respectively.Conclusion-General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.

We report the unique depiction of brown adipose tissue (BAT) by MRI and computed tomography (CT) in a human three month-old infant. Based on cellular differences between BAT and more lipid-rich white adipose tissue (WAT), chemical-shift MRI and CT were both capable of generating distinct signal contrasts between the two tissues and against surrounding anatomy, utilizing fat-signal fraction metrics in the former and X-ray attenuation values in the latter. While numerous BAT imaging experiments have been performed previously in rodents, the identification of BAT in humans has only recently been described with fusion positron emission and computed tomography in adults. The imaging of BAT in children has not been widely reported and furthermore, MRI of human BAT in general has not been demonstrated. In the present work, large bilateral supraclavicular BAT depots were clearly visualized with MRI and CT. Tissue identity was subsequently confirmed by histology. BAT has important implications in regulating energy metabolism and non-shivering thermogenesis and has the potential to combat the onset of weight gain and the development of obesity. Current findings suggest that BAT is present in significant amounts in children and that MRI and CT can differentiate BAT from WAT based on intrinsic tissue properties.

Objective To characterize the changes in brown adipose tissue (BAT) during puberty in boys and girls. Study design We examined the prevalence and the volume of BAT at different stages of sexual development in pediatric patients who underwent positron emission tomography/computer tomography (PET/CT) studies. Results Of the 73 patients, 43 (59%) had BAT depicted on PET/CT. Visualized BAT was significantly less prevalent in PET/CT studies of pre-pubertal (Tanner stage 1) children than pubertal (Tanner stages 2-5) subjects (15% vs. 75%). Values for the volume of BAT also increased during puberty, but the magnitude of the increase was substantially greater during the final two stages of puberty (Tanner stage 4 or 5) than in earlier stages of sexual development (Tanner stages 1, 2, and 3) (Boys: 499±246 vs. 50±36, p <0.0001, Girls: 286±139 vs. 36±29, p = 0.024). Changes in BAT volume were also significantly greater in boys than in girls (p = 0.004) and were closely related to muscle volume (r’s = 0.52, 0.64 and both p’s<0.01, for boys and girls, respectively). Conclusion The depiction and the volume of brown fat increase during puberty. Metabolic and hormonal events related to the achievement of sexual maturity are likely responsible for the rapid increase in brown fat that occurs during puberty.