Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

Objectives: “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods: National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results: The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions: The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings

A random matrix decimation procedure relating β=2/(r+1)\beta = 2/(r+1) to β=2(r+1)\beta = 2(r+1)

Classical random matrix ensembles with orthogonal symmetry have the property that the joint distribution of every second eigenvalue is equal to that of a classical random matrix ensemble with symplectic symmetry. These results are shown to be the case $r=1$ of a family of inter-relations between eigenvalue probability density functions for generalizations of the classical random matrix ensembles referred to as $\beta$-ensembles. The inter-relations give that the joint distribution of every $(r+1)$-st eigenvalue in certain $\beta$-ensembles with $\beta = 2/(r+1)$ is equal to that of another $\beta$-ensemble with $\beta = 2(r+1)$. The proof requires generalizing a conditional probability density function due to Dixon and Anderson.Comment: 19 pages, 1 figur

Synthesis and biodistribution of immunoconjugates of a human IgM and polymeric drug carriers

The synthesis and purification of radiolabelled immunoconjugates, composed of a human IgM monoclonal antibody directed against an intracellular tumour-associated antigen and either poly (alpha-L-glutamic acid) (PGA) or poly[N5-(2-hydroxyethyl)-L-glutamine] (PHEG) is described. Coupling of polymers to the antibody was performed through disulfide bond formation involving a single thiol group at the C-terminus of the polymer chain and 2-pyridyldisulfide groups introduced onto the antibody. The antibody was iodinated with 131I before conjugation. The polymers contained tyrosinamide in a low degree of substitution and were radiolabelled with 125I. 125I-labelled PGA and PHEG were found to be stable for at least 3 days in murine and human plasma. The biodistribution in mice of the doubly labelled immunoconjugates was studied and was compared with the pharmacokinetics of the individual components.\ud \ud PHEG showed a relatively slow blood clearance, the half-life being approximately 10 h with low uptake in liver, kidneys and spleen. PGA was rapidly cleared from the circulation and was significantly taken up in liver, kidneys and spleen. The biodistribution of both immunoconjugates was indistinguishable from that of the IgM proper, with plasma half-lives of approximately 6 h, indicating that the pharmacokinetic properties of the immunoconjugates are largely determined by the antibody part

The manifest association structure of the single-factor model: insights from partial correlations

The association structure between manifest variables arising from the single-factor model is investigated using partial correlations. The additional insights to the practitioner provided by partial correlations for detecting a single-factor model are discussed. The parameter space for the partial correlations is presented, as are the patterns of signs in a matrix containing the partial correlations that are not compatible with a single-factor model

Arithmetical properties of Multiple Ramanujan sums

In the present paper, we introduce a multiple Ramanujan sum for arithmetic functions, which gives a multivariable extension of the generalized Ramanujan sum studied by D. R. Anderson and T. M. Apostol. We then find fundamental arithmetic properties of the multiple Ramanujan sum and study several types of Dirichlet series involving the multiple Ramanujan sum. As an application, we evaluate higher-dimensional determinants of higher-dimensional matrices, the entries of which are given by values of the multiple Ramanujan sum.Comment: 19 page

Systematic Review of Household Water Conservation Interventions Using the Information–Motivation–Behavioral Skills Model

Increasing droughts and water shortages are intensifying the need for residential water conservation. We identify and classify 24 water conservation studies using the information–motivation–behavioral skills (IMB) model by categorizing interventions based on content and water conservation effectiveness. This synthesis revealed several insights. First, all of the interventions used information, motivation, and/or behavioral skills, suggesting that water conservation interventions can be interpreted within the IMB framework. Second, interventions with two or more IMB components led to reductions in water usage, but the average effect sizes between different types of interventions were similar and there was a considerable range around these averages. To the extent that intervention effectiveness is driven by populations lacking specific IMB components, more elicitation research to identify gaps in specific populations could support greater effectiveness. Designing interventions explicitly with the IMB model would facilitate comparability across studies and could support a better understanding of water conservation interventions

Impurity-Induced Virtual Bound States in d-Wave Superconductors

It is shown that a single, strongly scattering impurity produces a bound or a virtual bound quasiparticle state inside the gap in a $d$-wave superconductor. The explicit form of the bound state wave function is found to decay exponentially with angle-dependent range. These states provide a natural explanation of the second Cu NMR rate arising from the sites close to Zn impurities in the cuprates. Finally, for finite concentration of impurities in a $d$-wave superconductor, we reexamine the growth of these states into an impurity band, and discuss the Mott criterion for this band.Comment: 12 pages and 2 figures, RevTex, LA-UR-94-194

Early-Holocene warming in Beringia and its mediation by sea-level and vegetation changes

Arctic land-cover changes induced by recent global climate change (e.g., expansion of woody vegetation into tundra and effects of permafrost degradation) are expected to generate further feedbacks to the climate system. Past changes can be used to assess our understanding of feedback mechanisms through a combination of process modelling and paleo-observations. The sub-continental region of Beringia (Northeast Siberia, Alaska, and northwestern Canada) was largely ice-free at the peak of deglacial warming and experienced both major vegetation change and loss of permafrost when many arctic regions were still ice covered. The evolution of Beringian climate at this time was largely driven by global features, such as the amplified seasonal cycle of Northern Hemisphere insolation and changes in global ice volume and atmospheric composition, but changes in regional land-surface controls, such as the widespread development of thaw lakes, the replacement of tundra by deciduous forest or woodland, and the flooding of the Bering–Chukchi land bridge, were probably also important. We examined the sensitivity of Beringia’s early Holocene climate to these regional-scale controls using a regional climate model (RegCM). Lateral and oceanic boundary conditions were provided by global climate simulations conducted using the GENESIS V2.01 atmospheric general circulation model (AGCM) with a mixed-layer ocean. We carried out two present day simulations of regional climate, one with modern and one with 11 ka geography, plus another simulation for 6 ka. In addition, we performed five ? 11 ka climate simulations, each driven by the same global AGCM boundary conditions: (i) 11 ka “Control”, which represents conditions just prior to the major transitions (exposed land bridge, no thaw lakes or wetlands, widespread tundra vegetation), (ii) sea-level rise, which employed present day continental outlines, (iii) vegetation change, with deciduous needleleaf and deciduous broadleaf boreal vegetation types distributed as suggested by the paleoecological record, (iv) thaw lakes, which used the present day distribution of lakes and wetlands; and (v) post-11 ka “All”, incorporating all boundary conditions changed in experiments (ii)–(iv). We find that regional-scale controls strongly mediate the climate responses to changes in the large-scale controls, amplifying them in some cases, damping them in others, and, overall, generating considerable spatial heterogeneity in the simulated climate changes. The change from tundra to deciduous woodland produces additional widespread warming in spring and early summer over that induced by the 11 ka insolation regime alone, and lakes and wetlands produce modest and localized cooling in summer and warming in winter. The greatest effect is the flooding of the land bridge and shelves, which produces generally cooler conditions in summer but warmer conditions in winter and is most clearly manifest on the flooded shelves and in eastern Beringia. By 6 ka continued amplification of the seasonal cycle of insolation and loss of the Laurentide ice sheet produce temperatures similar to or higher than those at 11 ka, plus a longer growing season

Nuclear spin-lattice relaxation rate in the D+iD superconducting state: implications for CoO superconductor

We calculated the nuclear spin-lattice relaxation rate $1/T_1$ for the D+iD superconducting state with impurities. We found that small amount of unitary impurities quickly produces the residual density of states inside the gap. As a result, the T-linear behavior in 1/T$_1$ is observed at low temperatures. Our results show that the D+iD pairing symmetry of the superconducting state of Na$_{0.35}$CoO$_{2} \cdot y$H$_2$ O is compatible with recent $^{59}$Co 1/T$_1$ experiments of several groups.Comment: 5 pages, 4 figures, minor change