LEIR lattice

The Low Energy Ion Ring (LEIR) is a low energy ion cooling and accumulation ring and serves to compress long ion pulses from Linac3 into high density bunches suitable for LHC ion operation. Issues of the LEIR lattice are to fulfil all constraints with a small number of quadrupoles and compensations of perturbations due to an electron cooler and gradients seen by the beam in the bending magnets during the ramp. Furthermore, experimental investigations via orbit response measurements will be reported

Variations in Cholesterol Management Practices of U.S. Physicians

AbstractObjectives. This study sought to evaluate national cholesterol management practices of U.S. physicians.Background. Past studies show that nonclinical factors affect physician practices. We tested the hypothesis that physician and patient characteristics influence cholesterol management.Methods. We used a stratified, random sample of 2,332 office-based physicians providing 56,215 visits to adults in the 1991–1992 National Ambulatory Medical Care Surveys. We investigated physicians’ reporting of cholesterol-related screening, counseling or medications during office visits and used multiple logistic regression to assess independent predictors.Results. An estimated 1.12 billion adult office visits occurred in 1991 and 1992 (95% confidence interval 1.06 to 1.18 billion). For the 1.03 billion visits by patients without reported hyperlipidemia, cholesterol screening (2.8% of visits) and counseling (1.2%) were not frequent. The likelihood of screening increased with older age, cardiovascular disease risk factors, white race and private insurance. We estimate that only 1 in 12 adults received cholesterol screening annually. In the 85 million visits by patients with hyperlipidemia, cholesterol testing was reported in 22.9%, cholesterol counseling in 34.4% and lipid-lowering medications in 23.1%. Testing was more likely in diabetic and nonobese patients. Counseling was more likely with younger age, cardiovascular disease and private insurance. Medications use was associated with cardiovascular disease, Northeast region of the United States, nonobese patients and visits to internists. Physician practices did not differ by patient gender.Conclusions. Although clinical conditions strongly influence cholesterol management, the appropriateness of variations noted by payment source, geographic region and physician specialty deserve further evaluation. These variations and the low estimated volume of services suggest that physicians have not fully adopted recommended cholesterol management practices.(J Am Coll Cardiol 1997;29:139–46)

Mechanisms Of Fracturing In Structures Built From Topologically Interlocked Blocks

Failure of materials is in many cases associated with initiation and subsequent propagation of macroscopic fractures. Consequently, in order to increase the strength, one needs to inhibit either crack initiation or propagation. The principle of topological interlocking provides a unique opportunity to construct materials and structures in which both routes of the strength increase can be realised. Materials and structures built on the basis of this principle consist of many elements which are hold together by the special geometry of their shape, together with an external constrain. The absence of the binder phase between the elements allows the interfaces to arrest macroscopic crack propagation. In addition, with sufficiently small size of the elements an increase in local strength and, possibly, in the stress for crack initiation can be achieved by capitalising on the size effect. Furthermore, the ability of some interlocking structures to tolerate missing elements can serve to prevent the avalanche-type failure initiated by failure of one of the elements. In this paper, experimental results and a theoretical analysis with regard to this possibility are presented

Interpersonal affect in groupwork: A comparative case study of two small groups with contrasting group dynamics outcomes

Teamwork capabilities are essential for 21st century life, with groupwork emerging as a fruitful context to develop these skills. Case studies that explore interpersonal affect dynamics in authentic higher education groupwork settings can highlight collaborative skills development needs. This comparative case-study traced the sociodynamic evolution of two groups of first-year university students to investigate the high collaborative variance outcomes of the two groups, which reported starkly contrasting group dynamics (negative and dysfunctional or positive and collaborative). Mixed-methods (video-recorded observations of five groupwork labs over one semester, and group interviews) provided interpersonal affect data as real-time visible behaviours, and the felt experiences and perceptions of participants. The study traced interpersonal affect dynamics in the natural fluctuation of not just task-focused (on-task), but also explicitly relational (off-task) interactions, which revealed their function in both task participation and group dynamics. Findings illustrate visible interpersonal affect behaviours that manifested and evolved over time as interactive patterns, and group dynamics outcomes. Fine-grained analysis of interactions unveiled interpersonal affect as a collective, evolving process, and the mechanism through which one group started and stayed highly positive and collaborative over the semester. The other group showed a tendency towards splitting to undertake tasks early, leading to low group-level interpersonal attentiveness, and over time, subgroups emerged through interactions both off-task and on-task. The study made visible the pervasive nature of interpersonal affect as enacted through seemingly inconsequential everyday behaviours that supported the relational and task-based needs of groupwork, and those behaviours which impeded collaboration

Cost-effectiveness of a smoking cessation program after myocardial infarction

AbstractObjectives. The purpose of this study was to evaluate the cost-effectiveness of a smoking cessation program initiated after acute myocardial infarction.Background. The value of allocating health care resources to smoking cessation programs after myocardial infarction has not been compared with the value of other currently accepted interventions.Methods. A model was developed to examine the cost-effectiveness of a recently reported smoking cessation program after an acute myocardial infarction. The cost was estimated by considering the resources necessary to implement the program, and the effectiveness was expressed as discounted years of life saved. Years of life saved were estimated by modeling life expectancy using a single declining exponential approximation of life expectancy based on data from published reports.Results. The cost-effectiveness of the nurse-managed smoking cessation program was estimated to be $220/year of life saved. In a one-way sensitivity analysis, the cost-effectiveness of the program remained <$20,000/year of life saved if the program decreased the smoking rate by only 3/1,000 smokers (baseline assumption 26/100 smokers), or if the program cost as much as $8,840/smoker (baseline assumption$100). In a two-way sensitivity analysis, even if the cost of the program were as high as $2,000/participant, the cost-effectiveness of the program would be <$10,000/year of life saved so as the an program helped an additional 12 smokers quit for every 100 enrolled.Conclusions. Over a wide range of estimates of costs and effectiveness, a nurse-managed smoking cessation program after acute myocardial infarction is an extremely cost-effective intervention. This program is more cost-elective than beta-adrenergic antagonist therapy after myocardial infarction

Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial

Background: Postoperative ileus is a common condition after abdominal surgery. Many prokinetic drugs have been evaluated including osmotic laxatives. The data on colon-stimulating laxatives are scarce. This prospective, randomized, double-blind trial investigates the effect of the colon-stimulating laxative bisacodyl on postoperative ileus in elective colorectal resections. Materials and methods: Between November 2004 and February 2007, 200 consecutive patients were randomly assigned to receive either bisacodyl or placebo. Primary endpoint was time to gastrointestinal recovery (mean time to first flatus passed, first defecation, and first solid food tolerated; GI-3). Secondary endpoints were incidence and duration of nasogastric tube reinsertion, incidence of vomiting, length of hospital stay, and visual analogue scores for pain, cramps, and nausea. Results: One hundred sixty-nine patients were analyzed, and 31 patients discontinued the study. Groups were comparable in baseline demographics. Time to GI-3 was significantly shorter in the bisacodyl group (3.0 versus 3.7days, P = 0.007). Of the single parameters defining GI-3, there was a 1-day difference in time to defecation in favor to the bisacodyl group (3.0 versus 4.0days, P = 0.001), whereas no significant difference in time to first flatus or tolerance of solid food was seen. No significant difference in the secondary endpoints was seen. Morbidity and mortality did not differ between groups. Conclusion: Bisacodyl accelerated gastrointestinal recovery and might be considered as part of multimodal recovery programs after colorectal surger