Locked and Unlocked Chains of Planar Shapes

We extend linkage unfolding results from the well-studied case of polygonal linkages to the more general case of linkages of polygons. More precisely, we consider chains of nonoverlapping rigid planar shapes (Jordan regions) that are hinged together sequentially at rotatable joints. Our goal is to characterize the families of planar shapes that admit locked chains, where some configurations cannot be reached by continuous reconfiguration without self-intersection, and which families of planar shapes guarantee universal foldability, where every chain is guaranteed to have a connected configuration space. Previously, only obtuse triangles were known to admit locked shapes, and only line segments were known to guarantee universal foldability. We show that a surprisingly general family of planar shapes, called slender adornments, guarantees universal foldability: roughly, the distance from each edge along the path along the boundary of the slender adornment to each hinge should be monotone. In contrast, we show that isosceles triangles with any desired apex angle less than 90 degrees admit locked chains, which is precisely the threshold beyond which the inward-normal property no longer holds.Comment: 23 pages, 25 figures, Latex; full journal version with all proof details. (Fixed crash-induced bugs in the abstract.

Dynamic analysis of a lithium-boiling potassium refractory metal Rankine cycle power system for the Jet Propulsion Laboratory

Lithium-boiling potassium refractory metal Rankine cycle power system heat transfer model

Interventions for improving clinical outcomes and health-related quality-of-life for people living with skeletal dysplasias: an evidence gap map

Purpose: Skeletal dysplasias are rare genetic disorders that are characterized by abnormal development of bone and cartilage. There are multiple medical and non-medical treatments for specific symptoms of skeletal dysplasias e.g. pain, as well as corrective surgical procedures to improve physical functioning. The aim of this paper was to develop an evidence-gap map of treatment options for skeletal dysplasias, and their impact on patient outcomes. Methods: We conducted an evidence-gap map to identify the available evidence on the impact of treatment options on people with skeletal dysplasias on clinical outcomes (such as increase in height), and dimensions of health-related quality of life. A structured search strategy was applied to five databases. Two reviewers independently assessed articles for inclusion in two stages: titles and abstracts (stage 1), and full text of studies retained at stage 2. Results: 58 studies fulfilled our inclusion criteria. The included studies covered 12 types of skeletal dysplasia that are non-lethal with severe limb deformities that could result in significant pain and numerous orthopaedic interventions. Most studies reported on the effect of surgical interventions (n = 40, 69%), followed by the effect of treatments on dimensions of health quality-of-life (n = 4, 6.8%) and psychosocial functioning (n = 8, 13.8%). Conclusion: Most studies reported on clinical outcomes from surgery for people living with Achondroplasia. Consequently, there are gaps in the literature on the full range of treatment options (including no active treatment), outcomes and the lived experience of people living with other skeletal dysplasias. More research is warranted to examine the impact of treatments on health-related quality-of-life of people living with skeletal dysplasias, including their relatives to enable them to make preference- and valued based decisions about treatment

Linking routinely collected social work, education and health data to enable monitoring of the health and health care of school-aged children in state care (‘looked after children’) in Scotland: a national demonstration project

Background and objectives: Children in state care (‘looked after children’) have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process. Study design and methods: National demonstration project testing the feasibility of linking routinely collected looked after children, education, and health data. Participants: All children in publicly funded school in Scotland in 2011/12. Results: Linkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1,757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the NHS Scotland master patient index demonstrated that a safe link to the child’s unique health service (Community Health Index, CHI) number could be obtained for a very high proportion of children in each group (94%, 95%, and 95% of children classified as currently, previously, and non-looked after respectively). In general linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering. Conclusions: This novel data linkage demonstrates the feasibility of monitoring population based health outcomes of school aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are pre- or post-school, home schooled, or in independent schooling)

The impact of posttraumatic stress disorder on upper gastrointestinal investigations in Australian Defence Force veterans: a retrospective review

Veterans with posttraumatic stress disorder (PTSD) commonly exhibit associated gastrointestinal (GI) symptoms. We compared upper GI endoscopy and abdominal ultrasound rates in veterans with and without PTSD. Veterans with PTSD were 77–81% more likely to undergo these procedures than those without PTSD. PTSD symptomatology influences GI investigation rate and more emphasis on clinician and patient education is recommended regarding stress-related gut symptoms

Post-traumatic stress disorder is associated with a higher rate of polypectomy independent of an increased frequency of colonoscopy in Australian veterans: a retrospective review

Background Post-traumatic stress disorder (PTSD) is associated with extensive physical comorbidities, including lower gastrointestinal symptoms. Diagnostic uncertainty and poor therapeutic responses may result in more frequent colonoscopies than clinically necessary. Polypectomy is standard practice when polyps are identified, and if PTSD is a risk factor for polyp formation, one would expect a higher rate of polyp detection and removal in veterans with PTSD than those without PTSD. Aim To determine the association between PTSD and the rate of colonoscopy and polypectomy in Australian veterans. Methods Diagnostic and therapeutic colonoscopy rates in Australian male Veterans aged >= 50 years were examined by reviewing case records of veterans who accessed Department of Veterans' Affairs funded health services between 1 January 2013 and 31 December 2018. Results A total of 138 471 veterans was included, of whom 28 018 had a diagnosis of PTSD; 56.4% were aged >= 65 years. Twenty-one percent of the entire cohort underwent at least one colonoscopy during the study period. Increased rates of diagnostic colonoscopy and polypectomy were associated with the presence of PTSD across all age brackets. The effect was empirically large as veterans with PTSD experience colonoscopy rates 76-81% greater than those without PTSD. Similarly, veterans with PTSD experienced polypectomy rates 76-81% greater than veterans without PTSD, and this increase persisted when controlling for the increased number of diagnostic colonoscopies they undergo. Conclusion The presence of PTSD has a marked impact on colonoscopy rates in Australian veterans. The increased polypectomy rate independent of increased colonoscopy rate suggests that PTSD is a risk factor for colonic polyp formation

A Temporal and Spatial Analysis of Relative Prices for General Practitioner and Specialist Services in Australia, 1984-1996

Australia's health care financing arrangements under Medicare involve Commonwealth subsidisation of private fee-for-service (FFS) medical services produced both in- and out-of-hospital. The Medicare institution, including those subsidy arrangements, operates in a uniform manner across geographical space. From time to time, since the introduction of Medicare on 1 February 1984, ad hoc reviews of the Medicare subsidy arrangements have been undertaken. This empirical study present the first examination of the price relativities of various specialist and general practitioner services that have arisen under Medicare over time, and across geographical space. The empirical work involves estimating and testing time-series relative price equations for ten groups of medical practitioner services, for each state and territory in Australia, on quarterly Health insurance Commission (HC) data. Seventy-two equations are estimated in total, on 49 quarterly observations from September, 1984 to September, 1996. The important conclusions of the work are that price outcomes under Medicare are characterised by spatial non-uniformity, despite the uniformity of the subsidy mechanism. A related conclusion is that institutional reforms to the subsidy arrangements under Medicare may, in some cases, prove blunt instruments if prices and their relativities are the relevant policy targets. The results inform a presently informed medico-legal debate about price relativities in the health sector under Medicare and service to caution the applications of institutional change as a tool for effecting relative price change