Prevention of osteoporotic refractures in regional Australia

Objective: Clinical guidelines recommend that patients who sustain a minimal trauma fracture (MTF) should receive a bone mineral density (BMD) scan and bisphosphonate (or equivalent) therapy if diagnosed with osteoporosis. A pilot fracture liaison service (FLS) was implemented in regional NSW to improve adherence to the guidelines. Design: Prospective cohort study with an historical control. Setting: Primary care. Participants: Control (n = 47) and cohort (n = 93) groups comprised patients consenting to interview who presented with a MTF to the major referral hospital 4 months before and 12 months after FLS implementation respectively. Main outcome measures: Primary outcome measures were the rates of BMD scans and anti-osteoporotic medication initiation/review after MTF. Hospital admission data were also examined to determine death and refracture rates for all patients presenting during the study period with a primary diagnosis of MTF within 3 years of their initial fracture. Results: Although there was no improvement in BMD scanning rates, the reported rate of medication initiation/review after fracture was significantly higher (P \u3c 0.05) in the FLS cohort. However, once adjusted for age, this association was not significant (P = 0.086). There was a lower refracture rate during the cohort period (P = 0.013), however, there were significantly more deaths (P = 0.035) within 3 years of initial fracture. When deaths were taken into account via competing risk regression, patients in the cohort period were significantly less likely to refracture than those in the control period (Hazard ratio = 0.576, P = 0.032). Conclusions: A rurally based nurse-led FLS was associated with modest improvement after MTF. Consideration should be given to ways to strengthen the model of care to improve outcomes

Utility of Lymph Node Aspiration in the Diagnosis of Visceral Leishmaniasis in Sudan.

We evaluated lymph node aspiration (LNA) as a simple diagnostic procedure for visceral leishmaniasis (VL). Lymph node aspiration was compared with the direct agglutination test (DAT) using a diagnostic titer > or = 1:6,400 in 7,880 suspected VL patients in eastern Sudan. Compared with DAT, LNA had a sensitivity of 65.1% (95% confidence interval = 63.5-66.6%). Parasite density in LNA correlated strongly with DAT titers (P < 0.0001), and low parasite density accounted for 78.1% of positive LNA results with DAT titers < 1:6,400 (n = 782). Risk factors predictive of a positive LNA result were an age of 1-29 years, male sex, a hemoglobin level < 10.0 g/dL, a DAT titer > or = 1:800, and a location with a higher prevalence of VL. Lymph node and splenic aspirations were similarly accurate as tests of cure after treatment of 50 VL patients in southern Sudan. Pre-treatment LNA results were negative in 20 cases of severe post kala-azar dermal leishmaniasis

Evaluating the named nurse understanding of recovery in forensic mental health

This article describes a service evaluation carried out on a personality disorder admission ward in a high-secure hospital to evaluate nurses understanding of recovery approaches in mental health. The study used semi-structured questionnaires to determine the participant’s understanding of recovery. The findings highlight that further development is required in staff training and education on recovery. Theories underpinning recovery principles also need to be disseminated to help nurses understand the relevance of current policy developments, and thus improve care

Bremsstrahlung simulation in K to pi l^pm nu_l (gamma) decays

In physics simulation chains, the PHOTOS Monte Carlo program is often used to simulate QED effects in decays of intermediate particles and resonances. The program is based on an exact multiphoton phase space. In general, the matrix element is obtained from iterations of a universal kernel and approximations are involved. To evaluate the program precision, it is necessary to formulate and implement within the generator the exact matrix element, which depends on the decay channel. Then, all terms necessary for non-leading logarithms are taken into account. In the present letter we focus on the decay K to pi l^pm nu_l and tests of the PHOTOS Monte Carlo program. We conclude a 0.2% relative precision in the implementation of the hard photon matrix element into the emission kernel, including the case where approximations are used.Comment: 1+20 pages, 8 figure

Universal Interface of TAUOLA Technical and Physics Documentation

Because of their narrow width, tau decays can be well separated from their production process. Only spin degrees of freedom connect these two parts of the physics process of interest for high energy collision experiments. In the following, we present a Monte Carlo algorithm which is based on that property. The interface supplements events generated by other programs, with tau decays. Effects of spin, genuine weak corrections or of new physics may be taken into account at the time when a tau decay is generated and written into an event record.Comment: 1+44 pages, 17 eps figure

Entanglement and co-tunneling of two equivalent protons in hydrogen bond pairs

The following article appeared in The Journal of Chemical Physics 148, 102307 (2018) and may be found at https://doi.org/10.1063/1.5000681A theoretical study is reported of a system of two identical symmetric hydrogen bonds, weakly coupled such that the two mobile protons can move either separately (stepwise) or together (concerted). It is modeled by two equivalent quartic potentials interacting through dipolar and quadrupolar coupling terms. The tunneling Hamiltonian has two imaginary modes (reaction coordinates) and a potential with a single maximum that may turn into a saddle-point of second order and two sets of (inequivalent) minima. Diagonalization is achieved via a modified Jacobi-Davidson algorithm. From this Hamiltonian the mechanism of proton transfer is derived. To find out whether the two protons move stepwise or concerted, a new tool is introduced, based on the distribution of the probability flux in the dividing plane of the transfer mode. While stepwise transfer dominates for very weak coupling, it is found that concerted transfer (co-tunneling) always occurs, even when the coupling vanishes since the symmetry of the Hamiltonian imposes permanent entanglement on the motions of the two protons. We quantify this entanglement and show that, for a wide range of parameters of interest, the lowest pair of states of the Hamiltonian represents a perfect example of highly entangled quantum states in continuous variables. The method is applied to the molecule porphycene for which the observed tunneling splitting is calculated in satisfactory agreement with experiment, and the mechanism of double-proton tunneling is found to be predominantly concerted. We show that, under normal conditions, when they are in the ground state, the two porphycene protons are highly entangled, which may have interesting applications. The treatment also identifies the conditions under which such a system can be handled by conventional one-instanton techniquesFinancial support from Ministerio de Economia y Competitividad of Spain (Research Grant No. CTQ2014-58617-R), the Consellería de Cultura, Educación e Ordenación Universitaria (Centro singular de investigacion de Galicia acreditación 2016-2019, No. ED431G/09), and the European Regional Development Fund (ERDF) is gratefully acknowledgedS

The see-saw mechanism: neutrino mixing, leptogenesis and lepton flavor violation

The see-saw mechanism to generate small neutrino masses is reviewed. After summarizing our current knowledge about the low energy neutrino mass matrix we consider reconstructing the see-saw mechanism. Low energy neutrino physics is not sufficient to reconstruct see-saw, a feature which we refer to as ``see-saw degeneracy''. Indirect tests of see-saw are leptogenesis and lepton flavor violation in supersymmetric scenarios, which together with neutrino mass and mixing define the framework of see-saw phenomenology. Several examples are given, both phenomenological and GUT-related. Variants of the see-saw mechanism like the type II or triplet see-saw are also discussed. In particular, we compare many general aspects regarding the dependence of LFV on low energy neutrino parameters in the extreme cases of a dominating conventional see-saw term or a dominating triplet term. For instance, the absence of mu -> e gamma or tau -> e gamma in the pure triplet case means that CP is conserved in neutrino oscillations. Scanning models, we also find that among the decays mu -> e gamma, tau -> e gamma and tau -> mu gamma the latter one has the largest branching ratio in (i) SO(10) type I see-saw models and in (ii) scenarios in which the triplet term dominates in the neutrino mass matrix.Comment: 26 pages, 7 figures. Expanded version of talk given at 10th Workshop In High Energy Physics Phenomenology (WHEPP 10), January 2008, Chennai, India. Typos corrected, comments and references adde

Macroscopic Quantum Tunneling of a Fluxon in a Long Josephson Junction

Macroscopic quantum tunneling (MQT) for a single fluxon moving along a long Josephson junction is studied theoretically. To introduce a fluxon-pinning force, we consider inhomogeneities made by modifying thickness of an insulating layer locally. Two different situations are studied: one is the quantum tunneling from a metastable state caused by a single inhomogeneity, and the other is the quantum tunneling in a two-state system made by two inhomogeneities. In the quantum tunneling from a metastable state, the decay rate is estimated within the WKB approximation. Dissipation effects on a fluxon dynamics are taken into account by the Caldeira-Leggett theory. We propose a device to observe quantum tunneling of a fluxon experimentally. Required experimental resolutions to observe MQT of a fluxon seem attainable within the presently available micro-fabrication technique. For the two-state system, we study quantum resonance between two stable states, i.e., macroscopic quantum coherence (MQC). From the estimate for dissipation coefficients due to quasiparticle tunneling, the observation of MQC appears to be possible within the Caldeira-Leggett theory.Comment: 30 pages LaTeX including 11 PS figures, using jpsj.sty. To be published on J. Phys. Soc. Jpn. Overestimates for damping amplitude is correcte

Nuclear Antishadowing in Neutrino Deep Inelastic Scattering

The shadowing and antishadowing of nuclear structure functions in the Gribov-Glauber picture is due respectively to the destructive and constructive interference of amplitudes arising from the multiple-scattering of quarks in the nucleus. The effective quark-nucleon scattering amplitude includes Pomeron and Odderon contributions from multi-gluon exchange as well as Reggeon quark-exchange contributions. We show that the coherence of these multiscattering nuclear processes leads to shadowing and antishadowing of the electromagnetic nuclear structure functions in agreement with measurements. This picture leads to substantially different antishadowing for charged and neutral current reactions, thus affecting the extraction of the weak-mixing angle $\theta_W$. We find that part of the anomalous NuTeV result for $\theta_W$ could be due to the nonuniversality of nuclear antishadowing for charged and neutral currents. Detailed measurements of the nuclear dependence of individual quark structure functions are thus needed to establish the distinctive phenomenology of shadowing and antishadowing and to make the NuTeV results definitive.Comment: 38 pages, 15 figure

Quantum Breathers in a Nonlinear Lattice

We study nonlinear phonon excitations in a one-dimensional quantum nonlinear lattice model using numerical exact diagonalization. We find that multi-phonon bound states exist as eigenstates which are natural counterparts of breather solutions of classical nonlinear systems. In a translationally invariant system, these quantum breather states form particle-like bands and are characterized by a finite correlation length. The dynamic structure factor has significant intensity for the breather states, with a corresponding quenching of the neighboring bands of multi-phonon extended states.Comment: 4 pages, RevTex, 4 postscript figures, Physical Relview Letters (in press