Cost effectiveness of community leg ulcer clinics: randomised controlled trial

Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses. Design: Randomised controlled trial with 1 year of follow up. Setting: Eight community based research clinics in four trusts in Trent. Subjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group. Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group). Main outcome measures: Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored. Results: The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P=0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2.03). No significant differences were found between the groups in health status. Mean total NHS costs were £878.06 per year for the clinic group and £859.34 for the control (P=0.89). Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used

Effect of varying the volume infill sand on synthetic clay surfaces in terms of the shoe-surface friction

The friction developed by the shoe-surface interface on artificial clay has not been widely studied, and can influence player's performance and injury risk. The aim of this research was to investigate the effect of varying the quantity of infill sand on shoe- surface friction on an artificial clay court tennis surface. A laboratory-based mechanical test rig was used to measure the friction force developed at the shoe-surface interface. Additionally, the perception of a group of participants, performing a turning movement on the same surface under dry conditions, was collected in order to compare against the mechanical results. The relationship between the normal force and friction generated by the shoe-surface interaction was examined for surfaces with different sand in-fill volumes. The mechanical testing was performed under dry and wet conditions, showing strong and significant differences. Results indicated that the normal force significantly influenced the static and dynamic frictional forces. For lower sand infill volumes, as normal loading increased, the dry condition was found to exhibit the lowest peak static friction force and highest average dynamic friction force. However, for higher sand infill volume conditions, the opposite behaviour was observed. Strong and significant positive linear relationships were found between peak friction force and average dynamic friction force for all infill sand volumes and conditions. The mechanical results were in agreement with the perception data, which suggests that the participants were sensitive to the small changes in sand infill volumes. The findings of this study will therefore aid the understanding of tennis players’ perceived response to a tennis court surface. In order to get a better understanding of friction behaviour, further testing needs to be performed, and once the mechanisms involved are understood, surface properties could be modified to increase performance and reduce injury risk

Friction at the tennis shoe-court interface: how biomechanically informed lab-based testing can enhance understanding

This paper presents some of the methodology, observations and findings from a 30-month study, aiming to improve the understanding of tennis shoe-court interactions and the biomechanical implications of changes in friction between the shoe and surface. A detailed programme of biomechanical player testing on different court surfaces provided the boundary conditions with which to develop a lab-based rig capable of simulating the key aspects of shoe-surface interaction that are required for acceptable performance (e.g. push-off to accelerate) within expected levels of consistency (e.g. for a controlled slide). Large- scale parametric testing could then be carried out for a variety of surface types and components under a range of loading conditions, without the risk of injury to human participants. Two case studies are described to demonstrate the value of a combined approach of biomechanical field testing and lab-based rigs that simulate shoe-court interactions. These include a study that compared different artificial clay court designs; and a study that examined the effect of different acrylic hard court parameters on friction and the tribological mechanisms that explain the observed interactio

The effect of EMAT coil geometry on the Rayleigh wave frequency behaviour

Understanding of optimal signal generation and frequency content for electromagnetic acoustic transducers (EMATs) is key to improving their design and signal to noise ratio. Linear and meander coil designs are fairly well understood, but other designs such as racetrack or focused coils have recently been proposed. Multiple transmission racetrack coil EMATs, with focused and unfocused designs, were constructed. The optimum driving frequency for maximum detected signal was found to range between 1.1 and 1.4 MHz on aluminium for a 1.5 mm width coil. A simple analytical model based on the instantaneous velocity of a wave predicts a maximum signal at 1.44 MHz. Modelling the detection coil as a spatial square wave agrees with this, and predicts a general relation of fP = 0.761v / L between the optimum frequency fP , the wave velocity v, and the coil width L. A time domain model of the detection coil predicts a 1.4 to 1.5 MHz peak for continuous wave excitation, with a frequency that decreases as the length of the wavepacket is decreased, consistent with the experimental data. Linear coil modelling using the same technique is shown to be consistent with previous work, with improving detection at lower wave frequencies, and signal minima at every integer multiple of the wavelength. Finite Element Analysis (FEA) is used to model the effects of the spatial width of the racetrack generation coil and focused geometry, and no significant difference is found between the focused and the unfocused EMAT response. This highlights the importance of designing the EMAT coil for the correct lift-off and desired frequency of operation

Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care

Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain. Design Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective. Setting The emergency department at the Northern General Hospital, Sheffield, United Kingdom. Participants 972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance. Main outcome measures The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service. Results Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, –7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of £78 per patient (–£56 to £210, P = 0.252). Conclusions Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care

One-Loop NMHV Amplitudes involving Gluinos and Scalars in N=4 Gauge Theory

We use Supersymmetric Ward Identities and quadruple cuts to generate n-pt NMHV amplitudes involving gluinos and adjoint scalars from purely gluonic amplitudes. We present a set of factors that can be used to generate one-loop NMHV amplitudes involving gluinos or adjoint scalars in N=4 Super Yang-Mills from the corresponding purely gluonic amplitude.Comment: 16 pages, JHEP versio

SUSY Ward identities for multi-gluon helicity amplitudes with massive quarks

We use supersymmetric Ward identities to relate multi-gluon helicity amplitudes involving a pair of massive quarks to amplitudes with massive scalars. This allows to use the recent results for scalar amplitudes with an arbitrary number of gluons obtained by on-shell recursion relations to obtain scattering amplitudes involving top quarks.Comment: 22 pages, references adde

MHV Techniques for QED Processes

Significant progress has been made in the past year in developing new `MHV' techniques for calculating multiparticle scattering amplitudes in Yang-Mills gauge theories. Most of the work so far has focussed on applications to Quantum Chromodynamics, both at tree and one-loop level. We show how such techniques can also be applied to abelian theories such as QED, by studying the simplest tree-level multiparticle process, e^+e^- to n \gamma. We compare explicit results for up to n=5 photons using both the Cachazo, Svrcek and Witten `MHV rules' and the related Britto-Cachazo-Feng `recursion relation' approaches with those using traditional spinor techniques.Comment: 19 pages, 10 figures. References adde

CEH-GEAR: 1 km resolution daily and monthly areal rainfall estimates for the UK for hydrological and other applications

The Centre for Ecology & Hydrology – Gridded Estimates of Areal Rainfall (CEH-GEAR) data set was developed to provide reliable 1 km gridded estimates of daily and monthly rainfall for Great Britain (GB) and Northern Ireland (NI) (together with approximately 3500 km2 of catchment in the Republic of Ireland) from 1890 onwards. The data set was primarily required to support hydrological modelling. The rainfall estimates are derived from the Met Office collated historical weather observations for the UK which include a national database of rain gauge observations. The natural neighbour interpolation methodology, including a normalisation step based on average annual rainfall (AAR), was used to generate the daily and monthly rainfall grids. To derive the monthly estimates, rainfall totals from monthly and daily (when complete month available) rain gauges were used in order to obtain maximum information from the rain gauge network. The daily grids were adjusted so that the monthly grids are fully consistent with the daily grids. The CEH-GEAR data set was developed according to the guidance provided by the British Standards Institution. The CEH-GEAR data set contains 1 km grids of daily and monthly rainfall estimates for GB and NI for the period 1890–2012. For each day and month, CEH-GEAR includes a secondary grid of distance to the nearest operational rain gauge. This may be used as an indicator of the quality of the estimates. When this distance is greater than 100 km, the estimates are not calculated due to high uncertainty

MHV Rules for Higgs Plus Multi-Gluon Amplitudes

We use tree-level perturbation theory to show how non-supersymmetric one-loop scattering amplitudes for a Higgs boson plus an arbitrary number of partons can be constructed, in the limit of a heavy top quark, from a generalization of the scalar graph approach of Cachazo, Svrcek and Witten. The Higgs boson couples to gluons through a top quark loop which generates, for large top mass, a dimension-5 operator H tr G^2. This effective interaction leads to amplitudes which cannot be described by the standard MHV rules; for example, amplitudes where all of the gluons have positive helicity. We split the effective interaction into the sum of two terms, one holomorphic (selfdual) and one anti-holomorphic (anti-selfdual). The holomorphic interactions give a new set of MHV vertices -- identical in form to those of pure gauge theory, except for momentum conservation -- that can be combined with pure gauge theory MHV vertices to produce a tower of amplitudes with more than two negative helicities. Similarly, the anti-holomorphic interactions give anti-MHV vertices that can be combined with pure gauge theory anti-MHV vertices to produce a tower of amplitudes with more than two positive helicities. A Higgs boson amplitude is the sum of one MHV-tower amplitude and one anti-MHV-tower amplitude. We present all MHV-tower amplitudes with up to four negative-helicity gluons and any number of positive-helicity gluons (NNMHV). These rules reproduce all of the available analytic formulae for Higgs + n-gluon scattering (n<=5) at tree level, in some cases yielding considerably shorter expressions.Comment: 34 pages, 8 figures; v2, references correcte