Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial

OBJECTIVE: To evaluate the cost effectiveness of standard treatment with and without the addition of ward based non-invasive ventilation in patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Incremental cost effectiveness analysis of a randomised controlled trial. SETTING: Medical wards in 14 hospitals in the United Kingdom. PARTICIPANTS: The trial comprised 236 patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease and mild to moderate acidosis (pH 7.25-7.35) secondary to respiratory failure. The economic analysis compared the costs of treatment that these patients received after randomisation. MAIN OUTCOME MEASURE: Incremental cost per in-hospital death. RESULTS: 24/118 died in the group receiving standard treatment and 12/118 in the group receiving non-invasive ventilation (P=0.05). Allocation to the group receiving non-invasive ventilation was associated with a reduction in costs of £49 362 ($78 741; 73 109), mainly through reduced use of intensive care units. The incremental cost effectiveness ratio was £645 per death avoided (95% confidence interval £2310 to £386), indicating a dominant (more effective and less costly) strategy. Modelling of these data indicates that a typical UK hospital providing a non-invasive ventilation service will avoid six deaths and three to nine admissions to intensive care units per year, with an associated cost reduction of £12 000-53 000 per year. CONCLUSIONS: Non-invasive ventilation is a highly cost effective treatment that both reduced total costs and improved mortality in hospital

Effects of the reactor-coolant pumps during a small-break loss-of-coolant accident

TRAC-PD2 calculations indicate that more coolant mass remains in the system when the reactor coolant pumps are left in operation following a small cold-leg break. The analyses were performed for a Westinghouse plant (Zion-1) to help determine whether to trip the pumps at high-pressure injection initiation (the present operator directive), to trip the pumps at some later time in the transient, or to leave the pumps running indefinitely. The loop seals' behavior and the system refill characteristics primarily determined the results. 9 figures

Real-time digital signal processor implementation of self-calibrating pulse-shape discriminator for high purity germanium

Pulse-shape analysis of the ionization signals from germanium gamma-ray spectrometers is a method for obtaining information that can characterize an event beyond just the total energy deposited in the crystal. However, as typically employed, this method is data-intensive requiring the digitization, transfer, and recording of electronic signals from the spectrometer. A hardware realization of a real-time digital signal processor for implementing a parametric pulse shape is presented. Specifically, a previously developed method for distinguishing between single-site and multi-site gamma-ray interactions is demonstrated in an on-line digital signal processor, compared with the original off-line pulse-shape analysis routine, and shown to have no significant difference. Reduction of the amount of the recorded information per event is shown to translate into higher duty-cycle data acquisition rates while retaining the benefits of additional event characterization from pulse-shape analysis.Comment: Accepted by NIM

EXPRESS: Gender(ed) performances: women’s impression management in stand-up comedy

How do women navigate and make space for themselves in workspaces where they are not perceived to fit? Women in male dominated careers often face perceptions of role misfit, leading them to engage in impression management. Using a mixed-methods design, we investigate if women stand-up comedians present as female gendered at work in two settings - one dominated by male performers (N = 257) and one featuring more gender diverse performers (N = 843). Women, as compared to men, presented more gendered in the more gender diverse performer setting and less gendered in the male performer dominated setting. Using Lorber’s taxonomy of feminisms as a lens, assessment of how women presented their gender further implied greater constraint on women in the male dominated, compared to the diverse, setting. Our findings support Roberts’ theory of social-identity based impression management (SIM) in the novel context of stand-up comedy, refine the theory by presenting a fifth SIM strategy and demonstrate how women are able to adapt their feminism to the characteristics of the situation, thus helping secure their position in settings where they may be unwelcomed. These findings have theoretical implications for impression management and feminism, and practical implications for workplace equality initiatives

A global Mars dust composition refined by the Alpha-Particle X-ray Spectrometer in Gale Crater

Modern Martian dust is similar in composition to the global soil unit and bulk basaltic Mars crust, but it is enriched in S and Cl. The Alpha Particle X-ray Spectrometer (APXS) on the Mars Science Laboratory Curiosity rover analyzed air fall dust on the science observation tray (o-tray) in Gale Crater to determine dust oxide compositions. The o-tray dust has the highest concentrations of SO3 and Cl measured in Mars dust (SO3 8.3%; Cl 1.1 wt %). The molar S/Cl in the dust (3.35 ± 0.34) is consistent with previous studies of Martian dust and soils (S/Cl = 3.7 ± 0.7). Fe is also elevated ~25% over average Mars soils and the bulk crust. These enrichments link air fall dust with the S-, Cl-, and Fe-rich X-ray amorphous component of Gale Crater soil. Dust and soil have the same S/Cl, constraining the surface concentrations of S and Cl on a global scale

A Quantum-Mechanical Equivalent-Photon Spectrum for Heavy-Ion Physics

In a previous paper, we calculated the fully quantum-mechanical cross section for electromagnetic excitation during peripheral heavy-ion collisions. Here, we examine the sensitivity of that cross section to the detailed structure of the projectile and target nuclei. At the transition energies relevant to nuclear physics, we find the cross section to be weakly dependent on the projectile charge radius, and to be sensitive to only the leading momentum-transfer dependence of the target transition form factors. We exploit these facts to derive a quantum-mechanical ``equivalent-photon spectrum'' valid in the long-wavelength limit. This improved spectrum includes the effects of projectile size, the finite longitudinal momentum transfer required by kinematics, and the response of the target nucleus to the off-shell photon.Comment: 19 pages, 5 figure

Auger decay of degenerate and Bose-condensed excitons in Cu2_2O

We study the non-radiative Auger decay of excitons in Cu$_2$O, in which two excitons scatter to an excited electron and hole. The exciton decay rate for the direct and the phonon-assisted processes is calculated from first principles; incorporating the band structure of the material leads to a relatively shorter lifetime of the triplet state ortho excitons. We compare our results with the Auger decay rate extracted from data on highly degenerate triplet excitons and Bose-condensed singlet excitons in Cu$_2$O.Comment: 15 pages, revtex, figures available from G. Kavoulaki

The Harris-Luck criterion for random lattices

The Harris-Luck criterion judges the relevance of (potentially) spatially correlated, quenched disorder induced by, e.g., random bonds, randomly diluted sites or a quasi-periodicity of the lattice, for altering the critical behavior of a coupled matter system. We investigate the applicability of this type of criterion to the case of spin variables coupled to random lattices. Their aptitude to alter critical behavior depends on the degree of spatial correlations present, which is quantified by a wandering exponent. We consider the cases of Poissonian random graphs resulting from the Voronoi-Delaunay construction and of planar, ``fat'' $\phi^3$ Feynman diagrams and precisely determine their wandering exponents. The resulting predictions are compared to various exact and numerical results for the Potts model coupled to these quenched ensembles of random graphs.Comment: 13 pages, 9 figures, 2 tables, REVTeX 4. Version as published, one figure added for clarification, minor re-wordings and typo cleanu

Special fast diffusion with slow asymptotics. Entropy method and flow on a Riemannian manifold

We consider the asymptotic behaviour of positive solutions $u(t,x)$ of the fast diffusion equation $u_t=\Delta (u^{m}/m)={\rm div} (u^{m-1}\nabla u)$ posed for x\in\RR^d, $t>0$, with a precise value for the exponent $m=(d-4)/(d-2)$. The space dimension is $d\ge 3$ so that $m<1$, and even $m=-1$ for $d=3$. This case had been left open in the general study \cite{BBDGV} since it requires quite different functional analytic methods, due in particular to the absence of a spectral gap for the operator generating the linearized evolution. The linearization of this flow is interpreted here as the heat flow of the Laplace-Beltrami operator of a suitable Riemannian Manifold (\RR^d,{\bf g}), with a metric ${\bf g}$ which is conformal to the standard \RR^d metric. Studying the pointwise heat kernel behaviour allows to prove {suitable Gagliardo-Nirenberg} inequalities associated to the generator. Such inequalities in turn allow to study the nonlinear evolution as well, and to determine its asymptotics, which is identical to the one satisfied by the linearization. In terms of the rescaled representation, which is a nonlinear Fokker--Planck equation, the convergence rate turns out to be polynomial in time. This result is in contrast with the known exponential decay of such representation for all other values of $m$.Comment: 37 page

Higgs Scalars in the Minimal Non-minimal Supersymmetric Standard Model

We consider the simplest and most economic version among the proposed non-minimal supersymmetric models, in which the $\mu$-parameter is promoted to a singlet superfield, whose all self-couplings are absent from the renormalizable superpotential. Such a particularly simple form of the renormalizable superpotential may be enforced by discrete $R$-symmetries which are extended to the gravity-induced non-renormalizable operators as well. We show explicitly that within the supergravity-mediated supersymmetry-breaking scenario, the potentially dangerous divergent tadpoles associated with the presence of the gauge singlet first appear at loop levels higher than 5 and therefore do not destabilize the gauge hierarchy. The model provides a natural explanation for the origin of the $\mu$-term, without suffering from the visible axion or the cosmological domain-wall problem. Focusing on the Higgs sector of this minimal non-minimal supersymmetric standard model, we calculate its effective Higgs potential by integrating out the dominant quantum effects due to stop squarks. We then discuss the phenomenological implications of the Higgs scalars predicted by the theory for the present and future high-energy colliders. In particular, we find that our new minimal non-minimal supersymmetric model can naturally accommodate a relatively light charged Higgs boson, with a mass close to the present experimental lower bound.Comment: 63 pages (12 figures), extended versio