A solution to the zero-hamiltonian problem in 2-D gravity

The zero-hamiltonian problem, present in reparametrization invariant systems, is solved for the 2-D induced gravity model. Working with methods developed by Henneaux et al. we find systematically the reduced phase-space physics, generated by an {\it effective} hamiltonian obtained after complete gauge fixing.Comment: 5 pages, revte

Patients’ Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study

Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Eligible patients were identified in a service evaluation of emerge ncy presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in n iterative process. Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients’ (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients’ capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek further healthcare. The findings also point to potentially avoidable breakdowns in the diagnostic process. In particular, to encourage patients to return to the GP if symptoms escalate, a stronger emphasis is needed on diagnostic uncertainty in discussions between patients and doctors in both primary and secondary care. To improve appropriate access to rapid investigations, systems are needed for primary care to communicate directly with secondary care at the time of referral

Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality?

Background Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality. The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide. Methods This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012). Results Governmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients’ and family members’ experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically. Conclusions The relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality

New Exactly Solvable Two-Dimensional Quantum Model Not Amenable to Separation of Variables

The supersymmetric intertwining relations with second order supercharges allow to investigate new two-dimensional model which is not amenable to standard separation of variables. The corresponding potential being the two-dimensional generalization of well known one-dimensional P\"oschl-Teller model is proven to be exactly solvable for arbitrary integer value of parameter $p:$ all its bound state energy eigenvalues are found analytically, and the algorithm for analytical calculation of all wave functions is given. The shape invariance of the model and its integrability are of essential importance to obtain these results.Comment: 23 page

Comparison of the LUNA 3He(alpha,gamma)7Be activation results with earlier measurements and model calculations

Recently, the LUNA collaboration has carried out a high precision measurement on the 3He(alpha,gamma)7Be reaction cross section with both activation and on-line gamma-detection methods at unprecedented low energies. In this paper the results obtained with the activation method are summarized. The results are compared with previous activation experiments and the zero energy extrapolated astrophysical S factor is determined using different theoretical models.Comment: Accepted for publication in Journal of Physics

Influence of the radio frequency ponderomotive force on anomalous impurity transport in tokamaks

Trace impurity transport in tokamaks is studied using an electrostatic, collisionless fluid model for ion-temperature-gradient and trapped-electron mode driven turbulence in the presence of radio frequency (rf) fields, and the results are compared with neoclassical predictions. It is shown that the inward impurity convective velocity (pinch) that is usually obtained can be reduced by the rf fields, in particular close to the wave resonance location where the rf ponderomotive force may be significant. However, the impurity diffusivity and convective velocity are usually similarly affected by the ponderomotive force, and hence the steady-state impurity density peaking factor -∇nz/nz is only moderately affected by the rf fields

Treatment of acute rhinitis with a nasal spray containing tramazoline and essential oils: a multicenter, uncontrolled, observational trial

BACKGROUND: In this observational trial, data were collected on the effectiveness and tolerability/safety of a nasal spray containing tramazoline and essential oils (trade name Rhinospray((R)) Plus) used for symptomatic treatment of acute rhinitis due to common cold. METHODS: The trial was performed in 300 children, adolescents and adults, who were to be treated with Rhinospray((R)) Plus for up to 4 times per day for up to 10 days. Primary endpoints were the change from baseline to final visit in the mean of three single symptom scores (blocked nose, sneezing, and runny nose) and the mean improvement in two quality-of-life parameters (ability to perform normal daytime activities and quality of sleep). RESULTS: A total of 108 children, 30 adolescents and 162 adults were treated with Rhinospray((R)) Plus. No patient discontinued prematurely. There was a mean reduction of 2.0 +/- 0.6 (standard deviation) in nasal symptom scores from baseline to final visit; 297 of 300 of patients (99.0 %) reported an improvement. The mean value for improvement in quality-of-life parameters was 1.3 +/- 0.5. Improvement in daytime activities was reported by all 300 patients (100.0 %) and in quality of sleep by 292 patients (97.4 %). Effectiveness and tolerability were rated as 'very good' or 'good' by 95.4 % and 97.4 % of patients, respectively; the investigators rated effectiveness and tolerability as 'very good' or 'good' for 97.4 % and 100.0 % of patients, respectively. No adverse events were reported. CONCLUSIONS: Community-based patients reported a relief in acute rhinitis symptoms and improvement in quality of life as a result of treatment with Rhinospray((R)) Plus. Treatment was well-tolerated

Determining the 7Li(n,gamma) cross section via Coulomb dissociation of 8Li

The applicability of Coulomb dissociation reactions to determine the cross section for the inverse neutron capture reaction was explored using the reaction 8Li(gamma,n)7Li. A 69.5 MeV/nucleon 8Li beam was incident on a Pb target, and the outgoing neutron and 7Li nucleus were measured in coincidence. The deduced (n,gamma) excitation function is consistent with data for the direct capture reaction 7Li(n,gamma)8Li and with low-energy effective field theory calculations.Comment: Accepted for publication in Phys. Rev.

Quantum gravity correction, evolution of scalar field and inflation

We take the first nontrivial coefficient of the Schwinger-DeWitt expansion as a leading correction to the action of the second-derivative metric-dilaton gravity. To fix the ambiguities related with an arbitrary choice of the gauge fixing condition and the parametrization for the quantum field, one has to use the classical equations of motion. As a result, the only corrections are the ones to the potential of the scalar field. It turns out that the parameters of the initial classical action may be chosen in such a way that the potential satisfies most of the conditions for successful inflation.Comment: 11 pages, 3 figure