A paediatric telecardiology service for district hospitals in south-east England: an observational study.

The attached article is a Publisher version of the final published version which may be accessed at the link below. Copyright © 2010 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. All rights reservedOBJECTIVES: To compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements. DESIGN: Prospective cohort study over 15 months. SETTING: Four district hospitals in south-east England and a London paediatric cardiology centre. PATIENTS: Babies and children. INTERVENTION: A telecardiology service introduced alongside outreach clinics. MEASUREMENTS: Clinical outcomes and mean NHS costs per patient. RESULTS: 266 new patients were studied: 75 had teleconsultations (19 of 42 newborns and 56 of 224 infants and children). Teleconsultation patients generally were younger (49% being under 1 year compared with 32% seen personally (p = 0.025)) and their symptoms were not as severe. A cardiac intervention was undertaken immediately or planned for five telemedicine patients (7%) and 30 conventional patients (16%). However, similar proportions of patients were discharged after being assessed (32% telemedicine and 39% conventional). During scheduled teleconferences the mean duration of time per patient in sessions involving real-time echocardiography was 14.4 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost-neutral for the three hospitals with infrequently-held outreach clinics (1519 UK pounds vs 1724 UK pounds respectively after 14 days). CONCLUSION: Paediatric cardiology centres with small cadres of specialists are under pressure to cope with ever-expanding caseloads of new patients with suspected anomalies. Innovative use of telecardiology alongside conventional outreach services should suitably, and economically, enhance access to these specialists.The Department of Health and the Charitable Funds Committee of the Royal Brompton and Harefield NHS Trust funded the project

The Effect of wake Turbulence Intensity on Transition in a Compressor Cascade

Direct numerical simulations of separating flow along a section at midspan of a low-pressure V103 compressor cascade with periodically incoming wakes were performed. By varying the strength of the wake, its influence on both boundary layer separation and bypass transition were examined. Due to the presence of small-scale three-dimensional fluctuations in the wakes, the flow along the pressure surface undergoes bypass transition. Only in the weak-wake case, the boundary layer reaches a nearly-separated state between impinging wakes. In all simulations, the flow along the suction surface was found to separate. In the simulation with the strong wakes, separation is intermittently suppressed as the periodically passing wakes managed to trigger turbulent spots upstream of the location of separation. As these turbulent spots convect downstream, they locally suppress separation. © 2014 Springer Science+Business Media Dordrecht

Apparent competition drives community-wide parasitism rates and changes in host abundance across ecosystem boundaries

Species have strong indirect effects on others, and predicting these effects is a central challenge in ecology. Prey species sharing an enemy (predator or parasitoid) can be linked by apparent competition, but it is unknown whether this process is strong enough to be a community-wide structuring mechanism that could be used to predict future states of diverse food webs. Whether species abundances are spatially coupled by enemy movement across different habitats is also untested. Here, using a field experiment, we show that predicted apparent competitive effects between species, mediated via shared parasitoids, can significantly explain future parasitism rates and herbivore abundances. These predictions are successful even across edges between natural and managed forests, following experimental reduction of herbivore densities by aerial spraying over 20ha. This result shows that trophic indirect effects propagate across networks and habitats in important, predictable ways, with implications for landscape planning, invasion biology and biological control

Long-term stability studies of a semiconductor photoelectrode in three-electrode configuration

Improving the stability of semiconductor materials is one of the major challenges for sustainable and economic photoelectrochemical water splitting. N-terminated GaN nanostructures have emerged as a practical protective layer for conventional high efficiency but unstable Si and III-V photoelectrodes due to their near-perfect conduction band-alignment, which enables efficient extraction of photo-generated electrons, and N-terminated surfaces, which protects against chemical and photo-corrosion. Here, we demonstrate that Pt-decorated GaN nanostructures on an n+-p Si photocathode can exhibit an ultrahigh stability of 3000 h (i.e., over 500 days for usable sunlight ∼5.5 h per day) at a large photocurrent density (>35 mA cm-2) in three-electrode configuration under AM 1.5G one-sun illumination. The measured applied bias photon-to-current efficiency of 11.9%, with an excellent onset potential of ∼0.56 V vs. RHE, is one of the highest values reported for a Si photocathode under AM 1.5G one-sun illumination. This study provides a paradigm shift for the design and development of semiconductor photoelectrodes for PEC water splitting: stability is no longer limited by the light absorber, but rather by co-catalyst particles

On spherical twisted conjugacy classes

Let G be a simple algebraic group over an algebraically closed field of good odd characteristic, and let theta be an automorphism of G arising from an involution of its Dynkin diagram. We show that the spherical theta-twisted conjugacy classes are precisely those intersecting only Bruhat cells corresponding to twisted involutions in the Weyl group. We show how the analogue of this statement fails in the triality case. We generalize to good odd characteristic J-H. Lu's dimension formula for spherical twisted conjugacy classes.Comment: proof of Lemma 6.4 polished. The journal version is available at http://www.springerlink.com/content/k573l88256753640

Hsc66 substrate specificity is directed toward a discrete region of the iron-sulfur cluster template protein IscU

Hsc66 and Hsc20 comprise a specialized chaperone system important for the assembly of iron-sulfur clusters in Escherchia coli. Only a single substrate, the Fe/S template protein IscU, has been identified for the Hsc66/Hsc20 system, but the mechanism by which Hsc66 selectively binds IscU is unknown. We have investigated Hsc66 substrate specificity using phage display and a peptide array of IscU. Screening of a heptameric peptide phage display library revealed that Hsc66 prefers peptides with a centrally located Pro-Pro motif. Using a cellulose-bound peptide array of IscU we determined that Hsc66 interacts specifically with a region (residues 99-103, LPPVK) that is invariant among all IscU family members. A synthetic peptide (ELPPVKIHC) corresponding to IscU residues 98-106 behaves in a similar manner to native IscU, stimulating the ATPase activity of Hsc66 with similar affinity as IscU, preventing Hsc66 suppression of bovine rhodanese aggregation, and interacting with the peptide-binding domain of Hsc66. Unlike native IscU, however, the synthetic peptide is not bound by Hsc20 and does not synergistically stimulate Hsc66 ATPase activity with Hsc20. Our results indicate that Hsc66 and Hsc20 recognize distinct regions of IscU and further suggest that Hsc66 will not bind LPPVK motifs with high affinity in vivo unless they are in the context of native IscU and can be directed to Hsc66 by Hsc20

Femtosecond x rays from laser-plasma accelerators

Relativistic interaction of short-pulse lasers with underdense plasmas has recently led to the emergence of a novel generation of femtosecond x-ray sources. Based on radiation from electrons accelerated in plasma, these sources have the common properties to be compact and to deliver collimated, incoherent and femtosecond radiation. In this article we review, within a unified formalism, the betatron radiation of trapped and accelerated electrons in the so-called bubble regime, the synchrotron radiation of laser-accelerated electrons in usual meter-scale undulators, the nonlinear Thomson scattering from relativistic electrons oscillating in an intense laser field, and the Thomson backscattered radiation of a laser beam by laser-accelerated electrons. The underlying physics is presented using ideal models, the relevant parameters are defined, and analytical expressions providing the features of the sources are given. Numerical simulations and a summary of recent experimental results on the different mechanisms are also presented. Each section ends with the foreseen development of each scheme. Finally, one of the most promising applications of laser-plasma accelerators is discussed: the realization of a compact free-electron laser in the x-ray range of the spectrum. In the conclusion, the relevant parameters characterizing each sources are summarized. Considering typical laser-plasma interaction parameters obtained with currently available lasers, examples of the source features are given. The sources are then compared to each other in order to define their field of applications.Comment: 58 pages, 41 figure