Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease : 5-year follow-up of multicentre randomised trial (the REFLUX trial)

Peer reviewedPublisher PD

"Making Safety Happen" Through Probabilistic Risk Assessment at NASA

NASA is using Probabilistic Risk Assessment (PRA) as one of the tools in its Safety & Mission Assurance (S&MA) tool belt to identify and quantify risks associated with human spaceflight. This paper discusses some of the challenges and benefits associated with developing and using PRA for NASA human space programs. Some programs have entered operation prior to developing a PRA, while some have implemented PRA from the start of the program. It has been observed that the earlier a design change is made in the concept or design phase, the less impact it has on cost and schedule. Not finding risks until the operation phase yields much costlier design changes and major delays, which can result in discussions of just accepting the risk. Risk contributors identified by PRA are not just associated with hardware failures. They include but are not limited to crew fatality due to medical causes, the environment the vehicle and crew are exposed to, the software being used, and the reliability of the crew performing required actions. Some programs have entered operation prior to developing a PRA, and while PRA can still provide a benefit for operations and future design trades, the benefit of implementing PRA from the start of the program provides the added benefit of informing design and reducing risk early in program development. Currently, NASAs International Space Station (ISS) program is in its 20th year of on-orbit operations around the Earth and has several new programs in the design phase preparing to enter the operation phase all of which have active (or living) PRAs. These programs incorporate PRA as part of their Risk-Informed, Decision-Making (RIDM) process. For new NASA human spaceflight programs discussion begins with mission concept, establishing requirements, forming the PRA team, and continues through the design cycles into the operational phase. Several examples of PRA related applications and observed lessons are included

Evolution of speckle during spinodal decomposition

Time-dependent properties of the speckled intensity patterns created by scattering coherent radiation from materials undergoing spinodal decomposition are investigated by numerical integration of the Cahn-Hilliard-Cook equation. For binary systems which obey a local conservation law, the characteristic domain size is known to grow in time $\tau$ as $R = [B \tau]^n$ with n=1/3, where B is a constant. The intensities of individual speckles are found to be nonstationary, persistent time series. The two-time intensity covariance at wave vector ${\bf k}$ can be collapsed onto a scaling function $Cov(\delta t,\bar{t})$, where $\delta t = k^{1/n} B |\tau_2-\tau_1|$ and $\bar{t} = k^{1/n} B (\tau_1+\tau_2)/2$. Both analytically and numerically, the covariance is found to depend on $\delta t$ only through $\delta t/\bar{t}$ in the small-$\bar{t}$ limit and $\delta t/\bar{t} ^{1-n}$ in the large-$\bar{t}$ limit, consistent with a simple theory of moving interfaces that applies to any universality class described by a scalar order parameter. The speckle-intensity covariance is numerically demonstrated to be equal to the square of the two-time structure factor of the scattering material, for which an analytic scaling function is obtained for large $\bar{t}.$ In addition, the two-time, two-point order-parameter correlation function is found to scale as $C(r/(B^n\sqrt{\tau_1^{2n}+\tau_2^{2n}}),\tau_1/\tau_2)$, even for quite large distances $r$. The asymptotic power-law exponent for the autocorrelation function is found to be $\lambda \approx 4.47$, violating an upper bound conjectured by Fisher and Huse.Comment: RevTex: 11 pages + 12 figures, submitted to PR

The Phenomenology of a Top Quark Seesaw Model

The top quark seesaw mechanism offers a method for constructing a composite Higgs field without the usual difficulties that accompany traditional technicolor or topcolor theories. The focus of this article is to study the phenomenology of the new physics required by this mechanism. After establishing a set of criteria for a plausible top quark seesaw theory, we develop two models, the first of which has a heavy weak singlet fermion with hypercharge 4/3 while the second has, in addition, a heavy weak singlet hypercharge -2/3 fermion. At low energies, these theories contain one or two Higgs doublets respectively. We then derive the low energy effective Higgs potential in detail for the two-doublet theory as well as study the likely experimental signatures for both theories. A strong constraint on the one-doublet model is the measured value of the rho parameter which permits the new heavy fermion to have a mass of about 5-7 TeV, when the Higgs has a mass greater than 300 GeV. In the two-doublet model, mixing of the new heavy Y=-2/3 fermion and the b quark affects the prediction for R_b. In order to agree with the current limits on R_b, the mass of this fermion should be at least 12 TeV. The mass of the heavy Y=4/3 fermion in the two-doublet model is not as sharply constrained by experiments and can be as light as 2.5 TeV.Comment: 33 pages, 12 figures, uses harvmac and picte

Antiarrhythmic and proarrhythmic effects of subcutaneous nerve stimulation in ambulatory dogs

Background High output subcutaneous nerve stimulation (ScNS) remodels the stellate ganglia and suppresses cardiac arrhythmia. Objective To test the hypothesis that long duration low output ScNS causes cardiac nerve sprouting, increases plasma norepinephrine concentration and the durations of paroxysmal atrial tachycardia (PAT) in ambulatory dogs. Methods We prospectively randomized 22 dogs (11 males and 11 females) into 5 different output groups for 2 months of ScNS: 0 mA (sham) (N=6), 0.25 mA (N=4), 1.5 mA (N=4), 2.5 mA (N=4) and 3.5 mA (N=4). Results As compared with baseline, the changes of the durations of PAT episodes per 48 hours were significantly different among different groups (sham, -5.0±9.5 s; 0.25 mA 95.5±71.0 s; 1.5 mA, -99.3±39.6 s; 2.5 mA, -155.3±87.8 s and 3.5 mA, -76.3±44.8 s, p<0.001). The 3.5 mA group had greater reduction of sinus heart rate than the sham group (-29.8±15.0 bpm vs -14.5±3.0 bpm, p=0.038). Immunohistochemical studies showed that the 0.25 mA group had a significantly increased while 2.5 mA and 3.5 mA stimulation had a significantly reduced growth-associated protein 43 nerve densities in both atria and ventricles. The plasma Norepinephrine concentrations in 0.25 mA group was 5063.0±4366.0 pg/ml, which was significantly higher than other groups of dogs (739.3±946.3, p=0.009). There were no significant differences in the effects of simulation between males and females. Conclusions In ambulatory dogs, low output ScNS causes cardiac nerve sprouting, increases plasma norepinephrine concentration and the duration of PAT episodes while high output ScNS is antiarrhythmic

Spacings of Quarkonium Levels with the Same Principal Quantum Number

The spacings between bound-state levels of the Schr\"odinger equation with the same principal quantum number $N$ but orbital angular momenta $\ell$ differing by unity are found to be nearly equal for a wide range of power potentials $V = \lambda r^\nu$, with $E_{N \ell} \approx F(\nu, N) - G(\nu,N) \ell$. Semiclassical approximations are in accord with this behavior. The result is applied to estimates of masses for quarkonium levels which have not yet been observed, including the 2P $c \bar c$ states and the 1D $b \bar b$ states.Comment: 20 pages, latex, 3 uuencoded figures submitted separately (process using psfig.sty

Application of Confocal Laser Scanning Microscopy to Cytocompatibility Testing of Potential Orthopaedic Materials in Immortalised Osteoblast-Like Cell Lines

Confocal laser scanning microscopy (CLSM) was used in conjunction with in vitro cell culture to investigate cellular interactions with orthopaedic biomaterials. Transfected rat and human osteoblasts were seeded on two potential isoelastic hip prosthesis materials, carbon fibre reinforced polyetheretherketone (PEEK) and epoxy. Titanium 318 alloy was employed as a control. Determination of the material surface contour, an important factor influencing cellular adhesion, proliferation and function, was performed using the industry standard Talysurf® and compared to analogous results obtained using the CLSM. The latter technique consistently gave higher values of material roughness but offers the advantage that it can be used to correlate roughness with cell distribution on the same samples, whereas Talysurf® measurement of roughness requires clean rigid samples. Image analysis and processing, performed on cells after attachment and culture on the materials for 48 hours, provided cell morphology data. Cells cultured on titanium were larger, with a higher percentage of cytoplasm, than those grown on either of the other materials. The macroscopic surface of epoxy resulted in smaller cells with altered morphology, which orientated themselves along carbon fibres. In conclusion, we believe CLSM offers great potential for investigating the cellular interactions of biomaterials involving minimal sample preparation, non-invasive optical sectioning of samples and minimal opportunity for generation of cellular deformation and sample preparation artefacts

Molecular weight effects on chain pull-out fracture of reinforced polymeric interfaces

Using Brownian dynamics, we simulate the fracture of polymer interfaces reinforced by diblock connector chains. We find that for short chains the interface fracture toughness depends linearly on the degree of polymerization $N$ of the connector chains, while for longer chains the dependence becomes $N^{3/2}$. Based on the geometry of initial chain configuration, we propose a scaling argument that accounts for both short and long chain limits and crossover between them.Comment: 5 pages, 3 figure

Strength functions, entropies and duality in weakly to strongly interacting fermionic systems

We revisit statistical wavefunction properties of finite systems of interacting fermions in the light of strength functions and their participation ratio and information entropy. For weakly interacting fermions in a mean-field with random two-body interactions of increasing strength $\lambda$, the strength functions $F_k(E)$ are well known to change, in the regime where level fluctuations follow Wigner's surmise, from Breit-Wigner to Gaussian form. We propose an ansatz for the function describing this transition which we use to investigate the participation ratio $\xi_2$ and the information entropy $S^{\rm info}$ during this crossover, thereby extending the known behavior valid in the Gaussian domain into much of the Breit-Wigner domain. Our method also allows us to derive the scaling law for the duality point $\lambda = \lambda_d$, where $F_k(E)$, $\xi_2$ and $S^{\rm info}$ in both the weak ($\lambda=0$) and strong mixing ($\lambda = \infty$) basis coincide as $\lambda_d \sim 1/\sqrt{m}$, where $m$ is the number of fermions. As an application, the ansatz function for strength functions is used in describing the Breit-Wigner to Gaussian transition seen in neutral atoms CeI to SmI with valence electrons changing from 4 to 8