Formation and interaction of resonance chains in the open 3-disk system

In ballistic open quantum systems one often observes that the resonances in the complex-energy plane form a clear chain structure. Taking the open 3-disk system as a paradigmatic model system, we investigate how this chain structure is reflected in the resonance states and how it is connected to the underlying classical dynamics. Using an efficient scattering approach we observe that resonance states along one chain are clearly correlated while resonance states of different chains show an anticorrelation. Studying the phase space representations of the resonance states we find that their localization in phase space oscillate between different regions of the classical trapped set as one moves along the chains and that these oscillations are connected to a modulation of the resonance spacing. A single resonance chain is thus no WKB quantization of a single periodic orbits, but the structure of several oscillating chains arises from the interaction of several periodic orbits. We illuminate the physical mechanism behind these findings by combining the semiclassical cycle expansion with a quantum graph model.Comment: 25 pages, 15 figure

Percutaneous heart valve interventions: a South African perspective

Valvular heart disease represents a significant health care challenge in South Africa, mainly due to the prevalence of rheumatic fever. This review discusses the recent advances in percutaneous heart valve treatment, including heart valve replacement, as an alternative to open prosthetic valve replacement and it’s relevance in South Africa. Balloon mitral valvotomy is discussed with emphasis on patient selection, management during pregnancy and management in the presence of left atrial thrombus. Further developments regarding the percutaneous treatment of mitral valve disease include percutaneous treatment of mitral incompetence by annuloplasty via the coronary sinus and edge-to-edge repair with the aid of a mitral clip. Transcatheter aortic valve replacement is the more developed procedure and two valves have the CE mark of approval. Both have good short to medium term data demonstrating efficacy but are technically difficult to insert, very expensive and patient selection remains a major problem. Their use is thus limited to patients turned down for conventional surgery.Percutaneous pulmonary valve replacement has good evidence to show efficacy but its use is largely limited to patients with degenerated pulmonary outflow tract conduits

Experimental Observation of the Spectral Gap in Microwave n-Disk Systems

Symmetry reduced three-disk and five-disk systems are studied in a microwave setup. Using harmonic inversion the distribution of the imaginary parts of the resonances is determined. With increasing opening of the systems, a spectral gap is observed for thick as well as for thin repellers and for the latter case it is compared with the known topological pressure bounds. The maxima of the distributions are found to coincide for a large range of the distance to radius parameter with half of the classical escape rate. This confirms theoretical predictions based on rigorous mathematical analysis for the spectral gap and on numerical experiments for the maxima of the distributions.Comment: 5 pages, 4 figure

Variation in compulsory psychiatric inpatient admission in England:a cross-sectional, multilevel analysis

Background: Rates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes. Objectives: To quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places. Design: Cross-sectional analysis using multilevel statistical modelling. Setting: England, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services. Participants: 1,287,730 patients. Main outcome measure: The study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period. Data sources: The Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers. Results: A total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models. Conclusions: This was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Weyl asymptotics: From closed to open systems

We present microwave experiments on the symmetry reduced 5-disk billiard studying the transition from a closed to an open system. The measured microwave reflection signal is analyzed by means of the harmonic inversion and the counting function of the resulting resonances is studied. For the closed system this counting function shows the Weyl asymptotic with a leading exponent equal to 2. By opening the system successively this exponent decreases smoothly to an non-integer value. For the open systems the extraction of resonances by the harmonic inversion becomes more challenging and the arising difficulties are discussed. The results can be interpreted as a first experimental indication for the fractal Weyl conjecture for resonances.Comment: 9 pages, 7 figure

3D image of Inoue balloon inflation during mitral valvuloplasty

Mitral balloon valvuloplasty is an important intervention in the armory of the cardiologist, offering a safe and effective percutaneous option in the treatment of patients with mitral stenosis

Preparing a supervision model for the aftermath of Grenfell: An auto-ethnographic inquiry of relationship-based supervision

In this paper, we describe the preparation for the supervision approach that we used on behalf of the Social Work Company to supervise workers at the Grenfell Support Service. This paper centres on a moment of new consciousness concerning the formation of values that occurred when discussing a poem written by the first author, Deborah, during a narrative interview conducted by the second author, Hellmuth. We present the poem and use auto-ethnography to explore the new realisations that arose through the dialogue. We consider the multi-dimensional listening that created the opportunity for this new realisation and consider the conceptual resources that a dialogic theory of action might add to the practice of relationship-based supervision in social work

Decline in acute coronary syndrome hospitalisation rates during COVID-19 lockdown in private hospitals in South Africa

We conducted a study of admission rates of acute coronary syndrome (ACS) in all Mediclinic hospitals in South Africa. The aim of the study was to quantify the extent of change in admission rates of ACS subtypes and to establish the degree of change in subtype proportions in the private sector assumed to be related to COVID-19 and/or lockdown implementation. Time intervals were demarcated by lockdown measures (March: pre-lockdown versus April: post-lockdown implementation), and comparisons were performed with equitable time periods (2019 versus 2020). For the comparison of proportions, data for April and May were summated

Size and clustering of ethnic groups and rates of psychiatric admission in England

Aims and method To compare rates of admission for different types of severe mental illness between ethnic groups, and to test the hypothesis that larger and more clustered ethnic groups will have lower admission rates. This was a descriptive study of routinely collected data from the National Health Service in England. Results There was an eightfold difference in admission rates between ethnic groups for schizophreniform and mania admissions, and a fivefold variation in depression admissions. On average, Black and minority ethnic (BME) groups had higher rates of admission for schizophreniform and mania admissions but not for depression. This increased rate was greatest in the teenage years and early adulthood. Larger ethnic group size was associated with lower admission rates. However, greater clustering was associated with higher admission rates. Clinical implications Our findings support the hypothesis that larger ethnic groups have lower rates of admission. This was a between-group comparison rather than within each group. Our findings do not support the hypothesis that more clustered groups have lower rates of admission. In fact, they suggest the opposite: groups with low clustering had lower admission rates. The BME population in the UK is increasing in size and becoming less clustered. Our results suggest that both of these factors should ameliorate the overrepresentation of BME groups among psychiatric in-patients. However, this overrepresentation continues, and our results suggest a possible explanation, namely, changes in the delivery of mental health services, particularly the marked reduction in admissions for depression

Predictors of 1-year survival in South African transcatheter aortic valve implant candidates

Background. Transcatheter aortic valve implantation (TAVI) has undergone rapid expansion internationally over the past 15 years. In view of resource constraints in developing countries, a major challenge in applying this technology lies in identifying patients most likely to benefit. The development of a risk prediction model for TAVI has proved elusive, with a reported area under the curve (AUC) of 0.6 - 0.65. The available models were developed in a First-World setting and may not be applicable to South Africa (SA).Objectives. To evaluate novel indicators and to develop a TAVI risk prediction model unique to the SA context. The current work represents the important initial steps of derivation cohort risk model development and internal validation.Methods. Seven-year experience with 244 successive TAVI implants in three centres in Western Cape Province, SA, was used to derive risk parameters. All outcomes are reported in accordance with the Valve Academic Research Consortium definitions. Multiple preprocedural variables were assessed for their impact on 1-year survival using univariate and multivariate models.Results. Factors found not to correlate with 1-year survival included age, renal function and aortic valve gradients. The commonly used surgical risk prediction models (Society of Thoracic Surgeons score and EuroSCORE) showed no correlation with outcomes. Factors found to correlate best with 1-year survival on multivariate analysis were preprocedural body mass index (BMI) (favouring higher BMI), preprocedural left ventricular end-diastolic dimension (LVED) and ejection fraction (EF) (favouring smaller LVED and higher EF), absence of atrial fibrillation, and three novel parameters: independent living, ability to drive a car, and independent food acquisition/cooking. Discriminant analysis of these factors yielded an AUC of 0.8 (95% confidence interval 0.7 - 0.9) to predict 1-year survival, with resubstitution sensitivities and specificities of 72% and 71%, respectively.Conclusions. Apart from existing predictors, we identified three novel risk predictors (independent living, ability to drive a car, and independent food acquisition/cooking) for 1-year survival in TAVI candidates. These novel parameters performed well in this early evaluation, with an AUC for predicting 1-year survival higher than the AUCs for many of the internationally derived parameters. The parameters are inexpensive and easy to obtain at the initial patient visit. If validated prospectively in external cohorts, they may be applicable to other resource-constrained environments.