Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy‏

BACKGROUND: Breast cancer is the 2nd leading cause of cancer deaths among women in the United States. Breast cancer surgeries can be performed on either an inpatient or ambulatory basis. This systematic review of literature on outpatient mastectomy examines what is known about the factors that influence the use of this procedure, existing public policies, and strategies to promote the appropriate use of outpatient mastectomy. METHODS: Factors associated with the utilization of outpatient mastectomy were categorized and discussed under the following headings: ‘‘patient level,’’ ‘‘physician level,’’ and ‘‘system level.’’ RESULTS: Potential contributing factors to the use of outpatient mastectomy at the patient level were race, educational level, comorbid conditions, cancer stage, and health insurance. Contributing factors at the provider level were demographics, surgeon specialty, and whether physician is an American or international graduate. The associated factors at the system level were state policy and legislation and hospital characteristics. CONCLUSIONS: The evidence in the research literature suggests that the use of outpatient mastectomy is a function of interactions between patient and physician characteristics, managed care influences, and the state policies and law

Emergence of hexatic and long-range herringbone order in two-dimensional smectic liquid crystals : A Monte Carlo study

Using a high resolution Monte Carlo simulation technique based on multi-histogram method and cluster-algorithm, we have investigated critical properties of a coupled XY model, consists of a six-fold symmetric hexatic and a three-fold symmetric herringbone field, in two dimensions. The simulation results demonstrate a series of novel continues transitions, in which both long-range hexatic and herringbone orderings are established simultaneously. It is found that the specific-heat anomaly exponents for some regions in coupling constants space are in excellent agreement with the experimentally measured exponents extracted from heat-capacity data near the smecticA-hexaticB transition of two-layer free standing film

Present of Three-layered hydro-forming analysis of a new hybrid sandwich tubes using finite element method

Multi-layered tube hydro-forming is suitable to produce multi-layered joints to be used in special application in many industries. With using a middle layer of foam and making sandwich structures, tube bending strength increases when external loads are applied. Also because of the foam is high energy absorption, in the pipelines of major industries such as the nuclear, strength increases when natural disasters, especially earthquakes happen. In this paper for the first time, three-layered new sandwich tube (inner layer of copper, middle layer of aluminum foam and outer layer of annealed brass) hydroforming processes were numerically simulated using finite element method by ABAQUS/Explicit 6.10. As the result of three-layered sandwich tube hydro-forming not reported in the literature, the results of this paper are compared with the latest experimental result of bi-layered tube hydro-forming find in literature by approaching the thickness of middle layer to zero. Finite element analysis shows that numerical and experimental results have a good agreement

Understanding wind turbine power converter reliability under realistic wind conditions

The reliability of wind turbine power converters is crucial for analyzing wind energy project costs, and for estimating maintenance and downtime. The published literature in this field relies on evaluating the reliability effect of wind speed to estimate the converter lifetime. However, this paper demonstrates that wind turbulence intensity, which has not been widely considered in similar reliability analyses, shows a significant impact on converter lifetime. This paper uses 821 10‐min wind speed time series sampled at 1 Hz on the two most commonly deployed wind turbine converter topologies: the two‐level voltage source and the three‐level neutral point clamped. Electromechanical and thermal modelling, combined with statistical analysis shows that mean wind speed and turbulence intensity both impact the lifetime of both converter topologies. However, the paper estimates that the three‐level converter can operate 2.4 to 4.0 times longer than the two‐level converter depending on the operating wind speed and turbulence intensity

Anderson Transition in Disordered Graphene

We use the regularized kernel polynomial method (RKPM) to numerically study the effect disorder on a single layer of graphene. This accurate numerical method enables us to study very large lattices with millions of sites, and hence is almost free of finite size errors. Within this approach, both weak and strong disorder regimes are handled on the same footing. We study the tight-binding model with on-site disorder, on the honeycomb lattice. We find that in the weak disorder regime, the Dirac fermions remain extended and their velocities decrease as the disorder strength is increased. However, if the disorder is strong enough, there will be a {\em mobility edge} separating {\em localized states around the Fermi point}, from the remaining extended states. This is in contrast to the scaling theory of localization which predicts that all states are localized in two-dimensions (2D).Comment: 4 page

Tendon reattachment to bone in an ovine tendon defect model of retraction using allogenic and xenogenic demineralised bone matrix incorporated with mesenchymal stem cells

BACKGROUND: Tendon-bone healing following rotator cuff repairs is mainly impaired by poor tissue quality. Demineralised bone matrix promotes healing of the tendon-bone interface but its role in the treatment of tendon tears with retraction has not been investigated. We hypothesized that cortical demineralised bone matrix used with minimally manipulated mesenchymal stem cells will result in improved function and restoration of the tendon-bone interface with no difference between xenogenic and allogenic scaffolds. MATERIALS AND METHODS: In an ovine model, the patellar tendon was detached from the tibial tuberosity and a complete distal tendon transverse defect measuring 1 cm was created. Suture anchors were used to reattach the tendon and xenogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5), or allogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5) were used to bridge the defect. Graft incorporation into the tendon and its effect on regeneration of the enthesis was assessed using histomorphometry. Force plate analysis was used to assess functional recovery. RESULTS: Compared to the xenograft, the allograft was associated with significantly higher functional weight bearing at 6 (P = 0.047), 9 (P = 0.028), and 12 weeks (P = 0.009). In the allogenic group this was accompanied by greater remodeling of the demineralised bone matrix into tendon-like tissue in the region of the defect (p = 0.015), and a more direct type of enthesis characterized by significantly more fibrocartilage (p = 0.039). No failures of tendon-bone healing were noted in either group. CONCLUSION: Demineralised bone matrix used with minimally manipulated mesenchymal stem cells promotes healing of the tendon-bone interface in an ovine model of acute tendon retraction, with superior mechanical and histological results associated with use of an allograft

Level Crossing Analysis of Growing surfaces

We investigate the average frequency of positive slope $\nu_{\alpha}^{+}$, crossing the height $\alpha = h- \bar h$ in the surface growing processes. The exact level crossing analysis of the random deposition model and the Kardar-Parisi-Zhang equation in the strong coupling limit before creation of singularities are given.Comment: 5 pages, two column, latex, three figure