SPH simulations of irradiation-driven warped accretion discs and the long periods in X-ray binaries

We present three dimensional smoothed particle hydrodynamics (SPH) calculations of irradiation-driven warping of accretion discs. Initially unwarped planar discs are unstable to the radiation reaction when the disc is illuminated by a central radiation source. The disc warps and tilts and precesses slowly in a retrograde direction; its shape continuously flexes in response to the changing orientation of the Roche potential. We simulate ten systems: eight X-ray binaries, one cataclysmic variable (CV), and a `generic' low mass X-ray binary (LMXB). We adopt system parameters from observations and tune a single parameter: our model X-ray luminosity ($L_{*}$) to reproduce the observed or inferred super-orbital periods. Without exception, across a wide range of parameter space, we find an astonishingly good match between the observed $L_{X}$ and the model $L_{*}$. We conclude irradiation-driven warping is the mechanism underlying the long periods in X-ray binaries. Our Her X-1 simulation simultaneously reproduces the observed $L_{X}$, the "main-" and "short-high" X-ray states and the orbital inclination. Our simulations of SS 433 give a maximum warp angle of $18.6^{\circ}$, a good match to the cone traced by the jets, but this angle is reached only in the outer disc. In all cases, the overall disc tilt is less than \degrees{13} and the maximum disc warp is less than and or equal to \degrees{21}.Comment: 17 pages, 14 figures, shorter abstract (24 lines limit

Hospital expenditure at the end-of-life: what are the impacts of health status and health risks?

Background: It is important for health policy and expenditure projections to understand the relationship between age, death and expenditure on health care (HC). Research has shown that older age groups incur lower hospital costs than previously anticipated and that remaining time to death (TTD) was a much stronger indicator for expenditure than age. How health behaviour or risk factors impact on HC utilisation and costs at the end of life is relatively unknown. Smoking and Body Mass Index (BMI) have featured most prominently and mixed findings exist as to the exact nature of this association.<p></p> Methods: This paper considers the relationship between TTD, age and expenditure for inpatient care in the last 12 quarters of life; and introduces measures of health status and risks. A longitudinal dataset covering 35 years is utilised, including baseline survey data linked to hospital and death records. The effect of age, TTD and health indicators on expenditure for inpatient care is estimated using a two-part model.<p></p> Results: As individuals approach death costs increase. This effect is highly significant (p<0.01) from the last until the 8th quarter before death and influenced by age. Statistically significant effects on costs were found for: smoking status, systolic blood pressure and lung function (FEV1). On average, smokers incurred lower quarterly costs in their last 12 quarters of life than non-smokers (~7%). Participants’ BMI at baseline did show a negative association with probability of HC utilisation however this effect disappeared when costs were estimated.<p></p> Conclusions: Health risk measures obtained at baseline provide a good indication of individuals’ probability of needing medical attention later in life and incurring costs, despite the small size of the effect. Utilising a linked dataset, where such measures are available can add substantially to our ability to explain the relationship between TTD and costs.<p></p&gt

Superhumps in Low-Mass X-Ray Binaries

We propose a mechanism for the superhump modulations observed in optical photometry of at least two black hole X-ray transients (SXTs). As in extreme mass-ratio cataclysmic variables (CVs), superhumps are assumed to result from the presence of the 3:1 orbital resonance in the accretion disc. This causes the disc to become non-axisymmetric and precess. However the mechanism for superhump luminosity variations in low mass X-ray binaries (LMXBs) must differ from that in CVs, where it is attributed to a tidally-driven modulation of the disc's viscous dissipation, varying on the beat between the orbital and disc precession period. By contrast in LMXBs, tidal dissipation in the outer accretion disc is negligible: the optical emission is overwhelming dominated by reprocessing of intercepted central X-rays. Thus a different origin for the superhump modulation is required. Recent observations and numerical simulations indicate that in an extreme mass-ratio system the disc area changes on the superhump period. We deduce that the superhumps observed in SXTs arise from a modulation of the reprocessed flux by the changing area. Therefore, unlike the situation in CVs, where the superhump amplitude is inclination-independent, superhumps should be best seen in low-inclination LMXBs, whereas an orbital modulation from the heated face of the secondary star should be more prominent at high inclinations. Modulation at the disc precession period (10s of days) may indicate disc asymmetries such as warping. We comment on the orbital period determinations of LMXBs, and the possibility and significance of possible permanent superhump LMXBs.Comment: 6 pages, 1 encapsulated figure. MNRAS in press; replaced to correct typographical error

New control strategies for neuroprosthetic systems

The availability of techniques to artificially excite paralyzed muscles opens enormous potential for restoring both upper and lower extremity movements with\ud neuroprostheses. Neuroprostheses must stimulate muscle, and control and regulate the artificial movements produced. Control methods to accomplish these tasks include feedforward (open-loop), feedback, and adaptive control. Feedforward control requires a great deal of information about the biomechanical behavior of the limb. For the upper extremity, an artificial motor program was developed to provide such movement program input to a neuroprosthesis. In lower extremity control, one group achieved their best results by attempting to meet naturally perceived gait objectives rather than to follow an exact joint angle trajectory. Adaptive feedforward control, as implemented in the cycleto-cycle controller, gave good compensation for the gradual decrease in performance observed with open-loop control. A neural network controller was able to control its system to customize stimulation parameters in order to generate a desired output trajectory in a given individual and to maintain tracking performance in the presence of muscle fatigue. The authors believe that practical FNS control systems must\ud exhibit many of these features of neurophysiological systems

Comprehensive simulations of superhumps

(Abridged) We use 3D SPH calculations with higher resolution, as well as with more realistic viscosity and sound-speed prescriptions than previous work to examine the eccentric instability which underlies the superhump phenomenon in semi-detached binaries. We illustrate the importance of the two-armed spiral mode in the generation of superhumps. Differential motions in the fluid disc cause converging flows which lead to strong spiral shocks once each superhump cycle. The dissipation associated with these shocks powers the superhump. We compare 2D and 3D results, and conclude that 3D simulations are necessary to faithfully simulate the disc dynamics. We ran our simulations for unprecedented durations, so that an eccentric equilibrium is established except at high mass ratios where the growth rate of the instability is very low. Our improved simulations give a closer match to the observed relationship between superhump period excess and binary mass ratio than previous numerical work. The observed black hole X-ray transient superhumpers appear to have systematically lower disc precession rates than the cataclysmic variables. This could be due to higher disc temperatures and thicknesses. The modulation in total viscous dissipation on the superhump period is overwhelmingly from the region of the disc within the 3:1 resonance radius. As the eccentric instability develops, the viscous torques are enhanced, and the disc consequently adjusts to a new equilibrium state, as suggested in the thermal-tidal instability model. We quantify this enhancement in the viscosity, which is ~10 per cent for q=0.08. We characterise the eccentricity distributions in our accretion discs, and show that the entire body of the disc partakes in the eccentricity.Comment: 18 pages (mn2e LaTeX), 14 figures, 5 tables, Accepted for publication in MNRA

Supervision in Practice Education and Transition to Practice: Student and New Graduate Perceptions

Purpose: Transitioning into occupational therapy practice is a complex process in which new graduates develop their skills and professional identity. Evidence suggests this process requires guidance and support through supervision. This study investigated final year students’ and newly graduated occupational therapists’ perceptions and expectations of the role and efficacy of supervision as they transition into practice. Methods: A cross sectional online survey was sent to final year students and newly graduated occupational therapists within Australia and New Zealand, to explore experiences, perceptions, and the content of supervision received in practice. Results: Of 151 participants, 96% received supervision from an experienced occupational therapist and reported it facilitated skill development and enhanced quality of service to clients; however 4% reported they do not receive supervision in practice. The frequency of supervision decreased between students (63% weekly) and new graduates (41% monthly) and perceptions of supervision effectiveness changed over time. Conclusions: The transition to occupational therapy practice is complex and perceptions of the effectiveness of supervision change. Provision of education regarding supervision within undergraduate curriculum, and training for supervisors may alleviate associated stressors. Increasing the frequency of supervision and understanding the supervisory role may support transitioning into practice

Aiming higher : the Plymouth and Peninsula Tri-Level Model (PPM) for school/HE links : putting the university into school and community

"This report outlines an innovative, effective model of school/higher education (HE) liaison, the Plymouth & Peninsula Model (PPM). The PPM is of major national and international importance. The defining quality of PPM is that it is a genuine partnership, with parity of esteem between HEIs, schools and local authorities (LAs), supported by other major stakeholders. The PPM is based upon firm research evidence, is highly cost effective and could be rolled out nationally to cover geographically all primary and secondary schools and college grouped in consortia" - page iii

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

CONTEXT Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. OBJECTIVE To characterize the feasibility of OBOT-B in homeless relative to housed patients. DESIGN A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. RESULTS Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. CONCLUSIONS Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment