Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

Objectives: “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods: National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results: The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions: The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings

The Physical, Chemical and Biological Effects of Crude Oil Spills on Black Spruce Forest, Interior Alaska

... The overall objectives of the study were threefold: 1) To detail the physical effects of crude oil spills in black spruce forests of interior Alaska emphasizing the mode of transport, area of impact vs. time and effects on the active layer and underlying permafrost; 2) To determine the fate of petroleum contaminants once spilled in subarctic terrestrial environments; 3) To evaluate the effects of crude oil spills on vegetation. ..

Reliability and Validity of a Self-paced Cardiopulmonary Exercise Test in Post-MI Patients

A self-paced peak oxygen uptake (V?O2peak) test (SPV) has been shown to produce higher V?O2peak values compared to standard cardiopulmonary exercise tests (sCPET), but has not been tested on any clinical population. This study aimed to assess the reliability of the SPV in a healthy population (study 1), and the validity and reliability of the SPV in post Myocardial Infarction (post-MI) patients (study 2). For study 1, twenty-five healthy participants completed three SPV’s. For study 2, twenty-eight post-MI patients completed one sCPET and two SPV’s. The SPV consisted of 5 x 2- min stages where participants were able to self-regulate their effort by using incremental ‘clamps’ in ratings of perceived exertion. The sCPET consisted of a 20 W/min ramp. Results demonstrated the SPV to have a coefficient of variation for V?O2peak of 4.7% for the healthy population, and 8.2% for the post-MI patients. Limits of agreement ranged between ± 4.22-5.86 ml·kg-1·min-1, with the intraclass correlation coefficient ranging between 0.89-0.95. In study 2, there was a significantly higher V?O2peak achieved in the SPV (23.07 ± 4.90 ml·kg-1·min-1) against the sCPET (21.29 ± 4.93 ml·kg-1·min-1). It is concluded that these results provide initial evidence that the SPV may be a safe, valid and reliable method for determining exercise capacity in post-MI patients

Arches and contact forces in a granular pile

Assemblies of granular particles mechanically stable under their own weight contain arches. These are structural units identified as sets of mutually stable grains. It is generally assumed that these arches shield the weight above them and should bear most of the stress in the system. We test such hypothesis by studying the stress born by in-arch and out-of-arch grains. We show that, indeed, particles in arches withstand larger stresses. In particular, the isotropic stress tends to be larger for in-arch-grains whereas the anisotropic component is marginally distinguishable between the two types of particles. The contact force distributions demonstrate that an exponential tail (compatible with the maximization of entropy under no extra constraints) is followed only by the out-of-arch contacts. In-arch contacts seem to be compatible with a Gaussian distribution consistent with a recently introduced approach that takes into account constraints imposed by the local force balance on grains.Comment: 7 pages, 7 figures, major revisio

The effects of grain shape and frustration in a granular column near jamming

We investigate the full phase diagram of a column of grains near jamming, as a function of varying levels of frustration. Frustration is modelled by the effect of two opposing fields on a grain, due respectively to grains above and below it. The resulting four dynamical regimes (ballistic, logarithmic, activated and glassy) are characterised by means of the jamming time of zero-temperature dynamics, and of the statistics of attractors reached by the latter. Shape effects are most pronounced in the cases of strong and weak frustration, and essentially disappear around a mean-field point.Comment: 17 pages, 19 figure

Electromagnetic nucleon-delta transition in the perturbative chiral quark model

We apply the perturbative chiral quark model to the gamma N -> Delta transition. The four momentum dependence of the respective transverse helicity amplitudes A(1/2) and A(3/2) is determined at one loop in the pseudoscalar Goldstone boson fluctuations. Inclusion of excited states in the quark propagator is shown to result in a reasonable description of the experimental values for the helicity amplitudes at the real photon point.Comment: 25 page

Double-slit interference pattern from single-slit screen and its gravitational analogues

The double slit experiment (DSE) is known as an important cornerstone in the foundations of physical theories such as Quantum Mechanics and Special Relativity. A large number of different variants of it were designed and performed over the years. We perform and discuss here a new verion with the somewhat unexpected results of obtaining interference pattern from single-slit screen. This outcome, which shows that the routes of the photons through the array were changed, leads one to discuss it, using the equivalence principle, in terms of geodesics mechanics. We show using either the Brill's version of the canonical formulation of general relativity or the linearized version of it that one may find corresponding and analogous situations in the framework of general relativity.Comment: 51 pages, 12 Figures five of them contain two subfigures and thus the number of figures is 17, 1 Table. Some minor changes introduced, especially, in the reference

Is the Sun Embedded in a Typical Interstellar Cloud?

The physical properties and kinematics of the partially ionized interstellar material near the Sun are typical of warm diffuse clouds in the solar vicinity. The interstellar magnetic field at the heliosphere and the kinematics of nearby clouds are naturally explained in terms of the S1 superbubble shell. The interstellar radiation field at the Sun appears to be harder than the field ionizing ambient diffuse gas, which may be a consequence of the low opacity of the tiny cloud surrounding the heliosphere. The spatial context of the Local Bubble is consistent with our location in the Orion spur.Comment: "From the Outer Heliosphere to the Local Bubble", held at International Space Sciences Institute, October 200

Delta-to-N-gamma Coulomb Quadrupole Amplitude in PQCD

We present a leading-order pQCD calculation of the helicity-flip $\Delta\to N\gamma^*$ matrix element $G_0$ (Coulomb quadrupole amplitude $C2$), taking into account the transverse momenta of the quarks and the contribution from the gluons. In the large $Q^2$ limit, its scaling behavior acquires a double-logarithmic correction $\log^2{(Q^2/\Lambda^2)}$ compared with the standard scaling analysis, due to the contribution from the orbital motion of the small-$x$ partons. Based on this and on the latest JLab experimental results of the $C2-M1$ ratio $R_{SM}$ at $Q^2$ = 3 $\sim$ 4 GeV$^2$, we make a phenomenological prediction for the latter at higher values of $Q^2$.Comment: 9 pages, two figure

Kepler-22b: A 2.4 Earth-radius Planet in the Habitable Zone of a Sun-like Star

A search of the time-series photometry from NASA's Kepler spacecraft reveals a transiting planet candidate orbiting the 11th magnitude G5 dwarf KIC 10593626 with a period of 290 days. The characteristics of the host star are well constrained by high-resolution spectroscopy combined with an asteroseismic analysis of the Kepler photometry, leading to an estimated mass and radius of 0.970 +/- 0.060 MSun and 0.979 +/- 0.020 RSun. The depth of 492 +/- 10ppm for the three observed transits yields a radius of 2.38 +/- 0.13 REarth for the planet. The system passes a battery of tests for false positives, including reconnaissance spectroscopy, high-resolution imaging, and centroid motion. A full BLENDER analysis provides further validation of the planet interpretation by showing that contamination of the target by an eclipsing system would rarely mimic the observed shape of the transits. The final validation of the planet is provided by 16 radial velocities obtained with HIRES on Keck 1 over a one year span. Although the velocities do not lead to a reliable orbit and mass determination, they are able to constrain the mass to a 3{\sigma} upper limit of 124 MEarth, safely in the regime of planetary masses, thus earning the designation Kepler-22b. The radiative equilibrium temperature is 262K for a planet in Kepler-22b's orbit. Although there is no evidence that Kepler-22b is a rocky planet, it is the first confirmed planet with a measured radius to orbit in the Habitable Zone of any star other than the Sun.Comment: Accepted to Ap