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

Effectiveness of Community Forest Management at reducing deforestation in Madagascar

AbstractCommunity Forest Management (CFM) is a widespread conservation approach in the tropics. It is also promoted as a means by which payment for ecosystem services schemes can be implemented. However, evidence on its performance is weak. We investigated the effectiveness of CFM at reducing deforestation from 2000 to 2010 in Madagascar. To control for factors confounding impact estimates, we used statistical matching. We also contrasted the effects of CFM by whether commercial use of forest resources is allowed or not. We cannot detect an effect, on average, of CFM compared to no CFM, even when we restricted the sample to only where information suggests effective CFM implementation on the ground. Likewise, we cannot detect an effect of CFM where commercial use of natural resources is allowed. However, we can detect a reduction in deforestation in CFM that does not permit commercial uses, compared to no CFM or CFM allowing commercial uses. Our findings suggest that CFM and commercial use of forest resources are not guarantees of forest conservation and that differentiating among types of CFM is important

Multiple roles for UV RESISTANCE LOCUS8 in regulating gene expression and metabolite accumulation in arabidopsis under solar ultraviolet radiation

Photomorphogenic responses triggered by low fluence rates of ultraviolet B radiation (UV-B; 280–315 nm) are mediated by the UV-B photoreceptor UV RESISTANCE LOCUS8 (UVR8). Beyond our understanding of the molecular mechanisms of UV-B perception by UVR8, there is still limited information on how the UVR8 pathway functions under natural sunlight. Here, wild-type Arabidopsis (Arabidopsis thaliana) and the uvr8-2 mutant were used in an experiment outdoors where UV-A (315–400 nm) and UV-B irradiances were attenuated using plastic films. Gene expression, PYRIDOXINE BIOSYNTHESIS1 (PDX1) accumulation, and leaf metabolite signatures were analyzed. The results show that UVR8 is required for transcript accumulation of genes involved in UV protection, oxidative stress, hormone signal transduction, and defense against herbivores under solar UV. Under natural UV-A irradiance, UVR8 is likely to interact with UV-A/blue light signaling pathways to moderate UV-B-driven transcript and PDX1 accumulation. UVR8 both positively and negatively affects UV-A-regulated gene expression and metabolite accumulation but is required for the UV-B induction of phenolics. Moreover, UVR8-dependent UV-B acclimation during the early stages of plant development may enhance normal growth under long-term exposure to solar UV

The role of cranial and thoracic EMG within diagnostic criteria for ALS.

INTRODUCTION: The contribution of cranial and thoracic region electromyography (EMG) to diagnostic criteria for amyotrophic lateral sclerosis (ALS) has not been evaluated. METHODS: Clinical and EMG data from each craniospinal region were retrospectively assessed in 470 patients; 214 had ALS. Changes to diagnostic classification in Awaji-Shima and revised El Escorial criteria following withdrawal of cranial/thoracic EMG data were ascertained. RESULTS: Sensitivity for lower motor neuron involvement in ALS was highest in cervical/lumbar regions; specificity was highest in cranial/thoracic regions. Cranial EMG contributed to definite/probable Awaji-Shima categorization in 1.4% of patients. Thoracic EMG made no contribution. For revised El Escorial criteria, cranial and thoracic data reclassified 1% and 5% of patients, respectively. CONCLUSION: Cranial EMG data make small contributions to both criteria, thoracic data contribute only to the revised El Escorial criteria. However, cranial and thoracic region abnormalities are specific in ALS. Consideration should be given to allowing greater diagnostic contribution from thoracic EMG

Coherent manipulation of three-qubit states in a molecular single-ion magnet

We study the quantum spin dynamics of nearly isotropic Gd3+ ions entrapped in polyoxometalate molecules and diluted in crystals of a diamagnetic Y3+ derivative. The full energy-level spectrum and the orientations of the magnetic anisotropy axes have been determined by means of continuous-wave electron paramagnetic resonance experiments, using X-band (9-10 GHz) cavities and on-chip superconducting waveguides and 1.5-GHz resonators. The results show that seven allowed transitions between the 2S+1 spin states can be separately addressed. Spin coherence T2 and spin-lattice relaxation T1 rates have been measured for each of these transitions in properly oriented single crystals. The results suggest that quantum spin coherence is limited by residual dipolar interactions with neighbor electronic spins. Coherent Rabi oscillations have been observed for all transitions. The Rabi frequencies increase with microwave power and agree quantitatively with predictions based on the spin Hamiltonian of the molecular spin. We argue that the spin states of each Gd3+ ion can be mapped onto the states of three addressable qubits (or, alternatively, of a d=8-level "qudit"), for which the seven allowed transitions form a universal set of operations. Within this scheme, one of the coherent oscillations observed experimentally provides an implementation of a controlled-controlled-NOT (or Toffoli) three-qubit gate

From Tetraquark to Hexaquark: A Systematic Study of Heavy Exotics in the Large NcN_c Limit

A systematic study of multiquark exotics with one or $N_c-1$ heavy quarks in the large $N_c$ limit is presented. By binding a chiral soliton to a heavy meson, either a normal $N_c$-quark baryon or an exotic $(N_c+2)$-quark baryon is obtained. By replacing the heavy quark with $N_c-1$ heavy antiquarks, exotic $(2N_c-2)$-quark and $2N_c$-quark mesons are obtained. When $N_c = 3$, they are just the normal triquark baryon $Qqq$, the exotic pentaquark baryon $Q\bar q\bar q\bar q\bar q$, tetraquark di-meson $\bar Q \bar Q qq$ and the hexaquark di-baryon $\bar Q \bar Q \bar q \bar q\ bar q \bar q$ respectively. Their stabilities and decays are also discussed. In particular, it is shown that the ``heavy to heavy'' semileptonic decays are described by the Isgur--Wise form factors of the normal baryons.Comment: 14 pages in REVTeX, no Figure

Clustering transitions in vibro-fluidized magnetized granular materials

We study the effects of long range interactions on the phases observed in cohesive granular materials. At high vibration amplitudes, a gas of magnetized particles is observed with velocity distributions similar to non-magnetized particles. Below a transition temperature compact clusters are observed to form and coexist with single particles. The cluster growth rate is consistent with a classical nucleation process. However, the temperature of the particles in the clusters is significantly lower than the surrounding gas, indicating a breakdown of equipartition. If the system is quenched to low temperatures, a meta-stable network of connected chains self-assemble due to the anisotropic nature of magnetic interactions between particles.Comment: 4 pages, 5 figure

Slater-Pauling Behavior of the Half-Ferromagnetic Full-Heusler Alloys

Using the full-potential screened Korringa-Kohn-Rostoker method we study the full-Heusler alloys based on Co, Fe, Rh and Ru. We show that many of these compounds show a half-metallic behavior, however in contrast to the half-Heusler alloys the energy gap in the minority band is extremely small. These full-Heusler compounds show a Slater-Pauling behavior and the total spin-magnetic moment per unit cell (M_t) scales with the total number of valence electrons (Z_t) following the rule: M_t=Z_t-24. We explain why the spin-down band contains exactly 12 electrons using arguments based on the group theory and show that this rule holds also for compounds with less than 24 valence electrons. Finally we discuss the deviations from this rule and the differences compared to the half-Heusler alloys.Comment: 10 pages, 8 figures, revised figure 3, new text adde

Analog E1 transitions and isospin mixing

We investigate whether isospin mixing can be determined in a model-independent way from the relative strength of E1 transitions in mirror nuclei. The specific examples considered are the A=31 and A=35 mirror pairs, where a serious discrepancy between the strengths of 7/2--->5/2+ transitions in the respective mirror nuclei has been observed. A theoretical analysis of the problem suggests that it ought to be possible to disentangle the isospin mixing in the initial and final states given sufficient information on experimental matrix elements. With this in mind, we obtain a lifetime for the relevant 7/2- state in 31S using the Doppler-shift attenuation method. We then collate the available information on matrix elements to examine the level of isospin mixing for both A=31 and A=35 mirror pairs

An intermediate-depth source of hydrothermal 3He and dissolved iron in the North Pacific

We observed large water column anomalies in helium isotopes and trace metal concentrations above the Loihi Seamount. The 3He/4He of the added helium was 27.3 times the atmospheric ratio, clearly marking its origin to a primitive mantle plume. The dissolved iron to 3He ratio (dFe:3He) exported to surrounding waters was 9.3 ± 0.3 × 106. We observed the Loihi 3He and dFe “signal” at a depth of 1100 m at several stations within ∼100 – 1000 km of Loihi, which exhibited a distal dFe:3He ratio of ∼4 × 106, about half the proximal ratio. These ratios were remarkably similar to those observed over and near the Southern East Pacific Rise (SEPR) despite greatly contrasting geochemical and volcanictectonic origins. In contrast, the proximal and distal dMn:3He ratios were both ∼ 1 × 106, less than half of that observed at the SEPR. Dissolved methane was minimally enriched in waters above Loihi Seamount and was distally absent. Using an idealized regional-scale model we replicated the historically observed regional 3He distribution, requiring a hydrothermal 3He source from Loihi of 10.4 ± 4.2 mola−1, ∼2% of the global abyssal hydrothermal 3He flux. From this we compute a corresponding dFe flux of ∼40 Mmola−1. Global circulation model simulations suggest that the Loihi-influenced waters eventually upwell along the west coast of North America, also extending into the shallow northwest Pacific, making it a possibly important determinant of marine primary production in the subpolar North Pacific