Economic evaluation of a nursing-led intermediate care unit

Objectives: The aim of this paper is to examine the costs of introducing a nursing-led ward program together with examining the impact this may have on patients' outcomes. Methods; The study had a sample size of 177 patients with a mean age of 77, and randomized to either a treatment group (care on a nursing-led ward, n = 97) or a control group (standard care usually on a consultant-led acute ward, n = 80). Resource use data including length of stay, tests and investigations performed, and multidisciplinary involvement in care were collected. Results: There were no significant differences in outcome between the two groups. The inpatient costs for the treatment group were significantly higher, due to the longer length of stay in this group. However, the postdischarge costs were significantly lower for the treatment group. Conclusions: The provision of nursing-led intermediate care units has been proposed as a solution to inappropriate use of acute medical wards by patients who require additional nursing rather than medical care. Whether the treatment group is ultimately cost-additive is dependent on how long reductions in postdischarge resource use are maintained

Surface spin-flop phases and bulk discommensurations in antiferromagnets

Phase diagrams as a function of anisotropy D and magnetic field H are obtained for discommensurations and surface states for a model antiferromagnet in which $H$ is parallel to the easy axis. The surface spin-flop phase exists for all $D$. We show that there is a region where the penetration length of the surface spin-flop phase diverges. Introducing a discommensuration of even length then becomes preferable to reconstructing the surface. The results are used to clarify and correct previous studies in which discommensurations have been confused with genuine surface spin-flop states.Comment: 4 pages, RevTeX, 2 Postscript figure

On Vector Bundles of Finite Order

We study growth of holomorphic vector bundles E over smooth affine manifolds. We define Finsler metrics of finite order on E by estimates on the holomorphic bisectional curvature. These estimates are very similar to the ones used by Griffiths and Cornalba to define Hermitian metrics of finite order. We then generalize the Vanishing Theorem of Griffiths and Cornalba to the Finsler context. We develop a value distribution theory for holomorphic maps from the projectivization of E to projective space. We show that the projectivization of E can be immersed into a projective space of sufficiently large dimension via a map of finite order.Comment: version 2 has some typos corrected; to appear in Manuscripta Mathematic

Estimating the economic burden of cardiovascular events in patients receiving lipid-modifying therapy in the UK.

OBJECTIVES: To characterise the costs to the UK National Health Service of cardiovascular (CV) events among individuals receiving lipid-modifying therapy. DESIGN: Retrospective cohort study using Clinical Practice Research Datalink records from 2006 to 2012 to identify individuals with their first and second CV-related hospitalisations (first event and second event cohorts). Within-person differences were used to estimate CV-related outcomes. SETTING: Patients in the UK who had their first CV event between January 2006 and March 2012. PARTICIPANTS: Patients ≥18 years who had a CV event and received at least 2 lipid-modifying therapy prescriptions within 180 days beforehand. PRIMARY AND SECONDARY OUTCOME MEASURES: Direct medical costs (2014 £) were estimated in 3 periods: baseline (pre-event), acute (6 months afterwards) and long-term (subsequent 30 months). Primary outcomes included incremental costs, resource usage and total costs per period. RESULTS: There were 24 093 patients in the first event cohort of whom 5274 were included in the second event cohort. The mean incremental acute CV event costs for the first event and second event cohorts were: coronary artery bypass graft/percutaneous transluminal coronary angioplasty (CABG/PTCA) £5635 and £5823, myocardial infarction £4275 and £4301, ischaemic stroke £3512 and £4572, heart failure £2444 and £3461, unstable angina £2179 and £2489 and transient ischaemic attack £1537 and £1814. The mean incremental long-term costs were: heart failure £848 and £2829, myocardial infarction £922 and £1385, ischaemic stroke £973 and £682, transient ischaemic attack £705 and £1692, unstable angina £328 and £677, and CABG/PTCA £-368 and £599. Hospitalisation accounted for 95% of acute and 61% of long-term incremental costs. Higher comorbidity was associated with higher long-term costs. CONCLUSIONS: Revascularisation and myocardial infarction were associated with the highest incremental costs following a CV event. On the basis of real-world data, the economic burden of CV events in the UK is substantial, particularly among those with greater comorbidity burden

The Top Ten List of Gravitational Lens Candidates from the HST Medium Deep Survey

A total of 10 good candidates for gravitational lensing have been discovered in the WFPC2 images from the HST Medium Deep Survey (MDS) and archival primary observations. These candidate lenses are unique HST discoveries, i.e. they are faint systems with sub-arcsecond separations between the lensing objects and the lensed source images. Most of them are difficult objects for ground-based spectroscopic confirmation or for measurement of the lens and source redshifts. Seven are ``strong lens'' candidates which appear to have multiple images of the source. Three are cases where the single image of the source galaxy has been significantly distorted into an arc. The first two quadruply lensed candidates were reported in Ratnatunga et al 1995 (ApJL, 453, L5) We report on the subsequent eight candidates and describe them with simple models based on the assumption of singular isothermal potentials. Residuals from the simple models for some of the candidates indicate that a more complex model for the potential will probably be required to explain the full structural detail of the observations once they are confirmed to be lenses. We also discuss the effective survey area which was searched for these candidate lens objects.Comment: 26 pages including 12 figures and 10 tables. AJ Vol. 117, No.

Reconciling intuitive physics and Newtonian mechanics for colliding objects

People have strong intuitions about the influence objects exert upon one another when they collide. Because people's judgments appear to deviate from Newtonian mechanics, psychologists have suggested that people depend on a variety of task-specific heuristics. This leaves open the question of how these heuristics could be chosen, and how to integrate them into a unified model that can explain human judgments across a wide range of physical reasoning tasks. We propose an alternative framework, in which people's judgments are based on optimal statistical inference over a Newtonian physical model that incorporates sensory noise and intrinsic uncertainty about the physical properties of the objects being viewed. This noisy Newton framework can be applied to a multitude of judgments, with people's answers determined by the uncertainty they have for physical variables and the constraints of Newtonian mechanics. We investigate a range of effects in mass judgments that have been taken as strong evidence for heuristic use and show that they are well explained by the interplay between Newtonian constraints and sensory uncertainty. We also consider an extended model that handles causality judgments, and obtain good quantitative agreement with human judgments across tasks that involve different judgment types with a single consistent set of parameters

On the homology of the Harmonic Archipelago

We calculate the singular homology and \v{C}ech cohomology groups of the Harmonic archipelago. As a corollary, we prove that this space is not homotopy equivalent to the Griffiths space. This is interesting in view of Eda's proof that the first singular homology groups of these spaces are isomorphic

Particle Propagation on a Circle with a Point Interaction

We study a particle propagation on a circle in the presence of a point interaction. We show that the one-particle Feynman kernel can be written into the sum of reflected and transmitted trajectories which are weighted by the elements of the n-th power of the scattering matrix evaluated on a line with a point interaction. As a by-product we find three-parameter family of trace formulae as a generalization of the Poisson summation formula.Comment: 21 pages, 12 figure