Association between anaesthetic technique and unplanned admission to intensive care after thoracic lung resection surgery: the second Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) National Audit

Unplanned intensive care admission is a devastating complication of lung resection and is associated with significantly increased mortality. We carried out a two‐year retrospective national multicentre cohort study to investigate the influence of anaesthetic and analgesic technique on the need for unplanned postoperative intensive care admission. All patients undergoing lung resection surgery in 16 thoracic surgical centres in the UK in the calendar years 2013 and 2014 were included. We defined critical care admission as the unplanned need for either tracheal intubation and mechanical ventilation or renal replacement therapy, and sought an association between mode of anaesthesia (total intravenous anaesthesia vs. volatile) and analgesic technique (epidural vs. paravertebral) and need for intensive care admission. A total of 253 out of 11,208 patients undergoing lung resection in the study period had an unplanned admission to intensive care in the postoperative period, giving an incidence of intensive care unit admission of 2.3% (95%CI 2.0–2.6%). Patients who had an unplanned admission to intensive care unit had a higher mortality (29.00% vs. 0.03%, p < 0.001), and hospital length of stay was increased (26 vs. 6 days, p < 0.001). Across univariate, complete case and multiple imputation (multivariate) models, there was a strong and significant effect of both anaesthetic and analgesic technique on the need for intensive care admission. Patients receiving total intravenous anaesthesia (OR 0.50 (95%CI 0.34–0.70)), and patients receiving epidural analgesia (OR 0.56 (95%CI 0.41–0.78)) were less likely to have an unplanned admission to intensive care after thoracic surgery. This large retrospective study suggests a significant effect of both anaesthetic and analgesic technique on outcome in patients undergoing lung resection. We must emphasise that the observed association does not directly imply causation, and suggest that well‐conducted, large‐scale randomised controlled trials are required to address these fundamental questions

Child abuse: a common problem in Curaçao?

Objective: To assess the prevalence of child abuse among high school students in Curacao. Methods: A questionnaire survey among high school students up to 17 years of age was conducted. The questionnaire was based on existing literature and validated questionnaires. The questionnaire used was analysed and adapted to the situation in Curacao by a panel of experts on child abuse. The primary objective was to gain insight into the incidence, prevalence and various forms of child abuse among students in Curacao. Five forms of child abuse are distinguished in the literature: physical abuse, emotional abuse, sexual abuse, neglect and exploitation. Furthermore, the degree of confidence of the students in general practitioners (GPs) as care providers in the field of child abuse was explored. Results: Questionnaires from 545 of the 628 respondents were included. In total, 43% of the respondents had ever-experienced an event which could be defined as (a form of) child abuse. More than one-third of the respondents reporting child abuse ever had an experience that could be interpreted as physical abuse. More than 15% of the respondents reporting child abuse had experienced sexual abuse. Girls experienced significantly more sexual abuse than boys. Emotional abuse in the last year was experienced by 3% of the respondents. One per cent of the respondents ever-experienced neglect. According to most respondents, GPs were not seen as care providers in cases of child abuse; they believed that GPs were mainly to be consulted for illnesses or physical symptoms and not for forms of child abuse. Conclusion: The prevalence of ever-having-experienced a form of child abuse is estimated at 431 per 1000 students. Child abuse, particularly physical abuse, is common in Curacao, and is probably comparable to other surrounding countries. General practitioners were not seen as care providers in identifying and reporting cases of child abuse according to most respondents

Assessing seasonal nitrogen export to large tropical lakes

Rivers are exporting increasing amounts of nitrogen (N) to lakes, which is leading to eutrophication. However, the seasonality apparent in nutrient loading, especially in tropical areas, is thus far only partially understood. This study aims to better understand the seasonality and the sources of dissolved inorganic nitrogen (DIN) inputs from sub-basins to tropical lakes. We integrated existing approaches into a seasonal model that accounts for seasonality in human activities, meteorology and hydrology, and we applied the model to the sub-basins of a representative tropical lake: Lake Tana, Ethiopia. The model quantifies the river export of DIN by season, source and sub-basin and also accounts for open defecation to land as a diffuse source of N in rivers. Seasonality parameters were calibrated, and model outputs were validated against measured nitrogen loads in the main river outlets. The calibrated model showed good agreement with the measured nitrogen loads at the outflow of the main rivers. The model distinguishes four seasons: rainy (July–September), post-rainy (October–December), dry (January–March) and pre-rainy (April–June). The river export of DIN to Lake Tana was about 9 kton in 2017 and showed spatial and temporal variability: It was highest in the rainy and lowest in the dry seasons. Diffuse sources from agriculture were important contributors of DIN to rivers in 2017, and animal manure was the dominant source in all seasons. Our seasonal sub-basins and rivers model provides opportunities to identify the main nutrient sources to the lake and to formulate effective water quality management options. An example is nutrient application level that correspond to the crop needs in the sub-basins. Furthermore, our model can be used to analyse future trends and serves as an example for other large tropical lakes experiencing eutrophication.</p

Coupling between planes and chains in YBa2Cu3O7 : a possible solution for the order parameter controversy

We propose to explain the contradictory experimental evidence about the symmetry of the order parameter in $YBa_{2}Cu_{3}O_{7}$ by taking into account the coupling between planes and chains. This leads to an anticrossing of the plane and chain band. We include an attractive pairing interaction within the planes and a repulsive one between planes and chains, leading to opposite signs for the order parameter on planes and chains, and to nodes of the gap because of the anticrossing. Our model blends s-wave and d-wave features, and provides a natural explanation for all the contradictory experimentsComment: 13 pages, revtex, 2 uucoded figure

Transition Spectra for a BCS Superconductor with Multiple Gaps: Model Calculations for MgB_2

We analyze the qualitative features in the transition spectra of a model superconductor with multiple energy gaps, using a simple extension of the Mattis-Bardeen expression for probes with case I and case II coherence factors. At temperature T = 0, the far infrared absorption edge is, as expected, determined by the smallest gap. However, the large thermal background may mask this edge at finite temperatures and instead the secondary absorption edges found at Delta_i+Delta_j may become most prominent. At finite T, if certain interband matrix elements are large, there may also be absorption peaks at the gap difference frequencies | Delta_i-Delta_j | . We discuss the effect of sample quality on the measured spectra and the possible relation of these predictions to the recent infrared absorption measurement on MgB_2

Radiative Corrections for Pion Polarizability Experiments

We use the semi-analytical program RCFORGV to evaluate radiative corrections to one-photon radiative emission in the high-energy scattering of pions in the Coulomb field of a nucleus with atomic number Z. It is shown that radiative corrections can simulate a pion polarizability effect. The average effect was estimated for pion energies 40-600 GeV. We also study the range of applicability of the equivalent photon approximation in describing one-photon radiative emission.Comment: 11 pages (LaTex), 6 figures, 1 table. No changes in the paper. New submission because old files are corrupted in arXi

A Two-dimensional Superconductor in a Tilted Magnetic Field - new states with finite Cooper-pair momentum

Varying the angle Theta between applied field and the conducting planes of a layered superconductor in a small interval close to the plane-parallel field direction, a large number of superconducting states with unusual properties may be produced. For these states, the pair breaking effect of the magnetic field affects both the orbital and the spin degree of freedom. This leads to pair wave functions with finite momentum, which are labeled by Landau quantum numbers 0<n<\infty. The stable order parameter structure and magnetic field distribution for these states is found by minimizing the quasiclassical free energy near H_{c2} including nonlinear terms. One finds states with coexisting line-like and point-like order parameter zeros and states with coexisting vortices and antivortices. The magnetic response may be diamagnetic or paramagnetic depending on the position within the unit cell. The structure of the Fulde-Ferrell-Larkin-Ovchinnikov (FFLO) states at Theta=0 is reconsidered. The transition n->\infty of the paramagnetic vortex states to the FFLO-limit is analyzed and the physical reason for the occupation of higher Landau levels is pointed out.Comment: 24 pages, 11 figure

Simple heuristics for the assembly line worker assignment and balancing problem

We propose simple heuristics for the assembly line worker assignment and balancing problem. This problem typically occurs in assembly lines in sheltered work centers for the disabled. Different from the classical simple assembly line balancing problem, the task execution times vary according to the assigned worker. We develop a constructive heuristic framework based on task and worker priority rules defining the order in which the tasks and workers should be assigned to the workstations. We present a number of such rules and compare their performance across three possible uses: as a stand-alone method, as an initial solution generator for meta-heuristics, and as a decoder for a hybrid genetic algorithm. Our results show that the heuristics are fast, they obtain good results as a stand-alone method and are efficient when used as a initial solution generator or as a solution decoder within more elaborate approaches.Comment: 18 pages, 1 figur

Continuous wave optical parametric oscillator for quartz-enhanced photoacoustic trace gas sensing

A continuous wave optical parametric oscillator, generating up to 300 mW idler output in the 3–4 μm wavelength region, and pumped by a fiber-amplified DBR diode laser is used for trace gas detection by means of quartz-enhanced photoacoustic spectroscopy (QEPAS). Mode-hop-free tuning of the OPO output over 5.2 cm-1 and continuous spectral coverage exceeding 16.5 cm-1 were achieved via electronic pump source tuning alone. Online monitoring of the idler wavelength, with feedback to the DBR diode laser, provided an automated closed-loop control allowing arbitrary idler wavelength selection within the pump tuning range and locking of the idler wavelength with a stability of 1.7×10-3 cm-1 over at least 30 min.\ud \ud Using this approach, we locked the idler wavelength at an ethane absorption peak and obtained QEPAS data to verify the linear response of the QEPAS signal at different ethane concentrations (100 ppbv-20 ppmv) and different power levels. The detection limit for ethane was determined to be 13 ppbv (20 s averaging), corresponding to a normalized noise equivalent absorption coefficient of 4.4×10-7 cm-1  W/Hz1/2

Stress-energy tensor for a quantised bulk scalar field in the Randall-Sundrum brane model

We calculate the vacuum expectation value of the stress-energy tensor for a quantised bulk scalar field in the Randall-Sundrum model, and discuss the consequences of its local behaviour for the self-consistency of the model. We find that, in general, the stress-energy tensor diverges in the vicinity of the branes. Our main conclusion is that the stress-energy tensor is sufficiently complicated that it has implications for the effective potential, or radion stabilisation, methods that have so far been used.Comment: 16 pages, 3 figures. Minor changes made and references added. To appear in Phys. Rev.