Risk adjustment for hospital use using social security data: cross sectional small area analysis

OBJECTIVES: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. DESIGN: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. SETTING: Northern Ireland. MAIN OUTCOME MEASURE: Intensity of use of inpatient services. RESULTS: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. CONCLUSIONS: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula

Evaluation of feasibility of measuring EHD film thickness associated with cryogenic fluids

The feasibility of measuring elastohydrodynamic (EHD) films as formed with a cryogenic (LN2) fluid is evaluated. Modifications were made to an existing twin disk EHD apparatus to allow for disk lubrication with liquid nitrogen. This disk apparatus is equipped with an X-ray system for measuring the thickness of any lubricant film that is formed between the disks. Several film thickness experiments were conducted with the apparatus which indicate that good lubrication films are filmed with LN2. In addition to the film thickness studies, failure analyses of three bearings were conducted. The HPOTP turbine end bearings had experienced axial loads of 36,000 to 44,000 N (8,000 to 10,000 lb). High continuous radial loads were also experienced, which were most likely caused by thermal growth of the inner race. The resulting high internal loads caused race spalling and ball wear to occur

Measurements of elastohydrodynamic film thickness, wear and tempering behavior of high pressure oxygen turbopump bearings

The reusable design of the Space Shuttle requires a target life of 7.5 hours for the turbopumps of the Space Shuttle main engine (SSME). This large increase from the few hundred seconds required in single-use rockets has caused various problems with the bearings of the turbopumps. The berings of the high pressure oxygen turbopump (HPOTP) were of particular concern because of wear, spalling, and cage failures at service time well below the required 7.5 hours. Lubrication and wear data were developed for the bearings. Since the HPOTP bearings operate in liquid oxygen, conventional liquid lubricants cannot be applied. Therefore, solid lubricant coatings and lubricant transfer from the polytetrafluorethylene (FTFE) cage were the primary lubrication approaches for the bearings. Measurements were made using liquid nitrogen in a rolling disk machine to determine whether usable elastohydrodynamic films could be generated to assist in the bearing lubrication

Evaluation of outer race tilt and lubrication on ball wear and SSME bearing life reductions

Several aspects of the SSME bearing operation were evaluated. The possibility of elastohydrodynamics (EHD) lubrication with a cryogenic fluid was analyzed. Films as thick as .61 microns were predicted with one theory which may be thick enough to provide hydrodynamic support. The film formation, however, is heavily dependent on good surface finish and a low bulk bearing temperature. Bearing dynamics to determine if the radial stiffness of a bearing which are dependent on bearing misalignment were analyzed. Four ball tests were conducted at several environmental conditions from an LN2 bath to 426 C in air. Surface coatings and ball materials are evaluated. Severe wear and high friction are measured for all ball materials except when the balls have surface lubricant coatings

Infiltrated carbon foam composites

An infiltrated carbon foam composite and method for making the composite is described. The infiltrated carbon foam composite may include a carbonized carbon aerogel in cells of a carbon foam body and a resin is infiltrated into the carbon foam body filling the cells of the carbon foam body and spaces around the carbonized carbon aerogel. The infiltrated carbon foam composites may be useful for mid-density ablative thermal protection systems

On several families of elliptic curves with arbitrary large Selmer groups

In this paper, we calculate the $\phi (\hat{\phi})-$Selmer groups S^{(\phi)} (E / \Q) and S^{(\hat{\varphi})} (E^{\prime} / \Q) of elliptic curves $y^{2} = x (x + \epsilon p D) (x + \epsilon q D)$ via descent theory (see [S, Chapter X]), in particular, we obtain that the Selmer groups of several families of such elliptic curves can be arbitrary large.Comment: 22 page

Scaling Up Sagebrush Chemistry with Near-Infrared Spectroscopy and UAS-Acquired Hyperspectral Imagery

Sagebrush ecosystems (Artemisia spp.) face many threats including large wildfires and conversion to invasive annuals, and thus are the focus of intense restoration efforts across the western United States. Specific attention has been given to restoration of sagebrush systems for threatened herbivores, such as Greater Sage-Grouse (Centrocercus urophasianus) and pygmy rabbits (Brachylagus idahoensis), reliant on sagebrush as forage. Despite this, plant chemistry (e.g., crude protein, monoterpenes and phenolics) is rarely considered during reseeding efforts or when deciding which areas to conserve. Near-infrared spectroscopy (NIRS) has proven effective in predicting plant chemistry under laboratory conditions in a variety of ecosystems, including the sagebrush steppe. Our objectives were to demonstrate the scalability of these models from the laboratory to the field, and in the air with a hyperspectral sensor on an unoccupied aerial system (UAS). Sagebrush leaf samples were collected at a study site in eastern Idaho, USA. Plants were scanned with an ASD FieldSpec 4 spectroradiometer in the field and laboratory, and a subset of the same plants were imaged with a SteadiDrone Hexacopter UAS equipped with a Rikola hyperspectral sensor (HSI). All three sensors generated spectral patterns that were distinct among species and morphotypes of sagebrush at specific wavelengths. Lab-based NIRS was accurate for predicting crude protein and total monoterpenes (R2 = 0.7–0.8), but the same NIRS sensor in the field was unable to predict either crude protein or total monoterpenes (R2 \u3c 0.1). The hyperspectral sensor on the UAS was unable to predict most chemicals (R2 \u3c 0.2), likely due to a combination of too few bands in the Rikola HSI camera (16 bands), the range of wavelengths (500–900 nm), and small sample size of overlapping plants (n = 28–60). These results show both the potential for scaling NIRS from the lab to the field and the challenges in predicting complex plant chemistry with hyperspectral UAS. We conclude with recommendations for next steps in applying UAS to sagebrush ecosystems with a variety of new sensors

The role of primary care in cancer diagnosis via emergency presentation: qualitative synthesis of significant event reports

Background: Patients diagnosed with cancer in the context of an emergency presentation (EP) have poorer outcomes. It is often assumed that such patients present to the emergency department without consulting their general practitioner (GP). Little work has been done to identify primary care involvement before hospital attendance. Methods: Participating primary care practices completed a significant event audit (SEA) report for the last patient diagnosed with cancer as a result of an EP. Accounts were synthesised and a qualitative approach to analysis undertaken. Results: SEAs for 222 patients were analysed. A range of cancers were included, the most common being lung (32.4%) and upper gastrointestinal (19.8%). In most cases, patients had contact with their practice before diagnosis, primarily in the period immediately before admission. In only eight cases had there been no input from primary care. Accounts of protracted primary care contact generally demonstrated complexity, often related to comorbidity, patient-mediated factors or reassurance provided by negative investigations. Learning points identified by practices centred on the themes of presentation and diagnosis, consultation and safety-netting, communication and system issues, patient factors and referral guidelines. Conclusions: There is extensive primary care input into patients whose diagnosis results from EP, and for the most part potential ‘delay’ in referral can be reasonably explained by the complexity of the presentation or by coexisting patient factors