Are Variations in the Use of Carotid Endarterectomy Explained by Population Need? A Study of Health Service Utilisation in Two English Health Regions

AbstractObjectives:to describe variation in utilisation of carotid endarterectomy (CEA) within two English health regions and explore relationships between use, need and proximity to services.Design:consecutive case series of operations. Comparison at a population level with district stroke mortality, hospital admissions and material deprivation.Main outcome measures:standardised utilisation rates for CEA and measures of inter-district variability. Spearman's rank correlation coefficients for associations between variables.Results:variation in utilisation rates was considerable (14-fold difference across district populations). More individuals had bilateral surgery in the Yorkshire region than in the Northern (11.7% vs. 5.5%, p=0.002). There was no association between utilisation rates for CEA and district stroke mortality (r=−0.06, 95% CI −0.41 to 0.30) or admission rates for stroke (r=0.17, 95% CI −0.2 to 0.49). There was a strong relationship between residence in districts where services were located and higher utilisation. Rates of CEA were lowest in the regions» most affluent wards.Conclusion:use of CEA varies widely, depending on area of residence. Variation is not a consequence of differences in need, but reflects clinical practice and supply of services. There is evidence to suggest unmet need for CEA

Modification of the Alfvén wave spectrum by pellet injection

International audienceAlfvén eigenmodes driven by energetic particles are routinely observed in tokamak plasmas. These modes consist of poloidal harmonics of shear Alfvén waves coupled by inhomogeneity in the magnetic field. Further coupling is introduced by 3D inhomogeneities in the ion density during the assimilation of injected pellets. This additional coupling modifies the Alfvén continuum and discrete eigenmode spectrum. The frequencies of Alfvén eigenmodes drop dramatically when a pellet is injected in JET. From these observations, information about the changes in the ion density caused by a pellet can be inferred. To use Alfvén eigenmodes for MHD spectroscopy of pellet injected plasmas, the 3D MHD codes Stellgap and AE3D were generalised to incorporate 3D density profiles. A model for the expansion of the ionised pellet plasmoid along a magnetic field line was derived from the fluid equations. Thereby, the time evolution of the Alfvén eigenfrequency is reproduced. By comparing the numerical frequency drop of a toroidal Alfvén eigenmode (TAE) to experimental observations, the initial ion density of a cigar-shaped ablation region of length 4cm is estimated to be n * = 6.8×10 22 m −3 at the TAE location (r/a ≈ 0.75). The frequency sweeping of an Alfvén eigenmode ends when the ion density homogenises poloidally. Modelling suggests that the time for poloidal homogenisation of the ion density at the TAE position is τ h = 18 ± 4 ms for inboard pellet injection, and τ h = 26 ± 2 ms for outboard pellet injection. By reproducing the frequency evolution of the elliptical Alfvén eigenmode (EAE), the initial ion density at the EAE location (r/a ≈ 0.9) can be estimated to be n * = 4.8 × 10 22 m −3. Poloidal homogenisation of the ion density takes 2.7 times longer at the EAE location than at the TAE location for both inboard and outboard pellet injection

A Plant Extract of Ribes nigrum folium Possesses Anti-Influenza Virus Activity In Vitro and In Vivo by Preventing Virus Entry to Host Cells

Infections with influenza A viruses (IAV) are still amongst the major causes of highly contagious severe respiratory diseases not only bearing a devastating effect to human health, but also significantly impact the economy. Besides vaccination that represents the best option to protect from IAV infections, only two classes of anti-influenza drugs, inhibitors of the M2 ion channel and the neuraminidase, often causing resistant IAV variants have been approved. That is why the need for effective and amply available antivirals against IAV is of high priority. Here we introduce LADANIA067 from the leaves of the wild black currant (Ribes nigrum folium) as a potent compound against IAV infections in vitro and in vivo. LADANIA067 treatment resulted in a reduction of progeny virus titers in cell cultures infected with prototype avian and human influenza virus strains of different subtypes. At the effective dose of 100 µg/ml the extract did not exhibit apparent harming effects on cell viability, metabolism or proliferation. Further, viruses showed no tendency to develop resistance to LADANIA067 when compared to amantadine that resulted in the generation of resistant variants after only a few passages. On a molecular basis the protective effect of LADANIA067 appears to be mainly due to interference with virus internalisation. In the mouse infection model LADANIA067 treatment reduces progeny virus titers in the lung upon intranasal application. In conclusion, an extract from the leaves of the wild black currant might be a promising source for the development of new antiviral compounds to fight IAV infections

Can filesharers be triggered by economic incentives? Results of an experiment

Illegal filesharing on the internet leads to considerable financial losses for artists and copyright owners as well as producers and sellers of music. Thus far, measures to contain this phenomenon have been rather restrictive. However, there are still a considerable number of illegal systems, and users are able to decide quite freely between legal and illegal downloads because the latter are still difficult to sanction. Recent economic approaches account for the improved bargaining position of users. They are based on the idea of revenue-splitting between professional sellers and peers. In order to test such an innovative business model, the study reported in this article carried out an experiment with 100 undergraduate students, forming five small peer-to-peer networks.The networks were confronted with different economic conditions.The results indicate that even experienced filesharers hold favourable attitudes towards revenue-splitting.They seem to be willing to adjust their behaviour to different economic conditions

Physics of Solar Prominences: II - Magnetic Structure and Dynamics

Observations and models of solar prominences are reviewed. We focus on non-eruptive prominences, and describe recent progress in four areas of prominence research: (1) magnetic structure deduced from observations and models, (2) the dynamics of prominence plasmas (formation and flows), (3) Magneto-hydrodynamic (MHD) waves in prominences and (4) the formation and large-scale patterns of the filament channels in which prominences are located. Finally, several outstanding issues in prominence research are discussed, along with observations and models required to resolve them.Comment: 75 pages, 31 pictures, review pape

Professional closure by proxy: the impact of changing educational requirements on class mobility for a cohort of Big 8 partners

Closure events impacting on class mobility may include mechanisms initiated by bodies other than the professional body. The research examines if the introduction of full-time study requirements at universities for aspiring accountants effectively introduced a closure mechanism in the accounting profession. Data was derived from an Oral History study of partners in large firms. The younger partners (born after the Second World War) completed full-time degree study at university, but did not provide evidence of class mobility into the profession. The older cohort, born between 1928 and 1946, completed part-time studies only, few completed a degree, and, in contrast to the younger cohort, shows a perceptible upward movement from lower socio-economic classes into the professional class. This suggests that changing the preferred educational routes for new accountants entering the large chartered accounting (CA) firms compromised the "stepping stone" function of accounting as a portal into the professional class

Measurement of the polarisation of W bosons produced with large transverse momentum in pp collisions at sqrt(s) = 7 TeV with the ATLAS experiment

This paper describes an analysis of the angular distribution of W->enu and W->munu decays, using data from pp collisions at sqrt(s) = 7 TeV recorded with the ATLAS detector at the LHC in 2010, corresponding to an integrated luminosity of about 35 pb^-1. Using the decay lepton transverse momentum and the missing transverse energy, the W decay angular distribution projected onto the transverse plane is obtained and analysed in terms of helicity fractions f0, fL and fR over two ranges of W transverse momentum (ptw): 35 < ptw < 50 GeV and ptw > 50 GeV. Good agreement is found with theoretical predictions. For ptw > 50 GeV, the values of f0 and fL-fR, averaged over charge and lepton flavour, are measured to be : f0 = 0.127 +/- 0.030 +/- 0.108 and fL-fR = 0.252 +/- 0.017 +/- 0.030, where the first uncertainties are statistical, and the second include all systematic effects.Comment: 19 pages plus author list (34 pages total), 9 figures, 11 tables, revised author list, matches European Journal of Physics C versio

Observation of a new chi_b state in radiative transitions to Upsilon(1S) and Upsilon(2S) at ATLAS

The chi_b(nP) quarkonium states are produced in proton-proton collisions at the Large Hadron Collider (LHC) at sqrt(s) = 7 TeV and recorded by the ATLAS detector. Using a data sample corresponding to an integrated luminosity of 4.4 fb^-1, these states are reconstructed through their radiative decays to Upsilon(1S,2S) with Upsilon->mu+mu-. In addition to the mass peaks corresponding to the decay modes chi_b(1P,2P)->Upsilon(1S)gamma, a new structure centered at a mass of 10.530+/-0.005 (stat.)+/-0.009 (syst.) GeV is also observed, in both the Upsilon(1S)gamma and Upsilon(2S)gamma decay modes. This is interpreted as the chi_b(3P) system.Comment: 5 pages plus author list (18 pages total), 2 figures, 1 table, corrected author list, matches final version in Physical Review Letter

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters