Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial

OBJECTIVE: To evaluate the cost effectiveness of standard treatment with and without the addition of ward based non-invasive ventilation in patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Incremental cost effectiveness analysis of a randomised controlled trial. SETTING: Medical wards in 14 hospitals in the United Kingdom. PARTICIPANTS: The trial comprised 236 patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease and mild to moderate acidosis (pH 7.25-7.35) secondary to respiratory failure. The economic analysis compared the costs of treatment that these patients received after randomisation. MAIN OUTCOME MEASURE: Incremental cost per in-hospital death. RESULTS: 24/118 died in the group receiving standard treatment and 12/118 in the group receiving non-invasive ventilation (P=0.05). Allocation to the group receiving non-invasive ventilation was associated with a reduction in costs of £49 362 ($78 741; 73 109), mainly through reduced use of intensive care units. The incremental cost effectiveness ratio was £645 per death avoided (95% confidence interval £2310 to £386), indicating a dominant (more effective and less costly) strategy. Modelling of these data indicates that a typical UK hospital providing a non-invasive ventilation service will avoid six deaths and three to nine admissions to intensive care units per year, with an associated cost reduction of £12 000-53 000 per year. CONCLUSIONS: Non-invasive ventilation is a highly cost effective treatment that both reduced total costs and improved mortality in hospital

Differential rotation of nonlinear r-modes

Differential rotation of r-modes is investigated within the nonlinear theory up to second order in the mode amplitude in the case of a slowly-rotating, Newtonian, barotropic, perfect-fluid star. We find a nonlinear extension of the linear r-mode, which represents differential rotation that produces large scale drifts of fluid elements along stellar latitudes. This solution includes a piece induced by first-order quantities and another one which is a pure second-order effect. Since the latter is stratified on cylinders, it cannot cancel differential rotation induced by first-order quantities, which is not stratified on cylinders. It is shown that, unlikely the situation in the linearized theory, r-modes do not preserve vorticity of fluid elements at second-order. It is also shown that the physical angular momentum and energy of the perturbation are, in general, different from the corresponding canonical quantities.Comment: 9 pages, revtex4; section III revised, comments added in Introduction and Conclusions, references updated; to appear in Phys. Rev.

The rotational modes of relativistic stars: Numerical results

We study the inertial modes of slowly rotating, fully relativistic compact stars. The equations that govern perturbations of both barotropic and non-barotropic models are discussed, but we present numerical results only for the barotropic case. For barotropic stars all inertial modes are a hybrid mixture of axial and polar perturbations. We use a spectral method to solve for such modes of various polytropic models. Our main attention is on modes that can be driven unstable by the emission of gravitational waves. Hence, we calculate the gravitational-wave growth timescale for these unstable modes and compare the results to previous estimates obtained in Newtonian gravity (i.e. using post-Newtonian radiation formulas). We find that the inertial modes are slightly stabilized by relativistic effects, but that previous conclusions concerning eg. the unstable r-modes remain essentially unaltered when the problem is studied in full general relativity.Comment: RevTeX, 29 pages, 31 eps figure

r-modes in Relativistic Superfluid Stars

We discuss the modal properties of the $r$-modes of relativistic superfluid neutron stars, taking account of the entrainment effects between superfluids. In this paper, the neutron stars are assumed to be filled with neutron and proton superfluids and the strength of the entrainment effects between the superfluids are represented by a single parameter $\eta$. We find that the basic properties of the $r$-modes in a relativistic superfluid star are very similar to those found for a Newtonian superfluid star. The $r$-modes of a relativistic superfluid star are split into two families, ordinary fluid-like $r$-modes ($r^o$-mode) and superfluid-like $r$-modes ($r^s$-mode). The two superfluids counter-move for the $r^s$-modes, while they co-move for the $r^o$-modes. For the $r^o$-modes, the quantity $\kappa\equiv\sigma/\Omega+m$ is almost independent of the entrainment parameter $\eta$, where $m$ and $\sigma$ are the azimuthal wave number and the oscillation frequency observed by an inertial observer at spatial infinity, respectively. For the $r^s$-modes, on the other hand, $\kappa$ almost linearly increases with increasing $\eta$. It is also found that the radiation driven instability due to the $r^s$-modes is much weaker than that of the $r^o$-modes because the matter current associated with the axial parity perturbations almost completely vanishes.Comment: 14 pages, 4 figures. To appear in Physical Review

Adding value? A review of the international literature on the role of higher education in police training and education

This paper reviews the current English-language literature on developments in police training and education in order to identify common areas where higher education ‘adds value’ to police learning and development. Reforms in training and education are constituent parts of the ongoing shift to a service-oriented professional police in a number of countries. A comparative analysis of the literature on police training and education is provided here which focuses primarily on the USA, the European Union, Australia and India. The review provides a contribution to international policy debates about future developments in this area

Nonlinear r-Modes in Neutron Stars: Instability of an unstable mode

We study the dynamical evolution of a large amplitude r-mode by numerical simulations. R-modes in neutron stars are unstable growing modes, driven by gravitational radiation reaction. In these simulations, r-modes of amplitude unity or above are destroyed by a catastrophic decay: A large amplitude r-mode gradually leaks energy into other fluid modes, which in turn act nonlinearly with the r-mode, leading to the onset of the rapid decay. As a result the r-mode suddenly breaks down into a differentially rotating configuration. The catastrophic decay does not appear to be related to shock waves at the star's surface. The limit it imposes on the r-mode amplitude is significantly smaller than that suggested by previous fully nonlinear numerical simulations.Comment: Published in Phys. Rev. D Rapid Comm. 66, 041303(R) (2002

The r-modes in accreting neutron stars with magneto-viscous boundary layers

We explore the dynamics of the r-modes in accreting neutron stars in two ways. First, we explore how dissipation in the magneto-viscous boundary layer (MVBL) at the crust-core interface governs the damping of r-mode perturbations in the fluid interior. Two models are considered: one assuming an ordinary-fluid interior, the other taking the core to consist of superfluid neutrons, type II superconducting protons, and normal electrons. We show, within our approximations, that no solution to the magnetohydrodynamic equations exists in the superfluid model when both the neutron and proton vortices are pinned. However, if just one species of vortex is pinned, we can find solutions. When the neutron vortices are pinned and the proton vortices are unpinned there is much more dissipation than in the ordinary-fluid model, unless the pinning is weak. When the proton vortices are pinned and the neutron vortices are unpinned the dissipation is comparable or slightly less than that for the ordinary-fluid model, even when the pinning is strong. We also find in the superfluid model that relatively weak radial magnetic fields ~ 10^9 G (10^8 K / T)^2 greatly affect the MVBL, though the effects of mutual friction tend to counteract the magnetic effects. Second, we evolve our two models in time, accounting for accretion, and explore how the magnetic field strength, the r-mode saturation amplitude, and the accretion rate affect the cyclic evolution of these stars. If the r-modes control the spin cycles of accreting neutron stars we find that magnetic fields can affect the clustering of the spin frequencies of low mass x-ray binaries (LMXBs) and the fraction of these that are currently emitting gravitational waves.Comment: 19 pages, 8 eps figures, RevTeX; corrected minor typos and added a referenc

Gravitational-wave astronomy: the high-frequency window

This contribution is divided in two parts. The first part provides a text-book level introduction to gravitational radiation. The key concepts required for a discussion of gravitational-wave physics are introduced. In particular, the quadrupole formula is applied to the anticipated ``bread-and-butter'' source for detectors like LIGO, GEO600, EGO and TAMA300: inspiralling compact binaries. The second part provides a brief review of high frequency gravitational waves. In the frequency range above (say) 100Hz, gravitational collapse, rotational instabilities and oscillations of the remnant compact objects are potentially important sources of gravitational waves. Significant and unique information concerning the various stages of collapse, the evolution of protoneutron stars and the details of the supranuclear equation of state of such objects can be drawn from careful study of the gravitational-wave signal. As the amount of exciting physics one may be able to study via the detections of gravitational waves from these sources is truly inspiring, there is strong motivation for the development of future generations of ground based detectors sensitive in the range from hundreds of Hz to several kHz.Comment: 21 pages, 5 figures, Lectures presented at the 2nd Aegean Summer School on the Early Universe, Syros, Greece, September 200