2,176 research outputs found
The microscopic origin of thermal cracking in rocks: An investigation by simultaneous time-of-flight neutron diffraction and acoustic emission monitoring
We demonstrate that neutron diffraction measurements make it possible to quantify elastic strains within the interior of solid samples, and thus have great potential for addressing a wide range of problems connected with the characterization of the mechanical properties of geological materials. We use the time-of-flight neutron diffraction technique, in combination with acoustic emission monitoring, to study the evolution of thermal strain within the interior of samples of a pure quartzite during slow heating, and the onset of the associated thermal cracking. Thermal cracking commences around 180 degreesC when the thermal strain deficit along the a-axes of quartz grains induces a thermal stress that is close to the bulk tensile strength of the rock
The Resilience of the British and European Goods Industry: Challenge of Brexit
This is a study of the volume flexibility of the British and European goods industry, and its relative ability to cope with exogenous shocks, using the case of the Brexit process in a comparative context. It is located within the literature on comparative capitalism, and what it tells us in terms of how different institutional orders may be equipped to deal with such events. Using data for goods firms across 27 EU countries and the UK, we find that the UK goods industry has coped poorly with the shocks related to the Brexit process: its volume flexibility has declined. Brexit also has had an, albeit lesser, impact on the volume flexibility of their European firms counterparts. In particular, smaller firms in the EU coped better, a possible reflection of stronger institutional supports. However, firms that investing more in R&D, provide training to improve management efficiency, and apply innovation to improve asset efficiency, seem to be coping better. This study illustrates how the withdrawal of Britain from supra-national European institutions seems to have accentuated any negative effects of domestic institutions on firms, and, indeed, has had even worse consequences than the 2008 economic crisis for the British goods industry. The latter would suggest it is ill equipped to cope with further shocks, such as the 2020 pandemic. We draw out the implications for theorizing, policy and future research
Orientation cues for high-flying nocturnal insect migrants: do turbulence-induced temperature and velocity fluctuations indicate the mean wind flow?
Migratory insects flying at high altitude at night often show a degree of common alignment, sometimes with quite small angular dispersions around the mean. The observed orientation directions are often close to the downwind direction and this would seemingly be adaptive in that large insects could add their self-propelled speed to the wind speed, thus maximising their displacement in a given time. There are increasing indications that high-altitude orientation may be maintained by some intrinsic property of the wind rather than by visual perception of relative ground movement. Therefore, we first examined whether migrating insects could deduce the mean wind direction from the turbulent fluctuations in temperature. Within the atmospheric boundary-layer, temperature records show characteristic ramp-cliff structures, and insects flying downwind would move through these ramps whilst those flying crosswind would not. However, analysis of vertical-looking radar data on the common orientations of nocturnally migrating insects in the UK produced no evidence that the migrants actually use temperature ramps as orientation cues. This suggests that insects rely on turbulent velocity
and acceleration cues, and refocuses attention on how these can be detected, especially as small-scale turbulence is usually held to be directionally invariant (isotropic). In the second part of the paper we present a theoretical analysis and simulations showing that velocity fluctuations and accelerations felt by an insect are predicted to be anisotropic even when the small-scale turbulence (measured at a fixed point or along the trajectory of a fluid-particle) is isotropic. Our results thus provide further evidence that insects do indeed use turbulent velocity and acceleration cues as indicators of the mean wind direction
The False Economy of Seeking to Eliminate Delayed Transfers of Care: Some Lessons from Queueing Theory
This is the final version. Available on open access from Springer via the DOI in this recordBackground
It is a stated ambition of many healthcare systems to eliminate delayed transfers of care (DTOCs) between acute and step-down community services.
Objective
This study aims to demonstrate how, counter to intuition, pursual of such a policy is likely to be uneconomical, as it would require large amounts of community capacity to accommodate even the rarest of demand peaks, leaving much capacity unused for much of the time.
Methods
Some standard results from queueing theory—a mathematical discipline for considering the dynamics of queues and queueing systems—are used to provide a model of patient flow from the acute to community setting. While queueing models have a track record of application in healthcare, they have not before been used to address this question.
Results
Results show that ‘eliminating’ DTOCs is a false economy: the additional community costs required are greater than the possible acute cost saving. While a substantial proportion of DTOCs can be attributed to inefficient use of resources, the remainder can be considered economically essential to ensuring cost-efficient service operation. For England’s National Health Service (NHS), our modelling estimates annual cost savings of £117m if DTOCs are reduced to the 12% of current levels that can be regarded as economically essential.
Conclusion
This study discourages the use of ‘zero DTOC’ targets and instead supports an assessment based on the specific characteristics of the healthcare system considered.Health Data Research U
A close halo of large transparent grains around extreme red giant stars
Intermediate-mass stars end their lives by ejecting the bulk of their
envelope via a slow dense wind back into the interstellar medium, to form the
next generation of stars and planets. Stellar pulsations are thought to elevate
gas to an altitude cool enough for the condensation of dust, which is then
accelerated by radiation pressure from starlight, entraining the gas and
driving the wind. However accounting for the mass loss has been a problem due
to the difficulty in observing tenuous gas and dust tens of milliarcseconds
from the star, and there is accordingly no consensus on the way sufficient
momentum is transferred from the starlight to the outflow. Here, we present
spatially-resolved, multi-wavelength observations of circumstellar dust shells
of three stars on the asymptotic giant branch of the HR diagram. When imaged in
scattered light, dust shells were found at remarkably small radii (<~ 2 stellar
radii) and with unexpectedly large grains (~300 nm radius). This proximity to
the photosphere argues for dust species that are transparent to starlight and
therefore resistant to sublimation by the intense radiation field. While
transparency usually implies insufficient radiative pressure to drive a wind,
the radiation field can accelerate these large grains via photon scattering
rather than absorption - a plausible mass-loss mechanism for lower-amplitude
pulsating stars.Comment: 13 pages, 1 table, 6 figure
A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting
INTRODUCTION Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK.
METHODS A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs’ ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients.
RESULTS A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients.
CONCLUSIONS ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs’ diagnostic accuracy, patient outcomes and cost effectiveness
Search algorithms as a framework for the optimization of drug combinations
Combination therapies are often needed for effective clinical outcomes in the
management of complex diseases, but presently they are generally based on
empirical clinical experience. Here we suggest a novel application of search
algorithms, originally developed for digital communication, modified to
optimize combinations of therapeutic interventions. In biological experiments
measuring the restoration of the decline with age in heart function and
exercise capacity in Drosophila melanogaster, we found that search algorithms
correctly identified optimal combinations of four drugs with only one third of
the tests performed in a fully factorial search. In experiments identifying
combinations of three doses of up to six drugs for selective killing of human
cancer cells, search algorithms resulted in a highly significant enrichment of
selective combinations compared with random searches. In simulations using a
network model of cell death, we found that the search algorithms identified the
optimal combinations of 6-9 interventions in 80-90% of tests, compared with
15-30% for an equivalent random search. These findings suggest that modified
search algorithms from information theory have the potential to enhance the
discovery of novel therapeutic drug combinations. This report also helps to
frame a biomedical problem that will benefit from an interdisciplinary effort
and suggests a general strategy for its solution.Comment: 36 pages, 10 figures, revised versio
Development and Validation of a Composite Programmatic Assessment Tool for HIV Therapy
Background
We developed and validated a new and simple metric, the Programmatic Compliance Score (PCS), based on the IAS-USA antiretroviral therapy management guidelines for HIV-infected adults, as a predictor of all-cause mortality, at a program-wide level. We hypothesized that non-compliance would be associated with the highest probability of mortality.
Methods and Findings
3543 antiretroviral-naive HIV-infected patients aged ≥19 years who initiated antiretroviral therapy between January 1, 2000 and August 31, 2009 in British Columbia (BC), Canada, were followed until August 31, 2010. The PCS is composed by six non-performance indicators based on the IAS-USA guidelines: (1) having <3 CD4 count tests in the first year after starting antiretroviral therapy; (2) having <3 plasma viral load tests in the first year after starting antiretroviral therapy; (3) not having drug resistance testing done prior to starting antiretroviral therapy; (4) starting on a non-recommended antiretroviral therapy regimen; (5) starting therapy with CD4 <200 cells/mm3; and (6) not achieving viral suppression within 6 months since antiretroviral therapy initiation. The sum of these six indicators was used to develop the PCS score - higher score indicates poorer performance. The main outcome was all-cause mortality. Each PCS component was independently associated with mortality. In the mortality analysis, the odds ratio (OR) for PCS ≥4 versus 0 was 22.37 (95% CI 10.46–47.84).
Conclusions
PCS was strongly associated with all-cause mortality. These results lend independent validation to the IAS-USA treatment guidelines for HIV-infected adults. Further efforts are warranted to enhance the PCS as a means to further improve clinical outcomes. These should be specifically evaluated and targeted at healthcare providers and patients
Dietary changes in migrant adolescents with increasing length of stay in Australia and associated risk of wheeze – a retrospective, cross sectional study
Morphogenesis of the T4 tail and tail fibers
Remarkable progress has been made during the past ten years in elucidating the structure of the bacteriophage T4 tail by a combination of three-dimensional image reconstruction from electron micrographs and X-ray crystallography of the components. Partial and complete structures of nine out of twenty tail structural proteins have been determined by X-ray crystallography and have been fitted into the 3D-reconstituted structure of the "extended" tail. The 3D structure of the "contracted" tail was also determined and interpreted in terms of component proteins. Given the pseudo-atomic tail structures both before and after contraction, it is now possible to understand the gross conformational change of the baseplate in terms of the change in the relative positions of the subunit proteins. These studies have explained how the conformational change of the baseplate and contraction of the tail are related to the tail's host cell recognition and membrane penetration function. On the other hand, the baseplate assembly process has been recently reexamined in detail in a precise system involving recombinant proteins (unlike the earlier studies with phage mutants). These experiments showed that the sequential association of the subunits of the baseplate wedge is based on the induced-fit upon association of each subunit. It was also found that, upon association of gp53 (gene product 53), the penultimate subunit of the wedge, six of the wedge intermediates spontaneously associate to form a baseplate-like structure in the absence of the central hub. Structure determination of the rest of the subunits and intermediate complexes and the assembly of the hub still require further study
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