The health care burden and societal impact of acute otitis media in seven European countries: results of an Internet survey

This paper estimates medical resource use, direct costs, and productivity losses and costs (indirect costs) during episodes of acute otitis media (AOM) in young children. A 24-item Internet questionnaire was developed for parents in Belgium (Flanders), France, Germany, Italy, The Netherlands, Spain, and the United Kingdom (UK) to report health care resource use and productivity losses during the most recent episode of AOM in their child, younger than 5 years. The percentage who did not seek medical help for AOM was considerable in The Netherlands (28.3%) and the UK (19.7%). Antibiotic use was high, ranging from 60.8% (Germany) to 87.1% (Italy). Total costs per AOM episode ranged from D 332.00 (The Netherlands) to D 752.49 (UK). Losses in productivity accounted for 61% (France) to 83% (Germany) of the total costs. AOM poses a significant medical and economic burden to society

Fractal Stability Border in Plane Couette Flow

We study the dynamics of localised perturbations in plane Couette flow with periodic lateral boundary conditions. For small Reynolds number and small amplitude of the initial state the perturbation decays on a viscous time scale $t \propto Re$. For Reynolds number larger than about 200, chaotic transients appear with life times longer than the viscous one. Depending on the type of the perturbation isolated initial conditions with infinite life time appear for Reynolds numbers larger than about 270--320. In this third regime, the life time as a function of Reynolds number and amplitude is fractal. These results suggest that in the transition region the turbulent dynamics is characterised by a chaotic repeller rather than an attractor.Comment: 4 pages, Latex, 4 eps-figures, submitted to Phys. Rev. Le

Fragment Production in Non-central Collisions of Intermediate Energy Heavy Ions

The defining characteristics of fragment emission resulting from the non-central collision of 114Cd ions with 92Mo target nuclei at E/A = 50 MeV are presented. Charge correlations and average relative velocities for mid-velocity fragment emission exhibit significant differences when compared to standard statistical decay. These differences associated with similar velocity dissipation are indicative of the influence of the entrance channel dynamics on the fragment production process

Space and Time pattern of mid-velocity IMF emission in peripheral heavy-ion collisions at Fermi energies

The emission pattern in the V_perp - V_par plane of Intermediate Mass Fragments with Z=3-7 (IMF) has been studied in the collision 116Sn + 93Nb at 29.5 AMeV as a function of the Total Kinetic Energy Loss of the reaction. This pattern shows that for peripheral reactions most of IMF's are emitted at mid-velocity. Coulomb trajectory calculations demonstrate that these IMF's are produced in the early stages of the reaction and shed light on geometrical details of these emissions, suggesting that the IMF's originate both from the neck and the surface of the interacting nuclei.Comment: 4 pages, 3 figures, RevTex 3.1, submitted to Phys. Rev. Letter

Fission-Residues Produced in the Spallation Reaction 238U+p at 1 A GeV

Fission fragments from 1 A GeV 238U projectiles irradiating a hydrogen target were investigated by using the fragment separator FRS for magnetic selection of reaction products including ray-tracing and DE-ToF techniques. The momentum spectra of 733 identified fragments were analysed to provide isotopic production cross sections, fission-fragment velocities and recoil momenta of the fissioning parent nuclei. Besides their general relevance, these quantities are also demanded for applications. Calculations and simulations with codes commonly used and recently developed or improved are compared to the data.Comment: 60 pages, 21 figures, 4 tables, 2 appendices (15 pages

Basin boundary, edge of chaos, and edge state in a two-dimensional model

In shear flows like pipe flow and plane Couette flow there is an extended range of parameters where linearly stable laminar flow coexists with a transient turbulent dynamics. When increasing the amplitude of a perturbation on top of the laminar flow, one notes a a qualitative change in its lifetime, from smoothly varying and short one on the laminar side to sensitively dependent on initial conditions and long on the turbulent side. The point of transition defines a point on the edge of chaos. Since it is defined via the lifetimes, the edge of chaos can also be used in situations when the turbulence is not persistent. It then generalises the concept of basin boundaries, which separate two coexisting attractors, to cases where the dynamics on one side shows transient chaos and almost all trajectories eventually end up on the other side. In this paper we analyse a two-dimensional map which captures many of the features identified in laboratory experiments and direct numerical simulations of hydrodynamic flows. The analysis of the map shows that different dynamical situations in the edge of chaos can be combined with different dynamical situations in the turbulent region. Consequently, the model can be used to develop and test further characterisations that are also applicable to realistic flows.Comment: 24 pages, 9 color figure

Charge correlations and dynamical instabilities in the multifragment emission process

A new, sensitive method allows one to search for the enhancement of events with nearly equal-sized fragments as predicted by theoretical calculations based on volume or surface instabilities. Simulations have been performed to investigate the sensitivity of the procedure. Experimentally, charge correlations of intermediate mass fragments emitted from heavy ion reactions at intermediate energies have been studied. No evidence for a preferred breakup into equal-sized fragments has been found.Comment: 12 pages, TeX type, psfig, submitted to Phys. Rev. Lett, also available at http://csa5.lbl.gov/moretto/ps/zcor_pp.p

Budget impact from the incorporation of positron emission tomography - computed tomography for staging lung cancers.

Objective: To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer. Methods: The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease's prevalence and on the technologies' accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used. Results: The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively. Conclusions: The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated