A New Relativistic High Temperature Bose-Einstein Condensation

We discuss the properties of an ideal relativistic gas of events possessing Bose-Einstein statistics. We find that the mass spectrum of such a system is bounded by $\mu \leq m\leq 2M/\mu _K,$ where $\mu$ is the usual chemical potential, $M$ is an intrinsic dimensional scale parameter for the motion of an event in space-time, and $\mu _K$ is an additional mass potential of the ensemble. For the system including both particles and antiparticles, with nonzero chemical potential $\mu ,$ the mass spectrum is shown to be bounded by $|\mu |\leq m\leq 2M/\mu _K,$ and a special type of high-temperature Bose-Einstein condensation can occur. We study this Bose-Einstein condensation, and show that it corresponds to a phase transition from the sector of continuous relativistic mass distributions to a sector in which the boson mass distribution becomes sharp at a definite mass $M/\mu _K.$ This phenomenon provides a mechanism for the mass distribution of the particles to be sharp at some definite value.Comment: Latex, 22 page

Eikonal Approximation to 5D Wave Equations as Geodesic Motion in a Curved 4D Spacetime

We first derive the relation between the eikonal approximation to the Maxwell wave equations in an inhomogeneous anisotropic medium and geodesic motion in a three dimensional Riemannian manifold using a method which identifies the symplectic structure of the corresponding mechanics. We then apply an analogous method to the five dimensional generalization of Maxwell theory required by the gauge invariance of Stueckelberg's covariant classical and quantum dynamics to demonstrate, in the eikonal approximation, the existence of geodesic motion for the flow of mass in a four dimensional pseudo-Riemannian manifold. These results provide a foundation for the geometrical optics of the five dimensional radiation theory and establish a model in which there is mass flow along geodesics. Finally we discuss the case of relativistic quantum theory in an anisotropic medium as well. In this case the eikonal approximation to the relativistic quantum mechanical current coincides with the geodesic flow governed by the pseudo-Riemannian metric obtained from the eikonal approximation to solutions of the Stueckelberg-Schr\"odinger equation. This construction provides a model for an underlying quantum mechanical structure for classical dynamical motion along geodesics on a pseudo-Riemannian manifold. The locally symplectic structure which emerges is that of Stueckelberg's covariant mechanics on this manifold.Comment: TeX file. 17 pages. Rewritten for clarit

Economic outcomes of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with left main or three-vessel coronary artery disease: One-year results from the SYNTAX trial

Objectives: To evaluate the cost-effectiveness of alternative approaches to revascularization for patients with three-vessel or left main coronary artery disease (CAD). Background: Previous studies have demonstrated that, despite higher initial costs, long-term costs with bypass surgery (CABG) in multivessel CAD are similar to those for percutaneous coronary intervention (PCI). The impact of drug-eluting stents (DES) on these results is unknown. Methods: The SYNTAX trial randomized 1,800 patients with left main or three-vessel CAD to either CABG (n = 897) or PCI using paclitaxel-eluting stents (n = 903). Resource utilization data were collected prospectively for all patients, and cumulative 1-year costs were assessed from the perspective of the U.S. healthcare system. Results: Total costs for the initial hospitalization were $5,693/patient higher with CABG, whereas follow-up costs were$2,282/patient higher with PCI due mainly to more frequent revascularization procedures and higher outpatient medication costs. Total 1-year costs were thus $3,590/patient higher with CABG, while quality-adjusted life expectancy was slightly higher with PCI. Although PCI was an economically dominant strategy for the overall population, cost-effectiveness varied considerably according to angiographic complexity. For patients with high angiographic complexity (SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and the incremental cost-effectiveness ratio for CABG was$43,486 per quality-adjusted life-year gained. Conclusions: Among patients with three-vessel or left main CAD, PCI is an economically attractive strategy over the first year for patients with low and moderate angiographic complexity, while CABG is favored among patients with high angiographic complexity

Toward a 21st-century health care system: Recommendations for health care reform

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage. 8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges