Nucleus-Electron Model for States Changing from a Liquid Metal to a Plasma and the Saha Equation

We extend the quantal hypernetted-chain (QHNC) method, which has been proved to yield accurate results for liquid metals, to treat a partially ionized plasma. In a plasma, the electrons change from a quantum to a classical fluid gradually with increasing temperature; the QHNC method applied to the electron gas is in fact able to provide the electron-electron correlation at arbitrary temperature. As an illustrating example of this approach, we investigate how liquid rubidium becomes a plasma by increasing the temperature from 0 to 30 eV at a fixed normal ion-density $1.03 \times 10^{22}/cm^3$. The electron-ion radial distribution function (RDF) in liquid Rb has distinct inner-core and outer-core parts. Even at a temperature of 1 eV, this clear distinction remains as a characteristic of a liquid metal. At a temperature of 3 eV, this distinction disappears, and rubidium becomes a plasma with the ionization 1.21. The temperature variations of bound levels in each ion and the average ionization are calculated in Rb plasmas at the same time. Using the density-functional theory, we also derive the Saha equation applicable even to a high-density plasma at low temperatures. The QHNC method provides a procedure to solve this Saha equation with ease by using a recursive formula; the charge population of differently ionized species are obtained in Rb plasmas at several temperatures. In this way, it is shown that, with the atomic number as the only input, the QHNC method produces the average ionization, the electron-ion and ion-ion RDF's, and the charge population which are consistent with the atomic structure of each ion for a partially ionized plasma.Comment: 28 pages(TeX) and 11 figures (PS

General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

BACKGROUND: General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD