Operative versus nonoperative treatment of acute Achilles tendon ruptures: A pilot economic decision analysis

Background: The operative treatment of Achilles tendon ruptures has been associated with lower rerupture rates and better function but also a risk of surgery-related complications compared with nonoperative treatment, which may provide improved outcomes with accelerated rehabilitation protocols. However, economic decision analyses integrating the updated costs of both treatment options are limited in the literature. Purpose: To compare the cost-effectiveness of operative and nonoperative treatment of acute Achilles tendon tears. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: An economic decision model was built to assess the cost-utility ratio (CUR) of open primary repair versus nonoperative treatment for acute Achilles tendon ruptures, based on direct costs from the practices of sports medicine and foot and ankle surgeons at a single tertiary academic center, with published outcome probabilities and patient utility data. Multiway sensitivity analyses were performed to reflect the range of data. Results: Nonoperative treatment was more cost-effective in the average scenario (nonoperative CUR, US$520; operative CUR, US$1995), but crossover occurred during the sensitivity analysis (nonoperative CUR range, US$224-US$2079; operative CUR range, US$789-US$8380). Operative treatment cost an extra average marginal CUR of US$1475 compared with nonoperative treatment, assuming uneventful healing in both treatment arms. The sensitivity analysis demonstrated a decreased marginal CUR of operative treatment when the outcome utility was maximized, and rerupture rates were minimized compared with nonoperative treatment. Conclusion: Nonoperative treatment was more cost-effective in average scenarios. Crossover indicated that open primary repair would be favorable for maximized outcome utility, such as that for young athletes or heavy laborers. The treatment decision for acute Achilles tendon ruptures should be individualized. These pilot results provide inferences for further longitudinal analyses incorporating future clinical evidence

Diverse Stellar Haloes in Nearby Milky Way-Mass Disc Galaxies

We have examined the resolved stellar populations at large galactocentric distances along the minor axis (from 10 kpc up to between 40 and 75 kpc), with limited major axis coverage, of six nearby highly-inclined Milky Way-mass disc galaxies using HST data from the GHOSTS survey. We select red giant branch stars to derive stellar halo density profiles. The projected minor axis density profiles can be approximated by power laws with projected slopes of between $-2$ and $-3.7$ and a diversity of stellar halo masses of $1-6\times 10^{9}M_{\odot}$, or $2-14\%$ of the total galaxy stellar masses. The typical intrinsic scatter around a smooth power law fit is $0.05-0.1$ dex owing to substructure. By comparing the minor and major axis profiles, we infer projected axis ratios $c/a$ at $\sim 25$ kpc between $0.4-0.75$. The GHOSTS stellar haloes are diverse, lying between the extremes charted out by the (rather atypical) haloes of the Milky Way and M31. We find a strong correlation between the stellar halo metallicities and the stellar halo masses. We compare our results with cosmological models, finding good agreement between our observations and accretion-only models where the stellar haloes are formed by the disruption of dwarf satellites. In particular, the strong observed correlation between stellar halo metallicity and mass is naturally reproduced. Low-resolution hydrodynamical models have unrealistically high stellar halo masses. Current high-resolution hydrodynamical models appear to predict stellar halo masses somewhat higher than observed but with reasonable metallicities, metallicity gradients and density profiles.Comment: 26 pages, 17 figures. Accepted for publication in MNRA

Extragalactic archeology with the GHOSTS Survey I. - Age-resolved disk structure of nearby low-mass galaxies

We study the individual evolution histories of three nearby low-mass edge-on galaxies (IC 5052, NGC4244, and NGC5023). Using resolved stellar populations, we constructed star count density maps for populations of different ages and analyzed the change of structural parameters with stellar age within each galaxy. We do not detect a separate thick disk in any of the three galaxies, even though our observations cover a wider range in equivalent surface brightness than any integrated light study. While scale heights increase with age, each population can be well described by a single disk. Two of the galaxies contain a very weak additional component, which we identify as the faint halo. The mass of these faint halos is lower than 1% of the mass of the disk. The three galaxies show low vertical heating rates, which are much lower than the heating rate of the Milky Way. This indicates that heating agents, such as giant molecular clouds and spiral structure, are weak in low-mass galaxies. All populations in the three galaxies exhibit no or only little flaring. While this finding is consistent with previous integrated light studies, it poses strong constraints on galaxy simulations, where strong flaring is often found as a result of interactions or radial migration.Comment: Accepted for publication in A&

A Performance Assessment of a Tactical Airborne Separation Assistance System using Realistic, Complex Traffic Flows

This paper presents the results from a study that investigates the performance of aspects of an Airborne Separation Assistance System (ASAS) under varying demand levels using realistic traffic patterns. This study only addresses the tactical aspects of an ASAS using aircraft state data (latitude, longitude, altitude, heading and speed) to detect and resolve projected conflicts. The main focus of this paper is to determine the extent to which sole reliance on the proposed tactical ASAS can maintain aircraft separation at demand levels up to three times current traffic. The effect of mixing ASAS equipped aircraft with non-equipped aircraft that do not have the capability to self-separate is also investigated

A Dense Gas Trigger for OH Megamasers

HCN and CO line diagnostics provide new insight into the OH megamaser (OHM) phenomenon, suggesting a dense gas trigger for OHMs. We identify three physical properties that differentiate OHM hosts from other starburst galaxies: (1) OHMs have the highest mean molecular gas densities among starburst galaxies; nearly all OHM hosts have = 10^3-10^4 cm^-3 (OH line-emitting clouds likely have n(H2) > 10^4 cm^-3). (2) OHM hosts are a distinct population in the nonlinear part of the IR-CO relation. (3) OHM hosts have exceptionally high dense molecular gas fractions, L(HCN)/L(CO)>0.07, and comprise roughly half of this unusual population. OH absorbers and kilomasers generally follow the linear IR-CO relation and are uniformly distributed in dense gas fraction and L(HCN), demonstrating that OHMs are independent of OH abundance. The fraction of non-OHMs with high mean densities and high dense gas fractions constrains beaming to be a minor effect: OHM emission solid angle must exceed 2 pi steradians. Contrary to conventional wisdom, IR luminosity does not dictate OHM formation; both star formation and OHM activity are consequences of tidal density enhancements accompanying galaxy interactions. The OHM fraction in starbursts is likely due to the fraction of mergers experiencing a temporal spike in tidally driven density enhancement. OHMs are thus signposts marking the most intense, compact, and unusual modes of star formation in the local universe. Future high redshift OHM surveys can now be interpreted in a star formation and galaxy evolution context, indicating both the merging rate of galaxies and the burst contribution to star formation.Comment: 5 pages, 3 figures, 1 table, accepted by ApJ Letter

Testing galaxy formation models with the GHOSTS survey: The color profile of M81's stellar halo

We study the properties of the stellar populations in M81's outermost part, which hereafter we will term the stellar halo, using HST ACS/WFC observations of 19 fields from the GHOSTS survey. The observed fields probe the stellar halo out to a projected distance of ~ 50 kpc from the galactic center. Each field was observed in both F606W and F814W filters. The 50% completeness levels of the color magnitude diagrams (CMDs) are typically at 2 mag below the tip of the red giant branch (TRGB). Fields at distances closer than 15 kpc show evidence of disk-dominated populations whereas fields at larger distances are mostly populated by halo stars. The RGB of the M81's halo CMDs is well matched with isochrones of ~ 10 Gyr and metallicities [Fe/H] ~ -1.2 dex, suggesting that the dominant stellar population of M81's halo has a similar age and metallicity. The halo of M81 is characterized by a color distribution of width ~ 0.4 mag and an approximately constant median value of (F606W - F814W) ~ 1 mag measured using stars within the magnitude range 23.7 < F814W < 25.5. When considering only fields located at galactocentric radius R > 15 kpc, we detect no color gradient in the stellar halo of M81. We place a limit of 0.03+/-0.11 mag difference between the median color of RGB M81 halo stars at ~ 15 and at 50 kpc, corresponding to a metallicity difference of 0.08+/-0.35 dex over that radial range for an assumed constant age of 10 Gyr. We compare these results with model predictions for the colors of stellar halos formed purely via accretion of satellite galaxies. When we analyze the cosmologically motivated models in the same way as the HST data, we find that they predict no color gradient for the stellar halos, in good agreement with the observations.Comment: 16 pages, 7 figures. Accepted to Ap

Use of Redox Probes for Characterization of Layer-by-Layer Gold Nanoparticle-Modified Screen-Printed Carbon Electrodes

The electrochemical characteristics of bare and surface-modified screen-printed carbon electrodes (SPCEs) were compared using voltammetric responses of common redox probes to determine the potential role of nanomaterials in previously documented signal enhancement. SPCEs modified with gold nanoparticles (AuNPs) by layer-by-layer (LbL) electrostatic adsorption were previously reported to exhibit an increase in voltammetric signal for Fe(CN)63−/4− that corresponds to an improvement of 102% in electroactive surface area over bare SPCEs. AuNP-modified SPCEs prepared by the same LbL strategy using the polycation poly(diallyldimethylammonium chloride) (PDDA) here were found to provide no beneficial increase in electroactive surface area over bare SPCEs. Though similar improvement in voltammetric signal of Fe(CN)63−/4− was found for AuNP/PDDA-modified compared to bare SPCEs in these studies, results with other redox couples ferrocene methanol (FcMeOH/FcMeOH+) and Ru(NH3)63+/2+ indicated no difference between the electroactive surface areas of modified and bare SPCEs. Furthermore, gold present on AuNP/PDDA-modified SPCEs accounted for only 62 (±12)% of the electroactive surface area. The previously reported improvement in electroactive surface area that was attributed to the inclusion of AuNPs on the SPCE surface appears to have resulted from a misinterpretation of the non-ideal behavior of Fe(CN)63− as a redox probe for bare SPCEs

Constraining the age of the NGC 4565 HI Disk Warp: Determining the Origin of Gas Warps

We have mapped the distribution of young and old stars in the gaseous HI warp of NGC 4565. We find a clear correlation of young stars (<600 Myr) with the warp, but no coincident old stars (>1 Gyr), which places an upper limit on the age of the structure. The formation rate of the young stars, which increased ~300 Myr ago relative to the surrounding regions, is (6.3 +2.5/-1.5) x 10^-5 M_sol/yr/kpc^2. This implies a ~60+/-20 Gyr depletion time of the HI warp, similar to the timescales calculated for the outer HI disks of nearby spiral galaxies. While some stars associated with the warp fall into the asymptotic giant branch (AGB) region of the color magnitude diagram, where stars could be as old as 1 Gyr, further investigation suggests that they may be interlopers rather than real AGB stars. We discuss the implications of these age constraints for the formation of HI warps, and the gas fueling of disk galaxies.Comment: 12 pages, 9 figures. Accepted for publication in Ap

Meeting Air Transportation Demand in 2025 by Using Larger Aircraft and Alternative Routing to Complement NextGen Operational Improvements

A study was performed that investigates the use of larger aircraft and alternative routing to complement the capacity benefits expected from the Next Generation Air Transportation System (NextGen) in 2025. National Airspace System (NAS) delays for the 2025 demand projected by the Transportation Systems Analysis Models (TSAM) were assessed using NASA s Airspace Concept Evaluation System (ACES). The shift in demand from commercial airline to automobile and from one airline route to another was investigated by adding the route delays determined from the ACES simulation to the travel times used in the TSAM and re-generating new flight scenarios. The ACES simulation results from this study determined that NextGen Operational Improvements alone do not provide sufficient airport capacity to meet the projected demand for passenger air travel in 2025 without significant system delays. Using larger aircraft with more seats on high-demand routes and introducing new direct routes, where demand warrants, significantly reduces delays, complementing NextGen improvements. Another significant finding of this study is that the adaptive behavior of passengers to avoid congested airline-routes is an important factor when projecting demand for transportation systems. Passengers will choose an alternative mode of transportation or alternative airline routes to avoid congested routes, thereby reducing delays to acceptable levels for the 2025 scenario; the penalty being that alternative routes and the option to drive increases overall trip time by 0.4% and may be less convenient than the first-choice route