The effect of waiting time on health outcomes and costs of total joint replacement in hip and knee patients

Nivelrikko on yksi yleisimmistä liikuntakyvyttömyyttä ja kipua aiheuttavista tuki- ja liikuntaelinsairauksista. Tekonivelkirurgiaan liittyvät pitkät jonotusajat ovat olleet länsimaissa vuosikymmenien ajan huolen aiheena. Tämän tutkimuksen tarkoitus oli selvittää jonotusajan pituuden vaikutusta polven ja lonkan primaariin tekonivelleikkaukseen liittyviin terveysvaikutuksiin sekä kustannuksiin ennen leikkausta ja sen jälkeen. Tekonivelleikkausjonoon asetetut polvi- ja lonkkapotilaat satunnaistettiin kahteen ryhmään: lyhyen jonotusajan ryhmään ja normaalin sairaalakäytännön mukaisesti jonottavaan ryhmään. Terveysvaikutuksia mitattiin 15D-, Harris Hip Score -, Knee Score - ja VAS-mittareilla. Tietoja kerättiin lääkkeiden sekä sosiaali- ja terveyspalvelujen käytöstä ja kustannuksista. Vaikuttavuutta arvioitiin kustannusutiliteettianalyysilla. Mittaukset tehtiin jonoon asettamisajankohtana, sairaalaan saapumisajankohtana sekä kolmen ja kahdentoista kuukauden kuluttua leikkauksesta. Tulokset perustuvat satunnaistetun aineiston hoitoaikeen mukaiseen analyysiin, ja tulokset on testattu herkkyysanalyyseilla. Jonotusajan pituudella ei ollut satunnaistettujen vertailuryhmien välillä merkittävää vaikutusta elämänlaatuun, kipuun eikä liikuntakykyyn. Leikkauksen jälkeiset vaikuttavuusarvot olivat tilastollisesti merkitsevästi parempia kuin arvot sairaalaan saavuttaessa. Kustannusvaikuttavuusanalyysin mukaan nopean leikkausryhmän lonkkapotilaat saavuttivat enemmän laatupainotettuja lisäelinvuosia pienemmillä kustannuksilla kuin normaalin käytännön mukaan jonottaneet potilaat. Polvipotilailla tilanne oli päinvastainen. Tutkimuksen seuranta-aikana tapahtuneen kadon vuoksi analyysin tuloksiin liittyy jonkin verran epävarmuutta, joten yleistettävää johtopäätöstä jonotusajan vaikutuksesta tekonivelleikkausten kustannusutiliteettiin ei voida varmistaa.15,00 euro

Constraints on Conformal Windows from Holographic Duals

We analyze a beta function with the analytic form of Novikov-Shifman-Vainshtein-Zakharov result in the five dimensional gravity-dilaton environment. We show how dilaton inherits poles and fixed points of such beta function through the zeros and points of extremum in its potential. Super Yang-Mills and supersymmetric QCD are studied in detail and Seiberg's electric-magnetic duality in the dilaton potential is explicitly demonstrated. Non-supersymmetric proposals of similar functional form are tested and new insights into the conformal window as well as determinations of scheme-independent value of the anomalous dimension at the fixed point are presented.Comment: Fig. 5b is corrected to match the discussion in the tex

IEA EBC Annex83 positive energy districts

At a global level, the need for energy efficiency and an increased share of renewable energy sources is evident, as is the crucial role of cities due to the rapid urbanization rate. As a consequence of this, the research work related to Positive Energy Districts (PED) has accelerated in recent years. A common shared definition, as well as technological approaches or methodological issues related to PEDs are still unclear in this development and a global scientific discussion is needed. The International Energy Agency’s Energy in Buildings and Communities Programme (IEA EBC) Annex 83 is the main platform for this international scientific debate and research. This paper describes the challenges of PEDs and the issues that are open for discussions and how the Annex 83 is planned and organized to facilitate this and to actively steer the development of PEDs major leaps forward. The main topics of discussion in the PED context are the role and importance of definitions of PEDs, virtual and geographical boundaries in PEDs, the role of different stakeholders, evaluation approaches, and the learnings of realized PED projects

Centrality dependence of multiplicity, transverse energy, and elliptic flow from hydrodynamics

The centrality dependence of the charged multiplicity, transverse energy, and elliptic flow coefficient is studied in a hydrodynamic model, using a variety of different initializations which model the initial energy or entropy production process as a hard or soft process, respectively. While the charged multiplicity depends strongly on the chosen initialization, the p_t-integrated elliptic flow for charged particles as a function of charged particle multiplicity and the p_t-differential elliptic flow for charged particles in minimum bias events turn out to be almost independent of the initial energy density profile.Comment: 11 pages RevTex, including 10 postscript figures. Slightly modified discussion of Figs. 5 and 6, updated references. This version to appear in Nuclear Physics

Traumatic brain injury patients' family members' evaluations of the social support provided by healthcare professionals in acute care hospitals

Aims and objectives The study aimed to examine traumatic brain injury (TBI) patient family members' (FMs) experiences of the support they received from healthcare professionals in acute care hospitals. Background The length of hospitalisation following TBI is constantly decreasing, and patients may return home with several problems. FMs care for the patients at home although they may not be prepared for the patient's medical needs or financial burden of the illness. The burden which some FMs experience can impair patient care and rehabilitation outcomes. Therefore, FMs require support during acute phases of TBI treatment. Design A structured questionnaire was sent to 216 TBI patients FMs. The response rate was 47% (n = 102). Methods A structured questionnaire-based on a systematic literature review and a previous questionnaire on TBI patient FMs' perceptions of support-was developed and used in the data collection. The questionnaire included 46 statements and 11 background questions. Data were collected via an electronic questionnaire. The STROBE checklist was followed in reporting the study. Results A factor analysis identified five factors that describe the guidance of TBI patient FMs: guidance of TBI patients' symptoms and survival; benefits of guidance; needs-based guidance; guidance for use of services; and guidance methods. Most of the FMs (51%-88%) felt that they had not received enough guidance from healthcare professionals in acute care hospitals across all five aspects of support. Conclusions The content of guidance should be developed, and healthcare staff should be trained to consider a FM's starting point when providing guidance. A calm environment, proper timing, sufficient information in different forms and professional healthcare staff were found to be key factors to comprehensive guidance. Involving FMs in the discharge process and rehabilitation of their loved ones both supports the abilities of caregivers and promotes the outcome of the patient's rehabilitation. Relevance to clinical practice This study provides varied information on the need for social support of TBI patients FMs in the early stages of treatment from the FMs' perspective. This research adopted the FM's perspective to identify various areas of social support that need to be developed so that the FMs of TBI patients receive enough support during the early stages of TBI treatment.Peer reviewe

Low frequency current noise of the single-electron shuttle

Coupling between electronic and mechanical degrees of freedom in a single electron shuttle system can cause a mechanical instability leading to shuttle transport of electrons between external leads. We predict that the resulting low frequency current noise can be enhanced due to amplitude fluctuations of the shuttle oscillations. Moreover, at the onset of mechanical instability a pronounced peak in the low frequency noise is expected.Comment: 14 pages, 3 figures, 1 tabl

AXL and CAV-1 play a role for MTH1 inhibitor TH1579 sensitivity in cutaneous malignant melanoma

Cutaneous malignant melanoma (CMM) is the deadliest form of skin cancer and clinically challenging due to its propensity to develop therapy resistance. Reactive oxygen species (ROS) can induce DNA damage and play a significant role in CMM. MTH1 protein protects from ROS damage and is often overexpressed in different cancer types including CMM. Herein, we report that MTH1 inhibitor TH1579 induced ROS levels, increased DNA damage responses, caused mitotic arrest and suppressed CMM proliferation leading to cell death both in vitro and in an in vivo xenograft CMM zebrafish disease model. TH1579 was more potent in abrogating cell proliferation and inducing cell death in a heterogeneous co-culture setting when compared with CMM standard treatments, vemurafenib or trametinib, showing its broad anticancer activity. Silencing MTH1 alone exhibited similar cytotoxic effects with concomitant induction of mitotic arrest and ROS induction culminating in cell death in most CMM cell lines tested, further emphasizing the importance of MTH1 in CMM cells. Furthermore, overexpression of receptor tyrosine kinase AXL, previously demonstrated to contribute to BRAF inhibitor resistance, sensitized BRAF mutant and BRAF/NRAS wildtype CMM cells to TH1579. AXL overexpression culminated in increased ROS levels in CMM cells. Moreover, silencing of a protein that has shown opposing effects on cell proliferation, CAV-1, decreased sensitivity to TH1579 in a BRAF inhibitor resistant cell line. AXL-MTH1 and CAV-1-MTH1 mRNA expressions were correlated as seen in CMM clinical samples. Finally, TH1579 in combination with BRAF inhibitor exhibited a more potent cell killing effect in BRAF mutant cells both in vitro and in vivo. In summary, we show that TH1579-mediated efficacy is independent of BRAF/NRAS mutational status but dependent on the expression of AXL and CAV-1

Periodic and Aperiodic Bunching in the Addition Spectra of Quantum Dot

We study electron addition spectra of quantum dots in a broad range of electron occupancies starting from the first electron. Spectra for dots containing <200 electrons reveal a surprising feature. Electron additions are not evenly spaced in gate voltage. Rather, they group into bunches. With increasing electron number the bunching evolves from occurring randomly to periodically at about every fifth electron. The periodicity of the bunching and features in electron tunneling rates suggest that the bunching is associated with electron additions into spatially distinct regions within the dots.Comment: 4 pages, 2 figures. Submitted to PR