Scalar Field Cosmologies with Barotropic Matter: Models of Bianchi class B

We investigate in detail the qualitative behaviour of the class of Bianchi type B spatially homogeneous cosmological models in which the matter content is composed of two non-interacting components; the first component is described by a barotropic fluid having a gamma-law equation of state, whilst the second is a non-interacting scalar field (phi) with an exponential potential V=Lambda exp(k phi). In particular, we study the asymptotic properties of the models both at early and late times, paying particular attention on whether the models isotropize (and inflate) to the future, and we discuss the genericity of the cosmological scaling solutions.Comment: 18 pages, 1 figure, uses revtex and epsf to insert figur

The Dynamics of Multi-Scalar Field Cosmological Models and Assisted Inflation

We investigate the dynamical properties of a class of spatially homogeneous and isotropic cosmological models containing a barotropic perfect fluid and multiple scalar fields with independent exponential potentials. We show that the assisted inflationary scaling solution is the global late-time attractor for the parameter values for which the model is inflationary, even when curvature and barotropic matter are included. For all other parameter values the multi-field curvature scaling solution is the global late-time attractor (in these solutions asymptotically the curvature is not dynamically negligible). Consequently, we find that in general all of the scalar fields in multi-field models with exponential potentials are non-negligible in late-time behaviour, contrary to what is commonly believed. The early-time and intermediate behaviour of the models is also studied. In particular, n-scalar field models are investigated and the structure of the saddle equilibrium points corresponding to inflationary m-field scaling solutions and non-inflationary m-field matter scaling solutions are also studied (where m<n), leading to interesting transient dynamical behaviour with new physical scenarios of potential importance.Comment: 27 pages, uses REVTeX Added an appendix illustrating some of the details needed to compute the stability of the assisted inflationary solutio

Disparities in kidney transplantation accessibility among immigrant populations in Europe: A systematic review and meta-analysis

Background and objectives: Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe. Methods: A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis. Results: Out of 109 articles, 5 were included (n&nbsp;=&nbsp;24,614). One Italian study (n&nbsp;=&nbsp;24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n&nbsp;=&nbsp;196, n = 283, n&nbsp;=&nbsp;77, n&nbsp;=&nbsp;119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31). Conclusions: In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them

Scaling Solutions in Robertson-Walker Spacetimes

We investigate the stability of cosmological scaling solutions describing a barotropic fluid with $p=(\gamma-1)\rho$ and a non-interacting scalar field $\phi$ with an exponential potential V(\phi)=V_0\e^{-\kappa\phi}. We study homogeneous and isotropic spacetimes with non-zero spatial curvature and find three possible asymptotic future attractors in an ever-expanding universe. One is the zero-curvature power-law inflation solution where $\Omega_\phi=1$ ($\gamma2/3,\kappa^2<2$). Another is the zero-curvature scaling solution, first identified by Wetterich, where the energy density of the scalar field is proportional to that of matter with $\Omega_\phi=3\gamma/\kappa^2$ ($\gamma3\gamma$). We find that this matter scaling solution is unstable to curvature perturbations for $\gamma>2/3$. The third possible future asymptotic attractor is a solution with negative spatial curvature where the scalar field energy density remains proportional to the curvature with $\Omega_\phi=2/\kappa^2$ ($\gamma>2/3,\kappa^2>2$). We find that solutions with $\Omega_\phi=0$ are never late-time attractors.Comment: 8 pages, no figures, latex with revte

Late-time behaviour of the tilted Bianchi type VI−1/9_{-1/9} models

We study tilted perfect fluid cosmological models with a constant equation of state parameter in spatially homogeneous models of Bianchi type VI$_{-1/9}$ using dynamical systems methods and numerical simulations. We study models with and without vorticity, with an emphasis on their future asymptotic evolution. We show that for models with vorticity there exists, in a small region of parameter space, a closed curve acting as the attractor.Comment: 13 pages, 1 figure, v2: typos fixed, minor changes, matches published versio

Conservative treatment in patients with an acute lumbosacral radicular syndrome: design of a randomised clinical trial [ISRCTN68857256]

BACKGROUND: The objective is to present the design of randomised clinical trial (RCT) on the effectiveness of physical therapy added to general practitioners management compared to general practitioners management only in patients with an acute lumbosacral radicular syndrome (also called sciatica). METHODS/DESIGN: Patients in general practice diagnosed with an acute (less than 6 weeks) lumbosacral radicular syndrome and an age above 18 years are eligible for participation. The general practitioners treatment follows their clinical guideline. The physical therapy treatment will consist of patient education and exercise therapy. The primary outcome measure is patients reported global perceived effect. Secondary outcome measures are severity of complaints, functional status, health status, fear of movement, medical consumption, sickness absence, costs and treatment preference. The follow-up is 52 weeks. DISCUSSION: Treatment by general practitioners and physical therapists in this study will be transparent and not a complete "black box". The results of this trial will contribute to the decision of the general practitioner regarding referral to physical therapy in patients with an acute lumbosacral radicular syndrome

Isotropic singularity in inhomogeneous brane cosmological models

We discuss the asymptotic dynamical evolution of spatially inhomogeneous brane-world cosmological models close to the initial singularity. By introducing suitable scale-invariant dependent variables and a suitable gauge, we write the evolution equations of the spatially inhomogeneous $G_{2}$ brane cosmological models with one spatial degree of freedom as a system of autonomous first-order partial differential equations. We study the system numerically, and we find that there always exists an initial singularity, which is characterized by the fact that spatial derivatives are dynamically negligible. More importantly, from the numerical analysis we conclude that there is an initial isotropic singularity in all of these spatially inhomogeneous brane cosmologies for a range of parameter values which include the physically important cases of radiation and a scalar field source. The numerical results are supported by a qualitative dynamical analysis and a calculation of the past asymptotic decay rates. Although the analysis is local in nature, the numerics indicates that the singularity is isotropic for all relevant initial conditions. Therefore this analysis, and a preliminary investigation of general inhomogeneous ($G_0$) models, indicates that it is plausible that the initial singularity is isotropic in spatially inhomogeneous brane-world cosmological models and consequently that brane cosmology naturally gives rise to a set of initial data that provide the conditions for inflation to subsequently take place.Comment: 32 pages with 8 pictures. submitted to Class. Quant. Gra

Exploring key elements of approaches that support childrens' preferences during painful and stressful medical procedures: A scoping review

PROBLEM: Children undergoing medical procedures can experience pain and distress. While numerous interventions exist to mitigate pain and distress, the ability to individualize the intervention to suit the needs and preferences of individual children is emerging as an important aspect of providing family-centered care and shared decision making. To date, the approaches for supporting children to express their preferences have not been systematically identified and described. A scoping review was conducted to identify such approaches and to describe the elements that are included in them. ELIGIBILITY CRITERIA: Studies that (a) described approaches with the aim to support children to express their coping preferences during medical procedures; (b) included the option for children to choose coping interventions; (c) included a child (1--18 years). SAMPLE: Searches were conducted in December 2019 and November 2020 in the following databases: Cinahl, Embase, PubMed and Psycinfo. RESULTS: Thirteen studies were identified that included six distinct approaches. Four important key elements were identified: 1) Aid to express preferences or choice, 2) Information Provision, 3) Assessment of feelings/emotions, 4) Feedback/Reflection and Reward. CONCLUSIONS: Identified approaches incorporate components of shared decision-making to support children in expressing their preferences during medical procedures and treatments. IMPLICATIONS: Children undergoing medical procedures can be supported in expressing their coping needs and preferences by using components of shared decision-making

Phase Space Analysis of Quintessence Cosmologies with a Double Exponential Potential

We use phase space methods to investigate closed, flat, and open Friedmann-Robertson-Walker cosmologies with a scalar potential given by the sum of two exponential terms. The form of the potential is motivated by the dimensional reduction of M-theory with non-trivial four-form flux on a maximally symmetric internal space. To describe the asymptotic features of run-away solutions we introduce the concept of a `quasi fixed point.' We give the complete classification of solutions according to their late-time behavior (accelerating, decelerating, crunch) and the number of periods of accelerated expansion.Comment: 46 pages, 5 figures; v2: minor changes, references added; v3: title changed, refined classification of solutions, 3 references added, version which appeared in JCA

Vascular architecture and hypoxic profiles in human head and neck squamous cell carcinomas

Tumour oxygenation and vasculature are determinants for radiation treatment outcome and prognosis in patients with squamous cell carcinomas of the head and neck. In this study we visualized and quantified these factors which may provide a predictive tool for new treatments. Twenty-one patients with stage III–IV squamous cell carcinomas of the head and neck were intravenously injected with pimonidazole, a bioreductive hypoxic marker. Tumour biopsies were taken 2 h later. Frozen tissue sections were stained for vessels and hypoxia by fluorescent immunohistochemistry. Twenty-two sections of biopsies of different head and neck sites were scanned and analysed with a computerized image analysis system. The hypoxic fractions varied from 0.02 to 0.29 and were independent from T- and N-classification, localization and differentiation grade. No significant correlation between hypoxic fraction and vascular density was observed. As a first attempt to categorize tumours based on their hypoxic profile, three different hypoxia patterns are described. The first category comprised tumours with large hypoxic, but viable, areas at distances even greater than 200 μm from the vessels. The second category showed a typical band-like distribution of hypoxia at an intermediate distance (50–200 μm) from the vessels with necrosis at greater distances. The third category demonstrated hypoxia already within 50 μm from the vessels, suggestive for acute hypoxia. This method of multiparameter analysis proved to be clinically feasible. The information on architectural patterns and the differences that exist between tumours can improve our understanding of the tumour micro-environment and may in the future be of assistance with the selection of (oxygenation modifying) treatment strategies. © 2000 Cancer Research Campaig