Bronchial thermoplasty: implementing best practice in the era of cost containment.

Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine. Bronchial thermoplasty (BT), a US Food and Drug Administration approved bronchoscopy procedure in difficult-to-control persistent asthma, is a prime example of a new technology facing cost and implementation challenges. We discuss the specific indications and contraindications for BT and review recent real-world experiences that can provide the foundation for building a comprehensive asthma program that provides BT for difficult-to-control asthma patients who fail national guideline treatment recommendations after an adequate clinical trial of one. We also offer insight into the barriers to implementing a successful BT program and strategies for overcoming them

EFFECTS OF COMPOST TEA MAKING FROM DIFFERENTLY TREATED COMPOST ON PLANT DISEASE CONTROL

Joint Research on Environmental Science and Technology for the Eart

Adjusted ADM systems and their expected stability properties: constraint propagation analysis in Schwarzschild spacetime

In order to find a way to have a better formulation for numerical evolution of the Einstein equations, we study the propagation equations of the constraints based on the Arnowitt-Deser-Misner formulation. By adjusting constraint terms in the evolution equations, we try to construct an "asymptotically constrained system" which is expected to be robust against violation of the constraints, and to enable a long-term stable and accurate numerical simulation. We first provide useful expressions for analyzing constraint propagation in a general spacetime, then apply it to Schwarzschild spacetime. We search when and where the negative real or non-zero imaginary eigenvalues of the homogenized constraint propagation matrix appear, and how they depend on the choice of coordinate system and adjustments. Our analysis includes the proposal of Detweiler (1987), which is still the best one according to our conjecture but has a growing mode of error near the horizon. Some examples are snapshots of a maximally sliced Schwarzschild black hole. The predictions here may help the community to make further improvements.Comment: 23 pages, RevTeX4, many figures. Revised version. Added subtitle, reduced figures, rephrased introduction, and a native checked. :-

Constraints and Reality Conditions in the Ashtekar Formulation of General Relativity

We show how to treat the constraints and reality conditions in the $SO(3)$-ADM (Ashtekar) formulation of general relativity, for the case of a vacuum spacetime with a cosmological constant. We clarify the difference between the reality conditions on the metric and on the triad. Assuming the triad reality condition, we find a new variable, allowing us to solve the gauge constraint equations and the reality conditions simultaneously.Comment: LaTeX file, 12 pages, no figures; to appear in Classical and Quantum Gravit

A trick for passing degenerate points in Ashtekar formulation

We examine one of the advantages of Ashtekar's formulation of general relativity: a tractability of degenerate points from the point of view of following the dynamics of classical spacetime. Assuming that all dynamical variables are finite, we conclude that an essential trick for such a continuous evolution is in complexifying variables. In order to restrict the complex region locally, we propose some `reality recovering' conditions on spacetime. Using a degenerate solution derived by pull-back technique, and integrating the dynamical equations numerically, we show that this idea works in an actual dynamical problem. We also discuss some features of these applications.Comment: 9 pages by RevTeX or 16 pages by LaTeX, 3 eps figures and epsf-style file are include

SU(2)-invariant reduction of the 3+1 dimensional Ashtekar's gravity

We consider a space-time with spatial sections isomorphic to the group manifold of SU(2). Triad and connection fluctuations are assumed to be SU(2)-invariant. Thus, they form a finite dimensional phase space. We perform non-perturbative path integral quantization of the model. Contarary to previous claims the path integral measure appeared to be non-singular near configurations admitting additional Killing vectors. In this model we are able to calculate the generating functional of Green functions of the reduced phase space variables exactly.Comment: 12 page