Nurse telephone triage in out of hours primary care: a pilot study

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Constraining the Equation of State with Moment of Inertia Measurements

We estimate that the moment of inertia of star A in the recently discovered double pulsar system PSR J0737-3039 may be determined after a few years of observation to something like 10% accuracy. This would enable accurate estimates of the radius of the star and the presure of matter in the vicinity of 1 to 2 times the nuclear saturation density, which would in turn provide strong constraints on the equation of state of neutron stars and the physics of their interiors.Comment: Submitted to ApJ, 4 figure

Emergency and on-demand health care: modelling a large complex system

This paper describes how system dynamics was used as a central part of a whole-system review of emergency and on-demand health care in Nottingham, England. Based on interviews with 30 key individuals across health and social care, a 'conceptual map' of the system was developed, showing potential patient pathways through the system. This was used to construct a stock-flow model, populated with current activity data, in order to simulate patient flows and to identify system bottle-necks. Without intervention, assuming current trends continue, Nottingham hospitals are unlikely to reach elective admission targets or achieve the government target of 82% bed occupancy. Admissions from general practice had the greatest influence on occupancy rates. Preventing a small number of emergency admissions in elderly patients showed a substantial effect, reducing bed occupancy by 1% per annum over 5 years. Modelling indicated a range of undesirable outcomes associated with continued growth in demand for emergency care, but also considerable potential to intervene to alleviate these problems, in particular by increasing the care options available in the community

NS 1987A in SN 1987A

The possible detection of a compact object in the remnant of SN 1987A presents an unprecedented opportunity to follow its early evolution. The suspected detection stems from an excess of infrared emission from a dust blob near the compact object's predicted position. The infrared excess could be due to the decay of isotopes like 44Ti, accretion luminosity from a neutron star or black hole, magnetospheric emission or a wind originating from the spindown of a pulsar, or thermal emission from an embedded, cooling neutron star (NS 1987A). It is shown that the last possibility is the most plausible as the other explanations are disfavored by other observations and/or require fine-tuning of parameters. Not only are there indications the dust blob overlaps the predicted location of a kicked compact remnant, but its excess luminosity also matches the expected thermal power of a 30 year old neutron star. Furthermore, models of cooling neutron stars within the Minimal Cooling paradigm readily fit both NS 1987A and Cas A, the next-youngest known neutron star. If correct, a long heat transport timescale in the crust and a large effective stellar temperature are favored, implying relatively limited crustal n-1S0 superfluidity and an envelope with a thick layer of light elements, respectively. If the locations don't overlap, then pulsar spindown or accretion might be more likely, but the pulsar's period and magnetic field or the accretion rate must be rather finely tuned. In this case, NS 1987A may have enhanced cooling and/or a heavy-element envelope.Comment: 21 pages, 6 figures, to be published in Ap

Revisiting the Parallax of the Isolated Neutron Star RX J185635-3754 Using HST/ACS Imaging

We have redetermined the parallax and proper motion of the nearby isolated neutron star RX~J185635-3754. We used eight observations with the high resolution camera of the HST/ACS taken from 2002 through 2004. We performed the astrometric fitting using five independent methods, all of which yielded consistent results. The mean estimate of the distance is 123 (+11, -15) pc (1 sigma), in good agreement with our earlier published determination

Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation

Effect of the momentum dependence of nuclear symmetry potential on the transverse and elliptic flows

In the framework of the isospin-dependent Boltzmann-Uehling-Uhlenbeck transport model, effect of the momentum dependence of nuclear symmetry potential on nuclear transverse and elliptic flows in the neutron-rich reaction $^{132}$Sn+$^{124}$Sn at a beam energy of 400 MeV/nucleon is studied. We find that the momentum dependence of nuclear symmetry potential affects the rapidity distribution of the free neutron to proton ratio, the neutron and the proton transverse flows as a function of rapidity. The momentum dependence of nuclear symmetry potential affects the neutron-proton differential transverse flow more evidently than the difference of neutron and proton transverse flows as well as the difference of proton and neutron elliptic flows. It is thus better to probe the symmetry energy by using the difference of neutron and proton flows since the momentum dependence of nuclear symmetry potential is still an open question. And it is better to probe the momentum dependence of nuclear symmetry potential by using the neutron-proton differential transverse flow and the rapidity distribution of the free neutron to proton ratio.Comment: 6 pages, 6 figures, to be published by EPJ

Equation of state and phase transitions in asymmetric nuclear matter

The structure of the 3-dimension pressure-temperature-asymmetry surface of equilibrium of the asymmetric nuclear matter is studied within the thermal Thomas-Fermi approximation. Special attention is paid to the difference of the asymmetry parameter between the boiling sheet and that of the condensation sheet of the surface of equilibrium. We derive the condition of existence of the regime of retrograde condensation at the boiling of the asymmetric nuclear matter. We have performed calculations of the caloric curves in the case of isobaric heating. We have shown the presence of the plateau region in caloric curves at the isobaric heating of the asymmetric nuclear matter. The shape of the caloric curve depends on the pressure and is sensitive to the value of the asymmetry parameter. We point out that the experimental value of the plateau temperature T \approx 7 MeV corresponds to the pressure P = 0.01 MeV/fm^3 at the isobaric boiling.Comment: 6 pages, 6 figures, submitted to Phys. Rev.

Neutron stars with isovector scalar correlations

Neutron stars with the isovector scalar $\delta$-field are studied in the framework of the relativistic mean field ($RMF$) approach in a pure nucleon plus lepton scheme. The $\delta$-field leads to a larger repulsion in dense neutron-rich matter and to a definite splitting of proton and neutron effective masses. Both features are influencing the stability conditions of the neutron stars. Two parametrizations for the effective nonlinear Lagrangian density are used to calculate the nuclear equation of state ($EOS$) and the neutron star properties, and compared to correlated Dirac-Brueckner results. We conclude that in order to reproduce reasonable nuclear structure and neutron star properties within a $RMF$ approach a density dependence of the coupling constants is required.Comment: 11 pages, 5 figures, revtex4 styl

The Equation of State of Neutron-Star Matter in Strong Magnetic Fields

We study the effects of very strong magnetic fields on the equation of state (EOS) in multicomponent, interacting matter by developing a covariant description for the inclusion of the anomalous magnetic moments of nucleons. For the description of neutron star matter, we employ a field-theoretical approach which permits the study of several models which differ in their behavior at high density. Effects of Landau quantization in ultra-strong magnetic fields ($B>10^{14}$ Gauss) lead to a reduction in the electron chemical potential and a substantial increase in the proton fraction. We find the generic result for $B>10^{18}$ Gauss that the softening of the EOS caused by Landau quantization is overwhelmed by stiffening due to the incorporation of the anomalous magnetic moments of the nucleons. In addition, the neutrons become completely spin polarized. The inclusion of ultra-strong magnetic fields leads to a dramatic increase in the proton fraction, with consequences for the direct Urca process and neutron star cooling. The magnetization of the matter never appears to become very large, as the value of $|H/B|$ never deviates from unity by more than a few percent. Our findings have implications for the structure of neutron stars in the presence of large frozen-in magnetic fields.Comment: 40 pages, 7 figures, accepted for publication in Ap