Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

Objectives: “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods: National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results: The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions: The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings

Ripple and kink dynamics

We propose a relevant modification of the Nishimori-Ouchi model [{\em Phys. Rev. Lett.} {\bf 71}, 197 (1993)] for granular landscape erosion. We explicitly introduce a new parameter: the angle of repose $\theta_r$, and a new process: avalanches. We show that the $\theta_r$ parameter leads to an asymmetry of the ripples, as observed in natural patterns. The temporal evolution of the maximum ripple height $h_{max}$ is limited and not linear, according to recent observations. The ripple symmetry and the kink dynamics are studied and discussed.Comment: 7 pages, 10 figure, RevTe

Effects of different regions of the developing gut on the migration of enteric neural crest-derived cells: A role for Sema3A, but not Sema3F

AbstractThe enteric nervous system arises from vagal (caudal hindbrain) and sacral level neural crest-derived cells that migrate into and along the developing gut. Data from previous studies have suggested that (i) there may be gradients along the gut that induce the caudally directed migration of vagal enteric neural precursors (ENPs), (ii) exposure to the caecum might alter the migratory ability of vagal ENPs and (iii) Sema3A might regulate the entry into the hindgut of ENPs derived from sacral neural crest. Using co-cultures we show that there is no detectable gradient of chemoattractive molecules along the pre-caecal gut that specifically promotes the caudally directed migration of vagal ENPs, although vagal ENPs migrate faster caudally than rostrally along explants of hindgut. Exposure to the caecum did not alter the rate at which ENPs colonized explants of hindgut, but it did alter the ability of ENPs to colonize the midgut. The co-cultures also revealed that there is localized expression of a repulsive cue in the distal hindgut, which might delay the entry of sacral ENPs. We show that Sema3A is expressed by the hindgut mesenchyme and its receptor, neuropilin-1, is expressed by migrating ENPs. Furthermore, there is premature entry of sacral ENPs and extrinsic axons into the distal hindgut of fetal mice lacking Sema3A. These data show that Sema3A expressed by the distal hindgut regulates the entry of sacral ENPs and extrinsic axons into the hindgut. ENPs did not express neuropilin-2 and there was no detectable change in the timetable by which ENPs colonize the gut in mice lacking neuropilin-2

Gyroid cuticular structures in butterfly wing scales: biological photonic crystals

We present a systematic study of the cuticular structure in the butterfly wing scales of some papilionids (Parides sesostris and Teinopalpus imperialis) and lycaenids (Callophrys rubi, Cyanophrys remus, Mitoura gryneus and Callophrys dumetorum). Using published scanning and transmission electron microscopy (TEM) images, analytical modelling and computer-generated TEM micrographs, we find that the three-dimensional cuticular structures can be modelled by gyroid structures with various filling fractions and lattice parameters. We give a brief discussion of the formation of cubic gyroid membranes from the smooth endoplasmic reticulum in the scale's cell, which dry and harden to leave the cuticular structure behind when the cell dies. The scales of C. rubi are a potentially attractive biotemplate for producing three-dimensional optical photonic crystals since for these scales the cuticle-filling fraction is nearly optimal for obtaining the largest photonic band gap in a gyroid structure

Confinement of Spin and Charge in High-Temperature Superconductors

By exploiting the internal gauge-invariance intrinsic to a spin-charge separated electron, we show that such degrees of freedom must be confined in two-dimensional superconductors experiencing strong inter-electron repulsion. We also demonstrate that incipient confinement in the normal state can prevent chiral spin-fluctuations from destroying the cross-over between strange and psuedo-gap regimes in under-doped high-temperature superconductors. Last, we suggest that the negative Hall anomaly observed in these materials is connected with this confinement effect.Comment: 12 pages, 1 postscript figure, to appear in PRB (RC), May 199

Evidence for composite nature of quasiparticles in the 2D t-J model

It is shown that the dynamics of a single hole in a quantum antiferromagnet (described by the t--J model) can be simply understood in terms of a composite quasiparticle. This description provides naturally two different energy scales t and J corresponding to the inverse masses of the charge (holon) and spin (spinon) elementary excitations respectively. This picture is consistent with the exact results obtained on small clusters for the single hole spectral function and optical conductivity providing that one assumes the existence of a string-like force of magnitude J between the holon and the spinon. Then the hole quasiparticle can be interpreted as a bound state of its two constituents.Comment: 5 pages (revtex), 6 figures uuencoded, (Submitted to Nuclear Physics B

Minimal model for aeolian sand dunes

We present a minimal model for the formation and migration of aeolian sand dunes. It combines a perturbative description of the turbulent wind velocity field above the dune with a continuum saltation model that allows for saturation transients in the sand flux. The latter are shown to provide the characteristic length scale. The model can explain the origin of important features of dunes, such as the formation of a slip face, the broken scale invariance, and the existence of a minimum dune size. It also predicts the longitudinal shape and aspect ratio of dunes and heaps, their migration velocity and shape relaxation dynamics. Although the minimal model employs non-local expressions for the wind shear stress as well as for the sand flux, it is simple enough to serve as a very efficient tool for analytical and numerical investigations and to open up the way to simulations of large scale desert topographies.Comment: 19 pages, 22 figure

Quasi-1D dynamics and nematic phases in the 2D Emery model

We consider the Emery model of a Cu-O plane of the high temperature superconductors. We show that in a strong-coupling limit, with strong Coulomb repulsions between electrons on nearest-neighbor O sites, the electron-dynamics is strictly one dimensional, and consequently a number of asymptotically exact results can be obtained concerning the electronic structure. In particular, we show that a nematic phase, which spontaneously breaks the point- group symmetry of the square lattice, is stable at low enough temperatures and strong enough coupling.Comment: 8 pages, 5 eps figures; revised manuscript with more detailed discussions; two new figures and three edited figuresedited figures; 14 references; new appendix with a detailed proof of the one-dimensional dynamics of the system in the strong coupling limi

Thermodynamics and Kinetic Theory of Relativistic Gases in 2-D Cosmological Models

A kinetic theory of relativistic gases in a two-dimensional space is developed in order to obtain the equilibrium distribution function and the expressions for the fields of energy per particle, pressure, entropy per particle and heat capacities in equilibrium. Furthermore, by using the method of Chapman and Enskog for a kinetic model of the Boltzmann equation the non-equilibrium energy-momentum tensor and the entropy production rate are determined for a universe described by a two-dimensional Robertson-Walker metric. The solutions of the gravitational field equations that consider the non-equilibrium energy-momentum tensor - associated with the coefficient of bulk viscosity - show that opposed to the four-dimensional case, the cosmic scale factor attains a maximum value at a finite time decreasing to a "big crunch" and that there exists a solution of the gravitational field equations corresponding to a "false vacuum". The evolution of the fields of pressure, energy density and entropy production rate with the time is also discussed.Comment: 23 pages, accepted in PR