Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study

OBJECTIVES: Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice. DESIGN: Observational study. SETTING: 20 hospitals across the former Yorkshire region. PARTICIPANTS: All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months. MAIN OUTCOME MEASURES: Variable life­adjusted displays showing cumulative differences between observed and expected mortality of patients; expected mortality calculated from risk model based on admission characteristics of age, heart rate, and systolic blood pressure. RESULTS: The performance of two individual hospitals over three months was examined as an example. One, the smallest district hospital in the region, had a series of 30 consecutive patients but had five more deaths than predicted. The variable life­adjusted display showed minimal variation from that predicted for the first 15 patients followed by a run of unexpectedly high mortality. The second example was the main tertiary referral centre for the region, which admitted 188 consecutive patients. The display showed a period of apparently poor performance followed by substantial improvement, where the plot rose steadily from a cumulative net lives saved of - 4 to 7. These variations in patient outcome are unlikely to have been revealed during conventional audit practice. CONCLUSIONS: Variable life­adjusted display has been integrated into surgical care as a graphical display of risk­adjusted survival for individual surgeons or centres. In combination with a simple risk model, it may have a role in monitoring performance and outcome in patients with acute myocardial infarction

Long-Time Behavior of Macroscopic Quantum Systems: Commentary Accompanying the English Translation of John von Neumann's 1929 Article on the Quantum Ergodic Theorem

The renewed interest in the foundations of quantum statistical mechanics in recent years has led us to study John von Neumann's 1929 article on the quantum ergodic theorem. We have found this almost forgotten article, which until now has been available only in German, to be a treasure chest, and to be much misunderstood. In it, von Neumann studied the long-time behavior of macroscopic quantum systems. While one of the two theorems announced in his title, the one he calls the "quantum H-theorem", is actually a much weaker statement than Boltzmann's classical H-theorem, the other theorem, which he calls the "quantum ergodic theorem", is a beautiful and very non-trivial result. It expresses a fact we call "normal typicality" and can be summarized as follows: For a "typical" finite family of commuting macroscopic observables, every initial wave function $\psi_0$ from a micro-canonical energy shell so evolves that for most times $t$ in the long run, the joint probability distribution of these observables obtained from $\psi_t$ is close to their micro-canonical distribution.Comment: 34 pages LaTeX, no figures; v2: minor improvements and additions. The English translation of von Neumann's article is available as arXiv:1003.213

Solidification of Al-Sn-Cu based immiscible alloys under intense shearing

The official published version of the Article can be accessed from the link below - Copyright @ 2009 The Minerals, Metals & Materials Society and ASM InternationalThe growing importance of Al-Sn based alloys as materials for engineering applications necessitates the development of uniform microstructures with improved performance. Guided by the recently thermodynamically assessed Al-Sn-Cu system, two model immiscible alloys, Al-45Sn-10Cu and Al-20Sn-10Cu, were selected to investigate the effects of intensive melt shearing provided by the novel melt conditioning by advanced shear technology (MCAST) unit on the uniform dispersion of the soft Sn phase in a hard Al matrix. Our experimental results have confirmed that intensive melt shearing is an effective way to achieve fine and uniform dispersion of the soft phase without macro-demixing, and that such dispersed microstructure can be further refined in alloys with precipitation of the primary Al phase prior to the demixing reaction. In addition, it was found that melt shearing at 200 rpm and 60 seconds will be adequate to produce fine and uniform dispersion of the Sn phase, and that higher shearing speed and prolonged shearing time can only achieve minor further refinement.This work is funded by the EPSRC and DT

Universality and Critical Phenomena in String Defect Statistics

The idea of biased symmetries to avoid or alleviate cosmological problems caused by the appearance of some topological defects is familiar in the context of domain walls, where the defect statistics lend themselves naturally to a percolation theory description, and for cosmic strings, where the proportion of infinite strings can be varied or disappear entirely depending on the bias in the symmetry. In this paper we measure the initial configurational statistics of a network of string defects after a symmetry-breaking phase transition with initial bias in the symmetry of the ground state. Using an improved algorithm, which is useful for a more general class of self-interacting walks on an infinite lattice, we extend the work in \cite{MHKS} to better statistics and a different ground state manifold, namely $\R P^2$, and explore various different discretisations. Within the statistical errors, the critical exponents of the Hagedorn transition are found to be quite possibly universal and identical to the critical exponents of three-dimensional bond or site percolation. This improves our understanding of the percolation theory description of defect statistics after a biased phase transition, as proposed in \cite{MHKS}. We also find strong evidence that the existence of infinite strings in the Vachaspati Vilenkin algorithm is generic to all (string-bearing) vacuum manifolds, all discretisations thereof, and all regular three-dimensional lattices.Comment: 62 pages, plain LaTeX, macro mathsymb.sty included, figures included. also available on http://starsky.pcss.maps.susx.ac.uk/groups/pt/preprints/96/96011.ps.g

The Middle Way: East Asian masters students’ perceptions of critical argumentation in U.K. universities.

The paper explores the learning experiences of East Asian masters students in dealing with Western academic norms of critical thinking in classroom debate and assignment writing. The research takes a cultural approach, and employs grounded theory and case study methodology, the aims being for students to explain their perceptions of their personal learning journeys. The data suggest that the majority of students interviewed rejected full academic acculturation into Western norms of argumentation. They instead opted for a ‘Middle Way’ that synergizes the traditional cultural academic values held by many East Asian students with those elements of Western academic norms that are perceived to be aligned with these. This is a relatively new area of research which represents a challenge for British lecturers and students

Charged black holes in quadratic gravity

Iterative solutions to fourth-order gravity describing static and electrically charged black holes are constructed. Obtained solutions are parametrized by two integration constants which are related to the electric charge and the exact location of the event horizon. Special emphasis is put on the extremal black holes. It is explicitly demonstrated that in the extremal limit, the exact location of the (degenerate) event horizon is given by \rp = |e|. Similarly to the classical Reissner-Nordstr\"om solution, the near-horizon geometry of the charged black holes in quadratic gravity, when expanded into the whole manifold, is simply that of Bertotti and Robinson. Similar considerations have been carried out for the boundary conditions of second type which employ the electric charge and the mass of the system as seen by a distant observer. The relations between results obtained within the framework of each method are briefly discussed

The Global Forest Transition as a Human Affair

Forests across the world stand at a crossroads where climate and land-use changes are shaping their future. Despite demonstrations of political will and global efforts, forest loss, fragmentation, and degradation continue unabated. No clear evidence exists to suggest that these initiatives are working. A key reason for this apparent ineffectiveness could lie in the failure to recognize the agency of all stakeholders involved. Landscapes do not happen. We shape them. Forest transitions are social and behavioral before they are ecological. Decision makers need to integrate better representations of people’s agency in their mental models. A possible pathway to overcome this barrier involves eliciting mental models behind policy decisions to allow better representation of human agency, changing perspectives to better understand divergent points of view, and refining strategies through explicit theories of change. Games can help decision makers in all of these tasks

It Is Hot in the Sun: Antarctic Mosses Have High Temperature Optima for Photosynthesis Despite Cold Climate

The terrestrial flora of Antarctica’s frozen continent is restricted to sparse ice-free areas and dominated by lichens and bryophytes. These plants frequently battle sub-zero temperatures, extreme winds and reduced water availability; all influencing their ability to survive and grow. Antarctic mosses, however, can have canopy temperatures well above air temperature. At midday, canopy temperatures can exceed 15°C, depending on moss turf water content. In this study, the optimum temperature of photosynthesis was determined for six Antarctic moss species: Bryum pseudotriquetrum, Ceratodon purpureus, Chorisodontium aciphyllum, Polytrichastrum alpinum, Sanionia uncinata, and Schistidium antarctici collected from King George Island (maritime Antarctica) and/ or the Windmill Islands, East Antarctica. Both chlorophyll fluorescence and gas exchange showed maximum values of electron transport rate occurred at canopy temperatures higher than 20°C. The optimum temperature for both net assimilation of CO2 and photoprotective heat dissipation of three East Antarctic species was 20–30°C and at temperatures below 10°C, mesophyll conductance did not significantly differ from 0. Maximum mitochondrial respiration rates occurred at temperatures higher than 35°C and were lower by around 80% at 5°C. Despite the extreme cold conditions that Antarctic mosses face over winter, the photosynthetic apparatus appears optimised to warm temperatures. Our estimation of the total carbon balance suggests that survival in this cold environment may rely on a capacity to maximize photosynthesis for brief periods during summer and minimize respiratory carbon losses in cold conditions.Alicia V. Perera-Castro, Melinda J. Waterman, Johanna D. Turnbull, Michael B. Ashcroft, Ella McKinley, Jennifer R. Watling, Jessica Bramley-Alves, Angelica Casanova-Katny, Gustavo Zuniga, Jaume Flexas, and Sharon A. Robinso