Renew : a renal redesign project in predialysis patient care

Background: An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. Methods: 'RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics-An inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey-And (ii) solution design-An inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics. Results: Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance. Conclusion: Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals

The fate of black branes in Einstein-Gauss-Bonnet gravity

Black branes are studied in Einstein-Gauss-Bonnet (EGB) gravity. Evaporation drives black branes towards one of two singularities depending on the sign of $\alpha$, the Gauss-Bonnet coupling. For positive $\alpha$ and sufficiently large ratio $\sqrt{\alpha}/L$, where $L/2\pi$ is the radius of compactification, black branes avoid the Gregory-Laflamme (GL) instability before reaching a critical state. No black branes with the radius of horizon smaller than the critical value can exist. Approaching the critical state branes have a nonzero Hawking temperature. For negative $\alpha$ all black branes encounter the GL instability. No black branes may exist outside of the interval of the critical values, $0\leq\beta<3$, where $\beta=1- 8\alpha/r_h^2$ and $r_h$ is the radius of horizon of the black brane. The first order phase transition line of GL transitions ends in a second order phase transition point at $\beta=0$

Compact QED3_3 - a simple example of a variational calculation in a gauge theory

We apply a simple mean field like variational calculation to compact QED in 2+1 dimensions. Our variational ansatz explicitly preserves compact gauge invariance of the theory. We reproduce in this framework all the known results, including dynamical mass generation, Polyakov scaling and the nonzero string tension. It is hoped that this simple example can be a useful reference point for applying similar approximation techniques to nonabelian gauge theories.Comment: 18 pages, OUTP- 94-23 P, TPI-MINN-94/37-

The Color--Flavor Transformation of induced QCD

The Zirnbauer's color-flavor transformation is applied to the $U(N_c)$ lattice gauge model, in which the gauge theory is induced by a heavy chiral scalar field sitting on lattice sites. The flavor degrees of freedom can encompass several `generations' of the auxiliary field, and for each generation, remaining indices are associated with the elementary plaquettes touching the lattice site. The effective, color-flavor transformed theory is expressed in terms of gauge singlet matrix fields carried by lattice links. The effective action is analyzed for a hypercubic lattice in arbitrary dimension. We investigate the corresponding d=2 and d=3 dual lattices. The saddle points equations of the model in the large-$N_c$ limit are discussed.Comment: 24 pages, 6 figures, to appear in Int. J. Mod. Phys.

Classical instability in Lovelock gravity

We introduce a simple method for the investigation of the classical stability of static solutions with a horizon in Lovelock gravity. The method is applicable to the investigation of high angular momentum instabilities, similar to those found by Dotti and Gleiser for Gauss-Bonnet black holes. The method does not require the knowledge of the explicit analytic form of the black hole solution. In this paper we apply our method to a case where the explicit solution is known and show that it identifies correctly the resulting unstable modes.Comment: 13 pages, 2 figure

Partition function for general multi-level systems

We describe a unified approach to calculating the partition functions of a general multi-level system with a free Hamiltonian. Particularly, we present new results for parastatistical systems of any order in the second quantized approach. Anyonic- like systems are briefly discussed.Comment: Latex file, 16 page

Gauged Yukawa Matrix Models and 2-Dimensional Lattice Theories

We argue that chiral symmetry breaking in three dimensional QCD can be identified with N\'eel order in 2-dimensional quantum antiferromagnets. When operators which drive the chiral transition are added to these theories, we postulate that the resulting quantum critical behavior is in the universality class of gauged Yukawa matrix models. As a consequence, the chiral transition is typically of first order, although for a limited class of parameters it can be second order with computable critical exponents.Comment: LaTeX, 11 page

Hamiltonian Study of Improved U(1U(1 Lattice Gauge Theory in Three Dimensions

A comprehensive analysis of the Symanzik improved anisotropic three-dimensional U(1) lattice gauge theory in the Hamiltonian limit is made. Monte Carlo techniques are used to obtain numerical results for the static potential, ratio of the renormalized and bare anisotropies, the string tension, lowest glueball masses and the mass ratio. Evidence that rotational symmetry is established more accurately for the Symanzik improved anisotropic action is presented. The discretization errors in the static potential and the renormalization of the bare anisotropy are found to be only a few percent compared to errors of about 20-25% for the unimproved gauge action. Evidence of scaling in the string tension, antisymmetric mass gap and the mass ratio is observed in the weak coupling region and the behaviour is tested against analytic and numerical results obtained in various other Hamiltonian studies of the theory. We find that more accurate determination of the scaling coefficients of the string tension and the antisymmetric mass gap has been achieved, and the agreement with various other Hamiltonian studies of the theory is excellent. The improved action is found to give faster convergence to the continuum limit. Very clear evidence is obtained that in the continuum limit the glueball ratio $M_{S}/M_{A}$ approaches exactly 2, as expected in a theory of free, massive bosons.Comment: 13 pages, 15 figures, submitted to Phys. Rev.

Generalized Weyl solutions in d=5 Einstein-Gauss-Bonnet theory: the static black ring

We argue that the Weyl coordinates and the rod-structure employed to construct static axisymmetric solutions in higher dimensional Einstein gravity can be generalized to the Einstein-Gauss-Bonnet theory. As a concrete application of the general formalism, we present numerical evidence for the existence of static black ring solutions in Einstein-Gauss-Bonnet theory in five spacetime dimensions. They approach asymptotically the Minkowski background and are supported against collapse by a conical singularity in the form of a disk. An interesting feature of these solutions is that the Gauss-Bonnet term reduces the conical excess of the static black rings. Analogous to the Einstein-Gauss-Bonnet black strings, for a given mass the static black rings exist up to a maximal value of the Gauss-Bonnet coupling constant $\alpha'$. Moreover, in the limit of large ring radius, the suitably rescaled black ring maximal value of $\alpha'$ and the black string maximal value of $\alpha'$ agree.Comment: 43 pages, 14 figure