580 research outputs found
Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany
Background
The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany.
Methods
Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions.
Results
Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice.
Conclusion
Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process
Quantum Hall effect and Landau level crossing of Dirac fermions in trilayer graphene
We investigate electronic transport in high mobility (\textgreater 100,000
cm/Vs) trilayer graphene devices on hexagonal boron nitride, which
enables the observation of Shubnikov-de Haas oscillations and an unconventional
quantum Hall effect. The massless and massive characters of the TLG subbands
lead to a set of Landau level crossings, whose magnetic field and filling
factor coordinates enable the direct determination of the
Slonczewski-Weiss-McClure (SWMcC) parameters used to describe the peculiar
electronic structure of trilayer graphene. Moreover, at high magnetic fields,
the degenerate crossing points split into manifolds indicating the existence of
broken-symmetry quantum Hall states.Comment: Supplementary Information at
http://jarilloherrero.mit.edu/wp-content/uploads/2011/04/Supplementary_Taychatanapat.pd
Microscopic Polarization in Bilayer Graphene
Bilayer graphene has drawn significant attention due to the opening of a band
gap in its low energy electronic spectrum, which offers a promising route to
electronic applications. The gap can be either tunable through an external
electric field or spontaneously formed through an interaction-induced symmetry
breaking. Our scanning tunneling measurements reveal the microscopic nature of
the bilayer gap to be very different from what is observed in previous
macroscopic measurements or expected from current theoretical models. The
potential difference between the layers, which is proportional to charge
imbalance and determines the gap value, shows strong dependence on the disorder
potential, varying spatially in both magnitude and sign on a microscopic level.
Furthermore, the gap does not vanish at small charge densities. Additional
interaction-induced effects are observed in a magnetic field with the opening
of a subgap when the zero orbital Landau level is placed at the Fermi energy
Topological Price of Anarchy bounds for clustering games on networks
We consider clustering games in which the players are embedded in a network and want to coordinate (or anti-coordinate) their choices with their neighbors. Recent studies show that even very basic variants of these games exhibit a large Price of Anarchy. Our main goal is to understand how structural properties of the network topology impact the inefficiency of these games. We derive topological bounds on the Price of Anarchy for different classes of clustering games. These topological bounds provide a more informative assessment of the inefficiency of these games than the corresponding (worst-case) Price of Anarchy bounds. As one of our main results, we derive (tight) bounds on the Price of Anarchy for clustering games on Erdős-Rényi random graphs, which, depending on the graph density, stand in stark contrast to the known Price of Anarchy bounds
Transport Spectroscopy of Symmetry-Broken Insulating States in Bilayer Graphene
The flat bands in bilayer graphene(BLG) are sensitive to electric fields
E\bot directed between the layers, and magnify the electron-electron
interaction effects, thus making BLG an attractive platform for new
two-dimensional (2D) electron physics[1-5]. Theories[6-16] have suggested the
possibility of a variety of interesting broken symmetry states, some
characterized by spontaneous mass gaps, when the electron-density is at the
carrier neutrality point (CNP). The theoretically proposed gaps[6,7,10] in
bilayer graphene are analogous[17,18] to the masses generated by broken
symmetries in particle physics and give rise to large momentum-space Berry
curvatures[8,19] accompanied by spontaneous quantum Hall effects[7-9]. Though
recent experiments[20-23] have provided convincing evidence of strong
electronic correlations near the CNP in BLG, the presence of gaps is difficult
to establish because of the lack of direct spectroscopic measurements. Here we
present transport measurements in ultra-clean double-gated BLG, using
source-drain bias as a spectroscopic tool to resolve a gap of ~2 meV at the
CNP. The gap can be closed by an electric field E\bot \sim13 mV/nm but
increases monotonically with a magnetic field B, with an apparent particle-hole
asymmetry above the gap, thus providing the first mapping of the ground states
in BLG.Comment: 4 figure
Imaging Electronic Correlations in Twisted Bilayer Graphene near the Magic Angle
Twisted bilayer graphene with a twist angle of around 1.1{\deg} features a
pair of isolated flat electronic bands and forms a strongly correlated
electronic platform. Here, we use scanning tunneling microscopy to probe local
properties of highly tunable twisted bilayer graphene devices and show that the
flat bands strongly deform when aligned with the Fermi level. At half filling
of the bands, we observe the development of gaps originating from correlated
insulating states. Near charge neutrality, we find a previously unidentified
correlated regime featuring a substantially enhanced flat band splitting that
we describe within a microscopic model predicting a strong tendency towards
nematic ordering. Our results provide insights into symmetry breaking
correlation effects and highlight the importance of electronic interactions for
all filling factors in twisted bilayer graphene.Comment: Main text 9 pages, 4 figures; Supplementary Information 25 page
Tradeoff between Stability and Maneuverability during Whole-Body Movements
Understanding how stability and/or maneuverability affects motor control strategies can provide insight on moving about safely in an unpredictable world. Stability in human movement has been well-studied while maneuverability has not. Further, a tradeoff between stability and maneuverability during movement seems apparent, yet has not been quantified. We proposed that greater maneuverability, the ability to rapidly and purposefully change movement direction and speed, is beneficial in uncertain environments. We also hypothesized that gaining maneuverability comes at the expense of stability and perhaps also corresponds with decreased muscle coactivation.We used a goal-directed forward lean movement task that integrated both stability and maneuverability. Subjects (n = 11) used their center of pressure to control a cursor on a computer monitor to reach a target. We added task uncertainty by shifting the target anterior-posterior position mid-movement. We used a balance board with a narrow beam that reduced the base of support in the medio-lateral direction and defined stability as the probability that subjects could keep the balance board level during the task.During the uncertainty condition, subjects were able to change direction of their anterior-posterior center of pressure more rapidly, indicating that subjects were more maneuverable. Furthermore, medio-lateral center of pressure excursions also approached the edges of the beam and reduced stability margins, implying that subjects were less stable (i.e. less able to keep the board level). On the narrow beam board, subjects increased muscle coactivation of lateral muscle pairs and had greater muscle activity in the left leg. However, there were no statistically significant differences in muscle activity amplitudes or coactivation with uncertainty.These results demonstrate that there is a tradeoff between stability and maneuverability during a goal-directed whole-body movement. Tasks with added uncertainty could help individuals learn to be more maneuverable yet sufficiently stable
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Risk measures for direct real estate investments with non-normal or unknown return distributions
The volatility of returns is probably the most widely used risk measure for real estate. This is rather surprising since a number of studies have cast doubts on the view that volatility can capture the manifold risks attached to properties and corresponds to the risk attitude of investors. A central issue in this discussion is the statistical properties of real estate returns—in contrast to neoclassical capital market theory they are mostly non-normal and often unknown, which render many statistical measures useless. Based on a literature review and an analysis of data from Germany we provide evidence that volatility alone is inappropriate for measuring the risk of direct real estate.
We use a unique data sample by IPD, which includes the total returns of 939 properties across different usage types (56% office, 20% retail, 8% others and 16% residential properties) from 1996 to 2009, the German IPD Index, and the German Property Index. The analysis of the distributional characteristics shows that German real estate returns in this period were not normally distributed and that a logistic distribution would have been a better fit. This is in line with most of the current literature on this subject and leads to the question which indicators are more appropriate to measure real estate risks. We suggest that a combination of quantitative and qualitative risk measures more adequately captures real estate risks and conforms better with investor attitudes to risk. Furthermore, we present criteria for the purpose of risk classification
Interacting multi-channel topological boundary modes in a quantum Hall valley system
Symmetry and topology play key roles in the identification of phases of
matter and their properties. Both concepts are central to understanding quantum
Hall ferromagnets (QHFMs), two-dimensional electronic phases with spontaneously
broken spin or pseudospin symmetry whose wavefunctions also have topological
properties. Domain walls between distinct broken symmetry QHFM phases are
predicted to host gapless one-dimensional (1D) modes that emerge due to a
topological change of the underlying electronic wavefunctions at such
interfaces. Although a variety of QHFMs have been identified in different
materials, probing interacting electronic modes at these domain walls has not
yet been accomplished. Here we use a scanning tunneling microscope (STM) to
directly visualize the spontaneous formation of boundary modes, within a
sign-changing topological gap, at domain walls between different
valley-polarized quantum Hall phases on the surface of bismuth. By changing the
valley occupation and the corresponding number of modes at the domain wall, we
can realize different regimes where the valley-polarized channels are either
metallic or develop a spectroscopic gap. This behavior is a consequence of
Coulomb interactions constrained by the symmetry-breaking valley flavor, which
determines whether electrons in the topological modes can backscatter, making
these channels a unique class of interacting Luttinger liquids
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