Methodological perspectives for register-based health system performance assessment : Developing a hip fracture monitoring system in Finland

The resources of health systems are limited. There is a need for information concerning the performance of the health system for the purposes of decision-making. This study is about utilization of administrative registers in the context of health system performance evaluation. In order to address this issue, a multidisciplinary methodological framework for register-based data analysis is defined. Because the fixed structure of register-based data indirectly determines constraints on the theoretical constructs, it is essential to elaborate the whole analytic process with respect to the data. The fundamental methodological concepts and theories are synthesized into a data sensitive approach which helps to understand and overcome the problems that are likely to be encountered during a register-based data analyzing process. A pragmatically useful health system performance monitoring should produce valid information about the volume of the problems, about the use of services and about the effectiveness of provided services. A conceptual model for hip fracture performance assessment is constructed and the validity of Finnish registers as a data source for the purposes of performance assessment of hip fracture treatment is confirmed. Solutions to several pragmatic problems related to the development of a register-based hip fracture incidence surveillance system are proposed. The monitoring of effectiveness of treatment is shown to be possible in terms of care episodes. Finally, an example on the justification of a more detailed performance indicator to be used in the profiling of providers is given. In conclusion, it is possible to produce useful and valid information on health system performance by using Finnish register-based data. However, that seems to be far more complicated than is typically assumed. The perspectives given in this study introduce a necessary basis for further work and help in the routine implementation of a hip fracture monitoring system in Finland.

Fracture analysis of stiffened panels under combined tensile, bending, and shear loads

The objective is to present the formulation of numerically integrated modified virtual crack closure integral technique for concentrically and eccentrically stiffened panels for computation of strain-energy release rate and stress intensity factor based on linear elastic fracture mechanics principles. Fracture analysis of cracked stiffened panels under combined tensile, bending, and shear loads has been conducted by employing the stiffened plate/shell finite element model, MQL9S2. This model can be used to analyze plates with arbitrarily located concentric/eccentric stiffeners, without increasing the total number of degrees of freedom, of the plate element. Parametric studies on fracture analysis of stiffened plates under combined tensile and moment loads have been conducted. Based on the results of parametric,studies, polynomial curve fitting has been carried out to get best-fit equations corresponding to each of the stiffener positions. These equations can be used for computation of stress intensity factor for cracked stiffened plates subjected to tensile and moment loads for a given plate size, stiffener configuration, and stiffener position without conducting finite element analysis.

Stereoselectivity in the addition of hydrogen chloride to cyclohex-1-enecarbonitrile: Possible role of chlorine lone pair-nitrile π-orbital pseudoallylic A1, 3 interaction

The (overall trans) addition of hydrogen chloride to cyclohex-1- enecarbonitrile in anhydrous alcoholic media proceeds to give cis-2-chlorocyclohexanecarboxylate (together with some cis-2- chlorocyclohexanecarboxamide): no corresponding products with the trans-configuration are detectable. In anhydrous ether the addition proceeds to give a single isomer, presumably cis-, of 2-chlorocyclohexanecarbonitrile, indicating that the configuration of the products may not be equilibrium-controlled in alcoholic media. An examination of the steric factors indicates that the transition state for protonation of the presumed intermediate, 2-chlorocyclohexylidenemethylideneimine, leading to cis-product is favoured if interaction between the lateral π-orbital of the C-N double bond and the lone-pairs on the chlorine atom at the 2-position is large. Consideration of interactions in the transition states meets Zimmerman's criticism that invoking A1, 3 interaction existing in ground states to explain product configuration takes insufficient account of the Curtin-Hammett principle.

Fracture behavior of concrete–concrete interface using acoustic emission technique

The fracture behavior of concrete–concrete interface is characterized using acoustic emission (AE). Beams of different sizes having jointed interface between two different strengths of concrete are tested. The results of load, displacement, CMOD, AE-events and AE-energy are analyzed. The width of fracture process zone and damage zone are computed using AE-data and are found to be independent of size. It is observed that, as the difference in compressive strength of concrete on either side of interface increases, the load carrying capacity, number of AE-events, AE-energy, width of fracture process zone and damage zone decreases.

The fracture toughness of bulk metallic glasses

Stiffness, strength, and toughness are the three primary attributes of a material, in terms of its mechanical properties. Bulk metallic glasses (BMGs) are known to exhibit elastic moduli at a fraction lower than crystalline alloys and have extraordinary strength. However, the reported values of fracture toughness of BMGs are highly variable; some BMGs such as the Zr-based ones have toughness values that are comparable to some high strength steels and titanium alloys, whereas there are also BMGs that are almost as brittle as silicate glasses. Invariably, monolithic BMGs exhibit no or low crack growth resistance and tend to become brittle upon structural relaxation. Despite its critical importance for the use of BMGs as structural materials, the fracture toughness of BMGs is relatively poorly understood. In this paper, we review the available literature to summarize the current understanding of the mechanics and micromechanisms of BMG toughness and highlight the needs for future research in this important area.

A comparative study of dynamic,ductile fracture initiation in two specimen configurations

In this work a single edge notched plate (SEN(T)) subjected to a tensile stress pulse is analysed, using a 2D plane strain dynamic finite element procedure. The interaction of the notch with a pre-nucleated hole ahead of it is examined. The background material is modelled by the Gurson constitutive law and ductile failure by microvoid coalescence in the ligament connecting the notch and the hole is simulated. Both rate independent and rate dependent material behaviour is considered. The notch tip region is subjected to a range of loading rates j by varying the peak value and the rise time of the applied stress pulse. The results obtained from these simulations are compared with a three point bend (TPB) specimen subjected to impact loading analysed in an earlier work [3] The variation of J at fracture initiation, J(c), with average loading rate j is obtained from the finite element simulations. It is found that the functional relationship between J(c) and j is fairly independent of the specimen geometry and is only dependent on material behaviour.

Electronic structures of electron donor-acceptor complexes: results from ultraviolet photoelectron spectroscopy and molecular orbital calculations

HeI photoelectron spectra of 1:1 electron donor-acceptor complexes are discussed in the light of molecular orbital calculations. The complexes discussed include those formed by BH3, BF3 and SO2. Some systematics have been found in the ionization energy shifts of the complexes compared to the free components and these are related to the strength of the donor-acceptor bond. Hel spectra of hydrogen bonded complexes are discussed in comparison with results from MO calculations. Limitations of such studies as well as scope for further investigations are indicated.

Effect of copper addition on the fracture and fatigue crack growth behavior of solution heat-treated SUS 304H austenitic steel

Small additions of Cu to the SUS 304H, a high temperature austenitic stainless steel, enhance its high temperature strength and creep resistance. As Cu is known to cause embrittlement, the effect of Cu on room temperature mechanical properties that include fracture toughness and fatigue crack threshold of as-solutionized SUS 304H steel were investigated in this work. Experimental results show a linear reduction in yield and ultimate strengths with Cu addition of up to 5 wt.% while ductility drops markedly for 5 wt.% Cu alloy. However, the fracture toughness and the threshold stress intensity factor range for fatigue crack initiation were found to be nearly invariant with Cu addition. This is because the fracture in this alloy is controlled by the debonding from the matrix of chromium carbide precipitates, as evident from fractography. Cu, on the other hand, remains either in solution or as nano-precipitates and hence does not influence the fracture characteristics. It is concluded that small additions of Cu to 304H will not have adverse effects on its fracture and fatigue behavior. (C) 2010 Elsevier B.V. All rights reserved.

Orbital evolution studies of two HMXB pulsars

High mass X-ray binary (HMXB) pulsars are of two types, persistent and transient. 4U1538-52 is a persistent HMXB whose orbit was previously measured to be circular but the RXTE observations revealed an eccentric orbit. We observed this system with RXTE-PCA in August 2003 and our timing analysis supports the eccentric orbit of the system. However, we do not find any evidence for orbital evolution. Rotational and tidal interactions between the stars of a closed binary system result in apsidal motion which can be measured in systems with eccentric orbit. 4U0115+63 is a Be-transient HMXB whose eccentric orbit was well-determined during its 1978 outburst. We report preliminary results from analysis of data obtained during the 1999 outburst of this source with the RXTE-PCA.

Orbital evolution and orbital phase resolved spectroscopy of the HMXB pulsar 4U 1538-52 with RXTE-PCA and BeppoSAX

We report here results from detailed timing and spectral studies of the high mass X-ray binary pulsar 4U 1538-52 over several binary periods using observations made with the Rossi X-ray Timing Explorer (RXTE) and BeppoSAX satellites. Pulse timing analysis with the 2003 RXTE data over two binary orbits confirms an eccentric orbit of the system. Combining the orbitial parameters determined from this observation with the earlier measurements we did not find any evidence of orbital decay in this X-ray binary. We have carried out orbital phase resolved spectroscopy to measure changes in the spectral parameters with orbital phase, particularly the absorption column density and the iron line flux. The RXTE-PCA spectra in the 3-20 keV energy range were fitted with a power law and a high energy cut-off along with a Gaussian line at similar to 6.4 keV, whereas the BeppoSAX spectra needed only a power law and Gaussian emission line at similar to 6.4keV in the restricted energy range of 0.3-10.0 keV. An absorption along the line of sight was included for both the RXTE and BeppoSAX data. The variation of the free spectral parameters over the binary orbit was investigated and we found that the variation of the column density of absorbing material in the line of sight with orbital phase is in reasonable agreement with a simple model of a spherically symmetric stellar wind from the companion star.

Orbital evolution studies of two HMXB pulsars

High mass X-ray binary (H M X B) pulsars are of two types, persistent and transient. 4U 1538-52 is a persistent HMXB whose orbit was previously measured to be circular but the RXTE observations revealed an eccentric orbit. We observed this system with RXTE-PCA in August 2003 and our timing analysis supports the eccentric orbit of the system. However, we do not find any evidence for orbital evolution. Rotational and tidal interactions between the stars of a closed binary system result in apsidal motion which can be measured in systems with eccentric orbit. 4U0115+63 is a Be-transient HMXB whose eccentric orbit was well-determined during its 1978 outburst. We report preliminary results from analysis of data obtained during the 1999 outburst of this source with the RXTE-PCA.

KO2: Realization of Orbital Ordering in a p-Orbital System

KO2 is a molecular solid consisting of oxygen dimers. K present in the lattice donates an electron which goes on to occupy the O p levels.As the basic electronic structure is similar to that of an oxygen molecule, except for broadening due to solid state effects, KO2 represents the realization of the doping of oxygen molecules arranged in a lattice. These considerations alone result in magnetism with high ordering temperatures as our calculations reveal. However, we find that the high temperature structure is unstable to an orbital ordering (OO) transition. The microscopic considerations driving the OO transition, however, are electrostatic interactions instead of the often encountered superexchange driven ordering within the Kugel-Khomskii model often used to describe the OO. This OO transition is also found to preclude any possibility of high magnetic ordering temperatures, which otherwise seemed possible.

Ab-initio molecular orbital studies on C---H…X hydrogen bonded systemsstar

C---H…X hydrogen bonded systems are studied by the STO-3G method. The proton donor ability of carbon is analysed in terms of its hybridization states and the substituents.

Apsidal motion in 4U 0115+63 and orbital parameters of 2S 1417-624 and V0332+53

Be/X-ray binary pulsars have wide eccentric orbits and hence the angle of periastron of the orbit is very well defined in these sources. The presence of an X-ray pulsar allows for accurate measurements of orbital elements. A Be star usually is a rapidly rotating star and hence will deviate from spherical geometry. The tidal interaction between the neutron star and the Be star will add to the distortion of the Be star and alter its mass distribution. Thus a measurable rate of apsidal motion is expected from these systems. In this paper, we present the first conclusive detection of apsidal motion of the binary 4U 0115+63. We also present new and accurate orbital parameters of the Be/X-ray binaries V0332+53 and 2S 1417-624.