The rate of outpatient cataract surgery in ten European countries: an analysis using data from the SHARE survey

BACKGROUND: The aim of this study was to determine the rates of outpatient cataract surgery (ROCS) in ten European countries and to find country-specific health indicators explaining the differences. METHODS: Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), 251 eligible respondents were identified for which cataract surgery was the last surgical procedure. The ROCS of ten countries were compared using logistic regression. The influence of the public expenditure on health as per cent of the total expenditure on health, of the number of acute care beds per 1,000 population, and of the number of practicing physicians per 1,000 population, was studied by multiple logistic regression. Additional information was obtained from country-specific opinion leaders in the field of cataract surgery. RESULTS: The ROCS differed significantly between the ten analysed European countries where Denmark had the highest (100%) and Austria the lowest (0%) rate of day care surgery. A decrease in the density of acute care beds (p < 0.0000001) and in the density of practicing physicians (p < 0.05) and an increase in the public expenditure on health as per cent of the total health expenditure (p < 0.01) lead to an increase in the ROCS. According to the opinion leaders, regulations and financial incentives also have a strong influence on the ROCS. CONCLUSIONS: The outpatient rate of cataract surgery in the ten European countries was mainly influenced by the acute-care beds density, but also by the density of practicing physicians, and by the public expenditure on health.

The rate of recovery in renal function when patients with HIV infection discontinue treatment with tenofovir

OBJECTIVES Tenofovir is associated with reduced renal function. It is not clear whether patients can be expected to fully recover their renal function if tenofovir is discontinued. METHODS We calculated the estimated glomerular filtration rate (eGFR) for patients in the Swiss HIV Cohort Study remaining on tenofovir for at least 1 year after starting a first antiretroviral therapy regimen with tenofovir and either efavirenz or the ritonavir-boosted protease inhibitor lopinavir, atazanavir or darunavir. We estimated the difference in eGFR slope between those who discontinued tenofovir after 1 year and those who remained on tenofovir. RESULTS A total of 1049 patients on tenofovir for at least 1 year were then followed for a median of 26 months, during which time 259 patients (25%) discontinued tenofovir. After 1 year on tenofovir, the difference in eGFR between those starting with efavirenz and those starting with lopinavir, atazanavir and darunavir was - 0.7 [95% confidence interval (CI) -2.3 to 0.8], -1.4 (95% CI -3.2 to 0.3) and 0.0 (95% CI -1.7 to 1.7) mL/min/1.73 m(2) , respectively. The estimated linear rate of decline in eGFR on tenofovir was -1.1 (95% CI -1.5 to -0.8) mL/min/1.73 m(2) per year and its recovery after discontinuing tenofovir was 2.1 (95% CI 1.3 to 2.9) mL/min/1.73 m(2) per year. Patients starting tenofovir with either lopinavir or atazanavir appeared to have the same rates of decline and recovery as those starting tenofovir with efavirenz. CONCLUSIONS If patients discontinue tenofovir, clinicians can expect renal function to recover more rapidly than it declined.

Snow Accumulation Rate on Qomolangma (Mount Everest), Himalaya: Synchroneity With Sites Across the Tibetan Plateau on 50-100 Year Timescales

Annual-layer thickness data, spanning AD 1534-2001, from an ice core from East Rongbuk Coll on Qomolangma (Mount Everest, Himalaya) yield an age-depth profile that deviates systematically from a constant accumulation-rate analytical model. The profile clearly shows that the mean accumulation rate has changed every 50-100 years. A numerical model was developed to determine the magnitude of these multi-decadal-scale rates. The model was used to obtain a time series of annual accumulation. The mean annual accumulation rate decreased from similar to 0.8 m ice equivalent in the 1500s to similar to 0.3 m in the mid-1800s. From similar to 1880 to similar to 1970 the rate increased. However, it has decreased since similar to 1970. Comparison with six other records from the Himalaya and the Tibetan Plateau shows that the changes in accumulation in East Rongbuk Col are broadly consistent with a regional pattern over much of the Plateau. This suggests that there may be an overarching mechanism controlling precipitation and mass balance over this area. However, a record from Dasuopu, only 125 km northwest of Qomolangma and 700 m higher than East Rongbuk Col, shows a maximum in accumulation during the 1800s, a time during which the East Rongbuk Col and Tibetan Plateau ice-core and tree-ring records show a minimum. This asynchroneity may be due to altitudinal or seasonal differences in monsoon versus westerly moisture sources or complex mountain meteorology.

Post-Depositional Movement of Methanesulphonic Acid at Law Dome, Antarctica, and the Influence of Accumulation Rate

A series of ice cores from sites with different snow-accumulation rates across Law Dome, East Antarctica, was investigated for methanesulphonic acid (MSA) movement. The precipitation at these sites (up to 35 km apart) is influenced by the same air masses, the principal difference being the accumulation rate. At the low-accumulation-rate W20k site (0.17 in ice equivalent), MSA was completely relocated from the summer to winter layer. Moderate movement was observed at the intermediate-accumulation-rate site (0.7 in ice equivalent), Dome Summit South (DSS), while there was no evidence of movement at the high-accumulation-rate DE08 site (1.4 in ice equivalent). The main DSS record of MSA covered the epoch AD 1727-2000 and was used to investigate temporal post-depositional changes. Co-deposition of MSA and sea-salt ions was observed of the surface layers, outside of the main summer MSA peak, which complicates interpretation of these peaks as evidence of movement in deeper layers. A seasonal study of the 273 year DSS record revealed MSA migration predominantly from summer into autumn (in the up-core direction), but this migration was suppressed during the Tambora (1815) and unknown (1809) volcanic eruption period, and enhanced during an epoch (1770-1800) with high summer nitrate levels. A complex interaction between the gradients in nss-sulphate, nitrate and sea salts (which are influenced by accumulation rate) is believed to control the rate and extent of movement of MSA.

Clinical study on survival rate of short implants placed in the posterior mandibular region: resonance frequency analysis.

OBJECTIVE Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible. MATERIAL AND METHODS Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had <10 mm of bone height measured from the bone crest to the outer wall of the mandibular canal. Resonance frequency analysis (RFA) was performed at time intervals T0 (immediately after implant placement), T1 (after 15 days), T2 (after 30 days), T3 (after 60 days), and T4 (after 90 days). RESULTS The survival rate after 90 days was 87.5% for the short implants and 100% for regular implants (P < 0.05). There was no significant difference between the implants in time intervals T1, T2, T3, and T4. In T0, the RFA values of 5 × 5.5 implants were higher than values of 5 × 7 and 4 × 11.5 implants (P < 0.05). A total of six short implants that were placed in four patients were lost (three of 5 × 5.5 mm and three of 5 × 7 mm). Three lost implants started with high ISQ values, which progressively decreased. The other three lost implants started with a slightly lower ISQ value, which rose and then began to fall. CONCLUSIONS Survival rate of short implants after 90 days was lower than that of regular implants. However, short implants may be considered a reasonable alternative for rehabilitation of severely resorbed mandibles with reduced height, to avoid performing bone reconstruction before implant placement. Patients need to be aware of the reduced survival rate compared with regular implants before implant placement to avoid disappointments.

On loop corrections to the dilepton rate

Next-to-leading order analyses of the dilepton production rate from a hot QCD plasma are reviewed. In general, the photon invariant mass is taken to be in the range K2∼(πT)2, permitting thereby for an interpolation between an OPE computation in a hard regime K2≫(πT)2 and an LPM resummed computation in a soft regime 0the computations are extended into the spacelike domain K2<0 in the future, they can also be systematically compared with lattice results at non-zero momentum.

The calculation of Afρ and mass loss rate for comets

Ab initio calculations of Afρ are presented using Mie scattering theory and a Direct Simulation Monte Carlo (DSMC) dust outflow model in support of the Rosetta mission and its target 67P/Churyumov-Gerasimenko (CG). These calculations are performed for particle sizes ranging from 0.010 μm to 1.0 cm. The present status of our knowledge of various differential particle size distributions is reviewed and a variety of particle size distributions is used to explore their effect on Afρ , and the dust mass production View the MathML sourcem˙. A new simple two parameter particle size distribution that curtails the effect of particles below 1 μm is developed. The contributions of all particle sizes are summed to get a resulting overall Afρ. The resultant Afρ could not easily be predicted a priori and turned out to be considerably more constraining regarding the mass loss rate than expected. It is found that a proper calculation of Afρ combined with a good Afρ measurement can constrain the dust/gas ratio in the coma of comets as well as other methods presently available. Phase curves of Afρ versus scattering angle are calculated and produce good agreement with observational data. The major conclusions of our calculations are: – The original definition of A in Afρ is problematical and Afρ should be: qsca(n,λ)×p(g)×f×ρqsca(n,λ)×p(g)×f×ρ. Nevertheless, we keep the present nomenclature of Afρ as a measured quantity for an ensemble of coma particles.– The ratio between Afρ and the dust mass loss rate View the MathML sourcem˙ is dominated by the particle size distribution. – For most particle size distributions presently in use, small particles in the range from 0.10 to 1.0 μm contribute a large fraction to Afρ. – Simplifying the calculation of Afρ by considering only large particles and approximating qsca does not represent a realistic model. Mie scattering theory or if necessary, more complex scattering calculations must be used. – For the commonly used particle size distribution, dn/da ∼ a−3.5 to a−4, there is a natural cut off in Afρ contribution for both small and large particles. – The scattering phase function must be taken into account for each particle size; otherwise the contribution of large particles can be over-estimated by a factor of 10. – Using an imaginary index of refraction of i = 0.10 does not produce sufficient backscattering to match observational data. – A mixture of dark particles with i ⩾ 0.10 and brighter silicate particles with i ⩽ 0.04 matches the observed phase curves quite well. – Using current observational constraints, we find the dust/gas mass-production ratio of CG at 1.3 AU is confined to a range of 0.03–0.5 with a reasonably likely value around 0.1.

The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Growth rates and stable carbon and oxygen isotope record of corals from the Red Sea

Monthly delta18O records of 2 coral colonies (Porites cf. lutea and P. cf. nodifera) from different localities (Aqaba and Eilat) from the northern Gulf of Aqaba, Red Sea, were calibrated with recorded sea surface temperatures (SST) between 1988 and 2000. The results show high correlation coefficients between SST and delta18O. Seasonal variations of coral delta18O in both locations could explain 91% of the recorded SST. Different delta18O/SST relations from both colonies and from the same colonies were obtained, indicating that delta18O from coral skeletons were subject to an extension rate effect. Significant delta18O depletions are associated with high extension rates and higher values with low extension rates. The relation between coral skeletal delta18O and extension rate is not linear and can be described by a simple exponential model. An inverse relationship extends over extension rates from 1 to 5 mm/yr, while for more rapidly growing corals and portions of colonies the relation is constant and the extension rate does not appear to have a significant effect. We recommend that delta18O values be obtained from fast-growing corals or from portions in which the isotopic disequilibrium is fairly constant (extension rate >5 mm/yr). The results show that interspecific differences in corals may produce a significant delta18O profile offset between 2 colonies that is independent of environmental and extension-rate effects. We conclude that the rate of skeletal extension and the species of coral involved have an important influence on coral delta18O and must be considered when using delta18O records for paleoclimatic reconstructions.

Geochemistry and physics on sediment cores from the Peru Basin

We studied preservation/dissolution cycles and paleoproductivity in eight sediment cores from the Peru Basin south of the highly productive surface waters of the eastern equatorial Pacific. Stratigraphy is based on stable oxygen isotopes and on combined magnetostratigraphy and biostratigraphy. Sediment cores which span the last 8 m.y., were retrieved during cruise 79 with RV SONNE close to the carbonate compensation depth (CCD). In general, sediments show Pacific-type carbonate cycles. We interpret a pronounced carbonate peak between 6 and 7 Ma as the result of a western and northern extension of the highly productive Peru Current. Decreased carbonate contents from the late Miocene to the late Pliocene might be associated with a slow contraction of the latitudinal extent of the high-productivity belt north of the study areas. During the Pliocene, carbonate variations showed 400 kyr cycles indicating the growth and decay of ice sheets, which should have been associated with pulsations of the Antarctic ice cap. An abrupt collapse of the carbonate system occurred at 2.4 Ma. Higher frequency variations of the carbonate record indicate the major increase of the northern hemisphere glaciation. During the Quaternary, carbonate fluxes are high during glacials and low during interglacials. Large amplitude variations with long broad minima and maxima, associated with small migrations of the lysocline and the CCD (< 200 m), are indicative of the preservation/dissolution history in the Peru Basin. During the early Pleistocene, climatic forcing by the 41 kyr obliquity cycle is not observed in the carbonate record. During the last 800 kyr, variability in the carbonate record was dominated by the 100 kyr eccentricity cycle. Fluxes of biogenic material (calcium carbonate, organic carbon, opal, and barium) were greatest during glacials, which imply higher productivity and export production of the Peru Current during cold climatic periods. Dissolution was greatest during interglacials as inferred from the relatively poor preservation of planktonic foraminifera and from the low accumulation rate of carbonate. After the Mid-Brunhes Event (400 ka), we observe a plateaulike shift to enhanced dissolution and to intensified productivity.

Detriral flux of sediment cores in the southeast Indian Ocean

Because of a close relationship between detrital flux variations and magnetic susceptibility (MS) flux (MS cm**3 of bulk sediment multiplied by the linear sedimentation rate) variations in the southeast Indian basin of the southern ocean, MS flux profiles have been used to examine the spatial and temporal detrital flux changes in this basin during the last climatic cycle. Results indicate a general increase in detrital material input during the coldest periods, suggesting a widespread phenomenon, at least on the basin scale. Mineralogical data, geochemical data, and 87Sr/86Sr isotopic ratios have been used to determine the origin and transport mechanisms responsible for increased detrital flux during glacial periods. Mineralogical and geochemical data show that these glacial 'highs' are due to increases in both Kerguelen-Crozet volcanic and Antarctic detrital inputs. The 87Sr/86Sr isotopic composition of the >45-µm fraction indicates that the Kerguelen-Crozet province contributes to at least 50% of the coarse particule input to the west. This contribution decreases eastward to reach less than 10%. These tracers clearly indicate that the Crozet-Kerguelen province was a major source region of detrital in the western part of the basin during glacial times. In contrast, material of Antarctic origin is well represented in the whole basin (fine and coarse fractions). Because of the minor amount of coarse particles in the sediments, volcanic particles from Kerguelen and crustal particles from Antarctica have most probably been transported by the Antarctic bottom water current and/or the Circumpolar deepwater current during glacial periods as is the case today. Nevertheless, the presence of coarse particles even in low amount suggests also a transport by ice rafting (sea-ice and icebergs), originated from both Kerguelen and Antarctic sources. However, the relative importance of both hydrographic and ice-rafting modes of transport cannot be identified accurately with our data. During low sea level stands (glacial maximum periods), increasing instability and erosion of the continental platform and shallow plateaus could have resulted in a more efficient transfer of crustal and volcano-detrital material to the Southeast Indian basin. At the same time, extension of the grounded ice shelves over the continental margins and increase in the erosion rate of the Antarctic ice sheet could have induced a greater input of ice rafted detritus (IRD) to southern ocean basins. Enhancement of the circumpolar deepwater current strength might have also carried a more important flux of detrital material from Kerguelen. However, an increase in the bottom water flow is not necessarily required.

Stable oxygen isotope record of corales from the Red Sea

In order to assess the ability of Porites corals to accurately record environmental variations, high-resolution (weekly/biweekly) coral delta18O records were obtained from four coral colonies from the northern Gulf of Aqaba, which grew at depths of 7, 19, 29, and 42 m along one transect. Adjacent to each colony, hourly temperatures, biweekly salinities, and monthly delta18O of seawater were continuously recorded over a period of 14 months (April 1999 to June 2000). Contrary to water temperature, which shows a regular and strong seasonal variation and change with depth, seawater delta18O exhibits a weak seasonality and little change with depth. Positive correlations between seawater delta18O and salinity were observed. The two parameters were related to each other by the equation delta18O Seawater (per mil, VSMOW) = 0.281 * Salinity - 9.14. The high-resolution coral delta18O records from this study show a regular pattern of seasonality and are able to capture fine details of the weekly average temperature records. They resolve more than 95% of the weekly average temperature range. On the other hand, attenuation and amplification of coral seasonal amplitudes were recorded in deep, slow-growing corals, which were not related to environmental effects (temperature and/or seawater delta18O) or sampling resolution. We propose that these result from a combined effect of subannual variations in extension rate and variable rates of spine thickening of skeletal structures within the tissue layer. However, no smoothing or distortion of the isotopic signals was observed due to calcification within the tissue layer in shallow-water, fast-growing corals. The calculations from coral delta18O calibrations against the in situ measurements show that temperature (T) is related to coral delta18O (delta c) and seawater delta18O (delta w) by the equation T (°C) = -5.38 (delta c - delta w) -1.08. Our results demonstrate that coral delta18O from the northern Gulf of Aqaba is a reliable recorder of temperature variations, and that there is a minor contribution of seawater delta18O to this proxy, which could be ignored.

(Table 2) Horizontal ice flow velocities, azimuths (relative to true north), and vertical ice-particle velocities in the vicinity of Vostok Station, Antarctica

In the austral summer seasons 2001/02 and 2002/03, Global Positioning System (GPS) data were collected in the vicinity of Vostok Station to determine ice flow velocities over Lake Vostok. Ten GPS sites are located within a radius of 30 km around Vostok Station on floating ice as well as on grounded ice to the east and to the west of the lake. Additionally, a local deformation network around the ice core drilling site 5G-1 was installed. The derived ice flow velocity for Vostok Station is 2.00 m/a ± 0.01 m/a. Along the flowline of Vostok Station an extension rate of about 10**-5/a (equivalent to 1 cm/km/a) was determined. This significant velocity gradient results in a new estimate of 28700 years for the transit time of an ice particle along the Vostok flowline from the bedrock ridge in the southwest of the lake to the eastern shoreline. With these lower velocities compared to earlier studies and, hence, larger transit times the basal accretion rate is estimated to be 4 mm/a along a portion of the Vostok flowline. An assessment of the local accretion rate at Vostok Station using the observed geodetic quantities yields an accretion rate in the same order of magnitude. Furthermore, the comparison of our geodetic observations with results inferred from ice-penetrating radar data indicates that the ice flow may not have changed significantly for several thousand years.

Age determination of sediment cores from the Shelf Edge off Mauritania, Northwest Africa

The impact of late glacial changes on the sedimentary record was investigated in two long vibracores, collected from the shelf edge off Mauritania, northwest Africa. Lithology and radiocarbon dates indicate that the sedimentary sequences were mainly controlled by sea-level changes on the shelf. The upper Pleistocene sequence is characterized by deposition in coastal environments, while the Holocene sequence represents deposition in shelf environments. During low sea level, much sediment was supplied to the present outer shelf, and the data imply an average accumulation rate of up to 43.0 cm/1000 yrs during the late Pleistocene, which is substantially higher than the Holocene rate. Shelf sediments were continuously reworked and redistributed on a regional scale during falling and rising sea level. The presence of reworked material results in radiocarbon ages which are too old. The mollusc. Venus striatula, which presently is found north of, but not along, the Mauritanian coast, occurs in the upper Pleistocene sequence, suggesting cooler water conditions in the shelf during late glacial times. This species probably migrated to the south during late glacial times, following the southward extension of the cold Canary Current. Radiocarbon dates of the shells broadly coincide with a lowstand of sea level over this part of the continental shelf.

Petrography and geochemical composition of the Atlantis II Fracture Zone

SeaBeam echo sounding, seismic reflection, magnetics, and gravity profiles were run along closely spaced tracks (5 km) parallel to the Atlantis II Fracture Zone on the Southwest Indian Ridge, giving 80% bathymetric coverage of a 30- * 170-nmi strip centered over the fracture zone. The southern and northern rift valleys of the ridge were clearly defined and offset north-south by 199 km. The rift valleys are typical of those found elsewhere on the Southwest Indian Ridge, with relief of more than 2200 m and widths from 22 to 38 km. The ridge-transform intersections are marked by deep nodal basins lying on the transform side of the neovolcanic zone that defines the present-day spreading axis. The walls of the transform generally are steep (25°-40°), although locally, they can be more subdued. The deepest point in the transform is 6480 m in the southern nodal basin, and the shallowest is an uplifted wave-cut terrace that exposes plutonic rocks from the deepest layer of the ocean crust at 700 m. The transform valley is bisected by a 1.5-km-high median tectonic ridge that extends from the northern ridge-transform intersection to the midpoint of the active transform. The seismic survey showed that the floor of the transform contains up to 0.5 km of sediment. Piston-coring at two locations on the transform floor recovered more than 1 m of sand and gravel, which appears to be turbidites shed from the walls of the fracture zone. Extensive dredging showed that more than two-thirds of the crust exposed in the transform valley and its walls were plutonic rocks, principally gabbros and residual mantle peridotites. In contrast, based on dredging and seafloor morphology, only relatively undisrupted pillow basalt flows have been exposed on crust of the same age spreading away from the transform. Magnetic anomalies are well defined out to 11 m.y. over the flanking transverse ridges and transform valley, even where layer 2 appears to be absent. The total opening rate is 1.6 cm/yr, but the arrangement of the anomalies indicates that the spreading for each ridge is asymmetric, with the ridge flanks facing the transform spreading at a rate of 1.0 cm/yr. Such an asymmetric spreading pattern requires that both the northern and southern ridges migrate away from each other at 0.2 cm/yr, thus lengthening the transform at 0.4 cm/yr for the last 11 m.y. To the north, the fracture zone valley is oriented differently from the present-day transform, indicating a paleospreading direction change at 17 m.y. from N10°E to due north-south. This change placed the transform into extension for the 11-m.y. period required for simple orthogonal ridge-transform geometry to be reestablished and produced a large transtensional basin within the transform valley. This basin was split by continued transform slip after 11 m.y., with the larger half moving to the north with the African Plate.