Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services

Effect of ion temperature on propagation of ion-acoustic solitary waves of small amplitudes in collisionless plasma

By using a perturbation technique, the Korteweg-de Vries equation is derived for a mixture of warm-ion fluid and hot, isothermal electrons. Stationary solutions are obtained for this equation and are compared with the corresponding solutions for a mixture consisting of cold-ion fluid and hot, isothermal electrons.

Effect of surface resistance on gas absorption accompanied by a chemical reaction in a gas - liquid contactor

An analysis of gas absorption accompanied by chemical reaction in the presence of interfacial resistance is presented. The analysis indicates that the effect of interfacial resistance on interphase mass transfer is significantly higher in presence of a reaction compared to the pure absorption case. For fixed values of surface resistance and contact time, the difference between the amount of gas transferred across the interface with and without surface resistance increases as the value of reaction velocity increases. For ranges of contact time and surface resistance of practical relevance, the influence of surface resistance is too high to be neglected while designing gas-liquid contactors.

The effect of solar activity on temperatures in the equatorial mesosphere

A study of the response of neutral temperatures in the equatorial mesosphere to variations in solar activity has been carried out by investigating the correlation between the 10.7 cm solar radio flux and temperatures obtained from a series of 51 rocket soundings conducted over Thumba, India (8°N, 77°E) during the period December 1970–December 1971. A strong positive correlation between these two parameters has been obtained, indicating mesospheric heating effects caused by day-to-day variations in solar EUV emission. The correlation analysis indicates that this response persists over several days and that the peak correlation between the temperatures and the F10.7 index occurs with a time lag of less than 24 hr.

Effect of Broadcast Baiting on Abundance Patterns of Red Imported Fire Ants (Hymenoptera: Formicidae) and Key Local Ant Genera at Long-Term Monitoring Sites in Brisbane, Australia

In 2001, the red imported fire ant (Solenopsis invicta Buren) was identified in Brisbane, Australia. An eradication program involving broadcast bait treatment with two insect growth regulators and a metabolic inhibitor began in September of that year and is currently ongoing. To gauge the impacts of these treatments on local ant populations, we examined long-term monitoring data and quantified abundance patterns of S. invicta and common local ant genera using a linear mixed-effects model. For S. invicta, presence in pitfalls reduced over time to zero on every site. Significantly higher numbers of S. invicta workers were collected on high-density polygyne sites, which took longer to disinfest compared with monogyne and low-density polygyne sites. For local ants, nine genus groups of the 10 most common genera analyzed either increased in abundance or showed no significant trend. Five of these genus groups were significantly less abundant at the start of monitoring on high-density polygyne sites compared with monogyne and low-density polygyne sites. The genus Pheidole significantly reduced in abundance over time, suggesting that it was affected by treatment efforts. These results demonstrate that the treatment regime used at the time successfully removed S. invicta from these sites in Brisbane, and that most local ant genera were not seriously impacted by the treatment. These results have important implications for current and future prophylactic treatment efforts, and suggest that native ants remain in treated areas to provide some biological resistance to S. invicta.

Effect of magnetic and electrical fields on dendritic freezing of aqueous solutions of sodium chloride

Aqueous solutions of sodium chloride were solidified under the influence of magnetic and electrical fields using two different freezing systems. In the droplet system, small droplets of the solution are introduced in an organic liquid column at −20°C which acts as the heat sink. In the unidirectional freezing system the solutions are poured into a tygon tube mounted on a copper chill, maintained at −70°C, from which the freezing initiates. Application of magnetic fields caused an increase in the spacing and promoted side branching of primary ice dendrites in the droplet freezing system, but had no measurable effect on the dendrites formed in the unidirectional freezing system. The range of electric fields applied in this investigation had no measurable effect on the dendritic structure. Possible interactions between external magnetic and electrical fields have been reviewed and it is suggested that the selective effect of magnetic fields on dendrite spacings in a droplet system could be due to a change in the nucleation behaviour of the solution in the presence of a magnetic field.

Effect of added nitrogen on plant litter decomposition depends on initial soil carbon and nitrogen stoichiometry

Increasing organic carbon inputs to agricultural soils through the use of pastures or crop residues has been suggested as a means of restoring soil organic carbon lost via anthropogenic activities, such as land use change. However, the decomposition and retention of different plant residues in soil, and how these processes are affected by soil properties and nitrogen fertiliser application, is not fully understood. We evaluated the rate and extent of decomposition of 13C-pulse labelled plant material in response to nitrogen addition in four pasture soils of varying physico-chemical characteristics. Microbial respiration of buffel grass (Cenchrus ciliaris L.), wheat (Triticum aestivum L.) and lucerne (Medicago sativa L.) residues was monitored over 365-days. A double exponential model fitted to the data suggested that microbial respiration occurred as an early rapid and a late slow stage. A weighted three-compartment mixing model estimated the decomposition of both soluble and insoluble plant 13C (mg C kg−1 soil). Total plant material decomposition followed the alkyl C: O-alkyl C ratio of plant material, as determined by solid-state 13C nuclear magnetic resonance spectroscopy. Urea-N addition increased the decomposition of insoluble plant 13C in some soils (≤0.1% total nitrogen) but not others (0.3% total nitrogen). Principal components regression analysis indicated that 26% of the variability of plant material decomposition was explained by soil physico-chemical characteristics (P = 0.001), which was primarily described by the C:N ratio. We conclude that plant species with increasing alkyl C: O-alkyl C ratio are better retained as soil organic matter, and that the C:N stoichiometry of soils determines whether N addition leads to increases in soil organic carbon stocks.

Effect of ionic temperature on propagation of ion-acoustic solitary waves in a collisionless plasma of warm-ion fluid and non-isothermal electrons

Using a perturbation technique, we derive Modified Korteweg—de Vries (MKdV) equations for a mixture of warm-ion fluid (γ i = 3) and hot and non-isothermal electrons (γ e> 1), (i) when deviations from isothermality are finite, and (ii) when deviations from isothermality are small. We obtain stationary solutions for these equations, and compare them with the corresponding solutions for a mixture of warm-ion fluid (γ i = 3) and hot, isothermal electrons (γ i = 1).

Effect of Molecular Weight on the Thermal and Impact Sensitivity of Polymers in Propellants

Abstract is not available.

Effect of soil variability on the bearing capacity of clay and in slope stability problems

Site-specific geotechnical data are always random and variable in space. In the present study, a procedure for quantifying the variability in geotechnical characterization and design parameters is discussed using the site-specific cone tip resistance data (qc) obtained from static cone penetration test (SCPT). The parameters for the spatial variability modeling of geotechnical parameters i.e. (i) existing trend function in the in situ qc data; (ii) second moment statistics i.e. analysis of mean, variance, and auto-correlation structure of the soil strength and stiffness parameters; and (iii) inputs from the spatial correlation analysis, are utilized in the numerical modeling procedures using the finite difference numerical code FLAC 5.0. The influence of consideration of spatially variable soil parameters on the reliability-based geotechnical deign is studied for the two cases i.e. (a) bearing capacity analysis of a shallow foundation resting on a clayey soil, and (b) analysis of stability and deformation pattern of a cohesive-frictional soil slope. The study highlights the procedure for conducting a site-specific study using field test data such as SCPT in geotechnical analysis and demonstrates that a few additional computations involving soil variability provide a better insight into the role of variability in designs.

Effect of surface radiation on conjugate natural convection in a horizontal annulus driven by inner heat generating solid cylinder

This paper reports a numerical study of the laminar conjugate natural convection heat transfer with and without the interaction of the surface radiation in a horizontal cylindrical annulus formed between an inner heat generating solid circular cylinder and an outer isothermal circular boundary. Numerical solutions are obtained by solving the governing equations with a pressure correction method on a collocated (non-staggered) mesh. Steady-state results are presented for the flow and temperature distributions and Nusselt numbers for the heat generation based Grashof number ranging from 10(7) to 10(10), solid-to-fluid thermal conductivity ratios of 1, 5, 10, 50 and 100, radius ratios of 0.226 and 0.452 and surface emissivities of 0-0.8 with air as the working medium. It is observed that surface radiation reduces the convective heat transfer in the annulus compared to the pure natural convection case and enhances the overall Nusselt number.

The effect of horizontal resolution on simulation of very extreme US precipitation events in a global atmosphere model

We investigate the ability of a global atmospheric general circulation model (AGCM) to reproduce observed 20 year return values of the annual maximum daily precipitation totals over the continental United States as a function of horizontal resolution. We find that at the high resolutions enabled by contemporary supercomputers, the AGCM can produce values of comparable magnitude to high quality observations. However, at the resolutions typical of the coupled general circulation models used in the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, the precipitation return values are severely underestimated.