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.

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.

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.

Effect of Prestrain on Fracture Toughness of Rolled Mild Steel with Significant Inclusion Content

The basic method of JIc calculation using a single specimen is discussed. Dokouipil's approach for evaluating the JIc value is extended further and the effect of prestrain on rolled mild steel with significant inclusions is studied using this modified approach. Although this method does not give an accurate value of JIc, it is quite effective for a comparative study. While the fracture toughness of annealed and 7% prestrained materials are about the same, the fracture toughness of 3% prestrained material is significantly lower.

Completeness of the Coulomb wave functions in quantum mechanics

We give an explicit, direct, and fairly elementary proof that the radial energy eigenfunctions for the hydrogen atom in quantum mechanics, bound and scattering states included, form a complete set. The proof uses only some properties of the confluent hypergeometric functions and the Cauchy residue theorem from analytic function theory; therefore it would form useful supplementary reading for a graduate course on quantum mechanics.

The Mechanics and Statistics of Active Matter

Active particles contain internal degrees of freedom with the ability to take in and dissipate energy and, in the process, execute systematic movement. Examples include all living organisms and their motile constituents such as molecular motors. This article reviews recent progress in applying the principles of nonequilibrium statistical mechanics and hydrodynamics to form a systematic theory of the behavior of collections of active particles-active matter-with only minimal regard to microscopic details. A unified view of the many kinds of active matter is presented, encompassing not only living systems but inanimate analogs. Theory and experiment are discussed side by side.

Effect of interface friction on the mechanics of indentation of a finite layer resting on a rigid substrate

Copper strips of 2.5 mm thickness resting on stainless steel anvils were normally indented by wedges under nominal plane strain conditions. Inflections in the hardness-penetration characteristics were identified. Inflections separate stages where each stage has typical mechanics of deformation. These are arrived at by studying the distortion of 0.125 mm spaced grids inscribed on the deformation plane of the strip. The sensitivity of hardness and deformation mechanics to wedge angle and the interfacial friction between strip and anvil were investigated within the framework of existing slip line field models of indentation of semi-infinite and finite blocks.

Descriptions of operators in quantum mechanics

The problem of expressing a general dynamical variable in quantum mechanics as a function of a primitive set of operators is studied from several points of view. In the context of the Heisenberg commutation relation, the Weyl representation for operators and a new Fourier-Mellin representation are related to the Heisenberg group and the groupSL(2,R) respectively. The description of unitary transformations via generating functions is analysed in detail. The relation between functions and ordered functions of noncommuting operators is discussed, and results closely paralleling classical results are obtained.

Wigner distribution for angle coordinates in quantum mechanics

The method of Wigner distribution functions, and the Weyl correspondence between quantum and classical variables, are extended from the usual kind of canonically conjugate position and momentum operators to the case of an angle and angular momentum operator pair. The sense in which one has a description of quantum mechanics using classical phase‐space language is much clarified by this extension.

Alloy design for fracture resistance

Several methods for improving the strength of metallic materials are available and correlations between strength and various microstructural features have been established. The purpose of this paper is to review parallel developments favouring improved fracture resistance. Resistance to fracture in monotonie loading, cyclic loading and when fracture is environment-aided have been considered in steels, aluminium alloys and anisotropic materials. Finally, the question of optimising alloy behaviour is discussed.

A finite element analysis of dynamic fracture initiation by ductile failure mechanisms in a 4340 steel

In some recent dropweight impact experiments [5] with pre-notched bend specimens of 4340 steel, it was observed that considerable crack tunneling occurred in the interior of the specimen prior to gross fracture initiation on the free surfaces. The final failure of the side ligaments happened because of shear lip formation. The tunneled region is characterized by a flat, fibrous fracture surface. In this paper, the experiments of [5] (corresponding to 5 m/s impact speed) are analyzed using a plane strain, dynamic finite element procedure. The Gurson constitutive model that accounts for the ductile failure mechanisms of micro-void nucleation, growth and coalescence is employed. The time at which incipient failure was observed near the notch tip in this computation, and the value of the dynamic J-integral, J d, at this time, compare reasonably well with experiments. This investigation shows that J-controlled stress and deformation fields are established near the notch tip whenever J d , increases with time. Also, it is found that the evolution of micro-mechanical quantities near the notch root can be correlated with the time variation of J d .The strain rate and the adiabatic temperature rise experienced at the notch root are examined. Finally, spatial variations of stresses and deformations are analyzed in detail.