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Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 (P = .016). No significant differences were found between groups regarding clinical shoulder scores (P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.
The transition to a future electricity system based primarily on wind and solar PV is examined for all regions in the contiguous US. We present optimized pathways for the build-up of wind and solar power for least backup energy needs as well as for least cost obtained with a simplified, lightweight model based on long-term high resolution weather-determined generation data. In the absence of storage, the pathway which achieves the best match of generation and load, thus resulting in the least backup energy requirements, generally favors a combination of both technologies, with a wind/solar PV (photovoltaics) energy mix of about 80/20 in a fully renewable scenario. The least cost development is seen to start with 100% of the technology with the lowest average generation costs first, but with increasing renewable installations, economically unfavorable excess generation pushes it toward the minimal backup pathway. Surplus generation and the entailed costs can be reduced significantly by combining wind and solar power, and/or absorbing excess generation, for example with storage or transmission, or by coupling the electricity system to other energy sectors.
High shares of intermittent renewable power generation in a European electricity system will require flexible backup power generation on the dominant diurnal, synoptic, and seasonal weather timescales. The same three timescales are already covered by today’s dispatchable electricity generation facilities, which are able to follow the typical load variations on the intra-day, intra-week, and seasonal timescales. This work aims to quantify the changing demand for those three backup flexibility classes in emerging large-scale electricity systems, as they transform from low to high shares of variable renewable power generation. A weather-driven modelling is used, which aggregates eight years of wind and solar power generation data as well as load data over Germany and Europe, and splits the backup system required to cover the residual load into three flexibility classes distinguished by their respective maximum rates of change of power output. This modelling shows that the slowly flexible backup system is dominant at low renewable shares, but its optimized capacity decreases and drops close to zero once the average renewable power generation exceeds 50% of the mean load. The medium flexible backup capacities increase for modest renewable shares, peak at around a 40% renewable share, and then continuously decrease to almost zero once the average renewable power generation becomes larger than 100% of the mean load. The dispatch capacity of the highly flexible backup system becomes dominant for renewable shares beyond 50%, and reach their maximum around a 70% renewable share. For renewable shares above 70% the highly flexible backup capacity in Germany remains at its maximum, whereas it decreases again for Europe. This indicates that for highly renewable large-scale electricity systems the total required backup capacity can only be reduced if countries share their excess generation and backup power.
We compute the vacuum polarization correction to the binding energy of nuclear matter in the Walecka model using a nonperturbative approach. We first study such a contribution as arising from a ground-state structure with baryon-antibaryon condensates. This yields the same results as obtained through the relativistic Hartree approximation of summing tadpole diagrams for the baryon propagator. Such a vacuum is then generalized to include quantum effects from meson fields through scalar-meson condensates which amounts to summing over a class of multiloop diagrams. The method is applied to study properties of nuclear matter and leads to a softer equation of state giving a lower value of the incompressibility than would be reached without quantum effects. The density-dependent effective sigma mass is also calculated including such vacuum polarization effects.
A first testing ground for QED in the combined presence of a strong Coulomb field and a strong magnetic field is provided by the precise measurement of the hyperfine structure splitting of hydrogenlike 209Bi. We present a complete calculation of the one-loop self-energy correction to the first-order hyperfine interaction for various nuclear charges. In the low-Z regime we almost perfectly agree with the Z alpha expansion, but for medium and high Z there is a substantial deviation.
We investigate the production of heavy quarks in continuum and bound states in nuclear collisions. Creation rates for free bb and tt quark pairs and for bottomonium and toponium in the ground state are computed at energies of the BNL Relativistic Heavy Ion Collider, CERN Large Hadron Collider (LHC), and Superconducting Super Collider. Central and peripheral heavy-ion collisions are discussed. For top-quark creation we assumed a mass range of 90≤mt≤250 GeV. The creation rate for top quarks in peripheral collisions is estimated to be by a factor 40 to 130 smaller compared with corresponding central collisions. For mt=130 GeV we calculated a creation rate of about 4760 top-quark pairs per day at the LHC (3.5 TeV/nucleon) for Pb-Pb collisions.
We calculate the asymptotic high-energy amplitude for electrons scattering at one ion, as well as at two colliding ions, by means of perturbation theory. We show that the interaction with one ion eikonalizes and that the interaction with two ions causally decouples. We are able to put previous results on perturbative grounds and propose further applications for the obtained rules for interactions on the light cone. We discuss the implications of the eikonal amplitude on the pair production probability in ultrarelativistic peripheral heavy-ion collisions. In this context the Weizsäcker-Williams method is shown to be exact in the ultrarelativistic limit, irrespective of the produced particles’ mass. A new equivalent single-photon distribution is derived, which correctly accounts for Coulomb distortions. The impact on single-photon induced processes is discussed.
A calculation of the vacuum-polarization contribution to the hyperfine splitting for hydrogenlike atoms is presented. The extended nuclear charge distribution is taken into account. For the experimentally interesting case 209Bi82+ we predict a delta-lambda- -1.6 nm shift for the transition wavelength of the ground-state hyperfine splitting.