Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy

Objectives: To develop a decision analysis based and computerised clinical guidance programme (CGP) that provides patient specific guidance on the decision whether or not to undergo a prophylactic oophorectomy to reduce the risk of subsequent ovarian cancer and to undertake a preliminary pilot and evaluation. Subjects: Women who had already agreed to have a hysterectomy who otherwise had no ovarian pathology. Setting: Oophorectomy decision consultation at the outpatient or pre-admission clinic. Methods: A CGP was developed with advice from gynaecologists and patient groups, incorporating a set of Markov models within a decision analytical framework to evaluate the benefits of undergoing a prophylactic oophorectomy or not on the basis of quality adjusted life expectancy, life expectancy, and for varying durations of hormone replacement therapy. Sensitivity analysis and preliminary testing of the CGP were undertaken to compare its overall performance with established guidelines and practice. A small convenience sample of women invited to use the CGP were interviewed, the interviews were taped and transcribed, and a thematic analysis was undertaken. Results: The run time of the programme was 20 minutes, depending on the use of opt outs to default values. The CGP functioned well in preliminary testing. Women were able to use the programme and expressed overall satisfaction with it. Some had reservations about the computerised format and some were surprised at the specificity of the guidance given. Conclusions: A CGP can be developed for a complex healthcare decision. It can give evidence-based health guidance which can be adjusted to account for individual risk factors and reflects a patient’s own values and preferences concerning health outcomes. Future decision aids and support systems need to be developed and evaluated in a way which takes account of the variation in patients’ preferences for inclusion in the decision making process

Authors' reply to Colquhoun and Buchinsky

No abstract available

Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis

No abstract available

Comment:The Next Frontier: Prosody Research Gets Interpersonal

Neurocognitive models (e.g., Schirmer & Kotz, 2006) have helped to characterize how listeners incrementally derive meaning from vocal expressions of emotion in spoken language, what neural mechanisms are involved at different processing stages, and their relative time course. But how can these insights be applied to communicative situations in which prosody serves a predominantly interpersonal function? This comment examines recent data highlighting the dynamic interplay of prosody and language, when vocal attributes serve the sociopragmatic goals of the speaker or reveal interpersonal information that listeners use to construct a mental representation of what is being communicated. Our comment serves as a beacon to researchers interested in how the neurocognitive system “makes sense” of socioemotive aspects of prosody

Using cascading Bloom filters to improve the memory usage for de Brujin graphs

De Brujin graphs are widely used in bioinformatics for processing next-generation sequencing data. Due to a very large size of NGS datasets, it is essential to represent de Bruijn graphs compactly, and several approaches to this problem have been proposed recently. In this work, we show how to reduce the memory required by the algorithm of [3] that represents de Brujin graphs using Bloom filters. Our method requires 30% to 40% less memory with respect to the method of [3], with insignificant impact to construction time. At the same time, our experiments showed a better query time compared to [3]. This is, to our knowledge, the best practical representation for de Bruijn graphs.Comment: 12 pages, submitte

Digestion kinetics of dried cereal grains

Grain fermentability largely determines the feed value of grains for ruminants. Our objective was to evaluate the variation in kinetics of gas production of cereal grains and the relationship among gas production, chemical composition and feed value. Eighteen barley, 99 corn, 23 sorghum, and 57 wheat samples were fermented in vitro for 48 h. Gas production was measured with a computerized system and an exponential model was fitted to the data. The impact of the variation in composition and kinetics on the feed value of grains in feedlot rations was assessed with the Cornell Net Carbohydrate and Protein System (CNCPS). Fractional gas rates were significantly different between grains (P\u3c0.001), with a mean and S.D. of 0.24 (0.029) h-1 for barley (n=20), 0.15 (0.026) h-1 for corn (n=98), 0.06 (0.016) h-1 for sorghum (n=23) and 0.26 (0.039) h-1 for wheat (n=57). Fermentation rates were more variable than the chemical components. Fractional rates were poorly correlated with chemical composition within grain with the highest correlations for acid detergent insoluble crude protein (ADICP) (r=-0.31, P\u3c0.01) and ADF (r=-0.27, P\u3c0.01) for corn and neutral detergent insoluble crude protein (NDICP) (r=0.35, P\u3c0.05) for wheat. The impact of the variation in composition and kinetics on the feed value of grains in feedlot rations was assessed. The CNCPS predicted a maximal variation of \u3c2.1 MJ/day and \u3c60 g/day in metabolizable energy (ME) and metabolizable protein (MP) supply from grains, respectively. For sorghum, the fermentation rate was predicted to be a major determinant of the site of starch fermentation. A detailed evaluation of feed values for grains needs to include information on rates of fermentation

A two-strain model of infectious disease spread with asymmetric temporary immunity periods and partial cross-immunity

We introduce a two-strain model with asymmetric temporary immunity periods and partial cross-immunity. We derive explicit conditions for competitive exclusion and coexistence of the strains depending on the strain-specific basic reproduction numbers, temporary immunity periods, and degree of cross-immunity. The results of our bifurcation analysis suggest that, even when two strains share similar basic reproduction numbers and other epidemiological parameters, a disparity in temporary immunity periods and partial or complete cross-immunity can provide a significant competitive advantage. To analyze the dynamics, we introduce a quasi-steady state reduced model which assumes the original strain remains at its endemic steady state. We completely analyze the resulting reduced planar hybrid switching system using linear stability analysis, planar phase-plane analysis, and the Bendixson-Dulac criterion. We validate both the full and reduced models with COVID-19 incidence data, focusing on the Delta (B.1.617.2), Omicron (B.1.1.529), and Kraken (XBB.1.5) variants. These numerical studies suggest that, while early novel strains of COVID-19 had a tendency toward dramatic takeovers and extinction of ancestral strains, more recent strains have the capacity for co-existence.Comment: 29 pages, 18 figure

Association between exposure to environmental tobacco smoke and biomarkers of oxidative stress among patients hospitalised with acute myocardial infarction

Objective To determine whether exposure to environmental tobacco smoke was associated with oxidative stress among patients hospitalised for acute myocardial infarction.<p></p> Design An existing cohort study of 1,261 patients hospitalised for acute myocardial infarction.<p></p> Setting Nine acute hospitals in Scotland.<p></p> Participants Sixty never smokers who had been exposed to environmental tobacco smoke (admission serum cotinine ≥3.0 ng/mL) were compared with 60 never smokers who had not (admission serum cotinine ≤0.1 ng/mL).<p></p> Intervention None.<p></p> Main outcome measures Three biomarkers of oxidative stress (protein carbonyl, malondialdehyde (MDA) and oxidised low-density lipoprotein (ox-LDL)) were measured on admission blood samples and adjusted for potential confounders.<p></p> Results After adjusting for baseline differences in age, sex and socioeconomic status, exposure to environmental tobacco smoke was associated with serum concentrations of both protein carbonyl (beta coefficient 7.96, 95% CI 0.76, 15.17, p = 0.031) and MDA (beta coefficient 10.57, 95% CI 4.32, 16.81, p = 0.001) but not ox-LDL (beta coefficient 2.14, 95% CI −8.94, 13.21, p = 0.703).<p></p> Conclusions Exposure to environmental tobacco smoke was associated with increased oxidative stress. Further studies are requires to explore the role of oxidative stress in the association between environmental tobacco smoke and myocardial infarction.<p></p&gt