Closures of regular languages for profinite topologies

The Pin-Reutenauer algorithm gives a method, that can be viewed as a descriptive procedure, to compute the closure in the free group of a regular language with respect to the Hall topology. A similar descriptive procedure is shown to hold for the pseudovariety A of aperiodic semigroups, where the closure is taken in the free aperiodic omega-semigroup. It is inherited by a subpseudovariety of a given pseudovariety if both of them enjoy the property of being full. The pseudovariety A, as well as some of its subpseudovarieties are shown to be full. The interest in such descriptions stems from the fact that, for each of the main pseudovarieties V in our examples, the closures of two regular languages are disjoint if and only if the languages can be separated by a language whose syntactic semigroup lies in V. In the cases of A and of the pseudovariety DA of semigroups in which all regular elements are idempotents, this is a new result.PESSOA French-Portuguese project Egide-Grices 11113YM, "Automata, profinite semigroups and symbolic dynamics".FCT -- Fundação para a Ciência e a Tecnologia, respectively under the projects PEst-C/MAT/UI0144/2011 and PEst-C/MAT/UI0013/2011.ANR 2010 BLAN 0202 01 FREC.AutoMathA programme of the European Science Foundation.FCT and the project PTDC/MAT/65481/2006 which was partly funded by the European Community Fund FEDER

Towards an Integrative Cognitive-Socio-Technical Approach in Health Informatics: Analyzing Technology-Induced Error Involving Health Information Systems to Improve Patient Safety

The purpose of this paper is to argue for an integration of cognitive and socio-technical approaches to assessing the impact of health information systems. Historically, health informatics research has examined the cognitive and socio-technical aspects of health information systems separately. In this paper we argue that evaluations of health information systems should consider aspects related to cognition as well as socio-technical aspects including impact on workflow (i.e. an integrated view). Using examples from the study of technology-induced error in healthcare, we argue for the use of simulations to evaluate the cognitive-socio-technical impacts of health information technology [36]. Implications of clinical simulations and analysis of cognitive-social-technical impacts are discussed within the context of the system development life cycle to improve health information system design, implementation and evaluation

Can Subphotospheric Magnetic Reconnection Change the Elemental Composition in the Solar Corona?

Within the coronae of stars, abundances of those elements with low first ionization potential (FIP) often differ from their photospheric values. The coronae of the Sun and solar-type stars mostly show enhancements of low-FIP elements (the FIP effect) while more active stars such as M dwarfs have coronae generally characterized by the inverse-FIP effect (I-FIP). Here we observe patches of I-FIP effect solar plasma in AR 12673, a highly complex βγδ active region. We argue that the umbrae of coalescing sunspots, and more specifically strong light bridges within the umbrae, are preferential locations for observing I-FIP effect plasma. Furthermore, the magnetic complexity of the active region and major episodes of fast flux emergence also lead to repetitive and intense flares. The induced evaporation of the chromospheric plasma in flare ribbons crossing umbrae enables the observation of four localized patches of I-FIP effect plasma in the corona of AR 12673. These observations can be interpreted in the context of the ponderomotive force fractionation model which predicts that plasma with I-FIP effect composition is created by the refraction of waves coming from below the chromosphere. We propose that the waves generating the I-FIP effect plasma in solar active regions are generated by subphotospheric reconnection of coalescing flux systems. Although we only glimpse signatures of I-FIP effect fractionation produced by this interaction in patches on the Sun, on highly active M stars it may be the dominant process

Fatal gemcitabine-induced pulmonary toxicity in metastatic gallbladder adenocarcinoma

Gemcitabine is a chemotherapy agent that may cause unpredictable side effects. In this report, we describe a fatal gemcitabine-induced pulmonary toxicity in a patient with gallbladder metastatic adenocarcinoma. A 72-year-old patient was submitted to an elective laparoscopic cholecystectomy, and a tubular adenocarcinoma in the gallbladder was incidentally diagnosed. CT scan and ultrasound before the surgery did not show any tumor. After the surgery a Pet scan was positive for a hot-spot in the left colon. The colonic lesion was conveniently removed and the histology evaluation confirmed the diagnosis of adenocarcinoma tubular. The patient was then submitted to three sections of 1,600 mg/m2 of gemcitabine with intervals of 1 week. Three weeks later he developed severe respiratory distress. A helicoidal CT scan showed diffuse and severe interstitial pneumonitis, and lung biopsy confirmed accelerated usual interstitial pneumonia consistent with drug-induced toxicity. The patient presented unfavorable evolution with progressive worsening of respiratory function, hypotension, and renal failure. He died 1 month later in spite of methylprednisolone pulse therapy, large spectrum antimicrobial therapy, and full support of respiratory, hemodynamic and renal systems. Gemcitabine-induced pulmonary toxicity is usually a dramatic condition. Physicians should suspect pulmonary toxicity in patients with respiratory distress after gemcitabine chemotherapy, mainly in elderly patients

Usability evaluation of a clinical decision support tool for osteoporosis disease management

<p>Abstract</p> <p>Background</p> <p>Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs.</p> <p>Methods</p> <p>We conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT), the Risk Assessment Questionnaire (RAQ), and the Customised Osteoporosis Education (COPE) sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses.</p> <p>Results</p> <p>In study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able to understand and describe sections of the COPE sheet, and all considered discussing the information with their physicians. Suggestions for improvement included simplifying the language and improving the layout.</p> <p>Conclusions</p> <p>Findings from the three studies informed changes to the tool and confirmed the importance of usability testing on all end users to reduce errors, and as an important step in the development process of knowledge translation interventions.</p

Observational Evidence of S-web Source of the Slow Solar Wind

From 2022 March 18 to 21, NOAA Active Region (AR) 12967 was tracked simultaneously by Solar Orbiter at 0.35 au and Hinode/EIS at Earth. During this period, strong blueshifted plasma upflows were observed along a thin, dark corridor of open magnetic field originating at the AR’s leading polarity and continuing toward the southern extension of the northern polar coronal hole. A potential field source surface model shows large lateral expansion of the open magnetic field along the corridor. Squashing factor Q-maps of the large-scale topology further confirm super-radial expansion in support of the S-web theory for the slow wind. The thin corridor of upflows is identified as the source region of a slow solar wind stream characterized by ∼300 km s−1 velocities, low proton temperatures of ∼5 eV, extremely high density >100 cm−3, and a short interval of moderate Alfvénicity accompanied by switchback events. When the connectivity changes from the corridor to the eastern side of the AR, the in situ plasma parameters of the slow solar wind indicate a distinctly different source region. These observations provide strong evidence that the narrow open-field corridors, forming part of the S-web, produce some extreme properties in their associated solar wind streams

An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design

<p>Abstract</p> <p>Background</p> <p>There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication.</p> <p>Methods</p> <p>An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes.</p> <p>Results</p> <p>We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'.</p> <p>Conclusion</p> <p>The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.</p

Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

<p>Abstract</p> <p>Background</p> <p>To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices.</p> <p>Methods</p> <p>Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies.</p> <p>Results</p> <p>47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012).</p> <p>Conclusion</p> <p>Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.</p

Evaluation of a clinical decision support tool for osteoporosis disease management: protocol for an interrupted time series design

<p>Abstract</p> <p>Background</p> <p>Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care.</p> <p>Methods</p> <p>A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care.</p> <p>Discussion</p> <p>The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management.</p