Using PICO to Align Medical Evidence with MDs Decision Making Models

Modern medicine is characterized by an “explosion” in clinical research information making practical application of Evidence-Based Medicine (EBM), problematic for many clinicians. We have developed a PICO-(evidence based search strategy focusing on Patient/Population, Intervention, Comparison and Outcome)-based framework for (indexing and retrieving medical evidence and we posit that the use of PICO allows for organizing evidence that is aligned with an MD’s decision making model. We describe a study where medical students evaluated our PICO-based approach and results show that students are eager to apply EBM but are hindered by a lack of specialist skills. Students reported that the PICO-based framework for organizing evidence provided an intuitive way of accessing and evaluating evidence and would be useful for their clinical tasks

Clinical decision support system for point of care use--ontology-driven design and software implementation

OBJECTIVES: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation. METHODS: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications' functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions. RESULTS: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical prostatectomy on the hospital ward) and implemented on two computing platforms--desktop and handheld computers. CONCLUSIONS: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system

CCD and photon-counting photometric observations of asteroids carried out at Padova and Catania observatories

We present the results of observational campaigns of asteroids performed at Asiago Station of Padova Astronomical Observatory and at M.G. Fracastoro Station of Catania Astrophysical Observatory, as part of the large research programme on Solar System minor bodies undertaken since 1979 at the Physics and Astronomy Department of Catania University. Photometric observations of six Main-Belt asteroids (27 Euterpe, 173 Ino, 182 Elsa, 539 Pamina, 849 Ara, and 984 Gretia), one Hungaria (1727 Mette), and two Near-Earth Objects (3199 Nefertiti and 2004 UE) are reported. The first determination of the synodic rotational period of 2004 UE was obtained. For 182 Elsa and 1727 Mette the derived synodic period of 80.23+/-0.08 h and 2.981+/-0.001 h, respectively, represents a significant improvement on the previously published values. For 182 Elsa the first determination of the H-G magnitude relation is also presented.Comment: 19 pages, 11 figures, accepted for publication in Planetary and Space Scienc

The nature of GRB-selected submillimeter galaxies: hot and young

We present detailed fits of the spectral energy distributions (SEDs) of four submillimeter (submm) galaxies selected by the presence of a gamma-ray burst (GRB) event (GRBs 980703, 000210, 000418 and 010222). These faint ~3 mJy submm emitters at redshift ~1 are characterized by an unusual combination of long- and short-wavelength properties, namely enhanced submm and/or radio emission combined with optical faintness and blue colors. We exclude an active galactic nucleus as the source of long-wavelength emission. From the SED fits we conclude that the four galaxies are young (ages <2 Gyr), highly starforming (star formation rates ~150 MSun/yr), low-mass (stellar masses ~10^10 MSun) and dusty (dust masses ~3x10^8 MSun). Their high dust temperatures (Td>45 K) indicate that GRB host galaxies are hotter, younger, and less massive counterparts to submm-selected galaxies detected so far. Future facilities like Herschel, JCMT/SCUBA-2 and ALMA will test this hypothesis enabling measurement of dust temperatures of fainter GRB-selected galaxies.Comment: 9 pages, 2 figures, submitted to ApJ, for SED templates, see http://archive.dark-cosmology.dk

GRB 980425 host: [C II], [O I], and CO lines reveal recent enhancement of star formation due to atomic gas inflow

Context. Accretion of gas from the intergalactic medium is required to fuel star formation in galaxies. We have recently suggested that this process can be studied using host galaxies of gamma-ray bursts (GRBs). Aims. Our aim is to test this possibility by studying in detail the properties of gas in the closest galaxy hosting a GRB (980425). Methods. We obtained the first ever far-infrared (FIR) line observations of a GRB host, namely Herschel/PACS resolved [C ii] 158 μm and [O i] 63 μm spectroscopy, and an APEX/SHeFI CO(2-1) line detection and ALMA CO(1-0) observations of the GRB 980425 host. Results. The GRB 980425 host has elevated [C ii]/FIR and [O i]/FIR ratios and higher values of star formation rates (SFR) derived from line ([C ii], [O i], Hα) than from continuum (UV, IR, radio) indicators. [C ii] emission exhibits a normal morphology, peaking at the galaxy centre, whereas [O i] is concentrated close to the GRB position and the nearby Wolf-Rayet region. The high [O i] flux indicates that there is high radiation field and high gas density at these positions, as derived from modelling of photo-dissociation regions. The [C ii]/CO luminosity ratio of the GRB 980425 host is close to the highest values found for local star-forming galaxies. Indeed, its CO-derived molecular gas mass is low given its SFR and metallicity, but the [C ii]-derived molecular gas mass is close to the expected value. Conclusions. The [O i] and H i concentrations and the high radiation field and density close to the GRB position are consistent with the hypothesis of a very recent (at most a few tens of Myr ago) inflow of atomic gas triggering star formation. In this scenario dust has not had time to build up (explaining high line-to-continuum ratios). Such a recent enhancement of star formation activity would indeed manifest itself in high SFR/SFR ratios because the line indicators are sensitive only to recent (∼ 10 Myr) activity, whereas the continuum indicators measure the SFR averaged over much longer periods (~100 Myr). Within a sample of 32 other GRB hosts, 20 exhibit SFR/SFR> 1 with a mean ratio of 1.74 ± 0.32. This is consistent with a very recent enhancement of star formation that is common among GRB hosts, so galaxies that have recently experienced inflow of gas may preferentially host stars exploding as GRBs. Therefore GRBs may be used to select a unique sample of galaxies that is suitable for the investigation of recent gas accretion.J.L.W. is supported by a European Union COFUND/Durham Junior Research Fellowship under EU grant agreement number 267209, and acknowledges additional support from STFC (ST/L00075X/1). A.K. acknowledges support from the Foundation for Polish Science (FNP) and the Polish National Science Center grant 2013/11/N/ST9/00400. A.J.C.T. acknowledges support from the Spanish Ministry Project AYA2015-71718-R. D.X. acknowledges the support by the One-Hundred-Talent Program of the Chinese Academy of Sciences, and by the Strategic Priority Research Program >Multi-wavelength Gravitational Wave Universe> of the Chinese Academy of Sciences (No. XDB23000000).Peer Reviewe

An improved direct colorimetric method for the quantitative analysis of urinary hippuric acid as an index of toluene exposure

An improved direct colorimetric method for determining the concentration of urinary hippuric acid as an index of toluene exposure was described. One tenth ml of urine was diluted with 0.4 ml 0.01 M phosphate buffer H 6.9 and mixed with 0.5 ml pyridine. The mixture was layered on 0.2 ml benzenesulfonyl chloride. The reaction was started by mixing for one min with a mechanical shaker. The colored solution was allowed to stand for 30 min, diluted with 5 ml ethanol, and absorbance measured at 410 nm within 30 min after the dilution. The coefficient of variation of this method was 6% and the recovery 103% when urine contains about 0.2-0.5 mg hippuric acid per ml of urine. The concentration was linear up to 2.0 mg per ml hippuric acid in a specimen.</p

Herschel observations of gamma-ray burst host galaxies: implications for the topology of the dusty interstellar medium

Long-duration gamma-ray bursts (GRBs) are indisputably related to star formation, and their vast luminosity in gamma rays pin-points regions of star formation independent of galaxy mass. As such, GRBs provide a unique tool for studying star forming galaxies out to high-z independent of luminosity. Most of our understanding of the properties of GRB hosts (GRBHs) comes from optical and near-infrared (NIR) follow-up observations, and we therefore have relatively little knowledge of the fraction of dust-enshrouded star formation that resides within GRBHs. Currently ~20% of GRBs show evidence of significant amounts of dust along the line of sight to the afterglow through the host galaxy, and these GRBs tend to reside within redder and more massive galaxies than GRBs with optically bright afterglows. In this paper we present Herschel observations of five GRBHs with evidence of being dust-rich, targeted to understand the dust attenuation properties within GRBs better. Despite the sensitivity of our Herschel observations, only one galaxy in our sample was detected (GRBH 070306), for which we measure a total star formation rate (SFR) of ~100Mstar/yr, and which had a relatively high stellar mass (log[Mstar]=10.34+0.09/-0.04). Nevertheless, when considering a larger sample of GRBHs observed with Herschel, it is clear that stellar mass is not the only factor contributing to a Herschel detection, and significant dust extinction along the GRB sightline (A_{V,GRB}>1.5~mag) appears to be a considerably better tracer of GRBHs with high dust mass. This suggests that the extinguishing dust along the GRB line of sight lies predominantly within the host galaxy ISM, and thus those GRBs with A_{V,GRB}>1~mag but with no host galaxy Herschel detections are likely to have been predominantly extinguished by dust within an intervening dense cloud.Comment: 14 pages, 7 figures. Accepted for publication in A&

A Task-based Support Architecture for Developing Point-of-care Clinical Decision Support Systems for the Emergency Department

Objectives: The purpose of this study was to create a task-based support architecture for developing clinical decision support systems (CDSSs) that assist physicians in making decisions at the point-of-care in the emergency department (ED). The backbone of the proposed architecture was established by a task-based emergency workflow model for a patient-physician encounter. Methods: The architecture was designed according to an agent-oriented paradigm. Specifically, we used the O-MaSE (Organization-based Multi-agent System Engineering) method that allows for iterative translation of functional requirements into architectural components (e.g., agents). The agent-oriented paradigm was extended with ontology-driven design to implement ontological models representing knowledge required by specific agents to operate. Results: The task-based architecture allows for the creation of a CDSS that is aligned with the task-based emergency workflow model. It facilitates decoupling of executable components (agents) from embedded domain knowledge (ontological models), thus supporting their interoperability, sharing, and reuse. The generic architecture was implemented as a pilot system, MET3-AE – a CDSS to help with the management of pediatric asthma exacerbation in the ED. The system was evaluated in a hospital ED. Conclusions: The architecture allows for the creation of a CDSS that integrates support for all tasks from the task-based emergency workflow model, and interacts with hospital information systems. Proposed architecture also allows for reusing and sharing system components and knowledge across disease-specific CDSSs

Sub-millimeter galaxies as progenitors of compact quiescent galaxies

Three billion years after the big bang (at redshift z=2), half of the most massive galaxies were already old, quiescent systems with little to no residual star formation and extremely compact with stellar mass densities at least an order of magnitude larger than in low redshift ellipticals, their descendants. Little is known about how they formed, but their evolved, dense stellar populations suggest formation within intense, compact starbursts 1-2 Gyr earlier (at 3<z<6). Simulations show that gas-rich major mergers can give rise to such starbursts which produce dense remnants. Sub-millimeter selected galaxies (SMGs) are prime examples of intense, gas-rich, starbursts. With a new, representative spectroscopic sample of compact quiescent galaxies at z=2 and a statistically well-understood sample of SMGs, we show that z=3-6 SMGs are consistent with being the progenitors of z=2 quiescent galaxies, matching their formation redshifts and their distributions of sizes, stellar masses and internal velocities. Assuming an evolutionary connection, their space densities also match if the mean duty cycle of SMG starbursts is 42 (+40/-29) Myr (consistent with independent estimates), which indicates that the bulk of stars in these massive galaxies were formed in a major, early surge of star-formation. These results suggests a coherent picture of the formation history of the most massive galaxies in the universe, from their initial burst of violent star-formation through their appearance as high stellar-density galaxy cores and to their ultimate fate as giant ellipticals.Comment: ApJ (in press