Planar digraphs for automatic complexity

We show that the digraph of a nondeterministic finite automaton witnessing the automatic complexity of a word can always be taken to be planar. In the case of total transition functions studied by Shallit and Wang, planarity can fail. Let $s_q(n)$ be the number of binary words $x$ of length $n$ having nondeterministic automatic complexity $A_N(x)=q$. We show that $s_q$ is eventually constant for each $q$ and that the eventual constant value of $s_q$ is computable.Comment: Theory and Applications of Models of Computation (TAMC 2019), Lecture Notes in Computer Science 11436 (2019

Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>In many healthcare systems, people with severe joint disease wait months to years for joint replacement surgery. There are little empirical data on the health consequences of this delay and it is unclear whether people with substantial morbidity at entry to the waiting list continue to deteriorate further while awaiting surgery. This study investigated changes in Health-Related Quality of Life (HRQoL), health status and psychological distress among people waiting for total hip (THR) and knee replacement (TKR) surgery at a major metropolitan Australian public hospital.</p> <p>Methods</p> <p>134 patients completed questionnaires including the Assessment of Quality of Life (AQoL) instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kessler Psychological Distress Scale after entering an orthopaedic waiting list (baseline) and before surgery (preadmission). To quantify potential decline in wellbeing, we calculated the proportion of people experiencing clinically important deterioration using published guidelines and compared HRQoL and psychological distress outcomes with population norms.</p> <p>Results</p> <p>Most participants (69%) waited ≥6 months for surgery (median 286 days, IQR 169-375 days). Despite poor physical and psychological wellbeing at baseline, there was an overall deterioration in HRQoL during the waiting period (mean AQoL change -0.04, 95%CI -0.08 to -0.01), with 53% of participants experiencing decline in HRQoL (≥0.04 AQoL units). HRQoL prior to surgery remained substantially lower than Australian population norms (mean sample AQoL 0.37, 95%CI 0.33 to 0.42 vs mean population AQoL 0.83, 95%CI 0.82 to 0.84). Twenty-five per cent of participants showed decline in health status (≥9.6 WOMAC units) over the waiting period and prevalence of high psychological distress remained high at preadmission (RR 3.5, 95%CI 2.8 to 4.5). Most participants considered their pain (84%), fatigue (76%), quality of life (73%) and confidence in managing their health (55%) had worsened while waiting for surgery.</p> <p>Conclusions</p> <p>Despite substantial initial morbidity, over half of the participants awaiting joint replacement experienced deterioration in HRQoL during the waiting period. These data provide much-needed evidence to guide health professionals and policymakers in the design of care pathways and resource allocation for people who require joint replacement surgery.</p

Heart failure and the risk of stroke: the Rotterdam Study

Patients with heart failure used to have an increased risk of stroke, but this may have changed with current treatment regimens. We assessed the association between heart failure and the risk of stroke in a population-based cohort that was followed since 1990. The study uses the cohort of the Rotterdam Study and is based on 7,546 participants who at baseline (1990–1993) were aged 55 years or over and free from stroke. The associations between heart failure and risk of stroke were assessed using time-dependent Cox proportional hazards models, adjusted for cardiovascular risk factors (smoking, diabetes mellitus, BMI, ankle brachial index, blood pressure, atrial fibrillation, myocardial infarction and relevant medication). At baseline, 233 participants had heart failure. During an average follow-up time of 9.7 years, 1,014 persons developed heart failure, and 827 strokes (470 ischemic, 75 hemorrhagic, 282 unclassified) occurred. The risk of ischemic stroke was more than five-fold increased in the first month after diagnosis of heart failure (age and sex adjusted HR 5.79, 95% CI 2.15–15.62), but attenuated over time (age and sex adjusted HR 3.50 [95% CI 1.96–6.25] after 1–6 months and 0.83 [95% CI 0.53–1.29] after 0.5–6 years). Additional adjustment for cardiovascular risk factors only marginally attenuated these risks. In conclusion, the risk of ischemic stroke is strongly increased shortly after the diagnosis of heart failure but returns to normal within 6 months after onset of heart failure

Silence Is Not Golden: Invisible Latinas Living with HIV in the Midwest

This qualitative study was conducted to better understand the health needs and concerns of immigrant HIV-infected Latinas residing in the Midwest United States. Individual interviews (n = 18) were conducted in Spanish with Latinas in Kansas, Oklahoma and Missouri. Women were at different stages of acceptance about their HIV diagnosis and four common themes emerged from the data: pregnancy as a death sentence, HIV is taboo, God as their only resource, and living in isolation. Silence was an over-arching theme present throughout all the narratives and many women had never shared their stories about HIV with anyone. Depressive symptoms and suicidal ideation were common. These findings have implications for strategies to address the HIV prevention and HIV-related healthcare needs of this population of women. Results from this study further suggest that efforts are needed to break the silence surrounding HIV and to reduce HIV-related stigma in smaller Midwestern Hispanic communities

Maternal and neonatal factors related to prematurity

ABSTRACT OBJECTIVE To identify maternal and neonatal factors associated with prematurity in the municipality of Porto Alegre. METHOD This was a population-based case-control study. The cases were newborns under 37 weeks of gestation and the controls were newborns over 37 weeks. The data came from the records of 19,457 births in the city of Porto Alegre in the year 2012 from the Information System on Live Births of the Municipal Health Department. The analysis was carried outand adjusted by a Logistic Regression according to a hierarchical model. The variables studied were allocated into three hierarchy levels: sociodemographic variables; reproductive history; and gestational and birth factors. RESULTS There were 767 cases allocated and 1,534 controls in a design of a case for two controls (1:2) by simple randomization. In the final model, a statistically significant association was found for prematurity for the following variables: mother's age under 19 years old (OR=1.32; CI 95%: 1.02-1.71) or over 34 years old (OR=1.39; CI 95%: 1.12-1.72); inadequate maternal schooling for age (OR=2.11; CI 95%: 1.22-3.65); multiple pregnancies (OR=1.14; CI 95%: 1.01-1.29); C-section (OR=1.15; CI 95%: 1.03-1.29); birth weights under 2,500g (OR=4.04; CI 95%: 3.64-4.49); Apgar score at five minutes between zero and three (OR=1.47; CI 95%: 1.12-1.91); and inadequate prenatal care (OR=1.18; CI 95%: 1.02-1.36). CONCLUSION The present study showed the most immediate consequence of prematurity for newborns by evidencing its association with worse Apgar scores and low birth weight. The following factors were also shown as possible more distal determinants of prematurity: mother's age; inadequate maternal education; multiple gestation; inadequate prenatal care; and C-section

A novel approach to estimate the distribution, density and at-sea risks of a centrally-placed mobile marine vertebrate

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Formulating management strategies for mobile marine species is challenging, as knowledge is required of distribution, density, and overlap with putative threats. As a step towards assimilating knowledge, ecological niche models may identify likely suitable habitats for species, but lack the ability to enumerate species densities. Traditionally, this has been catered for by sightings-based distance sampling methods that may have practical and logistical limitations. Here we describe a novel method to estimate at-sea distribution and densities of a marine vertebrate, using historic aerial surveys of Gabonese leatherback turtle (Dermochelys coriacea) nesting beaches and satellite telemetry data of females at sea. We contextualise modelled patterns of distribution with putative threat layers of boat traffic, including fishing vessels and large ship movements, using Vessel Monitoring System (VMS) and Automatic Identification System (AIS) data. We identify key at-sea areas in which protection for inter-nesting leatherback turtles could be considered within the coastal zone of Gabonese Exclusive Economic Zone (EEZ). Our approach offers a holistic technique that merges multiple datasets and methodologies to build a deeper and insightful knowledge base with which to manage known activities at sea. As such, the methodologies presented in this study could be applied to other species of sea turtles for cumulative assessments; and with adaptation, may have utility in defining critical habitats for other central-place foragers such as pinnipeds, or sea bird species. Although our analysis focuses on a single species, we suggest that putative threats identified within this study (fisheries, seismic activity, general shipping) likely apply to other mobile marine vertebrates of conservation concern within Gabonese and central African coastal waters, such as olive ridley sea turtles (Lepidochelys olivacea), humpback dolphins (Sousa teuszii) and humpback whales (Megaptera novaeangliae).We thank the following for support and funding: CARPE (Central African Regional Program for the Environment, Darwin Initiative, EAZA ShellShock Campaign, Gabon Sea Turtle Partnership with funding from the Marine Turtle Conservation Fund (United States Fish and Wildlife Service, U.S. Department of the Interior), Harvest Energy, Large Pelagics Research Centre at the University of Massachusetts (Boston), NERC, Vaalco Energy and the Wildlife Conservation Society. We are sincerely grateful to the field teams and logistics staff who assisted in the aerial and ground surveys and with field-site assistance. BJG and MJW receive funding from the Natural Environment Research Council (NE/J012319/1), the European Union and the Darwin Initiative