Computer-assisted diagnosis in the noninvasive evaluation of patients with suspected coronary artery disease

A microcomputer program called CADENZA, which employs Bayes' theorem to analyze and report the results of various clinical descriptors and noninvasive tests relative to the diagnosis of coronary artery disease, was evaluated in 1,097 consecutive patients without previous myocardial infarction. With this program, each patient was characterized by a probability for coronary artery disease, based on Framingham risk factor analysis, symptom characterization, electrocardiographic stress testing, cardiokymography, cardiac fluoroscopy, thallium perfusion scintigraphy and technetium equilibrium-gated blood pool scintigraphy. A total of 11,808 probability estimates derived from various combinations of the available observations were analyzed: 2,180 in 170 patients undergoing coronary angiography and 9,628 in 969 patients who completed a 1 year follow-up for coronary events.The predicted probability of disease correlated linearly with observed angiographic prevalence in the 170 patients who subsequently had coronary angiography (prevalence = [0.001 ± 0.011] + [0.966 ± 0.019] x probability). The difference between probability and prevalence averaged 3.1%, and the magnitude of this correlation was not affected by the type or amount of data analyzed. The prevalence of multivessel disease in these patients increased as a monotonic function of disease probability. Below a probability of 25%, single vessel disease was slightly more common than multivessel disease. Above a probability of 75%, multivessel disease predominated. In the 969 patients followed up for 1 year from the date of testing, the incidence of cardiac death and nonfatal infarction increased as a cubic function of disease probability (from approximately 0 to 8% per year for each). Above a probability of 90%, however, the standard deviation for predicting these events was wide.These data indicate that Bayes' theorem in general— and CADENZA in particular—is an accurate, clinically applicable means for quantifying the prevalence of angiographic coronary artery disease, the risk of multivessel disease and the incidence of morbid coronary events in the year after testing

Partitions with Prescribed Hook Differences

We investigate partition identities related to off-diagonal hook differences. Our results generalize previous extensions of the Rogers—Ramanujan identities. The identity of the related polynomials with constructs in statistical mechanics is discussed

Mixed Species Plantations: Prospects and Challenges

About 2% of English-language literature on plantations deals with mixed-species plantations, but only a tiny proportion

British Literature of the 18th-20th Cenutry

Openly licensed anthology focused on the theme of British Literature from the 18th-20th centuries. Includes: Persuasion by Jane Austen, Lady Audley’s Secret by M.E. Braddon, Wuthering Heights by Emily Brontë, Middlemarch by George Eliot, A Passage to India by E.M. Forrester, Carmilla by Joseph Sheridan Le Fanu, The History of Mary Prince, a West Indian Slave by Mary Prince, Pamela, or Virtue Rewarded by Samuel Richardson

Context matters: combined influence of participation and intellectual stimulation on the promotion-focus/employee creativity relationship

In this paper, we examined the interactive effects of two contexts — participation and intellectual stimulation, and promotion focus on creativity. On the basis of a multi-organization sample of 213 employees, we tested and found that although promotion focus was positively related to creativity, the relationship between promotion focus and creativity was most positive when both participation and leader intellectual stimulation were high. We discuss the way contexts in combination influence employee creativity for promotion-oriented individuals, through increasing decision latitude as well as stimulating and promoting creativity

People with intellectual disabilities at the end of their lives: The case for specialist care?

Background: People with intellectual disabilities have a shorter life expectancy, but healthcare improvements mean that they are beginning to live longer, with associated health difficulties. This means that there is an urgent need to focus research on ageing as well as end-of-life care. This study aimed to explore a specialist intellectual disability service for older people who are dying and how it related to their quality of life and to costs associated with care provided. Method: Data were collected for nine residents and 15 staff members of the specialist service. A single case study design with mixed methods including observations, interviews, standardized questionnaires and costs analysis was utilized. Results: We found positive results regarding overall quality of life, although individuals had limited social networks. Placement fees paid by local health trusts and social services departments were slightly higher than the estimated cost of care reflecting good financial management by a small voluntary sector organization. Conclusion: Whilst the philosophical arguments around “specialist” care persist, this service fills a gap in intellectual disability care provision

Better Prognosis in Newborns with Trisomy 13 Who Received Intensive Treatments: A Retrospective Study of 16 Patients

Intensive treatment for newborns with trisomy 13 is controversial because of their lethal prognosis. We report the better life prognosis of patients with trisomy 13 who received intensive treatment. At our hospital, we provided an intensive management to such patients including resuscitation and surgical procedures as required. Herein, we present the results of a retrospective study (1989–2010) of 16 trisomy 13 cases who received an intensive treatment. None was diagnosed to have trisomy 13 before birth; 9 were delivered by C-section and oxygen was administered to all patients during postpartum resuscitation. Mechanical ventilation was used in 9 patients after tracheal intubation and tracheotomy was performed in 2 patients when withdrawing of extubation was difficult. Regarding prognosis, 9 patients died, 3 were referred to another hospital, and 4 were discharged from the hospital. Four and 7 patients died within 7 and 30 days after birth, respectively. Nine patients survived for >1 month, 7 for >180 days, and 5 for >3 years. Median survival for 16 patients was 733 days. The patients who received intensive treatments survived longer compared to the previous data. This study provides useful information concerning genetic counseling, especially from an ethical point of view, before providing intensive management to newborns with trisomy 13

What is Community Operational Research?

Community Operational Research (Community OR) has been an explicit sub-domain of OR for more than 30 years. In this paper, we tackle the controversial issue of how it can be differentiated from other forms of OR. While it has been persuasively argued that Community OR cannot be defined by its clients, practitioners or methods, we argue that the common concern of all Community OR practice is the meaningful engagement of communities, whatever form that may take – and the legitimacy of different forms of engagement may be open to debate. We then move on to discuss four other controversies that have implications for the future development of Community OR and its relationship with its parent discipline: the desire for Community OR to be more explicitly political; claims that it should be grounded in the theory, methodology and practice of systems thinking; the similarities and differences between the UK and US traditions; and the extent to which Community OR offers an enhanced understanding of practice that could be useful to OR more generally. Our positions on these controversies all follow from our identification of ‘meaningful engagement’ as a central feature of Community OR