Contourograph display system for monitoring electrocardiograms

Electrocardiogram is displayed as a contourogram on the cathode ray tube of a variable-persistence oscilloscope. Each cycle is stacked below its predecessors giving a three dimensional effect. A major change in the signal is apparent as a change in the contourogram pattern

Automated analysis of blood pressure measurements (Korotkov sound)

Automatic system for noninvasive measurements of arterial blood pressure is described. System uses Korotkov sound processor logic ratios to identify Korotkov sounds. Schematic diagram of system is provided to show components and method of operation

Apparatus and method for processing Korotkov sounds

A Korotkov sound processor, used in a noninvasive automatic blood measuring system where the brachial artery is occluded by an inflatable cuff, is disclosed. The Korotkoff sound associated with the systolic event is determined when the ratio of the absolute value of a voltage signal, representing Korotkov sounds in the range of 18 to 26 Hz to a maximum absolute peak value of the unfiltered signals, first equals or exceeds a value of 0.45. Korotkov sound associated with the diastolic event is determined when a ratio of the voltage signal of the Korotkov sounds in the range of 40 to 60 Hz to the absolute peak value of such signals within a single measurement cycle first falls below a value of 0.17. The processor signals the occurrence of the systolic and diastolic events and these signals can be used to control a recorder to record pressure values for these events

Implications of the Optical Observations of Neutron Stars

We show that observations of pulsars with pulsed optical emission indicate that the peak flux scales according to the magnetic field strength at the light cylinder. The derived relationships indicate that the emission mechanism is common across all of the observed pulsars with periods ranging from 33ms to 385 ms and ages of 1000-300,000 years. It is noted that similar trends exist for $\gamma$ ray pulsars. Furthermore the model proposed by Pacini (1971) and developed by Pacini and Salvati (1983,1987) still has validity and gives an adequate explanation of the optical phenomena.Comment: 23 pages, 6 figures, accepted for publication in the Astrophysical Journa

Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

BACKGROUND:At least 100,000 patients with schizophrenia receive care from community mental health teams (CMHTs) in England. These patients have regular meetings with clinicians, who assess them, engage them in treatment and co-ordinate care. As these routine meetings are not commonly guided by research evidence, a new intervention, DIALOG, was previously designed to structure consultations. Using a hand-held computer, clinicians asked patients to rate their satisfaction with eight life domains and three treatment aspects, and to indicate whether or not additional help was needed in each area, with responses being graphically displayed and compared with previous ratings. In a European multicentre trial, the intervention improved patients’ quality of life over a 1-year period. The current programme builds on this research by further developing DIALOG in the UK. RESEARCH QUESTIONS:(1) How can the practical procedure of the intervention be improved, including the software used and the design of the user interface? (2) How can elements of resource-oriented interventions be incorporated into a clinician manual and training programme for a new, more extensive ‘DIALOG+’ intervention? (3) How effective and cost-effective is the new DIALOG+ intervention in improving treatment outcomes for patients with schizophrenia or a related disorder? (4) What are the views of patients and clinicians regarding the new DIALOG+ intervention? METHODS:We produced new software on a tablet computer for CMHTs in the NHS, informed by analysis of videos of DIALOG sessions from the original trial and six focus groups with 18 patients with psychosis. We developed the new ‘DIALOG+’ intervention in consultation with experts, incorporating principles of solution-focused therapy when responding to patients’ ratings and specifying the procedure in a manual and training programme for clinicians. We conducted an exploratory cluster randomised controlled trial with 49 clinicians and 179 patients with psychosis in East London NHS Foundation Trust, comparing DIALOG+ with an active control. Clinicians working as care co-ordinators in CMHTs (along with their patients) were cluster randomised 1 : 1 to either DIALOG+ or treatment as usual plus an active control, to prevent contamination. Intervention and control were to be administered monthly for 6 months, with data collected at baseline and at 3, 6 and 12 months following randomisation. The primary outcome was subjective quality of life as measured on the Manchester Short Assessment of Quality of Life; secondary outcomes were also measured. We also established the cost-effectiveness of the DIALOG intervention using data from the Client Service Receipt Inventory, which records patients’ retrospective reports of using health- and social-care services, including hospital services, outpatient services and medication, in the 3 months prior to each time point. Data were supplemented by the clinical notes in patients’ medical records to improve accuracy. We conducted an exploratory thematic analysis of 16 video-recorded DIALOG+ sessions and measured adherence in these videos using a specially developed adherence scale. We conducted focus groups with patients (n = 19) and clinicians (n = 19) about their experiences of the intervention, and conducted thematic analyses. We disseminated the findings and made the application (app), manual and training freely available, as well as producing a protocol for a definitive trial. RESULTS:Patients receiving the new intervention showed more favourable quality of life in the DIALOG+ group after 3 months (effect size: Cohen’s d = 0.34), after 6 months (Cohen’s d = 0.29) and after 12 months (Cohen’s d = 0.34). An analysis of video-recorded DIALOG+ sessions showed inconsistent implementation, with adherence to the intervention being a little over half of the possible score. Patients and clinicians from the DIALOG+ arm of the trial reported many positive experiences with the intervention, including better self-expression and improved efficiency of meetings. Difficulties reported with the intervention were addressed by further refining the DIALOG+ manual and training. Cost-effectiveness analyses found a 72% likelihood that the intervention both improved outcomes and saved costs. LIMITATIONS:The research was conducted solely in urban east London, meaning that the results may not be broadly generalisable to other settings. CONCLUSIONS:(1) Although services might consider adopting DIALOG+ based on the existing evidence, a definitive trial appears warranted; (2) applying DIALOG+ to patient groups with other mental disorders may be considered, and to groups with physical health problems; (3) a more flexible use with variable intervals might help to make the intervention even more acceptable and effective; (4) more process evaluation is required to identify what mechanisms precisely are involved in the improvements seen in the intervention group in the trial; and (5) what appears to make DIALOG+ effective is that it is not a separate treatment and not a technology that is administered by a specialist; rather, it changes and utilises the existing therapeutic relationship between patients and clinicians in CMHTs to initiate positive change, helping the patients to improve their quality of life. FUTURE RESEARCH:Future studies should include a definitive trial on DIALOG+ and test the effectiveness of the intervention with other populations, such as people with depression. TRIAL REGISTRATION:Current Controlled Trials ISRCTN34757603. FUNDING:The National Institute for Health Research Programme Grants for Applied Research programme

Simultaneous Absolute Timing of the Crab Pulsar at Radio and Optical Wavelengths

The Crab pulsar emits across a large part of the electromagnetic spectrum. Determining the time delay between the emission at different wavelengths will allow to better constrain the site and mechanism of the emission. We have simultaneously observed the Crab Pulsar in the optical with S-Cam, an instrument based on Superconducting Tunneling Junctions (STJs) with $\mu$s time resolution and at 2 GHz using the Nan\c{c}ay radio telescope with an instrument doing coherent dedispersion and able to record giant pulses data. We have studied the delay between the radio and optical pulse using simultaneously obtained data therefore reducing possible uncertainties present in previous observations. We determined the arrival times of the (mean) optical and radio pulse and compared them using the tempo2 software package. We present the most accurate value for the optical-radio lag of 255 $\pm$ 21 $\mu$s and suggest the likelihood of a spectral dependence to the excess optical emission asociated with giant radio pulses.Comment: 8 pages; accepted for publication in Astronomy and Astrophysic

Minimizing the Cost of Team Exploration

A group of mobile agents is given a task to explore an edge-weighted graph $G$, i.e., every vertex of $G$ has to be visited by at least one agent. There is no centralized unit to coordinate their actions, but they can freely communicate with each other. The goal is to construct a deterministic strategy which allows agents to complete their task optimally. In this paper we are interested in a cost-optimal strategy, where the cost is understood as the total distance traversed by agents coupled with the cost of invoking them. Two graph classes are analyzed, rings and trees, in the off-line and on-line setting, i.e., when a structure of a graph is known and not known to agents in advance. We present algorithms that compute the optimal solutions for a given ring and tree of order $n$, in $O(n)$ time units. For rings in the on-line setting, we give the $2$-competitive algorithm and prove the lower bound of $3/2$ for the competitive ratio for any on-line strategy. For every strategy for trees in the on-line setting, we prove the competitive ratio to be no less than $2$, which can be achieved by the $DFS$ algorithm.Comment: 25 pages, 4 figures, 5 pseudo-code

Site-specific Mutants of Oncomodulin: 1H NMR and optical stopped-flow studies of the effect on the metal binding properties of an Asp59 → Glu59 substitution in the calcium-specific site

Abstract High resolution 1H nuclear magnetic resonance spectroscopy and optical stopped-flow techniques have been used to study the metal binding properties of a site-specific mutant of bacterial recombinant oncomodulin in which glutamate has replaced a liganding aspartate at position 59 in the CD calcium-binding site. In particular we have followed the replacement of calcium by lutetium in bacterial recombinant oncomodulin and D59E oncomodulin to provide a measure of the protein's preferences for metal ions of different ionic radii. The result of the Asp----Glu substitution is to make the mutant oncomodulin more similar to rat parvalbumin in terms of its relative CD- and EF-domain affinities for lutetium(III), that is to increase its affinity for metal ions with smaller ionic radii. This finding supports the original hypothesis that the presence of Asp at sequence position 59 is an important factor in the reduced preference of the CD site of oncomodulin for smaller metals such as magnesium (Williams, T. C., Corson, D. C., Sykes, B. D., and MacManus, J. P. (1987) J. Biol. Chem. 262, 6248-6256). However, our studies show that both the CD and the EF sites are affected by this single residue substitution suggesting that many factors play a role in the metal binding affinity and interaction between the two sites