What makes stroke rehabilitation patients complex? Clinician perspectives and the role of discharge pressure

Background: Approximately 80% of people who survive a stroke have on average five other conditions and a wide range of psychosocial issues. Attention to biopsychosocial issues has led to the identification of ‘complex patients’. No single definition of ‘patient complexity’ exists, therefore applied health researchers seek to understand ‘patient complexity’ as it relates to a specific clinical context. Objective: To understand how ‘patient complexity’ is conceptualized by clinicians, and to position the findings within the existing literature on patient complexity. Methods: A qualitative descriptive approach was utilized. Twenty-three rehabilitation clinicians participated in four focus groups. Results: Five elements of patient complexity were identified: medical/functional issues, social determinant factors, social/family support, personal characteristics, and health system factors. Using biopsychosocial factors to identify complexity results in all patients being complex; operationalization of the definition led to the identification of systemic elements. A disconnect between acute, inpatient rehabilitation and community services was identified as a trigger for increased complexity.Conclusions: Patient complexity is not a dichotomous state. If applying existing complexity definitions, all patients are complex. This study extends the understanding by suggesting a structural element of complexity from manageable to less manageable complexity based on ability to discharge. Journal of Comorbidity 2016;6(2):35–4

Neutral-Current Atmospheric Neutrino Flux Measurement Using Neutrino-Proton Elastic Scattering in Super-Kamiokande

Recent results show that atmospheric $\nu_\mu$ oscillate with $\delta m^2 \simeq 3 \times 10^{-3}$ eV$^2$ and $\sin^2{2\theta_{atm}} \simeq 1$, and that conversion into $\nu_e$ is strongly disfavored. The Super-Kamiokande (SK) collaboration, using a combination of three techniques, reports that their data favor $\nu_\mu \to \nu_\tau$ over $\nu_\mu \to \nu_{sterile}$. This distinction is extremely important for both four-neutrino models and cosmology. We propose that neutrino-proton elastic scattering ($\nu + p \to \nu + p$) in water \v{C}erenkov detectors can also distinguish between active and sterile oscillations. This was not previously recognized as a useful channel since only about 2% of struck protons are above the \v{C}erenkov threshold. Nevertheless, in the present SK data there should be about 40 identifiable events. We show that these events have unique particle identification characteristics, point in the direction of the incoming neutrinos, and correspond to a narrow range of neutrino energies (1-3 GeV, oscillating near the horizon). This channel will be particularly important in Hyper-Kamiokande, with $\sim 40$ times higher rate. Our results have other important applications. First, for a similarly small fraction of atmospheric neutrino quasielastic events, the proton is relativistic. This uniquely selects $\nu_\mu$ (not $\bar{\nu}_\mu$) events, useful for understanding matter effects, and allows determination of the neutrino energy and direction, useful for the $L/E$ dependence of oscillations. Second, using accelerator neutrinos, both elastic and quasielastic events with relativistic protons can be seen in the K2K 1-kton near detector and MiniBooNE.Comment: 10 pages RevTeX, 8 figure

Approximate Deadline-Scheduling with Precedence Constraints

We consider the classic problem of scheduling a set of n jobs non-preemptively on a single machine. Each job j has non-negative processing time, weight, and deadline, and a feasible schedule needs to be consistent with chain-like precedence constraints. The goal is to compute a feasible schedule that minimizes the sum of penalties of late jobs. Lenstra and Rinnoy Kan [Annals of Disc. Math., 1977] in their seminal work introduced this problem and showed that it is strongly NP-hard, even when all processing times and weights are 1. We study the approximability of the problem and our main result is an O(log k)-approximation algorithm for instances with k distinct job deadlines

Unusual morphologies and the occurrence of pseudomorphs after ikaite (CaCO3•6H2O) in fast growing, hyperalkaline speleothem

Unusual speleothem, associated with hyperalkaline (pH>12) groundwaters have formed within a shallow, abandoned railway tunnel at Peak Dale, Derbyshire, UK. The hyperalkaline groundwaters are produced by the leaching of a thin layer (<2 m) of old lime kiln waste above the soil-bedrock surface above the tunnel by rainwater. This results in a different reaction and chemical process to that more commonly associated with the formation of calcium carbonate speleothems from Ca-HCO3-type groundwaters and degassing of CO2. Stalagmites within the Peak Dale tunnel have grown rapidly (averaging 33 mm y-1), following the closure of the tunnel 70 years ago. They have an unusual morphology comprising a central sub-horizontally-laminated column of micro- to nano-crystalline calcium carbonate encompassed by an outer sub-vertical assymetric ripple laminated layer. The stalagmites are largely composed of secondary calcite forming pseudomorphs (<1 mm) which we believe to be predominantly after the ‘cold climate’ calcium carbonate polymorph, ikaite (calcium carbonate hexahydrate: CaCO3•6H2O), with minor volumes of small (<5 μm) pseudomorphs after vaterite. The tunnel has a near constant temperature of 8-9°C which is slightly above the previously published crystallisation temperatures for ikaite (<6°C). Analysis of a stalagmite actively growing at the time of sampling, and preserved immediately within a dry nitrogen cryogenic vessel, indicates that following crystallisation of ikaite, decomposition to calcite occurs rapidly, if not instantaneously. We believe this is the first occurrence of this calcium carbonate polymorph observed within speleothem

On Black Hole Detection with the OWL/Airwatch Telescope

In scenarios with large extra dimensions and TeV scale gravity ultrahigh energy neutrinos produce black holes in their interactions with the nucleons. We show that ICECUBE and OWL may observe large number of black hole events and provide valuable information about the fundamental Planck scale and the number of extra dimensions. OWL is especially well suited to observe black hole events produced by neutrinos from the interactions of cosmic rays with the 3 K background radiation. Depending on the parameters of the scenario of large extra dimensions and on the flux model, as many as 28 events per year are expected for a Planck scale of 3 TeV.Comment: 8 pages, including 7 color figures, three figure captions corrected, minor changes for clarification, one reference adde

Mental health correlates of autism spectrum disorder in gender diverse young people: Evidence from a specialised child and adolescent gender clinic in Australia

Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties

Reddening law and interstellar dust properties along Magellanic sight-lines

This study establishes that SMC, LMC and Milky Way extinction curves obey the same extinction law which depends on the 2200A bump size and one parameter, and generalizes the Cardelli, Clayton and Mathis (1989) relationship. This suggests that extinction in all three galaxies is of the same nature. The role of linear reddening laws over all the visible/UV wavelength range, particularly important in the SMC but also present in the LMC and in the Milky Way, is also highlighted and discussed.Comment: accepted for publication in Astrophysics and Space Science. 16 pages, 12 figures. Some figures are colour plot

Lyndon-Shirshov basis and anti-commutative algebras

Chen, Fox, Lyndon 1958 \cite{CFL58} and Shirshov 1958 \cite{Sh58} introduced non-associative Lyndon-Shirshov words and proved that they form a linear basis of a free Lie algebra, independently. In this paper we give another approach to definition of Lyndon-Shirshov basis, i.e., we find an anti-commutative Gr\"{o}bner-Shirshov basis $S$ of a free Lie algebra such that $Irr(S)$ is the set of all non-associative Lyndon-Shirshov words, where $Irr(S)$ is the set of all monomials of $N(X)$, a basis of the free anti-commutative algebra on $X$, not containing maximal monomials of polynomials from $S$. Following from Shirshov's anti-commutative Gr\"{o}bner-Shirshov bases theory \cite{S62a2}, the set $Irr(S)$ is a linear basis of a free Lie algebra

Spatio-temporal genetic tagging of a cosmopolitan planktivorous shark provides insight to gene flow, temporal variation and site-specific re-encounters

Migratory movements in response to seasonal resources often influence population structure and dynamics. Yet in mobile marine predators, population genetic consequences of such repetitious behaviour remain inaccessible without comprehensive sampling strategies. Temporal genetic sampling of seasonally recurring aggregations of planktivorous basking sharks, Cetorhinus maximus, in the Northeast Atlantic (NEA) affords an opportunity to resolve individual re-encounters at key sites with population connectivity and patterns of relatedness. Genetic tagging (19 microsatellites) revealed 18% of re-sampled individuals in the NEA demonstrated inter/multi-annual site-specific re-encounters. High genetic connectivity and migration between aggregation sites indicate the Irish Sea as an important movement corridor, with a contemporary effective population estimate (Ne) of 382 (CI = 241–830). We contrast the prevailing view of high gene flow across oceanic regions with evidence of population structure within the NEA, with early-season sharks off southwest Ireland possibly representing genetically distinct migrants. Finally, we found basking sharks surfacing together in the NEA are on average more related than expected by chance, suggesting a genetic consequence of, or a potential mechanism maintaining, site-specific re-encounters. Long-term temporal genetic monitoring is paramount in determining future viability of cosmopolitan marine species, identifying genetic units for conservation management, and for understanding aggregation structure and dynamics

Probing mSUGRA via the Extreme Universe Space Observatory

An analysis is carried out within mSUGRA of the estimated number of events originating from upward moving ultra-high energy neutralinos that could be detected by the Extreme Universe Space Observatory (EUSO). The analysis exploits a recently proposed technique that differentiates ultra-high energy neutralinos from ultra-high energy neutrinos using their different absorption lengths in the Earth's crust. It is shown that for a significant part of the parameter space, where the neutralino is mostly a Bino and with squark mass $\sim 1$ TeV, EUSO could see ultra-high energy neutralino events with essentially no background. In the energy range 10^9 GeV < E < 10^11 GeV, the unprecedented aperture of EUSO makes the telescope sensitive to neutralino fluxes as low as 1.1 \times 10^{-6} (E/GeV)^{-1.3} GeV^{-1} cm^{-2} yr^{-1} sr^{-1}, at the 95% CL. Such a hard spectrum is characteristic of supermassive particles' $N$-body hadronic decay. The case in which the flux of ultra-high energy neutralinos is produced via decay of metastable heavy particles with uniform distribution throughout the universe is analyzed in detail. The normalization of the ratio of the relics' density to their lifetime has been fixed so that the baryon flux produced in the supermassive particle decays contributes to about 1/3 of the events reported by the AGASA Collaboration below 10^{11} GeV, and hence the associated GeV gamma-ray flux is in complete agreement with EGRET data. For this particular case, EUSO will collect between 4 and 5 neutralino events (with 0.3 of background) in ~ 3 yr of running. NASA's planned mission, the Orbiting Wide-angle Light-collectors (OWL), is also briefly discussed in this context.Comment: Some discussion added, final version to be published in Physical Review