Nurses' views of using computerized decision support software in NHS Direct

Background. Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. Aims. To explore nurses' views of their roles and the computerized decision support software in NHS Direct. Methods. Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. Findings. Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. Conclusions. The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice

Locally minimal uniformly oriented shortest networks

AbstractThe Steiner problem in a λ-plane is the problem of constructing a minimum length network interconnecting a given set of nodes (called terminals), with the constraint that all line segments in the network have slopes chosen from λ uniform orientations in the plane. This network is referred to as a minimum λ-tree. The problem is a generalization of the classical Euclidean and rectilinear Steiner tree problems, with important applications to VLSI wiring design.A λ-tree is said to be locally minimal if its length cannot be reduced by small perturbations of its Steiner points. In this paper we prove that a λ-tree is locally minimal if and only if the length of each path in the tree cannot be reduced under a special parallel perturbation on paths known as a shift. This proves a conjecture on necessary and sufficient conditions for locally minimal λ-trees raised in [M. Brazil, D.A. Thomas, J.F. Weng, Forbidden subpaths for Steiner minimum networks in uniform orientation metrics, Networks 39 (2002) 186–222]. For any path P in a λ-tree T, we then find a simple condition, based on the sum of all angles on one side of P, to determine whether a shift on P reduces, preserves, or increases the length of T. This result improves on our previous forbidden paths results in [M. Brazil, D.A. Thomas, J.F. Weng, Forbidden subpaths for Steiner minimum networks in uniform orientation metrics, Networks 39 (2002) 186–222]

Blip10000: a social video dataset containing SPUG content for tagging and retrieval

The increasing amount of digital multimedia content available is inspiring potential new types of user interaction with video data. Users want to easilyfind the content by searching and browsing. For this reason, techniques are needed that allow automatic categorisation, searching the content and linking to related information. In this work, we present a dataset that contains comprehensive semi-professional user generated (SPUG) content, including audiovisual content, user-contributed metadata, automatic speech recognition transcripts, automatic shot boundary les, and social information for multiple `social levels'. We describe the principal characteristics of this dataset and present results that have been achieved on different tasks

Reliability of functional outcome measures in adults with neurofibromatosis 1

Objectives: To determine intra-rater and inter-rater reliability of functional outcome measures in adults with neurofibromatosis 1 (NF1) and to ascertain how closely objective and subjective measures align. Methods: Forty-nine ambulant adults with NF1 aged 16 years and over were included in this observational study. Median age 31 years (range 16-66), 29 females, 20 males. Participants were video-recorded or photographed performing four functional outcome measures. Four raters from the Neurofibromatosis centre multi-disciplinary team independently scored the measures to determine inter-rater reliability. One rater scored the measures a second time on a separate occasion to determine intra-rater reliability. The measures evaluated were the functional reach, timed up and go, ten metre walk and a modified nine-hole peg tests. Participants also completed a disease specific quality of life questionnaire (INF1-QOL). Results: Inter-rater reliability and intra-rater reliability scores (intra-class coefficient, ICC) were similar for each outcome measure. Excellent rater agreement (ICC r ≥ 0.9) was found for the functional reach, timed up and go and the 10 metre walk tests. Rater agreement was good for the modified 9-hole peg test; ICC r= 0.75 for intra-rater reliability and 0.76 for inter-rater reliability. The timed up and go and the 10 metre walk tests correlated highly with perceived mobility challenges in the quality of life questionnaire (INF1-QOL). Conclusions: The functional reach, timed up and go and 10 metre walk tests are potentially useful outcome measures for monitoring NF1 treatment and will be assessed for validity and reliability in future multi-centre studies

Phenomena exposure from the large scale gas injection test (Lasgit) dataset using a bespoke data analysis toolkit

The Large Scale Gas Injection Test (Lasgit) is a field-scale experiment designed to study the impact of gas buildup and subsequent migration through an engineered barrier system. Lasgit has a substantial experimental dataset containing in excess of 21 million datum points. The dataset is anticipated to contain a wealth of information, ranging from long-term trends and system behaviours to small-scale or ‘second-order’ features. In order to interrogate the Lasgit dataset, a bespoke computational toolkit, designed to expose difficult to observe phenomena, has been developed and applied to the dataset. The preliminary application of the toolkit, presented here, has resulted in a large number of phenomena being indicated/quantified, including highlighting of second-order events (small gas flows, perturbations in stress/pore-water sensors, etc.) and quantification of temperature record frequency content. Localized system behaviour has been shown to occur along with systematic aberrant behaviours that remain unexplained

Toxicity assessment of refill liquids for electronic cigarettes.

We analyzed 42 models from 14 brands of refill liquids for e-cigarettes for the presence of micro-organisms, diethylene glycol, ethylene glycol, hydrocarbons, ethanol, aldehydes, tobacco-specific nitrosamines, and solvents. All the liquids under scrutiny complied with norms for the absence of yeast, mold, aerobic microbes, Staphylococcus aureus, and Pseudomonas aeruginosa. Diethylene glycol, ethylene glycol and ethanol were detected, but remained within limits authorized for food and pharmaceutical products. Terpenic compounds and aldehydes were found in the products, in particular formaldehyde and acrolein. No sample contained nitrosamines at levels above the limit of detection (1 μg/g). Residual solvents such as 1,3-butadiene, cyclohexane and acetone, to name a few, were found in some products. None of the products under scrutiny were totally exempt of potentially toxic compounds. However, for products other than nicotine, the oral acute toxicity of the e-liquids tested seems to be of minor concern. However, a minority of liquids, especially those with flavorings, showed particularly high ranges of chemicals, causing concerns about their potential toxicity in case of chronic oral exposure

Lensing in an interior Kottler solution

We derive the interior Kottler solution of the incompressible fluid and show that the bending of light in this solution does depend on the cosmological constant.Comment: The inner Kottler solution derived and used in this paper is not new. Corresponding references to Stuchlik (2000) and Boehmer (2003) are added. Also added: a numerical example and a figure. This is the version accepted by Gen. Rel. Grav. However it includes a short passage that an anonymous referee had me suppress

Timed Parity Games: Complexity and Robustness

We consider two-player games played in real time on game structures with clocks where the objectives of players are described using parity conditions. The games are \emph{concurrent} in that at each turn, both players independently propose a time delay and an action, and the action with the shorter delay is chosen. To prevent a player from winning by blocking time, we restrict each player to play strategies that ensure that the player cannot be responsible for causing a zeno run. First, we present an efficient reduction of these games to \emph{turn-based} (i.e., not concurrent) \emph{finite-state} (i.e., untimed) parity games. Our reduction improves the best known complexity for solving timed parity games. Moreover, the rich class of algorithms for classical parity games can now be applied to timed parity games. The states of the resulting game are based on clock regions of the original game, and the state space of the finite game is linear in the size of the region graph. Second, we consider two restricted classes of strategies for the player that represents the controller in a real-time synthesis problem, namely, \emph{limit-robust} and \emph{bounded-robust} winning strategies. Using a limit-robust winning strategy, the controller cannot choose an exact real-valued time delay but must allow for some nonzero jitter in each of its actions. If there is a given lower bound on the jitter, then the strategy is bounded-robust winning. We show that exact strategies are more powerful than limit-robust strategies, which are more powerful than bounded-robust winning strategies for any bound. For both kinds of robust strategies, we present efficient reductions to standard timed automaton games. These reductions provide algorithms for the synthesis of robust real-time controllers

Minimal Steiner Trees for 2k×2kSquare Lattices

AbstractWe prove a conjecture of Chung, Graham, and Gardner (Math. Mag.62(1989), 83–96), giving the form of the minimal Steiner trees for the set of points comprising the vertices of a 2k×2ksquare lattice. Each full component of these minimal trees is the minimal Steiner tree for the four vertices of a square