Changing attitudes to 'the change'

Copyright © 2004 Royal Australian College of General PractitionersBACKGROUND In order to practise efficiently, experienced doctors use heuristics (decision making shortcuts). In most cases decision making shortcuts improve the service we offer, allowing us to make appropriate decisions more quickly. However, occasionally shortcuts can mislead. It is important to reflect on the shortcuts we use so as to reduce the risk of mistakes. OBJECTIVE This article examines the potential pitfalls of decision making shortcuts using hormone therapy (HT) in menopause as an example. DISCUSSION Recent randomised controlled trials have changed the thinking on the risk-benefit ratio for HT. The previously assumed long term health benefits of HT for women during and beyond menopause resulted from shortcuts in decision making including ‘association means causation’ (observational data), ‘experts know best’ (the experience of gynaecologists seeing women with severe menopausal symptoms is applied to all women) and ‘a biological theory to explain a phenomenon makes it likely to be true’ (oestrogen has a positive effect on lipid profiles and so was assumed to be cardioprotective).Katrina Allen, Peter Mansfiel

Field condensations and Noncritical String for c>1

Quantum theory of 2d gravity for $c>1$ is examined as a non-critical string theory by taking account of the loop-correction of open strings whose end points are on the 2d world surface of the closed string. This loop-correction leads to a conformal anomaly, and we obtain a modified target-space action which implies a new phase of the non-critical closed-string. In this phase, the dual field of the gauge field, which lives on the boundary, condenses and the theory can be extended to $c>1$ without any instability.Comment: 17 pages, Latex, no figur

A simplicial gauge theory

We provide an action for gauge theories discretized on simplicial meshes, inspired by finite element methods. The action is discretely gauge invariant and we give a proof of consistency. A discrete Noether's theorem that can be applied to our setting, is also proved.Comment: 24 pages. v2: New version includes a longer introduction and a discrete Noether's theorem. v3: Section 4 on Noether's theorem has been expanded with Proposition 8, section 2 has been expanded with a paragraph on standard LGT. v4: Thorough revision with new introduction and more background materia

3d absorption-spectra of Sr I through Sr IV

The extreme ultraviolet photoabsorption spectra of neutral to three-times-ionized strontium have been recorded in a comprehensive series of experiments with the dual laser-produced plasma technique. Striking differences were found in the spectra, which can be attributed to the transfer of oscillator strength from 3d→np to 3d→nf transitions at Sr2+ due to nf wave-function contraction. In Sr and Sr+, 3d→5p transitions dominate; in Sr2+, 3d→nf transitions are most intense, while in Sr3+ the 4p subshell opens and 3d→4p transitions are the strongest features. Partial cross sections for 3d→ɛf and 3d→ɛp photoionization were calculated and compared with experiment

Confidential Boosting with Random Linear Classifiers for Outsourced User-generated Data

User-generated data is crucial to predictive modeling in many applications. With a web/mobile/wearable interface, a data owner can continuously record data generated by distributed users and build various predictive models from the data to improve their operations, services, and revenue. Due to the large size and evolving nature of users data, data owners may rely on public cloud service providers (Cloud) for storage and computation scalability. Exposing sensitive user-generated data and advanced analytic models to Cloud raises privacy concerns. We present a confidential learning framework, SecureBoost, for data owners that want to learn predictive models from aggregated user-generated data but offload the storage and computational burden to Cloud without having to worry about protecting the sensitive data. SecureBoost allows users to submit encrypted or randomly masked data to designated Cloud directly. Our framework utilizes random linear classifiers (RLCs) as the base classifiers in the boosting framework to dramatically simplify the design of the proposed confidential boosting protocols, yet still preserve the model quality. A Cryptographic Service Provider (CSP) is used to assist the Cloud's processing, reducing the complexity of the protocol constructions. We present two constructions of SecureBoost: HE+GC and SecSh+GC, using combinations of homomorphic encryption, garbled circuits, and random masking to achieve both security and efficiency. For a boosted model, Cloud learns only the RLCs and the CSP learns only the weights of the RLCs. Finally, the data owner collects the two parts to get the complete model. We conduct extensive experiments to understand the quality of the RLC-based boosting and the cost distribution of the constructions. Our results show that SecureBoost can efficiently learn high-quality boosting models from protected user-generated data

Identifying patients with chronic widespread pain in primary care.

Chronic widespread pain (CWP) is common in the general population. It is unclear how people reporting this problem present in primary care; they may regularly consult for regional pains without being recognized as having a generalized condition. Our objectives were to determine the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consultation), the proportion with diagnosed generalized pain and survey-reported widespread pain, and if they have features characteristic of CWP. Phase 1 used electronic records from 12 general practices in North Staffordshire (Consultations in Primary Care Archive) from 2005 to 2009. Phase 2 used linked self-reported health and primary healthcare data from 8,286 people aged 50 plus in eight general practices (North Staffordshire Osteoarthritis Project) between 2002 and 2005. In Phase 1, 11% of registered patients fulfilled criteria for recurrent regional pain consultation. Three-quarters had no recorded CWP-related generalized pain condition (e.g. fibromyalgia). In Phase 2, 53% of recurrent regional pain consulters had survey-reported widespread pain and 88% had consulted for somatic symptoms. Self-reported general health was worse in recurrent regional pain consulters than in single-region consulters, and poorest in those who also reported persistent widespread pain. Recurrent regional pain consulters are a heterogeneous group of frequent consulters sharing features with CWP (e.g. somatic symptoms) but including those less severely affected. They lie on the spectrum of polysymptomatic distress characteristic of CWP and represent a group whose needs may be better met by earlier diagnosis of multi-site pain.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Patan hospital experience in treating philadelphia chromosome/BCR-ABL1 positive chronic myeloid leukemia patients with gleevec (imatinib mesylate); the first generation specific tyrosine kinase inhibitor

<p>Abstract</p> <p>Background</p> <p>Chronic Myeloid Leukemia (CML) is caused by the abnormal fusion protein BCR-ABL1, a constitutively active tyrosine kinase and product of the Philadelphia chromosome. Gleevec (Imatinib mesylate) is a selective inhibitor of this kinase. Treatment with this agent is known to result in hematologic, cytogenetic, and molecular responses. Patan hospital (Patan, Nepal) is one of the Gleevec International Patient Assistance Program (GIPAP) centers for patients with CML.</p> <p>Methods</p> <p>A total of 106 Philadelphia positive CML patients were enrolled in our center between Feb 2003 and Jun 2008, and 103 of them were eligible for cytogenetic and/or hematologic response analyses.</p> <p>Results</p> <p>Out of 103 patients, 27% patients underwent cytogenetic analysis. Imatinib induced major cytogenetic responses in 89% and complete hematologic responses in almost 100% of the patients with confirmed CML. After a mean follow up of 27 months, an estimated 90% of the patients on imatinib remained in hematologic remission and more than 90% of the patients are still alive. About 30% of patients developed some form of manageable myelosuppression. A few patients developed non-hematologic toxic side effects such as edema and hepatotoxicity.</p> <p>Conclusions</p> <p>Our study demonstrates that imatinib is safe to use in a developing country. Furthermore, we demonstrate that imatinib is very effective and induced long lasting responses in a high proportion of patients with Ph chromosome/BCR-ABL1 positive CML. Imatinib is well tolerated by our patients. The lack of cytogenetic analysis in the majority of our patients hindered our ability to detect inadequate responses to imatinib and adjust therapy appropriately.</p

Surface energy and stability of stress-driven discommensurate surface structures

A method is presented to obtain {\it ab initio} upper and lower bounds to surface energies of stress-driven discommensurate surface structures, possibly non-periodic or exhibiting very large unit cells. The instability of the stressed, commensurate parent of the discommensurate structure sets an upper bound to its surface energy; a lower bound is defined by the surface energy of an ideally commensurate but laterally strained hypothetical surface system. The surface energies of the phases of the Si(111):Ga and Ge(111):Ga systems and the energies of the discommensurations are determined within $\pm 0.2$ eV.Comment: 4 pages RevTeX. 2 Figures not included. Ask for a hard copy (through regular mail) to [email protected]

Hamiltonian evolutions of twisted gons in \RP^n

In this paper we describe a well-chosen discrete moving frame and their associated invariants along projective polygons in \RP^n, and we use them to write explicit general expressions for invariant evolutions of projective $N$-gons. We then use a reduction process inspired by a discrete Drinfeld-Sokolov reduction to obtain a natural Hamiltonian structure on the space of projective invariants, and we establish a close relationship between the projective $N$-gon evolutions and the Hamiltonian evolutions on the invariants of the flow. We prove that {any} Hamiltonian evolution is induced on invariants by an evolution of $N$-gons - what we call a projective realization - and we give the direct connection. Finally, in the planar case we provide completely integrable evolutions (the Boussinesq lattice related to the lattice $W_3$-algebra), their projective realizations and their Hamiltonian pencil. We generalize both structures to $n$-dimensions and we prove that they are Poisson. We define explicitly the $n$-dimensional generalization of the planar evolution (the discretization of the $W_n$-algebra) and prove that it is completely integrable, providing also its projective realization