Streamlining patient consultations for sleep disorders with a knowledge-based CDSS

© 2015 Elsevier Ltd. Objectives This paper examines the workflow of sleep physicians during a patient consultation and how an innovative clinical decision support system (CDSS) provides efficiency and effectiveness gains. Methods The CDSS tools consisted of two input applications for patient data, with a knowledge based decision support system developed participatively with physicians and an international panel. An argument tree approach was used to produce diagnostic explanations and an evidence-based report for the physician using medically correct and shared terminology. A usability evaluation using a qualitative approach was carried out to ensure that the CDSS met the physicians information needs, as well as the wider needs of a Sleep Investigation Unit. Results The physicians found the CDSS both useful and usable with clear applications in triage and diagnostic decision-making, and in patient education. Conclusion The CDSS both reduces the time and number of visits needed for consultations, and helps focus consultation on better individual patient care through informed explanation of diagnostic and treatment decisions

An experimental evaluation of a loop versus a reference design for two-channel microarrays

Motivation: Despite theoretical arguments that socalled "loop designs" of two-channel DNA microarray experiments are more efficient, biologists keep on using "reference designs". We describe two sets of microarray experiments with RNA from two different biological systems (TPA-stimulated mammalian cells and Streptomyces coelicor). In each case, both a loop and a reference design were performed using the same RNA preparations with the aim to study their relative efficiency. Results: The results of these experiments show that (1) the loop design attains a much higher precision than the reference design, (2) multiplicative spot effects are a large source of variability, and if they are not accounted for in the mathematical model, for example by taking log-ratios or including spot-effects, then the model will perform poorly. The first result is reinforced by a simulation study. Practical recommendations are given on how simple loop designs can be extended to more realistic experimental designs and how standard statistical methods allow the experimentalist to use and interpret the results from loop designs in practice

Kerr-Schild spacetimes with (A)dS background

General properties of Kerr-Schild spacetimes with (A)dS background in arbitrary dimension are studied. It is shown that the geodetic Kerr-Schild vector k is a multiple WAND of the spacetime. Einstein Kerr-Schild spacetimes with non-expanding k are shown to be of Weyl type N, while the expanding spacetimes are of type II or D. It is shown that this class of spacetimes obeys the optical constraint. This allows us to solve Sachs equation, determine r-dependence of boost weight zero components of the Weyl tensor and discuss curvature singularities.Comment: 17 pages, minor change

Radio observations of two intermittent pulsars: PSRs J1832+0029 and J1841-0500

We present long-term observations of two intermittent pulsars, PSRs~J1832+0029 and J1841$-$0500 using the Parkes 64\,m radio telescope. The radio emission for these pulsars switches "off" for year-long durations. Our new observations have enabled us to improve the determination of the on-off timescales and the spin down rates during those emission states. In general our results agree with previous studies of these pulsars, but we now have significantly longer data spans. We have identified two unexpected signatures in the data. Weak emission was detected in a single observation of PSR~J1832$+$0029 during an "off" emission state. For PSR~J1841$-$0500, we identified a quasi-periodic fluctuation in the intensities of the detectable single pulses, with a modulation period between 21 and 36 pulse periods.Comment: 7 pages, 7 figures, accepted for publication in Ap

How can exact and approximate solutions of Einstein's field equations be compared?

The problem of comparison of the stationary axisymmetric vacuum solutions obtained within the framework of exact and approximate approaches for the description of the same general relativistic systems is considered. We suggest two ways of carrying out such comparison: (i) through the calculation of the Ernst complex potential associated with the approximate solution whose form on the symmetry axis is subsequently used for the identification of the exact solution possessing the same multipole structure, and (ii) the generation of approximate solutions from exact ones by expanding the latter in series of powers of a small parameter. The central result of our paper is the derivation of the correct approximate analogues of the double-Kerr solution possessing the physically meaningful equilibrium configurations. We also show that the interpretation of an approximate solution originally attributed to it on the basis of some general physical suppositions may not coincide with its true nature established with the aid of a more accurate technique.Comment: 32 pages, 5 figure

Comprehensive health assessments during de-institutionalization: An observational study

Background: People with intellectual disability (ID) leaving institutions pass through a transition stage that makes them vulnerable to inadequate health care. They enter into community care under general practitioners (GPs) who are often untrained and inexperienced in their needs. Specifically designed health reviews may be of assistance to both them and their new GPs as they go through that phase

The 69 ms Radio Pulsar Near the Supernova Remnant RCW 103

We report the detection of the radio pulsar counterpart to the 69 ms X-ray pulsar discovered near the supernova remnant RCW 103 (G332.4-0.4). Our detection confirms that the pulsations arise from a rotation-powered neutron star, which we name PSR J1617-5055. The observed barycentric period derivative confirms that the pulsar has a characteristic age of only 8 kyr, the sixth smallest of all known pulsars. The unusual apparent youth of the pulsar and its proximity to a young remnant requires that an association be considered. Although the respective ages and distances are consistent within substantial uncertainties, the large inferred pulsar transverse velocity is difficult to explain given the observed pulsar velocity distribution, the absence of evidence for a pulsar wind nebula, and the symmetry of the remnant. Rather, we argue that the objects are likely superposed on the sky; this is reasonable given the complex area. Without an association, the question of where is the supernova remnant left behind following the birth of PSR J1617-5055 remains open. We also discuss a possible association between PSR J1617-5055 and the gamma-ray source 2CG 333+01. Though an association is energetically plausible, it is unlikely given that EGRET did not detect 2CG 333+01.Comment: 18 pages, 2 encapsulated Postscript figures, uses AAS LaTeX style files. Accepted for publication in The Astrophysical Journal Letter

Clinical and service implications of a cognitive analytic therapy model of psychosis

Cognitive analytic therapy (CAT) is an integrative, interpersonal model of therapy predicated on a radically social concept of self, developed over recent years in the UK by Anthony Ryle. A CAT-based model of psychotic disorder has been developed much more recently based on encouraging early experience in this area. The model describes and accounts for many psychotic experiences and symptoms in terms of distorted, amplified or muddled enactments of normal or ‘neurotic’ reciprocal role procedures (RRPs) and of damage at a meta-procedural level to the structures of the self. Reciprocal role procedures are understood in CAT to represent the outcome of the process of internalization of early, sign-mediated, interpersonal experience and to constitute the basis for all mental activity, normal or otherwise. Enactments of maladaptive RRPs generated by early interpersonal stress are seen in this model to constitute a form of ‘internal expressed emotion’. Joint description of these RRPs and their enactments (both internally and externally) and their subsequent revision is central to the practice of CAT during which they are mapped out through written and diagrammatic reformulations. This model may usefully complement and extend existing approaches, notably recent CBT-based interventions, particularly with ‘difficult’ patients, and generate meaningful and helpful understandings of these disorders for both patients and their treating teams. We suggest that use of a coherent and robust model such as CAT could have important clinical and service implications in terms of developing and researching models of these disorders as well as for the training of multidisciplinary teams in their effective treatment

Conical geometry and quantum entropy of a charged Kerr black hole

We apply the method of conical singularities to calculate the tree-level entropy and its one-loop quantum corrections for a charged Kerr black hole. The Euclidean geometry for the Kerr-Newman metric is considered. We show that for an arbitrary periodization in Euclidean space there exists a conical singularity at the horizon. Its $\delta$-function like curvatures are calculated and are shown to behave similar to the static case. The heat kernel expansion for a scalar field on this conical space background is derived and the (divergent) quantum correction to the entropy is obtained. It is argued that these divergences can be removed by renormalization of couplings in the tree-level gravitational action in a manner similar to that for a static black hole.Comment: 22 pages, latex, no figures; minor corrections mad

Kerr-Schild ansatz in Einstein-Gauss-Bonnet gravity: An exact vacuum solution in five dimensions

As is well-known, Kerr-Schild metrics linearize the Einstein tensor. We shall see here that they also simplify the Gauss-Bonnet tensor, which turns out to be only quadratic in the arbitrary Kerr-Schild function f when the seed metric is maximally symmetric. This property allows us to give a simple analytical expression for its trace, when the seed metric is a five dimensional maximally symmetric spacetime in spheroidal coordinates with arbitrary parameters a and b. We also write in a (fairly) simple form the full Einstein-Gauss-Bonnet tensor (with a cosmological term) when the seed metric is flat and the oblateness parameters are equal, a=b. Armed with these results we give in a compact form the solution of the trace of the Einstein-Gauss-Bonnet field equations with a cosmological term and a different than b. We then examine whether this solution for the trace does solve the remaining field equations. We find that it does not in general, unless the Gauss-Bonnet coupling is such that the field equations have a unique maximally symmetric solution.Comment: 10 pages, no figures, references added. Last version for CQ