The space of hyperkähler metrics on a 4-manifold with boundary

Let X be a compact 4-manifold with boundary. We study the space of hyperk¨ahler triples ω1, ω2, ω3 on X, modulo diffeomorphisms which are the identity on the boundary. We prove that this moduli space is a smooth infinite-dimensional manifold and describe the tangent space in terms of triples of closed anti-self-dual 2-forms. We also explore the corresponding boundary value problem: a hyperk¨ahler triple restricts to a closed framing of the bundle of 2-forms on the boundary; we identify the infinitesimal deformations of this closed framing that can be filled in to hyperk¨ahler deformations of the original triple. Finally we study explicit examples coming from gravitational instantons with isometric actions of SU(2)

Inherited epidermolysis bullosa

Inherited epidermolysis bullosa (EB) encompasses a number of disorders characterized by recurrent blister formation as the result of structural fragility within the skin and selected other tissues. All types and subtypes of EB are rare; the overall incidence and prevalence of the disease within the United States is approximately 19 per one million live births and 8 per one million population, respectively. Clinical manifestations range widely, from localized blistering of the hands and feet to generalized blistering of the skin and oral cavity, and injury to many internal organs. Each EB subtype is known to arise from mutations within the genes encoding for several different proteins, each of which is intimately involved in the maintenance of keratinocyte structural stability or adhesion of the keratinocyte to the underlying dermis. EB is best diagnosed and subclassified by the collective findings obtained via detailed personal and family history, in concert with the results of immunofluorescence antigenic mapping, transmission electron microscopy, and in some cases, by DNA analysis. Optimal patient management requires a multidisciplinary approach, and revolves around the protection of susceptible tissues against trauma, use of sophisticated wound care dressings, aggressive nutritional support, and early medical or surgical interventions to correct whenever possible the extracutaneous complications. Prognosis varies considerably and is based on both EB subtype and the overall health of the patient

Are we under-utilizing the talents of primary care personnel? A job analytic examination

BACKGROUND: Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions. METHODS: Seventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance. RESULTS: Objective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title. CONCLUSION: Primary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness

Causarum Investigatio and the Two Bell's Theorems of John Bell

"Bell's theorem" can refer to two different theorems that John Bell proved, the first in 1964 and the second in 1976. His 1964 theorem is the incompatibility of quantum phenomena with the joint assumptions of Locality and Predetermination. His 1976 theorem is their incompatibility with the single property of Local Causality. This is contrary to Bell's own later assertions, that his 1964 theorem began with the assumption of Local Causality, even if not by that name. Although the two Bell's theorems are logically equivalent, their assumptions are not. Hence, the earlier and later theorems suggest quite different conclusions, embraced by operationalists and realists, respectively. The key issue is whether Locality or Local Causality is the appropriate notion emanating from Relativistic Causality, and this rests on one's basic notion of causation. For operationalists the appropriate notion is what is here called the Principle of Agent-Causation, while for realists it is Reichenbach's Principle of common cause. By breaking down the latter into even more basic Postulates, it is possible to obtain a version of Bell's theorem in which each camp could reject one assumption, happy that the remaining assumptions reflect its weltanschauung. Formulating Bell's theorem in terms of causation is fruitful not just for attempting to reconcile the two camps, but also for better describing the ontology of different quantum interpretations and for more deeply understanding the implications of Bell's marvellous work.Comment: 24 pages. Prepared for proceedings of the "Quantum [Un]speakables II" conference (Vienna, 2014), to be published by Springe

Natural variation in immune responses to neonatal mycobacterium bovis bacillus calmette-guerin (BCG) vaccination in a cohort of Gambian infants

Background There is a need for new vaccines for tuberculosis (TB) that protect against adult pulmonary disease in regions where BCG is not effective. However, BCG could remain integral to TB control programmes because neonatal BCG protects against disseminated forms of childhood TB and many new vaccines rely on BCG to prime immunity or are recombinant strains of BCG. Interferon-gamma (IFN-) is required for immunity to mycobacteria and used as a marker of immunity when new vaccines are tested. Although BCG is widely given to neonates IFN- responses to BCG in this age group are poorly described. Characterisation of IFN- responses to BCG is required for interpretation of vaccine immunogenicity study data where BCG is part of the vaccination strategy. Methodology/Principal Findings 236 healthy Gambian babies were vaccinated with M. bovis BCG at birth. IFN-, interleukin (IL)-5 and IL-13 responses to purified protein derivative (PPD), killed Mycobacterium tuberculosis (KMTB), M. tuberculosis short term culture filtrate (STCF) and M. bovis BCG antigen 85 complex (Ag85) were measured in a whole blood assay two months after vaccination. Cytokine responses varied up to 10 log-fold within this population. The majority of infants (89-98% depending on the antigen) made IFN- responses and there was significant correlation between IFN- responses to the different mycobacterial antigens (Spearman’s coefficient ranged from 0.340 to 0.675, p=10-6-10-22). IL-13 and IL-5 responses were generally low and there were more non-responders (33-75%) for these cytokines. Nonetheless, significant correlations were observed for IL-13 and IL-5 responses to different mycobacterial antigens Conclusions/Significance Cytokine responses to mycobacterial antigens in BCG-vaccinated infants are heterogeneous and there is significant inter-individual variation. Further studies in large populations of infants are required to identify the factors that determine variation in IFN- responses

Random Numbers Certified by Bell's Theorem

Randomness is a fundamental feature in nature and a valuable resource for applications ranging from cryptography and gambling to numerical simulation of physical and biological systems. Random numbers, however, are difficult to characterize mathematically, and their generation must rely on an unpredictable physical process. Inaccuracies in the theoretical modelling of such processes or failures of the devices, possibly due to adversarial attacks, limit the reliability of random number generators in ways that are difficult to control and detect. Here, inspired by earlier work on nonlocality based and device independent quantum information processing, we show that the nonlocal correlations of entangled quantum particles can be used to certify the presence of genuine randomness. It is thereby possible to design of a new type of cryptographically secure random number generator which does not require any assumption on the internal working of the devices. This strong form of randomness generation is impossible classically and possible in quantum systems only if certified by a Bell inequality violation. We carry out a proof-of-concept demonstration of this proposal in a system of two entangled atoms separated by approximately 1 meter. The observed Bell inequality violation, featuring near-perfect detection efficiency, guarantees that 42 new random numbers are generated with 99% confidence. Our results lay the groundwork for future device-independent quantum information experiments and for addressing fundamental issues raised by the intrinsic randomness of quantum theory.Comment: 10 pages, 3 figures, 16 page appendix. Version as close as possible to the published version following the terms of the journa

Parenting behavior and the risk of becoming a victim and a bully/victim : a meta-analysis study

Objective: Being bullied has adverse effects on children's health. Children's family experiences and parenting behavior before entering school help shape their capacity to adapt and cope at school and have an impact on children's peer relationship, hence it is important to identify how parenting styles and parent–child relationship are related to victimization in order to develop intervention programs to prevent or mitigate victimization in childhood and adolescence. Methods: We conducted a systematic review of the published literature on parenting behavior and peer victimization using MEDLINE, PsychINFO, Eric and EMBASE from 1970 through the end of December 2012. We included prospective cohort studies and cross-sectional studies that investigated the association between parenting behavior and peer victimization. Results: Both victims and those who both bully and are victims (bully/victims) were more likely to be exposed to negative parenting behavior including abuse and neglect and maladaptive parenting. The effects were generally small to moderate for victims (Hedge's g range: 0.10–0.31) but moderate for bully/victims (0.13–0.68). Positive parenting behavior including good communication of parents with the child, warm and affectionate relationship, parental involvement and support, and parental supervision were protective against peer victimization. The protective effects were generally small to moderate for both victims (Hedge's g: range: −0.12 to −0.22) and bully/victims (−0.17 to −0.42). Conclusions: Negative parenting behavior is related to a moderate increase of risk for becoming a bully/victim and small to moderate effects on victim status at school. Intervention programs against bullying should extend their focus beyond schools to include families and start before children enter school

Comparative Tuberculosis (TB) Prevention Effectiveness in Children of Bacillus Calmette-Guérin (BCG) Vaccines from Different Sources, Kazakhstan

Except during a 1-year period when BCG vaccine was not routinely administered, annual coverage of infants with Bacillus Calmette-Guérin (BCG) in Kazakhstan since 2002 has exceeded 95%. BCG preparations from different sources (Japan, Serbia, and Russia) or none were used exclusively in comparable 7-month time-frames, September through March, in 4 successive years beginning in 2002. Our objective was to assess relative effectiveness of BCG immunization.Although there were differences in prevention effectiveness observed among the three BCG vaccines, all were protective. The Japanese vaccine (currently used in Kazakhstan), the Serbian vaccine, and the Russian vaccine respectively were 69%, 43%, and 22% effective with respect to clinical TB notifications, and 92%, 82%, and 51% effective with respect to culture confirmed TB. All three vaccines were >70% effective with respect to TB meningitis.Potential limitations included considerations that 1) the methodology used was retrospective, 2) multiple risk factors could have varied between cohorts and affected prevention effectiveness measures, 3) most cases were clinically diagnosed, and TB culture-positive case numbers and TB meningitis case numbers were sparse, and 4) small variations in reported population TB burden could have affected relative risk of exposure for cohorts.All three BCG vaccines evaluated were protective against TB, and prevention effectiveness varied by manufacturer. When setting national immunization policy, consideration should be given to prevention effectiveness of BCG preparations

Comparing approaches for numerical modelling of tsunami generation by deformable submarine slides

Tsunami generated by submarine slides are arguably an under-considered risk in comparison to earthquake-generated tsunami. Numerical simulations of submarine slide-generated waves can be used to identify the important factors in determining wave characteristics. Here we use Fluidity, an open source finite element code, to simulate waves generated by deformable submarine slides. Fluidity uses flexible unstructured meshes combined with adaptivity which alters the mesh topology and resolution based on the simulation state, focussing or reducing resolution, when and where it is required. Fluidity also allows a number of different numerical approaches to be taken to simulate submarine slide deformation, free-surface representation, and wave generation within the same numerical framework. In this work we use a multi-material approach, considering either two materials (slide and water with a free surface) or three materials (slide, water and air), as well as a sediment model (sediment, water and free surface) approach. In all cases the slide is treated as a viscous fluid. Our results are shown to be consistent with laboratory experiments using a deformable submarine slide, and demonstrate good agreement when compared with other numerical models. The three different approaches for simulating submarine slide dynamics and tsunami wave generation produce similar waveforms and slide deformation geometries. However, each has its own merits depending on the application. Mesh adaptivity is shown to be able to reduce the computational cost without compromising the accuracy of results