Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice.

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversation

Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery

Objective: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. Design: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1year after total hip arthroplasty (THA). Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries. Setting: A controlled laboratory study. Participants: This study examined 35 patients with primary, unilateral THA. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior, and 11 anterolateral. All the patients were assessed 1 year after THA. Patients were excluded from the study if they had contralateral hip pain or pathology, or any prior lower extremity total joint replacements. Main Outcome Measurements: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected. Results: No main effects for the physical performance measures or biomechanical variables were observed among the approach groups. Significant limb-to-limb asymmetries were observed among all the patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side. Conclusion: The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable. However, 1 year after THA, the patients demonstrated asymmetric gait patterns regardless of surgical approach, which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA. © 2014 American Academy of Physical Medicine and Rehabilitation

Generators for the hyperelliptic Torelli group and the kernel of the Burau representation at t = -1

We prove that the hyperelliptic Torelli group is generated by Dehn twists about separating curves that are preserved by the hyperelliptic involution. This verifies a conjecture of Hain. The hyperelliptic Torelli group can be identified with the kernel of the Burau representation evaluated at t = −1 and also the fundamental group of the branch locus of the period mapping, and so we obtain analogous generating sets for those. One application is that each component in Torelli space of the locus of hyperelliptic curves becomes simply connected when curves of compact type are added

Participating locally and nationally: explaining the offline and online activism of British party members

Drawing on survey data on the members of six British parties gathered in the immediate aftermath of the general election of 2015, this article addresses the question of what members do for their parties during campaigns. It identifies a key distinction between traditional forms of activity and more recent forms of online campaign participation. While the well-established general incentives theory of participation continues to offer a useful basis for explaining both types of campaign activism, we find that our understanding is significantly enhanced by considering the impact of national and local political contexts. Whereas the former chiefly adds explanatory value to the model of online participation by party members, the latter considerably improves the model of offline participation

Prognostic implications of immunohistochemically detected YKL-40 expression in breast cancer

BACKGROUND: YKL-40 has been implicated as a mediator of collagen synthesis and extracellular matrix re-modeling as well as mitogenesis. Elevated serum levels of YKL-40 have been associated with worse survival in a variety of malignancies including breast cancer. We wished to determine if immunohistochemically detected expression had prognostic implications in breast cancer. METHODS: A prospectively collected database of breast cancer patients treated at the University Hospital of Newark was used for analysis. Immunohistochemistry was performed on archived tumor tissue from 109 patients for whom full clinical information and follow up was available. RESULTS: YKL-40 expression was noted in 37 patients (34%). YKL-40 immunoreactivity significantly correlated with larger tumor size, poorer tumor differentiation, and a greater likelihood of being estrogen and/or progesterone receptor negative. No significant correlation was demonstrated between YKL-40 status and nodal stage. At a mean follow up of 3.2 years, disease-free survival was significantly worse in the subset of patients whose tumors demonstrated YKL-40 expression compared to the non-expressors. In multivariate analysis, YKL-40 status was independent of T-stage and N-stage in predicting disease recurrence. CONCLUSION: Immunoreactivity for YKL-40 was a significant predictor of breast cancer relapse in this subset of patients. This was independent of T or N-stage and suggests that tumor immunohistochemistry for this protein may be a valuable prognostic marker in breast cancer

Holographic Anomalous Conductivities and the Chiral Magnetic Effect

We calculate anomaly induced conductivities from a holographic gauge theory model using Kubo formulas, making a clear conceptual distinction between thermodynamic state variables such as chemical potentials and external background fields. This allows us to pinpoint ambiguities in previous holographic calculations of the chiral magnetic conductivity. We also calculate the corresponding anomalous current three-point functions in special kinematic regimes. We compare the holographic results to weak coupling calculations using both dimensional regularization and cutoff regularization. In order to reproduce the weak coupling results it is necessary to allow for singular holographic gauge field configurations when a chiral chemical potential is introduced for a chiral charge defined through a gauge invariant but non-conserved chiral density. We argue that this is appropriate for actually addressing charge separation due to the chiral magnetic effect.Comment: 17 pages, 1 figure. v2: 18 pages, 1 figure, discussion clarified throughout the text, references added, version accepted for publication in JHE

Nodal dynamics, not degree distributions, determine the structural controllability of complex networks

Structural controllability has been proposed as an analytical framework for making predictions regarding the control of complex networks across myriad disciplines in the physical and life sciences (Liu et al., Nature:473(7346):167-173, 2011). Although the integration of control theory and network analysis is important, we argue that the application of the structural controllability framework to most if not all real-world networks leads to the conclusion that a single control input, applied to the power dominating set (PDS), is all that is needed for structural controllability. This result is consistent with the well-known fact that controllability and its dual observability are generic properties of systems. We argue that more important than issues of structural controllability are the questions of whether a system is almost uncontrollable, whether it is almost unobservable, and whether it possesses almost pole-zero cancellations.Comment: 1 Figures, 6 page

Why Are Male Social Relationships Complex in the Doubtful Sound Bottlenose Dolphin Population?

Copyright 2008 Elsevier B.V., All rights reserved.Peer reviewedPublisher PD

Fracturing ranked surfaces

Discretized landscapes can be mapped onto ranked surfaces, where every element (site or bond) has a unique rank associated with its corresponding relative height. By sequentially allocating these elements according to their ranks and systematically preventing the occupation of bridges, namely elements that, if occupied, would provide global connectivity, we disclose that bridges hide a new tricritical point at an occupation fraction $p=p_{c}$, where $p_{c}$ is the percolation threshold of random percolation. For any value of $p$ in the interval $p_{c}< p \leq 1$, our results show that the set of bridges has a fractal dimension $d_{BB} \approx 1.22$ in two dimensions. In the limit $p \rightarrow 1$, a self-similar fracture is revealed as a singly connected line that divides the system in two domains. We then unveil how several seemingly unrelated physical models tumble into the same universality class and also present results for higher dimensions