2,195 research outputs found
Why the idea of framework propositions cannot contribute to an understanding of delusions
One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions
Enteric methane emissions in response to ruminal inoculation of Propionibacterium strains in beef cattle fed a mixed diet
Brain disorders? Not really: Why network structures block reductionism in psychopathology research
Could the clinical interpretability of subgroups detected using clustering methods be improved by using a novel two-stage approach?
Background: Recognition of homogeneous subgroups of patients can usefully improve prediction of their outcomes and the targeting of treatment. There are a number of research approaches that have been used to recognise homogeneity in such subgroups and to test their implications. One approach is to use statistical clustering techniques, such as Cluster Analysis or Latent Class Analysis, to detect latent relationships between patient characteristics. Influential patient characteristics can come from diverse domains of health, such as pain, activity limitation, physical impairment, social role participation, psychological factors, biomarkers and imaging. However, such 'whole person' research may result in data-driven subgroups that are complex, difficult to interpret and challenging to recognise clinically. This paper describes a novel approach to applying statistical clustering techniques that may improve the clinical interpretability of derived subgroups and reduce sample size requirements. Methods: This approach involves clustering in two sequential stages. The first stage involves clustering within health domains and therefore requires creating as many clustering models as there are health domains in the available data. This first stage produces scoring patterns within each domain. The second stage involves clustering using the scoring patterns from each health domain (from the first stage) to identify subgroups across all domains. We illustrate this using chest pain data from the baseline presentation of 580 patients. Results: The new two-stage clustering resulted in two subgroups that approximated the classic textbook descriptions of musculoskeletal chest pain and atypical angina chest pain. The traditional single-stage clustering resulted in five clusters that were also clinically recognisable but displayed less distinct differences. Conclusions: In this paper, a new approach to using clustering techniques to identify clinically useful subgroups of patients is suggested. Research designs, statistical methods and outcome metrics suitable for performing that testing are also described. This approach has potential benefits but requires broad testing, in multiple patient samples, to determine its clinical value. The usefulness of the approach is likely to be context-specific, depending on the characteristics of the available data and the research question being asked of it
The Prevalence of Natural Health Product Use in Patients with Acute Cardiovascular Disease
Background: Natural health products (NHP) use may have implications with respect to adverse effects, drug interactions and adherence yet the prevalence of NHP use by patients with acute cardiovascular disease and the best method to ascertain this information is unknown. Objective: To identify the best method to ascertain information on NHP, and the prevalence of use in a population with acute cardiovascular disease. Methods: Structured interviews were conducted with a convenience sample of consecutive patients admitted with acute cardiovascular disease to the University of Alberta Hospital during January 2009. NHP use was explored using structured and open-ended questions based on Health Canada’s definition of NHP. The medical record was reviewed, and documentation of NHP use by physicians, nurses, and pharmacists, compared against the gold-standard structured interview. Results: 88 patients were interviewed (mean age 62 years, standard deviation [SD 14]; 80 % male; 41 % admitted for acute coronary syndromes). Common co-morbidities included hypertension (59%), diabetes (26%) and renal impairment (19%). NHP use was common (78 % of patients) and 75 % of NHP users reported daily use. The category of NHP most commonly used was vitamins and minerals (73%) followed by herbal products (20%), traditional medicines including Chines
Star Formation and Dynamics in the Galactic Centre
The centre of our Galaxy is one of the most studied and yet enigmatic places
in the Universe. At a distance of about 8 kpc from our Sun, the Galactic centre
(GC) is the ideal environment to study the extreme processes that take place in
the vicinity of a supermassive black hole (SMBH). Despite the hostile
environment, several tens of early-type stars populate the central parsec of
our Galaxy. A fraction of them lie in a thin ring with mild eccentricity and
inner radius ~0.04 pc, while the S-stars, i.e. the ~30 stars closest to the
SMBH (<0.04 pc), have randomly oriented and highly eccentric orbits. The
formation of such early-type stars has been a puzzle for a long time: molecular
clouds should be tidally disrupted by the SMBH before they can fragment into
stars. We review the main scenarios proposed to explain the formation and the
dynamical evolution of the early-type stars in the GC. In particular, we
discuss the most popular in situ scenarios (accretion disc fragmentation and
molecular cloud disruption) and migration scenarios (star cluster inspiral and
Hills mechanism). We focus on the most pressing challenges that must be faced
to shed light on the process of star formation in the vicinity of a SMBH.Comment: 68 pages, 35 figures; invited review chapter, to be published in
expanded form in Haardt, F., Gorini, V., Moschella, U. and Treves, A.,
'Astrophysical Black Holes'. Lecture Notes in Physics. Springer 201
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