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

Role of the Fractalkine Receptor in CNS Autoimmune Inflammation: New Approach Utilizing a Mouse Model Expressing the Human CX3CR1

Multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system (CNS) is the leading cause of non-traumatic neurological disability in young adults. Immune mediated destruction of myelin and oligodendrocytes is considered the primary pathology of MS, but progressive axonal loss is the major cause of neurological disability. In an effort to understand microglia function during CNS inflammation, our laboratory focuses on the fractalkine/CX3CR1 signaling as a regulator of microglia neurotoxicity in various models of neurodegeneration. Fractalkine (FKN) is a transmembrane chemokine expressed in the CNS by neurons and signals through its unique receptor CX3CR1 present in microglia. During experimental autoimmune encephalomyelitis (EAE), CX3CR1 deficiency confers exacerbated disease defined by severe inflammation and neuronal loss. The CX3CR1 human polymorphism I249/M280 present in ∼20% of the population exhibits reduced adhesion for FKN conferring defective signaling whose role in microglia function and influence on neurons during MS remains unsolved. The aim of this study is to assess the effect of weaker signaling through hCX3CR1I249/M280 during EAE. We hypothesize that dysregulated microglial responses due to impaired CX3CR1 signaling enhance neuronal/axonal damage. We generated an animal model replacing the mouse CX3CR1 locus for the hCX3CR1I249/M280 variant. Upon EAE induction, these mice exhibited exacerbated EAE correlating with severe inflammation and neuronal loss. We also observed that mice with aberrant CX3CR1 signaling are unable to produce FKN and ciliary neurotrophic factor during EAE in contrast to wild type mice. Our results provide validation of defective function of the hCX3CR1I249/M280 variant and the foundation to broaden the understanding of microglia dysfunction during neuroinflammation. © 2018 Cardona et al

Quantum hypercomputation based on the dynamical algebra su(1,1)

An adaptation of Kieu's hypercomputational quantum algorithm (KHQA) is presented. The method that was used was to replace the Weyl-Heisenberg algebra by other dynamical algebra of low dimension that admits infinite-dimensional irreducible representations with naturally defined generalized coherent states. We have selected the Lie algebra $\mathfrak{su}(1,1)$, due to that this algebra posses the necessary characteristics for to realize the hypercomputation and also due to that such algebra has been identified as the dynamical algebra associated to many relatively simple quantum systems. In addition to an algebraic adaptation of KHQA over the algebra $\mathfrak{su}(1,1)$, we presented an adaptations of KHQA over some concrete physical referents: the infinite square well, the infinite cylindrical well, the perturbed infinite cylindrical well, the P{\"o}sch-Teller potentials, the Holstein-Primakoff system, and the Laguerre oscillator. We conclude that it is possible to have many physical systems within condensed matter and quantum optics on which it is possible to consider an implementation of KHQA.Comment: 25 pages, 1 figure, conclusions rewritten, typing and language errors corrected and latex format changed minor changes elsewhere and

Case based reasoning applied to medical diagnosis using multi-class classifier: A preliminary study

Case-based reasoning (CBR) is a process used for computer processing that tries to mimic the behavior of a human expert in making decisions regarding a subject and learn from the experience of past cases. CBR has demonstrated to be appropriate for working with unstructured domains data or difficult knowledge acquisition situations, such as medical diagnosis, where it is possible to identify diseases such as: cancer diagnosis, epilepsy prediction and appendicitis diagnosis. Some of the trends that may be developed for CBR in the health science are oriented to reduce the number of features in highly dimensional data. An important contribution may be the estimation of probabilities of belonging to each class for new cases. In this paper, in order to adequately represent the database and to avoid the inconveniences caused by the high dimensionality, noise and redundancy, a number of algorithms are used in the preprocessing stage for performing both variable selection and dimension reduction procedures. Also, a comparison of the performance of some representative multi-class classifiers is carried out to identify the most effective one to include within a CBR scheme. Particularly, four classification techniques and two reduction techniques are employed to make a comparative study of multiclass classifiers on CB

Time evolution of stimulated Raman scattering and two-plasmon decay at laser intensities relevant for shock ignition in a hot plasma

Laser–plasma interaction (LPI) at intensities 1015–1016 W cm2 is dominated by parametric instabilities which can be responsible for a significant amount of non-collisional absorption and generate large fluxes of high-energy nonthermal electrons. Such a regime is of paramount importance for inertial confinement fusion (ICF) and in particular for the shock ignition scheme. In this paper we report on an experiment carried out at the Prague Asterix Laser System (PALS) facility to investigate the extent and time history of stimulated Raman scattering (SRS) and two-plasmon decay (TPD) instabilities, driven by the interaction of an infrared laser pulse at an intensity 1:2 1016 W cm2 with a 100 mm scalelength plasma produced from irradiation of a flat plastic target. The laser pulse duration (300 ps) and the high value of plasma temperature (4 keV) expected from hydrodynamic simulations make these results interesting for a deeper understanding of LPI in shock ignition conditions. Experimental results show that absolute TPD/SRS, driven at a quarter of the critical density, and convective SRS, driven at lower plasma densities, are well separated in time, with absolute instabilities driven at early times of interaction and convective backward SRS emerging at the laser peak and persisting all over the tail of the pulse. Side-scattering SRS, driven at low plasma densities, is also clearly observed. Experimental results are compared to fully kinetic large-scale, two-dimensional simulations. Particle-in-cell results, beyond reproducing the framework delineated by the experimental measurements, reveal the importance of filamentation instability in ruling the onset of SRS and stimulated Brillouin scattering instabilities and confirm the crucial role of collisionless absorption in the LPI energy balance

Developing a mental health eClinic to improve access to and quality of mental health care for young people: Using participatory design as research methodologies

Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available

The stigmatisation of people with chronic back pain

This study responded to the need for better theoretical understanding of experiences that shape the beliefs, attitudes and needs of chronic back patients attending pain clinics. The aim was explore and conceptualise the experiences of people of working age who seek help from pain clinics for chronic back pain. Methods. This was a qualitative study, based on an interpretative phenomenological approach (IPA). During in-depth interviews in their homes, participants were invited to 'tell their story' from the time their pain began. Participants were twelve male and six female patients, aged between 28 and 62 years, diagnosed as having chronic benign back pain. All had recently attended one of two pain clinics as new referrals. The interview transcripts were analysed thematically. Findings. Stigmatisation emerged as a key theme from the narrative accounts of participants. The findings expose subtle as well as overt stigmatising responses by family, friends, health professionals and the general public which appeared to have a profound effect on the perceptions, self esteem and behaviours of those interviewed. Conclusions. The findings suggest that patients with chronic back pain feel stigmatised by the time they attend pain clinics and this may affect their attitudes and behaviours towards those offering professional help. Theories of chronic pain need to accommodate these responses, while pain management programmes need to address the realities and practicalities of dealing with stigma in everyday life

Capacidad de carga un método de aproximación al valor económico del patrimonio natural.

El documento muestra un nuevo método como alternativa para la valoración del patrimonio natural de diferentes ecosistemas de importancia económica y ambiental, el estudio se realizo en la Cuenca de Piedras Blancas Antioquia, teniendo en cuenta el grado de conservación del área y su capacidad de soporte humano realizando una actividad extractiva económica, siendo de esta manera el mismo ecosistema el que da una aproximación de su oferta natural de bienes y servicios y por lo tanto una buena aproximación a su valor económico

Finite axisymmetric charged dust disks in conformastatic spacetimes

An infinite family of axisymmetric charged dust disks of finite extension is presented. The disks are obtained by solving the vacuum Einstein-Maxwell equations for conformastatic spacetimes, which are characterized by only one metric function. In order to obtain the solutions, it is assumed that the metric function and the electric potential are functionally related and that the metric function is functionally dependent of another auxiliary function, which is taken as a solution of Laplace equation. The solutions for the auxiliary function are then taken as given by the infinite family of generalized Kalnajs disks recently obtained by Gonz\'alez and Reina (MNRAS 371, 1873, 2006), which is expressed in terms of the oblate spheroidal coordinates and represents a well behaved family of finite axisymmetric flat galaxy models. The so obtained relativistic thin disks have then a charge density that is equal, except maybe by a sign, to their mass density, in such a way that the electric and gravitational forces are in exact balance. The energy density of the disks is everywhere positive and well behaved, vanishing at the edge. Accordingly, as the disks are made of dust, their energy-momentum tensor it agrees with all the energy conditions.Comment: Submitted to PR