Evidence-based rules from family practice to inform family practice; The learning healthcare system case study on urinary tract infections

Background: Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). Methods: Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. Results: The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis". The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. Conclusions: We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data

Freshly Formed Dust in the Cassiopeia A Supernova Remnant as Revealed by the Spitzer Space Telescope

We performed Spitzer Infrared Spectrograph mapping observations covering nearly the entire extent of the Cassiopeia A supernova remnant (SNR), producing mid-infrared (5.5-35 micron) spectra every 5-10". Gas lines of Ar, Ne, O, Si, S and Fe, and dust continua were strong for most positions. We identify three distinct ejecta dust populations based on their continuum shapes. The dominant dust continuum shape exhibits a strong peak at 21 micron. A line-free map of 21 micron-peak dust made from the 19-23 micron range closely resembles the [Ar II], [O IV], and [Ne II] ejecta-line maps implying that dust is freshly formed in the ejecta. Spectral fitting implies the presence of SiO2, Mg protosilicates, and FeO grains in these regions. The second dust type exhibits a rising continuum up to 21 micron and then flattens thereafter. This ``weak 21 micron'' dust is likely composed of Al2O3 and C grains. The third dust continuum shape is featureless with a gently rising spectrum and is likely composed of MgSiO3 and either Al2O3 or Fe grains. Using the least massive composition for each of the three dust classes yields a total mass of 0.02 Msun. Using the most-massive composition yields a total mass of 0.054 Msun. The primary uncertainty in the total dust mass stems from the selection of the dust composition necessary for fitting the featureless dust as well as 70 micron flux. The freshly formed dust mass derived from Cas A is sufficient from SNe to explain the lower limit on the dust masses in high redshift galaxies.Comment: 8 figures: Accepted for the publication in Ap

Vertex corrections in localized and extended systems

Within many-body perturbation theory we apply vertex corrections to various closed-shell atoms and to jellium, using a local approximation for the vertex consistent with starting the many-body perturbation theory from a DFT-LDA Green's function. The vertex appears in two places -- in the screened Coulomb interaction, W, and in the self-energy, \Sigma -- and we obtain a systematic discrimination of these two effects by turning the vertex in \Sigma on and off. We also make comparisons to standard GW results within the usual random-phase approximation (RPA), which omits the vertex from both. When a vertex is included for closed-shell atoms, both ground-state and excited-state properties demonstrate only limited improvements over standard GW. For jellium we observe marked improvement in the quasiparticle band width when the vertex is included only in W, whereas turning on the vertex in \Sigma leads to an unphysical quasiparticle dispersion and work function. A simple analysis suggests why implementation of the vertex only in W is a valid way to improve quasiparticle energy calculations, while the vertex in \Sigma is unphysical, and points the way to development of improved vertices for ab initio electronic structure calculations.Comment: 8 Pages, 6 Figures. Updated with quasiparticle neon results, extended conclusions and references section. Minor changes: Updated references, minor improvement

A Paradox Within The Time Value Of Money: A Critical Thinking Exercise For Finance Students

This study presents a paradox within the time value of money (TVM), namely, that the interest-principal sequence embedded in the payment stream of an amortized loan is exactly the opposite of the interest-principal sequence implicit in the present value of a matching annuity.  We examine this inverse sequence, both mathematically and intuitively, and argue that it provides an excellent exercise for finance students to explore, both to enhance their critical thinking skills as well as to strengthen their understanding of TVM concepts.  Additionally, such an exercise will involve them actively in the learning process, as mandated by AACSB International’s Eligibility Procedures and Standards for Business Accreditation

Mapping the spectral index of Cassiopeia A : evidence for flattening from radio to infrared

Funding: The work of VD is supported by a grant from the NWO graduate programme/GRAPPA-PhD programme. JVHS acknowledges support from the STFC grant ST/R000824/1.Synchrotron radiation from supernova remnants is caused by electrons accelerated through diffusive shock acceleration (DSA). The standard DSA theory predicts an electron spectral index of p = 2, corresponding to a radio spectral index of α = −0.5. An extension of DSA theory predicts that the accelerated particles change the shock structure, resulting in a spectrum that is steeper than p > 2 (α < −0.5) at low energies and flattens with energy. For Cassiopeia A, a synchrotron spectral flattening was previously reported for a small part of the remnant in the mid-infrared regime. Here, we present new measurements for spectral flattening using archival radio (4.72 GHz) and mid-infrared (3.6 μm) data, and we produce a complete spectral index map to investigate the spatial variations within the remnant. We compare this to measurements of the radio spectral index from L-band (1.285 GHz) and C-band (4.64 GHz) maps. Our result shows overall spectral flattening across the remnant (αR-IR ∼ −0.5 to −0.7), to be compared with the radio spectral index of αR = −0.77. The flattest values coincide with the locations of most recent particle acceleration. In addition to overall flattening, we detect a relatively steeper region in the south-east of the remnant (αR-IR ∼ −0.67). We explore whether these locally steeper spectra could be the result of synchrotron cooling, which provides constraints on the local magnetic field strengths and the age of the plasma, suggesting B ≲ 2 mG for an age of 100 yr, and even B ≲ 1 mG using the age of Cas A, in agreement with other estimates.Publisher PDFPeer reviewe

The Identification of Infrared Synchrotron Radiation from Cassiopeia A

We report the discovery of polarized flux at 2.2 micron from the bright shell of the approximately 320 year old supernova remnant Cas A. The fractional polarizations are comparable at 6 cm and 2.2 micron, and the polarization angles are similar, demonstrating that synchrotron radiation from the same relativistic plasma is being observed at these widely separated wavebands. The relativistic electrons radiating at 2.2 micron have an energy of ~ 150 GeV, (gamma ~ 3e5), assuming an ~500 microGauss magnetic field. The total intensity at 2.2 micron lies close to the power law extrapolation from radio frequencies, showing that relativistic particle acceleration is likely an ongoing process; the infrared emitting electrons were accelerated no longer than ~80 years ago. There is a small but significant concave curvature to the spectrum, as expected if the accelerating shocks have been modified by the back pressure of the cosmic rays; given calibration uncertainties, this conclusion must be considered tentative at present. The 2.2 micron polarization angles and the emission-line filaments observed by HST are both offset from the local radial direction by 10 - 20 degrees, providing evidence that the magnetic fields in Cas A are generated by Rayleigh-Taylor instabilities in the decelerating ejecta.Comment: 11 pages, 3 figures, accepted for publication Ap

Omnivorousness in sport: The importance of social capital and networks

There has been for some time a significant and growing body of research around the relationship between sport and social capital. Similarly, within sociology there has been a corpus of work that has acknowledged the emergence of the omnivore–univore relationship. Surprisingly, relatively few studies examining sport and social capital have taken the omnivore–univore framework as a basis for understanding the relationship between sport and social capital. This gap in the sociology of sport literature and knowledge is rectified by this study that takes not Putnam, Coleman or Bourdieu, but Lin’s social network approach to social capital. The implications of this article are that researchers investigating sport and social capital need to understand more about how social networks and places for sport work to create social capital and, in particular, influence participating in sporting activities. The results indicate that social networks both facilitate and constrain sports participation; whilst family and friendship networks are central in active lifestyles, those who are less active have limited networks

Electric and magnetic polarizabilities of hexagonal Ln2CuTiO6 (Ln=Y, Dy, Ho, Er and Yb)

We investigated the rare-earth transition metal oxide series, Ln2CuTiO6 (Ln=Y, Dy, Ho, Er and Yb), crystallizing in the hexagonal structure with non-centrosymmetric P63cm space group for possible occurrences of multiferroic properties. Our results show that while these compounds, except Ln=Y, exhibit a low temperature antiferromagnetic transition due to the ordering of the rare-earth moments, the expected ferroelectric transition is frustrated by the large size difference between Cu and Ti at the B-site. Interestingly, this leads these compounds to attain a rare and unique combination of desirable paraelectric properties with high dielectric constants, low losses and weak temperature and frequency dependencies. First-principles calculations establish these exceptional properties result from a combination of two effects. A significant difference in the MO5 polyhedral sizes for M = Cu and M = Ti suppress the expected co-operative tilt pattern of these polyhedra, required for the ferroelectric transition, leading to relatively large values of the dielectric constant for every compound investigated in this series. Additionally, it is shown that the majority contribution to the dielectric constant arises from intermediate-frequency polar vibrational modes, making it relatively stable against any temperature variation. Changes in the temperature stability of the dielectric constant amongst different members of this series are shown to arise from changes in relative contributions from soft polar modes.Comment: Accepted for publication in Phys. Rev. B (21 pages, 2 Table, 8 Figures