How accurate is the ‘Surprise Question’ at identifying patients at the end of life? A systematic review and meta-analysis

Background Clinicians are inaccurate at predicting survival. The ‘Surprise Question’ (SQ) is a screening tool that aims to identify people nearing the end of life. Potentially, its routine use could help identify patients who might benefit from palliative care services. The objective was to assess the accuracy of the SQ by time scale, clinician, and speciality. Methods Searches were completed on Medline, Embase, CINAHL, AMED, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey literature (all from inception to November 2016). Studies were included if they reported the SQ and were written in English. Quality was assessed using the Newcastle–Ottawa Scale. Results A total of 26 papers were included in the review, of which 22 reported a complete data set. There were 25,718 predictions of survival made in response to the SQ. The c-statistic of the SQ ranged from 0.512 to 0.822. In the meta-analysis, the pooled accuracy level was 74.8% (95% CI 68.6–80.5). There was a negligible difference in timescale of the SQ. Doctors appeared to be more accurate than nurses at recognising people in the last year of life (c-statistic = 0.735 vs. 0.688), and the SQ seemed more accurate in an oncology setting 76.1% (95% CI 69.7–86.3). Conclusions There was a wide degree of accuracy, from poor to reasonable, reported across studies using the SQ. Further work investigating how the SQ could be used alongside other prognostic tools to increase the identification of people who would benefit from palliative care is warranted

Polarization forces in water deduced from single molecule data

Intermolecular polarization interactions in water are determined using a minimal atomic multipole model constructed with distributed polarizabilities. Hydrogen bonding and other properties of water-water interactions are reproduced to fine detail by only three multipoles $\mu_H$, $\mu_O$, and $\theta_O$ and two polarizabilities $\alpha_O$ and $\alpha_H$, which characterize a single water molecule and are deduced from single molecule data.Comment: 4 revtex pages, 3 embedded color PS figure

Fusion products, Kostka polynomials, and fermionic characters of su(r+1)_k

Using a form factor approach, we define and compute the character of the fusion product of rectangular representations of \hat{su}(r+1). This character decomposes into a sum of characters of irreducible representations, but with q-dependent coefficients. We identify these coefficients as (generalized) Kostka polynomials. Using this result, we obtain a formula for the characters of arbitrary integrable highest-weight representations of \hat{su}(r+1) in terms of the fermionic characters of the rectangular highest weight representations.Comment: 21 pages; minor changes, typos correcte

Localization in disordered superconducting wires with broken spin-rotation symmetry

Localization and delocalization of non-interacting quasiparticle states in a superconducting wire are reconsidered, for the cases in which spin-rotation symmetry is absent, and time-reversal symmetry is either broken or unbroken; these are referred to as symmetry classes BD and DIII, respectively. We show that, if a continuum limit is taken to obtain a Fokker-Planck (FP) equation for the transfer matrix, as in some previous work, then when there are more than two scattering channels, all terms that break a certain symmetry are lost. It was already known that the resulting FP equation exhibits critical behavior. The additional symmetry is not required by the definition of the symmetry classes; terms that break it arise from non-Gaussian probability distributions, and may be kept in a generalized FP equation. We show that they lead to localization in a long wire. When the wire has more than two scattering channels, these terms are irrelevant at the short distance (diffusive or ballistic) fixed point, but as they are relevant at the long-distance critical fixed point, they are termed dangerously irrelevant. We confirm the results in a supersymmetry approach for class BD, where the additional terms correspond to jumps between the two components of the sigma model target space. We consider the effect of random $\pi$ fluxes, which prevent the system localizing. We show that in one dimension the transitions in these two symmetry classes, and also those in the three chiral symmetry classes, all lie in the same universality class

Reply to Comment "Invalidity of classes of approximate Hall effect calculations."

We reply to the criticism raised by Ao in his Comment (cond-mat/9801180). Being unable to properly treat the Hall conductivity in a mixed state of superconductors, Ao is looking for possible mistakes in microscopic and phenomenological calculations, as well as in the corresponding experiments. The errors in his treatment of the problem (cond-mat/9704247) are analized. We indicate where the approach advocated by him fails to properly account for the interaction with impurities and other sources of relaxation.Comment: reply to Comment by Ao (cond-mat/9801180) on our paper in PRL, 79, 1377 (1997), revtex file, 1 page, no figure

Comparing the performance of the palliative prognostic (PaP) score with clinical predictions of survival: A systematic review

BACKGROUND: In patients with advanced cancer, prognosis is usually determined using clinicians' predictions of survival (CPS). The palliative prognostic (PaP) score is a prognostic algorithm that was developed to predict survival in patients with advanced cancer. The score categorises patients into three risk groups in accordance with their probability of surviving for 30 days. The relative accuracy of PaP and CPS is unclear. DESIGN: This was a systematic review of MEDLINE, Embase, AMED, CINAHL Plus and the Cochrane Database of Systematic Reviews and Trials from inception up to June 2021. The inclusion criteria were studies in adults with advanced cancer reporting data on performance of both PaP and CPS. Data were extracted on accuracy of prognoses and where available on discrimination (area under the receiver operating characteristic curve or C-index) and/or diagnostic performance (sensitivity, specificity). RESULTS: Eleven studies were included. One study reported a direct comparison between PaP risk groups and equivalent risk groups defined by CPS and found that PaP was as accurate as CPS. Five studies reported discrimination of PaP as a continuous total score (rather than using the previously validated risk categories) and reported C-statistics that ranged from 0.64 (95% confidence interval [CI] 0.54, 0.74) up to 0.90 (95% CI 0.87, 0.92). Other studies compared PaP against CPS using non-equivalent metrics (e.g. comparing probability estimates against length of survival estimates). CONCLUSIONS: PaP risk categories and CPS are equally able to discriminate between patients with different survival probabilities. Total PaP scores show good discrimination between patients in accordance with their length of survival. The role of PaP in clinical practice still needs to be defined. TRIAL REGISTRATION: PROSPERO (CRD42021241074, 5th March 2021)