Palliative care problem severity score: Reliability and acceptability in a national study

Background The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe). Aim To test the reliability and acceptability of the Palliative Care Problem Severity Score. Design: Multi-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool. Setting/participants Clinicians from 10 Australian palliative care services: 9 inpatient units and 1 mixed inpatient/community-based service. Results A total of 102 clinicians participated, with almost 600 paired assessments completed for each domain, involving 420 patients. A total of 91% of paired assessments were undertaken within 2 h. Strength of agreement for three of the four domains was moderate: pain (Kappa = 0.42, 95% confidence interval = 0.36 to 0.49); psychological/spiritual (Kappa = 0.48, 95% confidence interval = 0.42 to 0.54); family/carer (Kappa = 0.45, 95% confidence interval = 0.40 to 0.52). Strength of agreement for the remaining domain (other symptoms) was fair (Kappa = 0.38, 95% confidence interval = 0.32 to 0.45). Conclusion The Palliative Care Problem Severity Score is an acceptable measure, with moderate reliability across three domains. Variability in inter-rater reliability across sites and participant feedback indicate that ongoing education is required to ensure that clinicians understand the purpose of the tool and each of its domains. Raters familiar with the patient they were assessing found it easier to assign problem severity, but this did not improve inter-rater reliability.

Structural correlations in GexSe1-x glasses - a neutron diffraction study

Neutron diffraction measurement is carried out on GexSe1-x glasses, where 0.1 less than or equal to x less than or equal to 0.4, in a Q interval of 0.55-13.8 Angstrom(-1). The first sharp diffraction peak (FSDP) in the structure factor, S(Q), shows a systematic increase in the intensity and shifts to a lower Q with increasing Ge concentration. The coherence length of FSDP increases with x and becomes maximum for 0.33 less than or equal to x less than or equal to 0.4. The Monte-Carlo method, due to Soper, is used to generate S(Q) and also the pair correlation function, g(r). The generated S(Q) is in agreement with the experimental data for all x. Analysis of the first four peaks in the total correlation function, T(r), shows that the short range order in GeSe2 glass is due to Ge(Se-1/2)(4) tetrahedra, in agreement with earlier reports. Se-rich glasses contain Se-chains which are cross-linked with Ge(Se-1/2)(4) tetrahedra. Ge-2(Se-1/2)(6) molecular units are the basic structural units in Ge-rich, x = 0.4, glass. For x = 0.2, 0.33 and 0.4 there is evidence for some of the tetrahedra being in an edge-shared configuration. The number of edge-shared tetrahedra in these glasses increase with increasing Ge content.

Non-linear regression model for spatial variation in precipitation chemistry for South India

Chemical composition of rainwater changes from sea to inland under the influence of several major factors - topographic location of area, its distance from sea, annual rainfall. A model is developed here to quantify the variation in precipitation chemistry under the influence of inland distance and rainfall amount. Various sites in India categorized as 'urban', 'suburban' and 'rural' have been considered for model development. pH, HCO3, NO3 and Mg do not change much from coast to inland while, SO4 and Ca change is subjected to local emissions. Cl and Na originate solely from sea salinity and are the chemistry parameters in the model. Non-linear multiple regressions performed for the various categories revealed that both rainfall amount and precipitation chemistry obeyed a power law reduction with distance from sea. Cl and Na decrease rapidly for the first 100 km distance from sea, then decrease marginally for the next 100 km, and later stabilize. Regression parameters estimated for different cases were found to be consistent (R-2 similar to 0.8). Variation in one of the parameters accounted for urbanization. Model was validated using data points from the southern peninsular region of the country. Estimates are found to be within 99.9% confidence interval. Finally, this relationship between the three parameters - rainfall amount, coastline distance, and concentration (in terms of Cl and Na) was validated with experiments conducted in a small experimental watershed in the south-west India. Chemistry estimated using the model was in good correlation with observed values with a relative error of similar to 5%. Monthly variation in the chemistry is predicted from a downscaling model and then compared with the observed data. Hence, the model developed for rain chemistry is useful in estimating the concentrations at different spatio-temporal scales and is especially applicable for south-west region of India. (C) 2008 Elsevier Ltd. All rights reserved.

A direct adaptive neural command controller design for an unstable helicopter

This paper presents an off-line (finite time interval) and on-line learning direct adaptive neural controller for an unstable helicopter. The neural controller is designed to track pitch rate command signal generated using the reference model. A helicopter having a soft inplane four-bladed hingeless main rotor and a four-bladed tail rotor with conventional mechanical controls is used for the simulation studies. For the simulation study, a linearized helicopter model at different straight and level flight conditions is considered. A neural network with a linear filter architecture trained using backpropagation through time is used to approximate the control law. The controller network parameters are adapted using updated rules Lyapunov synthesis. The off-line trained (for finite time interval) network provides the necessary stability and tracking performance. The on-line learning is used to adapt the network under varying flight conditions. The on-line learning ability is demonstrated through parameter uncertainties. The performance of the proposed direct adaptive neural controller (DANC) is compared with feedback error learning neural controller (FENC).

Solution of singular integral equations with logarithmic and Cauchy kernels

A direct method of solution is presented for singular integral equations of the first kind, involving the combination of a logarithmic and a Cauchy type singularity. Two typical cages are considered, in one of which the range of integration is a Single finite interval and, in the other, the range of integration is a union of disjoint finite intervals. More such general equations associated with a finite number (greater than two) of finite, disjoint, intervals can also be handled by the technique employed here.

A randomized trial of fellowships for early career researchers finds a high reliability in funding decisions

Objectives Funding for early career researchers in Australia's largest medical research funding scheme is determined by a competitive peer-review process using a panel of four reviewers. The purpose of this experiment was to appraise the reliability of funding by duplicating applications that were considered by separate grant review panels. Study Design and Methods Sixty duplicate applications were considered by two independent grant review panels that were awarding funding for Australia's National Health and Medical Research Council. Panel members were blinded to which applications were included in the experiment and to whether it was the original or duplicate application. Scores were compared across panels using Bland–Altman plots to determine measures of agreement, including whether agreement would have impacted on actual funding. Results Twenty-three percent of the applicants were funded by both panels and 60 percent were not funded by both, giving an overall agreement of 83 percent [95% confidence interval (CI): 73%, 92%]. The chance-adjusted agreement was 0.75 (95% CI: 0.58, 0.92). Conclusion There was a comparatively high level of agreement when compared with other types of funding schemes. Further experimental research could be used to determine if this higher agreement is due to nature of the application, the composition of the assessment panel, or the characteristics of the applicants.

On the cubicity of bipartite graphs

A unit cube in k-dimension (or a k-cube) is defined as the Cartesian product R-1 x R-2 x ... x R-k, where each R-i is a closed interval on the real line of the form [a(j), a(i), + 1]. The cubicity of G, denoted as cub(G), is the minimum k such that G is the intersection graph of a collection of k-cubes. Many NP-complete graph problems can be solved efficiently or have good approximation ratios in graphs of low cubicity. In most of these cases the first step is to get a low dimensional cube representation of the given graph. It is known that for graph G, cub(G) <= left perpendicular2n/3right perpendicular. Recently it has been shown that for a graph G, cub(G) >= 4(Delta + 1) In n, where n and Delta are the number of vertices and maximum degree of G, respectively. In this paper, we show that for a bipartite graph G = (A boolean OR B, E) with |A| = n(1), |B| = n2, n(1) <= n(2), and Delta' = min {Delta(A),Delta(B)}, where Delta(A) = max(a is an element of A)d(a) and Delta(B) = max(b is an element of B) d(b), d(a) and d(b) being the degree of a and b in G, respectively , cub(G) <= 2(Delta' + 2) bar left rightln n(2)bar left arrow. We also give an efficient randomized algorithm to construct the cube representation of G in 3 (Delta' + 2) bar right arrowIn n(2)bar left arrow dimension. The reader may note that in general Delta' can be much smaller than Delta.

3,3,6,6-Tetramethyl-9-phenyl-3,4,5,6-tetrahydro-9H-xanthene-1,8(2H,7H)-dione

In the title compound, C23H26O3, the three six-membered rings of the xanthene system are non-planar, having total puckering amplitudes, QT, of 0.443 (2), 0.202 (2) and 0.449 (2) Å. The central ring adopts a boat conformation and the outer rings adopt sofa conformations. The crystal structure is stabilized by van der Waals interactions.

An upper bound for Cubicity in terms of Boxicity

An axis-parallel b-dimensional box is a Cartesian product R-1 x R-2 x ... x R-b where each R-i (for 1 <= i <= b) is a closed interval of the form [a(i), b(i)] on the real line. The boxicity of any graph G, box(G) is the minimum positive integer b such that G can be represented as the intersection graph of axis-parallel b-dimensional boxes. A b-dimensional cube is a Cartesian product R-1 x R-2 x ... x R-b, where each R-i (for 1 <= i <= b) is a closed interval of the form [a(i), a(i) + 1] on the real line. When the boxes are restricted to be axis-parallel cubes in b-dimension, the minimum dimension b required to represent the graph is called the cubicity of the graph (denoted by cub(G)). In this paper we prove that cub(G) <= inverted right perpendicularlog(2) ninverted left perpendicular box(G), where n is the number of vertices in the graph. We also show that this upper bound is tight.Some immediate consequences of the above result are listed below: 1. Planar graphs have cubicity at most 3inverted right perpendicularlog(2) ninvereted left perpendicular.2. Outer planar graphs have cubicity at most 2inverted right perpendicularlog(2) ninverted left perpendicular.3. Any graph of treewidth tw has cubicity at most (tw + 2) inverted right perpendicularlog(2) ninverted left perpendicular. Thus, chordal graphs have cubicity at most (omega + 1) inverted right erpendicularlog(2) ninverted left perpendicular and circular arc graphs have cubicity at most (2 omega + 1)inverted right perpendicularlog(2) ninverted left perpendicular, where omega is the clique number.

Association between biomechanical structural stresses of atherosclerotic carotid plaques and subsequent ischaemic cerebrovascular events - A longitudinal in vivo magnetic resonance imaging-based finite element study

Background: High-resolution magnetic resonance (MR) imaging has been used for MR imaging-based structural stress analysis of atherosclerotic plaques. The biomechanical stress profile of stable plaques has been observed to differ from that of unstable plaques; however, the role that structural stresses play in determining plaque vulnerability remains speculative. Methods: A total of 61 patients with previous history of symptomatic carotid artery disease underwent carotid plaque MR imaging. Plaque components of the index artery such as fibrous tissue, lipid content and plaque haemorrhage (PH) were delineated and used for finite element analysis-based maximum structural stress (M-C Stress) quantification. These patients were followed up for 2 years. The clinical end point was occurrence of an ischaemic cerebrovascular event. The association of the time to the clinical end point with plaque morphology and M-C Stress was analysed. Results: During a median follow-up duration of 514 days, 20% of patients (n=12) experienced an ischaemic event in the territory of the index carotid artery. Cox regression analysis indicated that M-C Stress (hazard ratio (HR): 12.98 (95% confidence interval (CI): 1.32-26.67, pZ0.02), fibrous cap (FC) disruption (HR: 7.39 (95% CI: 1.61e33.82), p Z 0.009) and PH (HR: 5.85 (95% CI: 1.27e26.77), p Z 0.02) are associated with the development of subsequent cerebrovascular events. Plaques associated with future events had higher M-C Stress than those which had remained asymptomatic (median (interquartile range, IQR): 330 kPa (229e494) vs. 254 kPa (166-290), p Z0.04). Conclusions: High biomechanical structural stresses, in addition to FC rupture and PH, are associated with subsequent cerebrovascular events.

Temporal dependence of in vivo USPIO-enhanced MRI signal changes in human carotid atheromatous plaques

Introduction: Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced MRI has been shown to be a useful modality to image activated macrophages in vivo, which are principally responsible for plaque inflammation. This study determined the optimum imaging time-window to detect maximal signal change post-USPIO infusion using T1-weighted (T1w), T2*- weighted (T2*w) and quantitative T2*(qT 2*) imaging. Methods: Six patients with an asymptomatic carotid stenosis underwent high resolution T1w, T2*w and qT2*MR imaging of their carotid arteries at 1.5 T. Imaging was performed before and at 24, 36, 48, 72 and 96 h after USPIO (Sinerem™, Guerbet, France) infusion. Each slice showing atherosclerotic plaque was manually segmented into quadrants and signal changes in each quadrant were fitted to an exponential power function to model the optimum time for post-infusion imaging. Results: The power function determining the mean time to convergence for all patients was 46, 41 and 39 h for the T1w, T 2*w and qT2*sequences, respectively. When modelling each patient individually, 90% of the maximum signal intensity change was observed at 36 h for three, four and six patients on T1w, T 2*w and qT2*, respectively. The rates of signal change decrease after this period but signal change was still evident up to 96 h. Conclusion: This study showed that a suitable imaging window for T 1w, T2*w and qT2*signal changes post-USPIO infusion was between 36 and 48 h. Logistically, this would be convenient in bringing patients back for one post-contrast MRI, but validation is required in a larger cohort of patients.

Smooth bootstrap methods for analysis of longitudinal data

In analysis of longitudinal data, the variance matrix of the parameter estimates is usually estimated by the 'sandwich' method, in which the variance for each subject is estimated by its residual products. We propose smooth bootstrap methods by perturbing the estimating functions to obtain 'bootstrapped' realizations of the parameter estimates for statistical inference. Our extensive simulation studies indicate that the variance estimators by our proposed methods can not only correct the bias of the sandwich estimator but also improve the confidence interval coverage. We applied the proposed method to a data set from a clinical trial of antibiotics for leprosy.

Renormalization of the axial-vector current in QCD

Following the method of Ioffe and Smilga, the propagation of the baryon current in an external constant axial-vector field is considered. The close similarity of the operator-product expansion with and without an external field is shown to arise from the chiral invariance of gauge interactions in perturbation theory. Several sum rules corresponding to various invariants both for the nucleon and the hyperons are derived. The analysis of the sum rules is carried out by two independent methods, one called the ratio method and the other called the continuum method, paying special attention to the nondiagonal transitions induced by the external field between the ground state and excited states. Up to operators of dimension six, two new external-field-induced vacuum expectation values enter the calculations. Previous work determining these expectation values from PCAC (partial conservation of axial-vector current) are utilized. Our determination from the sum rules of the nucleon axial-vector renormalization constant GA, as well as the Cabibbo coupling constants in the SU3-symmetric limit (ms=0), is in reasonable accord with the experimental values. Uncertainties in the analysis are pointed out. The case of broken flavor SU3 symmetry is also considered. While in the ratio method, the results are stable for variation of the fiducial interval of the Borel mass parameter over which the left-hand side and the right-hand side of the sum rules are matched, in the continuum method the results are less stable. Another set of sum rules determines the value of the linear combination 7F-5D to be ≊0, or D/(F+D)≊(7/12). .AE

Spin-state equilibria in the LCoO3 system from 59Co NMR

Spin-state equilibria in the whole set of LCoO3 (where L stands for a rare-earth metal or Y) have been investigated with the use of 59Co NMR as a probe for the polycrystalline samples (except Ce) in the temperature interval 110-550 K and frequency range 3- 11.6 MHz. Besides confirming the coexistence of the high-spin—low-spin state in this temperature range, a quadrupolar interaction of ∼0.1 -0.5 MHz has been detected for the first time from 59Co NMR. The NMR line shape is found to depend strongly on the relative magnitude of the magnetic and quadrupolar interactions present. Analysis of the powder pattern reveals two basically different types of transferred hyperfine interaction between the lighter and heavier members of the rare-earth series. The first three members of the lighter rare-earth metals La, Pr (rhombohedral), and Nd (tetragonal), exhibit second-order quadrupolar interaction with a zero-asymmetry parameter at lower temperatures. Above a critical temperature TS (dependent on the size of the rare-earth ion), the quadrupolar interaction becomes temperature dependent and eventually gives rise to a first-order interaction thus indicating a possible second-order phase change. Sm and Eu (orthorhombic) exhibit also a second-order quadrupolar interaction with a nonzero asymmetry parameter ((η∼0.47)) at 300 K, while the orthorhombic second-half members (Dy,..., Lu and Y) exhibit first-order quadrupolar interaction at all temperatures. Normal paramagnetic behavior, i.e., a linear variation of Kiso with T-1, has been observed in the heavier rare-earth cobaltites (Er,..., Lu and Y), whereas an anomalous variation has been observed in (La,..., Nd)CoO3. Thus, Kiso increases with increasing temperature in PrCoO3 and NdCoO3. These observations corroborate the model of the spin-state equilibria in LCoO3 originally proposed by Raccah and Goodenough. A high-spin—low-spin ratio, r=1, can be stabilized in the perovskite structure by a cooperative displacement of the oxygen atoms from the high-spin towards the low-spin cation. Where this ordering into high- and low-spin sublattices occurs at r=1, one can anticipate equivalent displacement of all near-neighbor oxygen atoms towards a low-spin cobalt ion. Thus the heavier LCoO3 exhibits a small temperature-independent first-order quadrupolar interaction. Where r<1, the high- and low-spin states are disordered, giving rise to a temperature-dependent second-order quadrupolar interaction with an anomalous Kiso for the lighter LCoO3.

Cubicity, boxicity, and vertex cover

A k-dimensional box is the cartesian product R-1 x R-2 x ... x R-k where each R-i is a closed interval on the real line. The boxicity of a graph G,denoted as box(G), is the minimum integer k such that G is the intersection graph of a collection of k-dimensional boxes. A unit cube in k-dimensional space or a k-cube is defined as the cartesian product R-1 x R-2 x ... x R-k where each Ri is a closed interval on the real line of the form [a(i), a(i) + 1]. The cubicity of G, denoted as cub(G), is the minimum k such that G is the intersection graph of a collection of k-cubes. In this paper we show that cub(G) <= t + inverted right perpendicularlog(n - t)inverted left perpendicular - 1 and box(G) <= left perpendiculart/2right perpendicular + 1, where t is the cardinality of a minimum vertex cover of G and n is the number of vertices of G. We also show the tightness of these upper bounds. F.S. Roberts in his pioneering paper on boxicity and cubicity had shown that for a graph G, box(G) <= left perpendicularn/2right perpendicular and cub(G) <= inverted right perpendicular2n/3inverted left perpendicular, where n is the number of vertices of G, and these bounds are tight. We show that if G is a bipartite graph then box(G) <= inverted right perpendicularn/4inverted left perpendicular and this bound is tight. We also show that if G is a bipartite graph then cub(G) <= n/2 + inverted right perpendicularlog n inverted left perpendicular - 1. We point out that there exist graphs of very high boxicity but with very low chromatic number. For example there exist bipartite (i.e., 2 colorable) graphs with boxicity equal to n/4. Interestingly, if boxicity is very close to n/2, then chromatic number also has to be very high. In particular, we show that if box(G) = n/2 - s, s >= 0, then chi (G) >= n/2s+2, where chi (G) is the chromatic number of G.