Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics?

Objectives: To determine whether diagnostic triage by general practitioners (GPs) or rheumatology nurses (RNs) can improve the positive predictive value of referrals to early arthritis clinics (EACs).

Methods: Four GPs and two RNs were trained in the assessment of early in?ammatory arthritis (IA) by four visits to an EAC supervised by hospital rheumatologists. Patients referred to one of three EACs were recruited for study and assessed independently by a GP, an RN and one of six rheumatologists. Each assessor was asked to record their clinical ?ndings and whether they considered the patient to have IA. Each was then asked to judge the appropriateness of the referral according to predetermined guidelines. The rheumatologists had been shown previously to have a satisfactory level of agreement in the assessment of IA.

Results: Ninety-six patients were approached and all consented to take part in the study. In 49 cases (51%), the rheumatologist judged that the patient had IA and that the referral was appropriate. The assessments of GPs and RNs were compared with those of the rheumatologists. Levels of agreement were measured using the kappa value, where 1.0 represents total unanimity. The kappa value was
0.77 for the GPs when compared with the rheumatologists and 0.79 for the RNs. Signi?cant stiffness in the morning or after rest and objective joint swelling were the most important clinical features enabling the GPs and RNs to discriminate between IA and non-IA conditions.

Conclusion: Diagnostic triage by GPs or RNs improved the positive predictive value of referrals to an EAC with a degree of accuracy approaching that of a group of experienced rheumatologists.

Directional performance in motion transparency

Motion transparency provides a challenging test case for our understanding of how visual motion, and other attributes, are computed and represented in the brain. However, previous studies of visual transparency have used subjective criteria which do not confirm the existence of independent representations of the superimposed motions. We have developed measures of performance in motion transparency that require observers to extract information about two motions jointly, and therefore test the information that is simultaneously represented for each motion. Observers judged whether two motions were at 90 to one another; the base direction was randomized so that neither motion taken alone was informative. The precision of performance was determined by the standard deviations (S.D.s) of probit functions fitted to the data. Observers also made judgments of orthogonal directions between a single motion stream and a line, for one of two transparent motions against a line and for two spatially segregated motions. The data show that direction judgments with transparency can be made with comparable accuracy to segregated (non-transparent) conditions, supporting the idea that transparency involves the equivalent representation of two global motions in the same region. The precision of this joint direction judgment is, however, 2–3 times poorer than that for a single motion stream. The precision in directional judgment for a single stream is reduced only by a factor of about 1.5 by superimposing a second stream. The major effect in performance, therefore, appears to be associated with the need to compute and compare two global representations of motion, rather than with interference between the dot streams per se. Experiment 2tested the transparency of motions separated by a range of angles from 5 to 180 by requiring subjects to set a line matching the perceived direction of each motion. The S.D.s of these settings demonstrated that directions of transparent motions were represented independently for separations over 20. Increasing dot speeds from 1 to 10 deg/s improved directional performance but had no effect on transparency perception. Transparency was also unaffected by variations of density between 0.1 and 19 dots/deg2

Modelling relative motion to facilitate intra-limb coordination

The importance of relative motion information when modelling a novel motor skill was examined. Participants were assigned to one of four groups. Groups 1 and 2 viewed demonstrations of a skilled cricket bowler presented in either video or point light format. Group 3 observed a single point of light pertaining to the wrist of the skilled bowler only. Participants in Group 4 did not receive a demonstration and acted as controls. During 60 acquisition trials, participants in the demonstration groups viewed a model five times before each 10-trial block. Retention was examined the following day. Intra-limb coordination was assessed for the right elbow relative to the wrist in comparison to the model. The demonstration groups showed greater concordance with the model than the control group. However, the wrist group performed less like the model than the point light and video groups, who did not differ from each other. These effects were maintained in retention. Relative motion information aided the acquisition of intra-limb coordination, while making this information more salient (through point lights) provided no additional benefit. The motion of the models bowling arm was replicated more closely than the non-bowling arm, suggesting that information from the end-effector is prioritized during observation for later reproduction.

The massive binary companion star to the progenitor of supernova 1993J

The massive star that underwent a collapse of its core to produce supernova (SN)1993J was subsequently identified as a non-variable red supergiant star in images of the galaxy M81 taken before explosion(1, 2). It showed an excess in ultraviolet and B-band colours, suggesting either the presence of a hot, massive companion star or that it was embedded in an unresolved young stellar association1. The spectra of SN1993J underwent a remarkable transformation from the signature of a hydrogen-rich type II supernova to one of a helium-rich (hydrogen-deficient) type Ib(3, 4). The spectral and photometric peculiarities were best explained by models in which the 13�20 solar mass supergiant had lost almost its entire hydrogen envelope to a close binary companion(5, 6, 7), producing a 'type IIb' supernova, but the hypothetical massive companion stars for this class of supernovae have so far eluded discovery. Here we report photometric and spectroscopic observations of SN1993J ten years after the explosion. At the position of the fading supernova we detect the unambiguous signature of a massive star: the binary companion to the progenitor.

Broken symmetry and pseudogaps in ropes of carbon nanotubes

We investigate the influence of tube-tube interactions in ropes of (10,10) carbon nanotubes, and find that these effects induce a pseudogap in the density of state (DOS) of the rope of width 0.1 eV at the Fermi level. In an isolated (n,n) carbon nanotube there are two bands that cross in a linear fashion at the Fermi level, making the nanotube metallic with a DOS that is constant in a 1.5 eV wide window around the Fermi energy. The presence of the neighbouring tubes causes these two bands to repel, opening up a band gap that can be as large as 0.3 eV. The small dispersion in the plane perpendicular to the rope smears out this gap for a rope with a large cross-sectional area, and we see a pseudogap at the Fermi energy in the DOS where the DOS falls to one third of its value for the isolated tube. This phenomenon should affect many properties of the behavior of ropes of (n,n) nanotubes, which should display a more semimetallic character than expected in transport and doping experiments, with the existence of both hole and electron carriers leading to qualitatively different thermopower and Hall-effect behaviors from those expected for a normal metal. Band repulsion like this can be expected to occur for any tube perturbed by a sufficiently strong interaction, for example, from contact with a surface or with other tubes.

Robust Speaker Recognition in Noisy Conditions

This paper investigates the problem of speaker identi-fication and verification in noisy conditions, assuming that speechsignals are corrupted by environmental noise, but knowledgeabout the noise characteristics is not available. This research ismotivated in part by the potential application of speaker recog-nition technologies on handheld devices or the Internet. Whilethe technologies promise an additional biometric layer of securityto protect the user, the practical implementation of such systemsfaces many challenges. One of these is environmental noise. Due tothe mobile nature of such systems, the noise sources can be highlytime-varying and potentially unknown. This raises the require-ment for noise robustness in the absence of information about thenoise. This paper describes a method that combines multicondi-tion model training and missing-feature theory to model noisewith unknown temporal-spectral characteristics. Multiconditiontraining is conducted using simulated noisy data with limitednoise variation, providing a “coarse” compensation for the noise,and missing-feature theory is applied to refine the compensationby ignoring noise variation outside the given training conditions,thereby reducing the training and testing mismatch. This paperis focused on several issues relating to the implementation of thenew model for real-world applications. These include the gener-ation of multicondition training data to model noisy speech, thecombination of different training data to optimize the recognitionperformance, and the reduction of the model’s complexity. Thenew algorithm was tested using two databases with simulated andrealistic noisy speech data. The first database is a redevelopmentof the TIMIT database by rerecording the data in the presence ofvarious noise types, used to test the model for speaker identifica-tion with a focus on the varieties of noise. The second database isa handheld-device database collected in realistic noisy conditions,used to further validate the model for real-world speaker verifica-tion. The new model is compared to baseline systems and is foundto achieve lower error rates.

Muldoon's Betweenness

Muldoon’s poetry frequently explores states of being ‘in-between’ and this can plausibly be related to his Catholic Northern Irish identity. He seems to be aware of the effects comprised in Derrida’s concept of différance, one version of which is the entre (‘between’). Nevertheless, Muldoon is more interested in exploring the experience of postmodernity than in offering a theory, or relating it to one culture. But this exploration has as many similarities with the concerns of existentialism and phenomenology as with deconstruction. Poems from Why Brownlee Left to Moy Sand and Gravel are discussed, and topics addressed include the South American exotic (new sources are suggested) and the troping on yarrow (compare Derrida’s pharmakon) in The Annals of Chile. Formal effects of repetition and difference reflect the themes. The redemption of repetition is studied with the help both of Kierkegaard and of Muldoon’s thoughts on the ‘magic mist’ of Irish romance.

Transfer of resistance training to enhance rapid coordinated force production by older adults

The purpose of this study was to examine the capacity of resistance training to enhance the rapid and coordinated production of force by older people. Thirty adults (greater than or equal to 60 years) completed a visually guided aiming task that required the generation of isometric torque in 2 df about the elbow prior to and following a 4-week training period. Groups of six participants were allocated to two progressive ( 40 - 100% maximal voluntary contraction (MVC)) resistance-training (PRT) groups, to two constant low-load (10% MVC) training groups (CLO) and to one no-training control group. Training movements required the generation of either combined flexion and supination (FLESUP), or combined extension and supination (EXTSUP). In response to training, target acquisition times in the aiming task decreased for all groups; however, both the nature of the training load and the training movement influenced the pattern and magnitude of improvements (EXTSUP_ CLO: 36%, FLESUP_ PRT 26%, EXTSUP_ PRT 22%, FLESUP_ CLO 20%, CONTROL 15%). For one group that trained with progressively increasing loads, there arose a subsequent decrease in performance in one condition of the transfer task. For each group, these adaptations were accompanied by systematic changes in the coordination of muscles about the elbow joint, particularly the biceps brachii.

Young Women’s Positive and Negative Perceptions of Self in Northern Ireland

This paper represents analysis of one aspect of a larger research project examining the everyday lives and experiences of young women in Northern Ireland. As an introductory exercise within focus groups, 48 young women considered and discussed the good and not so good things about being a young woman in Northern Ireland. Through these accounts many issues emerged, some in direct contrast and contradiction to one another. The area focused upon for the purpose of this paper is the body, particularly with regard to body image (self-expression versus pressure) and becoming a woman (growing up versus menarche). The aim is to illustrate that what young women cite as being potentially positive aspects of growing up or being a young woman often have negative experiences and implications attached to them. In light of the advancements made by young women in Northern Irish society, an opening of opportunities and their awareness of the persistence of gendered messages regarding their bodies, many young women are of the belief that such messages have less impact upon them today and that gender is a barrier that can be overcome. It is illustrated and argued here, however, that dominant cultural messages regarding women’s bodies are more subtle, confusing and perhaps pervasive than they ever have been. As a consequence, this has created more pressure and confusion for young women and tensions exist in terms of young women’s beliefs and their actions. In light of these research findings, this paper considers practice implications for those working with and for young women.

Accessing the Institutions: The Road to the Socialist-Green Alliance in Spain

This article traces the strategic re-orientation of the Spanish Greens (Los Verdes) from a position of hostility toward the Socialists (PSOE) to one of collaboration that allowed them to gain parliamentary representation in the 2004 national and European elections. Drawing upon insights from the party politics literature, it schematizes a model and then proceeds to use it to provide a diachronic account of factionalist conflict within the ranks of the Greens and their close competitors, the structure of political opportunities, exogenous factors and their interrelationship, up to the point of the electoral agreement between the two parties. In concludes by highlighting the role played by the Madrid bombings in bringing the PSOE back into power and offers some projections about the future institutional access of the Greens.

Both English and Latin: Bilingualism and Biculturalism in Milton's Neo-Latin Writings (219pp.)

Review by Emma A. Wilson, Milton Quarterly 49.1 (March, 2015), 54-59:

‘This volume provides an invaluable new perspective on both Milton’s neo-Latin poems and also the major vernacular poetry by insisting politely but firmly upon the bilingualism of their author and the manifest effects of that bilingualism upon style and intertextuality in his corpus. Through a dextrous combination of manuscript research, modern understandings of bilingualism, and crucially meticulous and demanding close readings, this volume succeeds in vivifying a wealth of new relationships between Milton’s neo-Latin works and his vernacular poems … Haan is expert in probing and elucidating the multiple linguistic and cultural lenses through which Milton projects his work, and the resulting volume brings a new set of historical contexts and consequences for both the major and minor texts, whilst also more importantly furnishing an exciting new method with which to approach these works as a whole ... Haan's linguistic expertise and meticulous archival research combine to create a critical work in which discoveries gradually accumulate and speak to one another in very specific, nuanced dialogues between chapters ... opening up exciting new reading vistas ... The final two chapters, in which Haan harvests some of the fruits of her considerable and fantastic labor in the archives and in current linguistic research into bilingualism, bring to light fresh perspectives on some of Milton's major published poetic works.’


Both English and Latin: Bilingualism and Biculturalism in Milton’s Neo-Latin Writings (2012) (Back Cover):

Gordon Campbell, University of Leicester:
‘Estelle Haan is the world’s foremost authority on Milton’s Latin poetry, and probably the most distinguished student of that poetry in the history of critical commentary. This is a work of extraordinary authority written by a scholar at the height of her powers. In short, this is a terrific book, elegant and informative.’

Anne Mahoney, Tufts University:
‘This book ssucceeds in presenting Milton's poetry as a single, unified body of work. Its biggest strength is the many close readings of Milton's Latin verse as engagements with classical Latin literature. In addition to introducing the Latin verse to new readers, it provides a new approach to Paradise Lost, one that accounts for one of the difficulties of Milton’s text—its language—in a novel way.’


Abstract:

Both English and Latin examines the interplay of Latin and English in a selection of John Milton's neo-Latin writings. It argues that this interplay is indicative of an inherent bilingualism that proceeds hand-in-hand with a self-fashioning that is bicultural in essence. Interlingual flexibility ultimately proved central to the poet of Paradise Lost, an epic uniquely characterized by its Latinate vernacular and its vernacular Latinitas.

The development of national in-group bias: English children's attributions of characteristics to English, American and German people

This study investigated the development of national in-group bias in 5-11-year-old children. Three hundred and seven English children were asked to attribute characteristics to their own national group either on its own or in conjunction with attributing characteristics to one of two national out-groups, either Americans or Germans. The importance which the children ascribed to their own national identity in relationship to their other social identities was also assessed. It was found that, with increasing age, there was an increase in the number of negative characteristics attributed to the national in-group, and an increase in the number of positive characteristics attributed to the two out-groups, the net result being an overall reduction in in-group bias across this age range. However, in-group favouritism was still exhibited at all ages. Greater importance was attributed to national identity with increasing age. However, the characteristics attributed to the English in-group did not vary as a function of the comparative out-group which was present while the attributions were being made. The presence of a comparative out-group also did not affect the importance that was ascribed to the national identity. These findings suggest that children are relatively insensitive to the prevailing comparative context when making judgments about national groups.

Far field subwavelength source resolution using Phase Conjugating Lens Assisted With Evanescent-to-Propagating Spectrum Conversion

The imaging properties of a phase conjugating lens operating in the far field zone of the imaged source and augmented with scatterers positioned in the source near field region are theoretically studied in this paper. The phase conjugating lens consists of a double sided 2D assembly of straight wire elements, individually interconnected through phase conjugation operators. The scattering elements are straight wire segments which are loaded with lumped impedance loads at their centers. We analytically and numerically analyze all stages of the imaging process; i) evanescent-to-propagating spectrum conversion; ii) focusing properties of infinite or finite sized phase conjugating lens; iii) source reconstruction upon propagating-to-evanescent spectrum conversion. We show that the resolution that can be achieved depends critically on the separation distance between the imaged source and scattering arrangement, as well as on the topology of the scatterers used. Imaged focal widths of up to one-seventh wavelength are demonstrated. The results obtained indicate the possibility of such an arrangement as a potential practical means for realising using conventional materials devices for fine feature extraction by electromagnetic lensing at distances remotely located from the source objects under investigation

Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.

Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.

Design. Qualitative practitioner research study.

Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.

Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.

Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.

Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

Regenerative Medicine and New Labour Life Science Policy: Rhetorics of Success, Narratives of Sustainability and Survival

Advances in stem cell science and tissue engineering are being turned into applications and products through a novel medical paradigm known as regenerative medicine. This paper begins by examining the vulnerabilities and risks encountered by the regenerative medicine industry during a pivotal moment in its scientific infancy: the 2000s. Under the auspices of New Labour, British medical scientists and life science innovation firms associated with regenerative medicine, received demonstrative rhetorical pledges of support, aligned with the publication of a number of government initiated reports presaged by Bioscience 2015: Improving National Health, Increasing National Wealth. The Department of Health and the Department of Trade and Industry (and its successors) held industry consultations to determine the best means by which innovative bioscience cultures might be promoted and sustained in Britain. Bioscience 2015 encapsulates the first chapter of this sustainability narrative. By 2009, the tone of this storyline had changed to one of survivability. In the second part of the paper, we explore the ministerial interpretation of the ‘bioscience discussion cycle’ that embodies this narrative of expectation, using a computer-aided content analysis programme. Our analysis notes that the ministerial interpretation of these reports has continued to place key emphasis upon the distinctive and exceptional characteristics of the life science industries, such as their ability to perpetuate innovations in regenerative medicine and the optimism this portends – even though many of the economic expectations associated with this industry have remained unfulfilled.