Collaborative cross-checking to enhance resilience

Resilience, the ability to adapt or absorb disturbance, disruption, and change, may be increased by team processes in a complex, socio-technical system. In particular, collaborative cross-checking is a strategy where at least two individuals or groups with different perspectives examine the others’ assumptions and/or actions to assess validity or accuracy. With this strategy, erroneous assessments or actions can be detected quickly enough to mitigate or eliminate negative consequences. In this paper, we seek to add to the understanding of the elements that are needed in effective cross-checking and the limitations of the strategy. We define collaborative cross-checking, describe in detail three healthcare incidents where collaborative cross-checks played a key role, and discuss the implications of emerging patterns.     

How Advances in Search Combine Databases, Sentence Diagramming, and "Just the Facts"

Among the most studied subfields of natural language processing (NLP) are information retrieval (IR, aka search) and information extraction (IE). Yet, even though researchers have wanted to combine IR and IE for nearly a decade, we are only now starting to see commercial applications that put the notion into practice. The search market remains dominated by traditional IR technologies, as evidenced by the likes of Google, Yahoo, and Verity. (Granted, Google's page-rank algorithm departs from traditional IR algorithms by including link data, but the underlying index of terms is conventional.) Two forces are driving the need for advanced search technologies: (a) users are more knowledgeable and are demanding greater search engine precision; and (b) vendors must create new search products, particularly enterprise search applications. This issue's theme articles represent several of these advancements. In this article, the author detail how IE-in particular action-oriented event extraction-enables new search functionality     

Intermediate order in tetrahedrally coordinated silicon: evidence for chainlike objects

In this report, we describe the nature of intermediate order in silicon as determined by recent measurements on thin films using transmission electron microscopy (TEM) and Raman scattering. The TEM images show in addition to the expected continuous random network (CRN), the presence of highly ordered quasi-one-dimensional “chain-like objects” (CLO's) that are 1–2 nm wide and tens of nm long that meander and show some evidence of cross-linking with each other. The presence of these objects correlate to a Raman feature centered at 490 cm⁻¹ whose width is 35–40 cm⁻¹, and is used to quantify the heterogeneity in terms of the CLO and CRN (=475 cm⁻¹ scattering) concentrations. The 490 and 35 cm⁻¹ values are consistent with bond angle deviations approaching 0°, and thus reinforces an association with the CLOs. We find that in reference quality a-Si:H (made using pure SiH₄), the CLO concentration is about 5 vol%, while in state-of-the-art material using high H₂ levels of dilution during processing, it increases to about 15%. Increased stability of such material to light-soaking is thus not mediated by a direct volumetric replacement of poor with high-quality components. Rather, an important characteristic of intermediate order in silicon is the low-dimensional aspect of its order, which allows it to influence more total volume than which it is itself composed. Consistent with these and other recent findings, we propose a tensegrity model of amorphous silicon.     

Equivalence of models for polynomial learnability

In this paper we consider several variants of Valiant's learnability model that have appeared in the literature. We give conditions under which these models are equivalent in terms of the polynomially learnable concept classes they define. These equivalences allow comparisons of most of the existing theorems in Valiant-style learnability and show that several simplifying assumptions on polynomial learning algorithms can be made without loss of generality. We also give a useful reduction of learning problems to the problem of finding consistent hypotheses, and give comparisons and equivalences between Valiant's model and the prediction learning models of Haussler, Littlestone, and Warmuth (in “29th Annual IEEE Symposium on Foundations of Computer Science,” 1988).     

Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy

The immune-mediated graft-versus-leukemia effect is important to prevent relapse after allogeneic progenitor cell transplantation. This process requires engraftment of donor immuno-competent cells. The objective of this study was to assess the feasibility of achieving engraftment of allogeneic peripheral blood or bone marrow progenitor cell after purine analog containing nonmyeloablative chemotherapy. Patients with advanced leukemia or myelodysplastic syndromes (MDS) who were not candidates for a conventional myeloablative therapy because of older age or organ dysfunction were eligible. All patients had an HLA-identical or one-antigen-mismatched related donor. Fifteen patients were treated (13 with acute myeloid leukemia and 2 with MDS). The median age was 59 years (range, 27 to 71 years). Twelve patients were either refractory to therapy or beyond first relapse. Eight patients received fludarabine at 30 mg/m2/d for 4 days with idarubicin at 12 mg/m2/d for 3 days and ara-c at 2 g/m2/d for 4 days (n = 7) or melphalan at 140 mg/m2/d (n = 1). Seven patients received 2-chloro-deoxyadenosine at 12 mg/m2/d for 5 days and ara-C 1 at g/m2/d for 5 days. Thirteen patients received allogeneic peripheral blood stem cells and 1 received bone marrow after chemotherapy. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and methyl-prednisolone. Treatment was generally well tolerated, with only 1 death from multiorgan failure before receiving stem cells. Thirteen patients achieved a neutrophil count of greater than 0.5 x 10(9)/L a median of 10 days postinfusion (range, 8 to 17 days). Ten patients achieved platelet counts of 20 x 10(9)/L a median of 13 days after progenitor cell infusion (range, 7 to 78 days). Eight patients achieved complete remissions (bone marrow blasts were < 5% with neutrophil recovery and platelet transfusion independence) that lasted a median of 60 days posttransplantation (range, 34 to 170+ days). Acute GVHD grade > or = 2 occurred in 3 patients. Chimerism analysis of bone marrow cells in 6 of 8 patients achieving remission showed > or = 90% donor cells between 14 and 30 days postinfusion, and 3 of 4 patients remaining in remission between 60 and 90 days continued to have > or = 80% donor cells. We conclude that purine analog-containing nonmyeloablative regimens allow engraftment of HLA-compatible hematopoietic progenitor cells. This approach permits us to explore the graft-versus-leukemia effect without the toxicity of myeloablative therapy and warrants further study in patients with leukemia who are ineligible for conventional transplantation with myeloablative regimens either because of age or concurrent medical conditions.     

Maternal nutrition and socio-economic status as determinants of birthweight in chronically malnourished African women

The birthweight is the most important determinant of mortality and morbidity in the neonatal period and may have an influence on health in adult life. The high rate of low birthweight in developing countries is therefore a major health problem. Maternal malnutrition is usually assumed to be a causal factor but other environmental factors are also involved. In this study we analysed maternal nutritional and socio-economic factors as determinants of birthweight in term infants from a rural African society characterised by a high rate of chronic malnutrition. Relations of maternal weight, gestational weight gain, parity, socio-economic status and infant sex with birthweight were analysed in 1,477 women and child pairs. The selected women were followed from early pregnancy and had an uncomplicated delivery at term of a living singleton child. The gestational weight gain was 5.6 (SD 6.0) kg and the mean birthweight 2.933 kg (SD 408). Maternal weight, representing the maternal long-term nutritional situation, was the most important independent determinant of birthweight, accounting for 13.0% of the variance in birthweight. The weight gain, representing the short-term nutritional situation, explained only 5.6% of the variance. Birthweight increased by 20 g (CI 18-23) for each kg maternal weight and by 15 g (CI 12-18) for each kg gestational weight gained. The socio-economic difference in birth-weight was 153 g (CI 109-196) 88 of which (CI 48-128) remained unexplained after adjustment for differences in maternal weight, parity and gender. Improved long-term nutritional situation and living conditions seems to be the most important prerequisites to counteract low birthweight in developing countries.     

Cytokines and other markers of intrathecal immune response in patients with herpes simplex encephalitis

Sequential samples of serum and cerebrospinal fluid (CSF), from 9 patients with herpes simplex encephalitis (HSE), were analyzed for cytokines and soluble cytokine receptors. The response to herpes simplex virus was characterized by a vigorous compartmentalized immune response. The intrathecal response comprised three different phases: an acute stage (first week of illness), characterized by elevated CSF levels of interleukin (IL)-6 and interferon-gamma; an early convalescence stage (weeks 2-6 after onset of disease), associated with peaking levels of tumor necrosis factor-alpha and late markers of the specific T cell-mediated immune response, soluble IL-2 receptor, and soluble CD8 antigen (sCD8); and finally, a late convalescence stage, lasting months to years and associated with persistently increased levels of sCD8 in particular. These findings show the compartmentalization and kinetics of the inflammatory response in HSE and demonstrate persistence of the intrathecal inflammatory process, which may have implications for antiviral and antiinflammatory therapy.     

Culture and region revisited

People in different regions of the world live under different cultural and religious orders and derive various practical ethics from them. Some of these moral and religious principles are clearly more favorable for economic development than others. Yet such ethnological differences are regrettably absent from our prevailing theories of regional economic development. In this paper, culture is defined as a system of relatively slow processes of change — known as cultural arenas. A complex interface exists between these slower processes and the relatively faster ones (known as games). In attempting to assess the development prospects of any region, a key point to grasp is that this cultural interface may be self-organizing. Its future trajectory will therefore be uncertain. To the extent that the proposed system of slow processes may be construed as a region's cultural base, they may control the nature and achievable pace of that region's development.An earlier version of this paper was presented at a Conference onThe Economics of the Cities of Art, held in Venice from 13–15 May 1991.