A rapid urease test for presumptive identification of Cryptococcus neoformans

Extra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainly because of their potential to generate unexpected expenditure. But ECRs can also be used as a tool for monitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington Health Authority district using a variety of methods including inter-disciplinary meetings, a series of interviews with local GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results of the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief that a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral to benefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throat services were over-represented. Questionnaire results were validated by comparison with an interview study of all GPs in the district. We conclude that trends in ECRs can be monitored as a convenient "early warning system' to alert purchasing authorities to changes in demand or perceived problems with local provider units. ECR data must be interpreted in the context of further local background information from sources such as GPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in services and contracts.     

Transient accumulation of proteins at interrod and rod enamel growth sites

Conceptually, there should be a brief interval in time when newly secreted proteins "pile up" at secretory sites just outside the membrane of ameloblasts. Indeed, previous cytochemical studies have suggested that glycosylated and/or sulfated glycoproteins accumulate at enamel growth sites. Colloidal gold lectin cytochemistry and immunocytochemistry with antibodies to enamel proteins and phosphoserine, combined with cycloheximide and brefeldin A to inhibit protein synthesis and secretion, were applied to characterize the distribution of newly formed proteins at enamel interrod and rod growth sites. Although enamel growth sites show a "rarefied" appearance, the results indicate that one or more subclasses of enamel proteins accumulate near the cell surface at sites where elongation of enamel crystallites contributes to thickening of the enamel layer. These proteins are glycosylated and/or phosphorylated and, at least in the case of the glycosylated ones, are rapidly processed after they are released extracellularly. In contrast, immunolabeling for amelogenins is generally weaker near the cell surface and more intense at a short distance away from the site where crystallites elongate. The data suggest that the enamel proteins accumulating at growth sites likely belong to the non-amelogenin category and play a transient role in promoting the lengthening of crystallites. It is concluded that areas near the ameloblast membrane where certain enamel proteins accumulate in fact constitute the equivalent of a mineralization front.     

Progressive subretinal fibrosis and blindness in patients with multifocal granulomatous chorioretinitis

Since women with a first-degree relative with breast cancer are at increased risk for breast cancer, it is of special importance that they adhere to early detection programs. In this study, women with (389) and without (3295) a family history of breast cancer were compared with respect to risk perception, breast cancer anxiety, and early detection behavior. Special attention was paid to the role of knowing that family history is a breast cancer risk factor. It was found that 46% of "family history positives" did not know that their risk was increased by their family history. Still, family history positives had increased risk perception; our results suggest that this was partly caused by their knowing they belonged to a risk group and partly by their having experienced the disease at close range. Although family history positives had higher risk perceptions, no differences in early detection behavior were found. This could not be attributed to high anxiety levels. Implications for health education are discussed.     

Harnessing graphics processors for the fast computation of acoustic likelihoods in speech recognition

In large vocabulary continuous speech recognition (LVCSR) the acoustic model computations often account for the largest processing overhead. Our weighted finite state transducer (WFST) based decoding engine can utilize a commodity graphics processing unit (GPU) to perform the acoustic computations to move this burden off the main processor. In this paper we describe our new GPU scheme that can achieve a very substantial improvement in recognition speed whilst incurring no reduction in recognition accuracy. We evaluate the GPU technique on a large vocabulary spontaneous speech recognition task using a set of acoustic models with varying complexity and the results consistently show by using the GPU it is possible to reduce the recognition time with largest improvements occurring in systems with large numbers of Gaussians. For the systems which achieve the best accuracy we obtained between 2.5 and 3 times speed-ups. The faster decoding times translate to reductions in space, power and hardware costs by only requiring standard hardware that is already widely installed.     

Plans, Actions and Dialogues Using Linear Logic

We describe how Intuitionistic Linear Logic can be used to provide a unified logical account for agents to find and execute plans. This account supports the modelling of agent interaction, including dialogue; allows agents to be robust to unexpected events and failures; and supports significant reuse of agent specifications. The framework has been implemented and several case studies have been considered. Further applications include human–computer interfaces as well as agent interaction in the semantic web.     

Characterizing the Nash equilibria of a three-player Bayesian quantum game

Quantum games with incomplete information can be studied within a Bayesian framework. We consider a version of prisoner’s dilemma (PD) in this framework with three players and characterize the Nash equilibria. A variation of the standard PD game is set up with two types of the second prisoner and the first prisoner plays with them with probability p and \(1-p\), respectively. The Bayesian nature of the game manifests in the uncertainty that the first prisoner faces about his opponent’s type which is encoded either in a classical probability or in the amplitudes of a wave function. Here, we consider scenarios with asymmetric payoffs between the first and second prisoner for different values of the probability, p, and the entanglement. Our results indicate a class of Nash equilibria (NE) with rich structures, characterized by a phase relationship on the strategies of the players. The rich structure can be exploited by the referee to set up rules of the game to push the players toward a specific class of NE. These results provide a deeper insight into the quantum advantages of Bayesian games over their classical counterpart.     

Contextual factors affecting task distribution in two participatory ergonomic interventions: a qualitative study

This article provides an analysis of the evolution of the division of labour in participatory ergonomics (PE) programmes in two worksites. The analysis is based on interviews and field observations in the worksites. In both settings there was meaningful participation by both worker and management members of ergonomic change teams (ECTs) in the hazard assessment and solution identification stages, but as the teams moved to the implementation stage, worker representatives were marginalised and the participatory nature of the programmes was severely curtailed. The removal of workers from the process was the outcome of the interplay among the type of activities pursued in the implementation stage, the skills and knowledge required to carry out those activities, and workers' limited influence in the organisational hierarchies. Findings highlight the salience of the social context in which participatory programmes are located and the importance of examining participatory programmes as they evolve over time. STATEMENT OF RELEVANCE: This article contributes to a growing literature on the process and implementation of PE programmes. The article's focus on social and organisational factors that affect the division of labour and attention to the evolution of involvement over time extend current understandings of participation in ergonomics programmes.     

Comments on “Adaptive variable structure set-point control ofunderactuated robots” [and reply]

This note points out several technical errors in the above mentioned paper by Su et al. (ibid. vol.44 (1999)). It is shown that the choice of Lyapunov function is inadequate for the system stability analysis, and the asymptotic tracking of the underactuated robot joints is not achievable under certain conditions. In reply, Su addresses, from the comments, some important issues that were not duly emphasised in the paper     

The renal factor in the post-traumatic "fluid overload" syndrome

Hypervolemia with hypertension often occurs 36-72 hours following massive blood and fluid replacement for hypovolemic shock. This syndrome of "fluid overload" has been attributed to the rapid intravascular flux of previously sequestered fluid in patients with impaired diuresis. This hypothesis was tested in 35 injured patients who received a mean of 9.3 L of blood and 17.4 L of salt during resucitation. The renal parameters measured soon after resuscitation included: 1) renal clearance of inulin (GFR), para-amino hippurate (ERPF), milliosmoles, sodium, and free water; 2) inulin space, renal vascular resistance (RVR), O2 consumption, renin, renal blood flow (RBF), and response to furosemide. Eighteen patients developed hypertension, hypervolemia, and respiratory insufficiency. When compared to the 17 normovolemic, non-hypertensive patients, the 18 hypervolemic patients had significantly increased RVR, with a significant decrease in RBF despite an increase in plasma volume and cardiac output. Furosemide produced less diuresis and natriuresis in the hypertensive patients. The balance between hypovolemia and "fluid overload" seemed percarious in the hypertensive patients. Peripheral renin and catecholamine levels were normal in both groups. Patients with post-traumatic "fluid overload" appear to have a combination of hypervolemia, respiratory insufficiency, hypertension, increased cardiac output, decreased extracellular fluid space, and decreased renal perfusion. These findings suggest that decreased interstitial fluid space compliance rather than "fluid overload" is the underlying factor leading to respiratory insufficiency. The therapeutic aspects of these findings are discussed.