Podcasts about sidm

Join us for SpaceTime Series 27 Episode 73, where we delve into the latest cosmic discoveries and advancements shaping our understanding of the universe.First, astronomers have developed a new theory of dark matter to explain the mysterious dwarf galaxy Crater 2. Despite its proximity at 383,000 light-years from Earth and its large size—making it the fourth largest satellite galaxy orbiting the Milky Way—Crater 2 has a surprisingly low surface brightness and velocity dispersion. This has led scientists to propose the self-interacting dark matter (SIDM) theory, which may better account for the galaxy's unusual properties.Next, new research dismisses the idea of a lake under the Martian south polar ice cap. Instead, it suggests that the bright radar reflections previously interpreted as liquid water are likely due to resolution interference between radio waves. This finding, based on computer simulations, challenges the notion of subsurface liquid water on Mars.Finally, we highlight the development of a new daytime optical telescope, the Huntsman, which allows astronomers to observe celestial objects even when the sun is high overhead. This groundbreaking instrument, located at Siding Spring Observatory, uses an array of camera lenses designed for ultra-sensitive night sky observations but can also accurately measure stars and satellites during daylight.Follow our cosmic conversations on X @stuartgary, Instagram, YouTube, and Facebook. Join us as we unravel the mysteries of the universe, one episode at a time.Sponsor OfferThis episode is proudly supported by NordPass. Secure your digital journey across the cosmos with a password manager you can trust. Find your stellar security solution at https://www.bitesz.com/nordpass.For more sponsor offers visit: https://www.bitesz.com/sponsors/Listen to SpaceTime on your favourite podcast app including Apple Podcasts, Spotify, YouTube Music, or wherever you get your podcasts.Support SpaceTimeBecome a supporter of SpaceTime: https://www.bitesz.com/show/spacetime/support/

In this episode of the ‘NDA@10' series, businessline's Dalip Singh talks to Rajinder Singh Bhatia, President of the SIDM, about the transformation of India's defence sector over the past decade.   Bhatia starts the discussion by commending the government's policy implementation and underscores the importance of export orientation and preference for Indian products as game changers.   Bhatia also talks about how India has been pushing towards policy transparency in defence procurement, preference for Indian products and focus on indigenisation.   The conversation goes on to highlight the nation's historical reliance on imports for defense equipment and emphasises the significant policy interventions and strides towards indigenisation since 2014.   Singh discusses the emergence of a vibrant defence industry, marked by increased private sector involvement, the proliferation of startups, and a notable surge in exports and military diplomacy.  Overall, the discussion provides a comprehensive overview of the evolution of India's defence sector under the NDA government, highlighting achievements, challenges, and future prospects. 

Orientations of DM Halos in FIRE-2 Milky Way-mass Galaxies by Jay Baptista et al. on Wednesday 30 November The shape and orientation of dark matter (DM) halos are sensitive to the micro-physics of the DM particle, yet in many mass models, the symmetry axes of the Milky Way's DM halo are often assumed to be aligned with the symmetry axes of the stellar disk. This is well-motivated for the inner DM halo but not for the outer halo. We use zoomed cosmological-baryonic simulations from the Latte suite of FIRE-2 Milky Way-mass galaxies to explore the evolution of the DM halo's orientation with radius and time, with or without a major merger with a Large Magellanic Cloud (LMC) analog, and when varying the DM model. In three of the four CDM halos we examine, the orientation of the halo minor axis diverges from the stellar disk vector by more than 20 degrees beyond about 30 galactocentric kpc, reaching a maximum of 30--90 degrees depending on the individual halo's formation history. In identical simulations using a model of self-interacting DM with $sigma = 1 , mathrm{cm}^2 , mathrm{g}^{-1}$, the halo remains aligned with the stellar disk out to $sim$200--400 kpc. Interactions with massive satellites ($M gtrsim 4 times 10^{10} , rm{M_odot}$ at pericenter; $M gtrsim 3.3 times 10^{10} , rm{M_odot}$ at infall) affect the orientation of the halo significantly, aligning the halo's major axis with the satellite galaxy from the disk to the virial radius. The relative orientation of the halo and disk beyond 30 kpc is a potential diagnostic of SIDM if the effects of massive satellites can be accounted for. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.16382v1

Orientations of DM Halos in FIRE-2 Milky Way-mass Galaxies by Jay Baptista et al. on Wednesday 30 November The shape and orientation of dark matter (DM) halos are sensitive to the micro-physics of the DM particle, yet in many mass models, the symmetry axes of the Milky Way's DM halo are often assumed to be aligned with the symmetry axes of the stellar disk. This is well-motivated for the inner DM halo but not for the outer halo. We use zoomed cosmological-baryonic simulations from the Latte suite of FIRE-2 Milky Way-mass galaxies to explore the evolution of the DM halo's orientation with radius and time, with or without a major merger with a Large Magellanic Cloud (LMC) analog, and when varying the DM model. In three of the four CDM halos we examine, the orientation of the halo minor axis diverges from the stellar disk vector by more than 20 degrees beyond about 30 galactocentric kpc, reaching a maximum of 30--90 degrees depending on the individual halo's formation history. In identical simulations using a model of self-interacting DM with $sigma = 1 , mathrm{cm}^2 , mathrm{g}^{-1}$, the halo remains aligned with the stellar disk out to $sim$200--400 kpc. Interactions with massive satellites ($M gtrsim 4 times 10^{10} , rm{M_odot}$ at pericenter; $M gtrsim 3.3 times 10^{10} , rm{M_odot}$ at infall) affect the orientation of the halo significantly, aligning the halo's major axis with the satellite galaxy from the disk to the virial radius. The relative orientation of the halo and disk beyond 30 kpc is a potential diagnostic of SIDM if the effects of massive satellites can be accounted for. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.16382v1

Orientations of DM Halos in FIRE-2 Milky Way-mass Galaxies by Jay Baptista et al. on Wednesday 30 November The shape and orientation of dark matter (DM) halos are sensitive to the micro-physics of the DM particle, yet in many mass models, the symmetry axes of the Milky Way's DM halo are often assumed to be aligned with the symmetry axes of the stellar disk. This is well-motivated for the inner DM halo but not for the outer halo. We use zoomed cosmological-baryonic simulations from the Latte suite of FIRE-2 Milky Way-mass galaxies to explore the evolution of the DM halo's orientation with radius and time, with or without a major merger with a Large Magellanic Cloud (LMC) analog, and when varying the DM model. In three of the four CDM halos we examine, the orientation of the halo minor axis diverges from the stellar disk vector by more than 20 degrees beyond about 30 galactocentric kpc, reaching a maximum of 30--90 degrees depending on the individual halo's formation history. In identical simulations using a model of self-interacting DM with $sigma = 1 , mathrm{cm}^2 , mathrm{g}^{-1}$, the halo remains aligned with the stellar disk out to $sim$200--400 kpc. Interactions with massive satellites ($M gtrsim 4 times 10^{10} , rm{M_odot}$ at pericenter; $M gtrsim 3.3 times 10^{10} , rm{M_odot}$ at infall) affect the orientation of the halo significantly, aligning the halo's major axis with the satellite galaxy from the disk to the virial radius. The relative orientation of the halo and disk beyond 30 kpc is a potential diagnostic of SIDM if the effects of massive satellites can be accounted for. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.16382v1

Strong Dark Matter Self-interactions Diversify Halo Populations Within and Surrounding the Milky Way by Daneng Yang et al. on Monday 28 November We perform a high-resolution cosmological zoom-in simulation of a Milky Way (MW)-like system, which includes a realistic Large Magellanic Cloud analog, using a large differential elastic dark matter self-interaction cross section that reaches $approx 100~mathrm{cm}^2 mathrm{g}^{-1}$ at relative velocities of $approx 10~mathrm{km s}^{-1}$, motivated by observational features of dwarf galaxies within and surrounding the MW. We explore the effects of dark matter self-interactions on satellite, splashback, and isolated halos through their abundance, central densities, maximum circular velocities, orbital parameters, and correlations between these variables. We use an effective constant cross section model to analytically predict the stages of our simulated halos' gravothermal evolution, demonstrating that deviations from the collisionless $R_{rm max}$--$V_{rm max}$ relation can be used to select deeply core-collapsed halos, where $V_{rm max}$ is a halo's maximum circular velocity and $R_{rm max}$ is the radius at which it occurs. We predict that a sizable fraction ($approx 20%$) of subhalos with masses down to $approx 10^8~M_{odot}$ are deeply core-collapsed in our SIDM model. Core-collapsed systems form $approx 10%$ of the total isolated halo population down to the same mass; these isolated, core-collapsed halos would host faint dwarf galaxies in the field with extremely steep central density profiles reminiscent of the Tucana dwarf galaxy. Finally, most halos with masses above $approx 10^9~M_{odot}$ are core-forming in our simulation. Our study thus demonstrates how self-interactions diversify halo populations in an environmentally-dependent fashion within and surrounding MW-mass hosts, providing a compelling avenue to address the diverse dark matter distributions of observed dwarf galaxies. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.13768v1

Strong Dark Matter Self-interactions Diversify Halo Populations Within and Surrounding the Milky Way by Daneng Yang et al. on Sunday 27 November We perform a high-resolution cosmological zoom-in simulation of a Milky Way (MW)-like system, which includes a realistic Large Magellanic Cloud analog, using a large differential elastic dark matter self-interaction cross section that reaches $approx 100~mathrm{cm}^2 mathrm{g}^{-1}$ at relative velocities of $approx 10~mathrm{km s}^{-1}$, motivated by observational features of dwarf galaxies within and surrounding the MW. We explore the effects of dark matter self-interactions on satellite, splashback, and isolated halos through their abundance, central densities, maximum circular velocities, orbital parameters, and correlations between these variables. We use an effective constant cross section model to analytically predict the stages of our simulated halos' gravothermal evolution, demonstrating that deviations from the collisionless $R_{rm max}$--$V_{rm max}$ relation can be used to select deeply core-collapsed halos, where $V_{rm max}$ is a halo's maximum circular velocity and $R_{rm max}$ is the radius at which it occurs. We predict that a sizable fraction ($approx 20%$) of subhalos with masses down to $approx 10^8~M_{odot}$ are deeply core-collapsed in our SIDM model. Core-collapsed systems form $approx 10%$ of the total isolated halo population down to the same mass; these isolated, core-collapsed halos would host faint dwarf galaxies in the field with extremely steep central density profiles reminiscent of the Tucana dwarf galaxy. Finally, most halos with masses above $approx 10^9~M_{odot}$ are core-forming in our simulation. Our study thus demonstrates how self-interactions diversify halo populations in an environmentally-dependent fashion within and surrounding MW-mass hosts, providing a compelling avenue to address the diverse dark matter distributions of observed dwarf galaxies. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.13768v1

A ~200 pc-sized core of Milky Way dark matter halo constrained from the OGLE micro-lensing sky map by Shu-Rui Lin et al. on Tuesday 22 November We report the detection of a 219 $^{+10}_{-28}$ pc-sized dark matter core structure in the center of Milky Way at $68%$ confidence level by using the micro-lensing event rate sky map data from the Optical Gravitational Lensing Experiment (OGLE) survey. For the first time, we apply the spacial information of the micro-lensing sky map and model it with the detailed Milky Way structure, the Mini Dark Matter Structure (MDMS) fraction ($f_{rm MDMS}=Omega_{rm MDMS}/Omega_{rm DM}$) and the core size. We find that this sky map can constrain both $f_{rm MDMS}$ and the core size simultaneously without strong degeneracy. This discovery provides not only guidance for dark matter particle models, such as self-interacting dark matter (SIDM), but also the baryonic physics of Milky Way. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.00666v2

A ~200 pc-sized core of Milky Way dark matter halo constrained from the OGLE micro-lensing sky map by Shu-Rui Lin et al. on Monday 21 November We report the detection of a 219 $^{+10}_{-28}$ pc-sized dark matter core structure in the center of Milky Way at $68%$ confidence level by using the micro-lensing event rate sky map data from the Optical Gravitational Lensing Experiment (OGLE) survey. For the first time, we apply the spacial information of the micro-lensing sky map and model it with the detailed Milky Way structure, the Mini Dark Matter Structure (MDMS) fraction ($f_{rm MDMS}=Omega_{rm MDMS}/Omega_{rm DM}$) and the core size. We find that this sky map can constrain both $f_{rm MDMS}$ and the core size simultaneously without strong degeneracy. This discovery provides not only guidance for dark matter particle models, such as self-interacting dark matter (SIDM), but also the baryonic physics of Milky Way. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.00666v2

Matching the mass function of Milky Way satellites in competing dark matter models by Mark R. Lovell et al. on Thursday 15 September Any successful model of dark matter must explain the diversity of observed Milky Way (MW) satellite density profiles, from very dense ultrafaints to large, low density satellites such as Crater~II that appear to be larger their anticipated host dark matter haloes. We consider cold dark matter (CDM), warm dark matter (WDM, 3.3keV thermal relic power spectrum), and a self-interacting dark matter model (SIDM) that induces gravothermal collapse in low mass subhaloes. Predictions for these density profiles are complicated by the limitations of simulation resolution in the stripping of subhaloes by the MW system, therefore we make predictions for satellite properties in these three models using $N$-body simulations combined with a semi-analytic halo stripping algorithm. We find that most CDM and WDM subhaloes of mass $>10^{8}$$M_{odot}$ are large enough after stripping to fit most satellites; however, the required amount of stripping often requires a stronger tidal field than is available on the subhalo's orbit. The lower concentrations of WDM subhaloes enable this model to explain the required satellite masses with less stripping than is necessary for CDM, and is thus consistent with orbits of larger pericentres. SIDM cores offer the best fits to massive, low density satellites at the expense of predicting many $>10^{9}$$M_{odot}$ subhaloes to host low density satellites with no observed analogue. We conclude that an SIDM model must have a very high velocity-dependent cross-section in order to match all satellites, and that WDM offers a marginally better fit than CDM to the MW satellite mass function. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2209.06834v1

Modelling self-interacting dark matter substructures I: Calibration with N-body simulations of a Milky-Way-sized halo and its satellite by Masato Shirasaki et al. on Tuesday 06 September We study evolution of single subhaloes with their masses of $sim10^9 M_odot$ in a Milky-Way-sized host halo for self-interacting dark matter (SIDM) models. We perform dark-matter-only N-body simulations of dynamical evolution of individual subhaloes orbiting its host by varying self-scattering cross sections (including a velocity-dependent scenario), subhalo orbits, and internal properties of the subhalo. We calibrate a gravothermal fluid model to predict time evolution in spherical mass density profiles of isolated SIDM haloes with the simulations. We find that tidal effects of SIDM subhaloes can be described with a framework developed for the case of collision-less cold dark matter (CDM), but a shorter typical time scale for the mass loss due to tidal stripping is required to explain our SIDM simulation results. As long as the cross section is less than $sim10, mathrm{cm}^2/mathrm{g}$ and initial states of subhaloes are set within a $2sigma$-level scatter at redshifts of $sim2$ predicted by the standard $Lambda$CDM cosmology, our simulations do not exhibit a prominent feature of gravothermal collapse in the subhalo central density for 10 Gyr. We develop a semi-analytic model of SIDM subhaloes in a time-evolving density core of the host with tidal stripping and self-scattering ram pressure effects. Our semi-analytic approach provides a simple, efficient and physically-intuitive prediction of SIDM subhaloes, but further improvements are needed to account for baryonic effects in the host and the gravothermal instability accelerated by tidal stripping effects. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2205.09920v2

L'une des questions qui taraude les astrophysiciens est l'origine des trous noirs supermassifs. Certains trous noirs de plus de 1 milliard de masses solaires sont observés dans l'Univers à peine âgé de 800 millions d'années. Un grossissement aussi rapide est difficilement conciliable avec ce que l'on connaît. Il faudrait notamment que ces trous noirs grossissent à partir de graines de trous noirs déjà suffisamment massives, mais les mécanismes à même de produire ces graines sont encore très incertains. Aujourd'hui, Wei-Xiang Feng, Hai-Bo Yu, and Yi-Ming Zhong, spécialistes de la matière noire qui interagit avec elle-même (la matière noire de type SIDM) montrent que ce type de matière noire peut grandement faciliter la constitution de graines de trous noirs très massives. Les chercheurs publient leur étude dans The Astrophysical Journal sous le titre Seeding Supermassive Black Holes with Self-interacting Dark Matter: A Unified Scenario with Baryons.

In this episode of GENEYE Pod, host Dr Jacqueline Beltz talks with Associate Professor Carmel Crock, OAM, Emergency Physician and Director of the Emergency Department at The Royal Victorian Eye and Ear Hospital about diagnostic error and medical professionalism. Medical Professionalism is a complex topic.  At first glance it can seem straight forward but professionalism is difficult to define.  Professionalism is important within medicine for our patients', our own and our workplace experiences, but it is also important for clinical outcomes.    We're more likely to make mistakes if we behave unprofessionally.  Professionalism in the medical setting is also associated with increased patient satisfaction, trust, and adherence to treatment plans;  fewer patient complaints and reduced risk of litigation.  Professionalism has also been associated with physician excellence.In this episode, Dr Beltz talks about why professionalism should be considered a buildable skill rather than a personality trait.  She discusses some of the concepts linking unprofessional behaviours to diagnostic errors and suggests that this is not only bad for our patients but for us too.  Dr Beltz and Associate Professor Crock take the discussion further, with particular focus on strategies to improve knowledge, skills and culture relating to diagnostic error.  They discuss why management of diagnostic errors is so difficult and why professionalism is critical.  They also discuss management strategies and ways to improve these skills, highlighting the importance of positive role modelling.At GENEYE, we care about ourselves and each other, so we can care for our patients.  We can't even begin to truly think we will serve our patients adequately if we don't care about ourselves.  Associate Professor Crock and Dr Beltz conclude their discussion with conversation about medical culture and wellbeing – what they have seen improve and what they hope will come next.___________________________________________________________________________Acknowledgments Jacqueline Beltz and GENEYE would like to thank The Mind Room, Collingwood for supporting our program and allowing us to record in their studio.   Thank you also to Professors Ian Incoll and Debra Nestel from University of Melbourne Masters of Surgical Education program for their ongoing support, teaching and encouragement.GENEYE POD is written, and hosted by Jacqueline Beltz and produced with the help of Nick Green from CORP COMM.We would like to acknowledge the people of the Kulin Nations who are the traditional custodians of the land on which this podcast was recorded.  We would also like to pay our respects to Elders past, present and emerging and to any Aboriginal and/or Torres Strait Islander people who might listen to this podcast.  ___________________________________________________________________________  Further resources:GENEYE   https://www.geneye.org.auSociety to improve diagnosis in medicine (SIDM) https://www.improvediagnosis.orgAustralasian Diagnostic Error in Medicine Conference https://www.ashm.org.au/Conferences/conferences-we-organise/AusDEM-Conference/

La découverte il y a deux ans de deux galaxies ultradiffuses qui semblent dépourvues presque totalement de matière noire (NGC 1052-DF2 et NGC 1052-DF4) a fait couler beaucoup d'encre. Aujourd'hui, des astrophysiciens chinois montrent qu'en substituant au modèle de matière noire CDM le modèle SIDM (Self Interacting Dark Matter), on parvient à expliquer les caractéristiques de ces deux galaxies anormales. Une étude publiée dans la très relevée Physical Review Letters.

In this episode, we speak to the co-founder of the Society to Improve Diagnosis in Medicine (SIDM) Paul Epner to get the skinny on the good, the bad, and the ugly of the diagnostic process and ways of using health IT and patient engagement to improve it, as well as health inequities and social determinants of health that can contribute to misdiagnosis and non-diagnosis, which we hope to expand on in future episodes. We also hear about the humble and surprisingly recent beginnings that led to the impressive current state of SIDM, what inspired its inception, and where it's headed in the future. SHOW NOTES: - SIDM PAIRED Program: Diagnosis: www.improvediagnosis.org/patients-imp…n-diagnosis/ - SIDM Patient Toolkit: www.improvediagnosis.org/patients-toolkit/ BIO: Paul L. Epner, MBA, MEd (Ex-officio) is the Chief Executive Officer and co-founder of the Society to Improve Diagnosis in Medicine (SIDM). He is also the Chair of the Coalition to Improve Diagnosis, a multi-organization collaboration. Paul is a Past President of the Clinical Laboratory Management Association (CLMA) where he also created the Increasing Clinical Effectiveness (ICE) initiative. He is a member of the CDC's “Clinical Laboratory Integration into Healthcare Collaborative,” a consultant to their Laboratory Medicine Best Practices program (an evidence-based practice initiative), and Chair of the Coordinating Council on the Clinical Laboratory Workforce's (CCCLW) Taskforce on Measuring Testing-Related Value. PRODUCED BY: Emily Wittenhagen | Marketing & Communications Manager, Foundation for Health Care Quality THEME MUSIC: Banadu | Seattle, WA: @banadu

Welcome to AiArthritis Voices 360. This episode join your host, Tiffany, as she and co-host Suz Schrandt discuss the importance of early detection and diagnosis. They address barriers to receiving an accurate diagnosis, as well as what patients can do to increase their chances of receiving an accurate diagnosis in a timely fashion. Research consistently shows that early intervention improves patient outcomes. Whether you are a patient looking to confirm the accuracy of your diagnosis or avoid diagnostic delays in the event of new disease onset or a member of the public wondering if you or someone you love could be experiencing the onset of a rheumatological disease, this episode is a must-listen!   AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Find us on the web at www.aiarthritis.org/podcast. Join our online private forum to have your seat at the table.  Show Notes: Episode 6 – “Early Diagnosis” 00:56 – Tiffany welcome listeners and Co-Host Suz Schrandt01:35 – Suz explains Expect, a patient engagement initiative she founded02:44 – The topic for today’s episode is early diagnosis because so many people        experience delays in diagnosis that last months or years04:15 – People frequently receive the wrong rheumatological diagnosis and treatment before discovering the correct one07:15 - Delays lead to regret and distress as people wonder if they could be in remission if they had been diagnosed and received treatment sooner07:48 - Suz’s diagnostic story16:20 - Suz explains Polyarticular, Oligoarticular, and Systemic JIA (3 of the most   common types of Juvenile Idiopathic Arthritis)16:57 - Systemic JIA can be difficult to differentiate from juvenile lupus 19:25 - Clinicians have a tendency to focus on specific symptoms or parts of the body instead of seeing the whole picture, which adds to diagnostic delays 19:40 - Institutional barriers like short appointment times, overcrowded physician schedules, and cost concerns also cause delays in diagnosis20:50 - Some of the hallmark symptoms of arthritis (like pain and fatigue) are invisible 21:17 - People will delay seeking medical help until they exhaust all options to manage symptoms themselves because amongst other things we assume it’s something we can manage or because we’re afraid of navigating the healthcare system23:16 - Early age onset can also contribute to diagnostic delays because the patient appears very healthy 23:29 - Diagnostic delays also occur when medical professionals do not believe patients’ stories24:50 - There are between 40,000 and 80,000 deaths per year in the United States due to delayed and missed diagnoses 25:12 - Age, gender, race, and ethnicity can all cause diagnostic delays25:56 - Patients need to receive all of their test results in a timely fashion and may need to advocate to receive access to them27:27 - Patients do not need positive bloodwork to receive an RA diagnosis, but it is very common for doctors to dismiss patients without supporting bloodwork results29:35 - ACR diagnostic criteria only requires 1 or more swollen joints for more than 6 weeks without another explanation, but many clinicians - especially primary care - do not know that30:26 - If your erythrocyte sedimentation rate (SED rate) is elevated or your RA factor is positive, that can be helpful for a diagnosis, but it is not required31:35 - Testing positive for the HLA-B27 antigen increases the chances that you have ankylosing spondylitis (but some with radiographic changes may not have the gene).32:38 - Suz explains work she has done to teach medical students how to diagnose aiarthritis 35:34 - The work Suz has done to teach practicing clinicians to identify aiarthritis diseases has increased referrals to a rheumatologist by 11% among doctors who completed the training she provides36:30 - Treatment in the first two years is critical to preventing longterm damage and destruction38:22 - You can review the diagnostic criteria for any rheumatological illness on the ACR or EULAR websites and use the information to discuss your concerns with your clinician39:19 - Tracking your symptoms can really help avoid diagnostic delays and maximize the value of your appointment time with your doctor41:13 - SIDM (Society to Improve Diagnosis in Medicine) collects stories from patients of delayed or missed diagnoses 42:23 - Tiffany invites listeners to visit aiarthritis.org/podcast and view the page for this episode to share your diagnosis story with SIDM or view diagnostic criteria on the ACR site43:08 - Tiffany invites listeners to visit aiarthrits.org/voices to register and participate in discussions about this and other important issues surrounding aiarthritis diseases 43:46 - Tiffany thanks Suz for stopping by to discuss early detection and diagnosis of aiarthritis diseases 

Listen NowTwenty years ago last month the National Academy of Sciences published the landmark report, “To Err Is Human, Building a Safer Health System.”  The report found upwards of 98,000 people die each year in hospitals alone as a result of medical errors.  One specific medical error, diagnostic error, was, and remains today, a substantial contributor.  Defined as a wrong, delayed or missed diagnosis, misdiagnoses continue to constitute a major public health problem, adversely affecting more than 12 million annually.  Approximately one-third of whom are seriously harmed and an estimated 40,000 to 80,000 die each year from diagnostic failures in hospitals alone.  Resulting costs are estimated over $100 billion annually.  Despite the problem's pervasiveness and dire effects, the federal government spends less than $10 million annually researching the problem.  (For perspective, the 2019 NIH budget was $39 billion.)   During this 30 minute conversation, Mr. Epner briefly describes the Society to Improve Diagnosis in Medicine's activities, discusses the use/non-use of autopsies in reducing diagnostic errors, the extent to which improved imaging technology is reducing errors and the extent to which this issue is a disparities problem.  He, moreover, discusses efforts to increase funding to address the problem, needed payment reforms, efforts to identify related quality performance measures and recently introduced legislation to improve funding and research.   Mr. Paul L. Epner, MBA, is the Chief Executive Officer and Co-founder of the Society to Improve Diagnosis in Medicine (SIDM).  He is also Chair of the Coalition to Improve Diagnosis, a collaborative with more than fifty of the country's leading healthcare societies, health systems, patient organizations, and organizations focused on improving quality.  He recently was named to the National Steering Committee for Patient Safety.  Mr. Epner is a Past President of the Clinical Laboratory Management Association (CLMA) where he also created the Increasing Clinical Effectiveness (ICE) initiative.  He was recently a member of the CDC's “Clinical Laboratory Integration into Healthcare Collaborative” and a consultant to their Laboratory Medicine Best Practices program (an evidence-based practice initiative).  Mr. Epner is an Associate Editor for the peer-reviewed journal, Diagnosis.Information on SIDM is at: https://www.improvediagnosis.org/. The 2015 National Academy of Sciences expert committee report noted during this interview, "Improving Diagnosis in Health Care," is at: http://www.nationalacademies.org/hmd/Reports/2015/Improving-Diagnosis-in-Healthcare. Recently introduced legislation to address misdiagnoses, i.e., the "Improving Diagnosis in Medicine Act of 2019" (HR 5014), is at: https://www.congress.gov/search?q=%7B%22congress%22%3A%22116%22%2C%22source%22%3A%22legislation%22%2C%22search%22%3A%22HR%205014%20%22%7D&searchResultViewType=expanded.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Enjoy a short episode where we bring you our highlights of the DEM2016 conference in Hollywood, Los Angeles. This is a very well-organised, relevant, and creative conference, and it just gets better every year.  Consider attending the next DEM conference.  Either in Boston in one year, or come to visit our neck of woods for the first Australasian DEM in Melbourne in May! You can get more information on the SIDM website: http://www.improvediagnosis.org  

The Diagnostic Error in Medicine Conference 2015 has finally come!  We have been looking forward to attending this conference for a while now.  This comes on the heels of the freshly published Institute of Medicine Report on diagnostic error, an initiative which was prompted by SIDM, with Mark Graber at the helm.  These three episodes, 6, 7, and 8 are our end-of-day reflections on the presentations we have heard. Don't forget to post your comments on our website imreasoning.com, in particular about your thoughts on the IOM's definition of a diagnostic error.

The Diagnostic Error in Medicine Conference 2015 has finally come!  We have been looking forward to attending this conference for a while now.  This comes on the heels of the freshly published Institute of Medicine Report on diagnostic error, an initiative which was prompted by SIDM, with Mark Graber at the helm.  These three episodes, 6, 7, and 8 are our end-of-day reflections on the presentations we have heard. Don't forget to post your comments on our website imreasoning.com, in particular about your thoughts on the IOM's definition of a diagnostic error.

The Diagnostic Error in Medicine Conference 2015 has finally come!  We have been looking forward to attending this conference for a while now.  This comes on the heels of the freshly published Institute of Medicine Report on diagnostic error, an initiative which was prompted by SIDM, with Mark Graber at the helm.  These three episodes, 6, 7, and 8 are our end-of-day reflections on the presentations we have heard. Don't forget to post your comments on our website imreasoning.com, in particular about your thoughts on the IOM's definition of a diagnostic error.

The genus Legionella consists of environmental bacteria which are the causative agents of the severe pneumonia Legionnaires’ disease. L. longbeachae and L. pneumophila are able to replicate intracellularly in human alveolar macrophages and aquatic or soil amoebae. In order to replicate within host cells the bacteria establish a compartment derived from the endoplasmatic reticulum (ER) which is called “Legionella-containing vacuole” (LCV). A bacterial intracellular multiplication/defective in organelle transport (Icm/Dot) type IV secretion system (T4SS) is essential for the formation of this LCV. The Icm/Dot T4SS enables translocation of effector proteins into the host cell. More than 100 effector proteins are presumably translocated during an L. longbeachae infection whereas around 300 translocated effector proteins are known for L. pneumophila. During maturation the LCV communicates with vesicles from the endocytic vesicle trafficking pathway, avoids fusion with lysosomes and instead fuses with the ER. Phosphoinositides (PI) such as phosphatitdylinositol-4-phosphate (PtdIns(4)P) are enriched on the LCV which mediate the binding of Icm/Dot translocated effector proteins like SidCLpn (substrate of Icm/Dot transporter) as well as its paralogous protein SdcALpn. The 73 kDa effector SidM but not the 106 kDa SidCLpn was found in a previous phosphoinositide pulldown assay with L. pneumophila lysate to be the major PtdIns(4)P binding protein. Using L. longbeachae lysate we showed binding of the 111 kDa SidCLlo to PtdIns(4)P in a phosphoinositide pulldown. This result was confirmed by protein-lipid overlay assays using “PIP-strips”. In further analysis the P4C (PtdIns(4)P-binding of SidC) domain was identified as a 19 kDa domain of SidCLlo located in the amino acid region 609 to 782. This P4C domain was located in the same region as the 20 kDa SidCLpn_P4C domain of L. pneumophila. Both P4C domains can be used as LCV markers. This was shown with GST-tagged proteins binding to LCVs in a cell homogenate. The two P4C domains show a sequence identity of only 45% and the full-length protein of 40%. Circular dichroism measurements revealed that the secondary structure of the two proteins is similar. Moreover, isothermal titration calorimetric measurements indicated a 3.4 higher affinity of SidCLlo towards PtdIns(4)P compared with SidCLpn. In RAW 264.7 macrophages infected with L. longbeachae we showed that endogenous SidCLlo as well as heterologously produced SidCLpn is translocated to the LCV in an Icm/Dot-dependent manner. The deletion of the sidCLlo gene led to a reduced recruitment of calnexin to the LCV in infected Dictyostelium discoideum. This effect was complemented by adding plasmid-encoded SidCLlo, SidCLpn or SdcALpn. The same recruitment defect for a L. pneumophila strain lacking the sidCLpn and sdcALpn genes was complemented by the production of SidCLlo and SidCLpn as published before. Therefore, these effectors play a role for pathogen-host interactions by promoting the recruitment of ER to the LCV. L. longbeachae or L. pneumophila wild-type strains outcompeted their sidC deletion mutant in a competition assay in Acanthamoeba castellanii. However neither of the deletion mutants were impaired in their growth in single strain replication experiments. In summary despite of the small sequence identity and the higher binding affinity to PtdIns(4)P of SidCLlo compared to SidCLpn both effector proteins seem to have similar functions during an infection of Legionella. For the characterization of L. longbeachae-containing vacuoles through proteomic analysis, LCVs had to be isolated from infected D. discoideum or RAW 264.7 macrophages. Endogenous SidCLlo or heterologously produced SidCLpn were used as LCV markers for the isolation. Pathogen vacuoles harbouring L. longbeachae were isolated by immuno-affinity purification using antibodies specifically recognizing SidCLlo or SidCLpn. Future investigations aim at optimizing the LCV purification protocol for L. longbeachae to determine the proteome composition of the L. longbeachae-containing vacuole.