Implementation of a computer-guided consultation in the assessment of suspected obstructive sleep apnoea syndrome.

BACKGROUND: We describe implementation of a clinical decision support system, a computer-guided consultation (CGC), in the assessment of subjects referred with suspected obstructive sleep apnoea syndrome (OSAS). METHODS: Two cohorts of patients were assessed. The first 100 cases had data collected with the CGC by a specialist sleep physician (stage1). A further 100 cases were assessed by a nonspecialist using the CGC (stage 2). For each case, the diagnosis suggested by the CGC was compared with the final diagnosis made by a second specialist sleep physician blinded to the CGC diagnosis. RESULTS: Stage 1: of 100 people evaluated, a final diagnosis of OSAS was made by both the sleep specialist and CGC in 88% of cases. In 7 of the remaining 12 cases, both agreed there was "No evidence of OSAS"; in 5 cases the CGC did not reach a final diagnosis instead prompting specialist referral. Stage 2: 100 people were evaluated; 95% were evaluable. Both CGC and the sleep specialist made a diagnosis of OSAS in 83 cases (87%), in 5 cases both agreed there was no OSAS, whereas in 7 cases the CGC prompted a specialist review due to unexplained symptoms. The CGC was concordant with the final diagnosis in 95% and 93% of cases in the two cohorts, respectively and where there was doubt, prompted for clinical review. No OSAS cases were overlooked by the CGC. CONCLUSION: An intelligent CGC program creates opportunities in sleep medicine management pathways to safely yet effectively utilise nonspecialists working under specialist supervision.

Palaeotsunamis and tsunami hazards in the Eastern Mediterranean.

The dominant uncertainties in assessing tsunami hazard in the Eastern Mediterranean are attached to the location of the sources. Reliable historical reports exist for five tsunamis associated with earthquakes at the Hellenic plate boundary, including two that caused widespread devastation. Because most of the relative motion across this boundary is aseismic, however, the modern record of seismicity provides little or no information about the faults that are likely to generate such earthquakes. Independent geological and geophysical observations of two large historical to prehistorical earthquakes, in Crete and Rhodes, lead to a coherent framework in which large to great earthquakes occurred not on the subduction boundary, but on reverse faults within the overlying crust. We apply this framework to the less complete evidence from the remainder of the Hellenic plate boundary zone, identifying candidate sources for future tsunamigenic earthquakes. Each such source poses a significant hazard to the North African coast of the Eastern Mediterranean. Because modern rates of seismicity are irrelevant to slip on the tsunamigenic faults, and because historical and geological data are too sparse, there is no reliable basis for a probabilistic assessment of this hazard, and a precautionary approach seems advisable.

Global systematics of arc volcano position.

Global systematics in the location of volcanic arcs above subduction zones are widely considered to be a clue to the melting processes that occur at depth, and the locations of the arcs have often been explained in terms of the release of hydrous fluids near the top of the subducting slab (see, for example, refs 3-6). Grove et al. conclude that arc volcano location is controlled by melting in the mantle at temperatures above the water-saturated upper-mantle solidus and below the upper limit of stability of the mineral chlorite and in particular, that the arc fronts lie directly above the shallowest point of such melt regions in the mantle. Here we show that this conclusion is incorrect because the calculated arc locations of Grove et al. are in error owing to the inadequate spatial resolution of their numerical models, and because the agreement that they find between predicted and observed systematics arises from a spurious correlation between calculated arc location and slab dip. A more informative conclusion to draw from their experiments is that the limits of chlorite stability (figure 1b of ref. 7) cannot explain the global systematics in the depth to the slab beneath the sharply localized arc fronts.

Melting above the anhydrous solidus controls the location of volcanic arcs.

Segregation of magma from the mantle in subduction zones is one of the principal mechanisms for chemical differentiation of the Earth. Fundamental aspects of this system, in particular the processes by which melt forms and travels to the Earth's surface, remain obscure. Systematics in the location of volcanic arcs, the surface expression of this melting, are widely considered to be a clue to processes taking place at depth, but many mutually incompatible interpretations of this clue exist (for example, see refs 1-6). We discriminate between those interpretations by the use of a simple scaling argument derived from a realistic mathematical model of heat transfer in subduction zones. The locations of the arcs cannot be explained by the release of fluids in reactions taking place near the top of the slab. Instead, the sharpness of the volcanic fronts, together with the systematics of their locations, requires that arcs must be located above the place where the boundary defined by the anhydrous solidus makes its closest approach to the trench. We show that heat carried by magma rising from this region is sufficient to modify the thermal structure of the wedge and determine the pathway through which both wet and dry melts reach the surface.

Earth science: palaeo-altimetry of Tibet.

The determination of palaeo-elevation has emerged in the past 15 years as an important tool for constraining physical processes that govern the formation of mountain belts. Rowley and Currie report palaeo-elevations for the Lunpola basin within the Tibetan plateau and claim that these elevations are incompatible with 'mantle-thickening models' for mountain formation. We show here that their data do not support this conclusion and, indeed, are consistent with its opposite. The Tibetan plateau could have risen by a kilometre or more as its dense lower lithosphere sank into the underlying mantle.

InSAR observations of low slip rates on the major faults of western Tibet.

Two contrasting views of the active deformation of Asia dominate the debate about how continents deform: (i) The deformation is primarily localized on major faults separating crustal blocks or (ii) deformation is distributed throughout the continental lithosphere. In the first model, western Tibet is being extruded eastward between the major faults bounding the region. Surface displacement measurements across the western Tibetan plateau using satellite radar interferometry (InSAR) indicate that slip rates on the Karakoram and Altyn Tagh faults are lower than would be expected for the extrusion model and suggest a significant amount of internal deformation in Tibet.