GIST with a twist: An extra-luminal pedunculated gastric GIST presenting with tumor torsion and hemoperitoneum

AbstractGastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. Most present with nonspecific symptoms. We present a case of a 17-year-old male with sudden abdominal pain. Imaging revealed a hypodense mass inferior to the stomach. Serial blood work showed a decreasing hemoglobin level. In the operating room a pedunculated, torted, hemorrhagic mass on the anterior surface of the stomach was resected. Pathology confirmed a GIST, c-kit positive with involved margins. The patient was started on imatinib. Pediatric GISTS are different than adult GISTs; the majority are c-kit negative (wild-type) and typically indolent. Despite a high recurrence rate, aggressive resection of pediatric GIST is generally not indicated. This pediatric GISTs was c-kit and PDGFR exon 18 mutation positive and thus was treated according to the National Comprehensive Cancer Network (NCCN) guidelines (for adults)

Eliciting human intelligence: police source handlers' perceptions and experiences of rapport during covert human intelligence sources (CHIS) interactions

Rapport is an integral part of interviewing, viewed as fundamental to the success of intelligence elicitation. One collection capability is human intelligence (HUMINT), the discipline charged with eliciting intelligence through interactions with human sources, such as covert human intelligence sources (CHIS). To date, research has yet to explore the perceptions and experiences of intelligence operatives responsible for gathering HUMINT within England and Wales. The present study consisted of structured interviews with police source handlers (N = 24). Rapport was perceived as essential, especially for maximising the opportunity for intelligence elicitation. Participants provided a range of rapport strategies while highlighting the importance of establishing, and maintaining, rapport. The majority of participants believed rapport could be trained to some degree. Thus, rapport was not viewed exclusively as a natural skill. However, participants commonly perceived some natural attributes are required to build rapport that can be refined and developed through training and experience

The impact of rapport on intelligence yield: police source handler telephone interactions with covert human intelligence sources

Covert Human Intelligence Sources (CHIS) provide unique access to criminals and organised crime groups, and their collection of intelligence is vital to understanding England and Wales’ threat picture. Rapport is essential to the establishment and maintenance of effective professional relationships between source handlers and their CHIS. Thus, rapport-based interviewing is a fundamental factor to maximising intelligence yield. The present research gained unprecedented access to 105 real-life audio recorded telephone interactions between England and Wales police source handlers and CHIS. This research quantified both the rapport component behaviours (e.g., attention, positivity, and coordination) displayed by the source handler and the intelligence yielded from the CHIS, in order to investigate the frequencies of these rapport components and their relationship to intelligence yield. Overall rapport, attention and coordination significantly correlated with intelligence yield, while positivity did not. Attention was the most frequently used component of rapport, followed by positivity, and then coordination

Source handler's perceptions of the interviewing process employed with Informants

The collection of accurate, detailed, and timely intelligence buttresses critical law enforcement decision-making. However, the quality and quantity of the intelligence gathered relies heavily upon the interviewing techniques that are used to retrieve it. The perceptions of intelligence practitioners are key to developing an understanding of practices concerning intelligence collection. Yet, to date, no research has been undertaken that explores the United Kingdom’s Source Handlers’ perceptions of the interviewing processes employed with informants. The present study interviewed 24 Source Handlers from Counter Terrorism Dedicated Source Units in the United Kingdom. Five themes emerged from the interviews, (i) a comparison between interviewing and debriefing; (ii) the PEACE model in intelligence interviews; (iii) the importance of effective communication; (iv) Source Handlers’ use of cognitive retrieval techniques; and, (v) Source Handler interview training. The perceived commonalities between interviewing and debriefing provided support for the transferability of investigative interviewing research and practices into the collection of Human Intelligence (HUMINT), reiterating themes (ii), (iii), and (iv). Finally, participants highlighted a need for additional training concerning intelligence gathering techniques, as police officers who are responsible for gathering HUMINT could benefit from further professional development based on investigative interviewing research and professional practices

Developing and validating subjective and objective risk-assessment measures for predicting mortality after major surgery: An international prospective cohort study

Background: Preoperative risk prediction is important for guiding clinical decision-making and resource allocation. Clinicians frequently rely solely on their own clinical judgement for risk prediction rather than objective measures. We aimed to compare the accuracy of freely available objective surgical risk tools with subjective clinical assessment in predicting 30-day mortality. Methods and findings: We conducted a prospective observational study in 274 hospitals in the United Kingdom (UK), Australia, and New Zealand. For 1 week in 2017, prospective risk, surgical, and outcome data were collected on all adults aged 18 years and over undergoing surgery requiring at least a 1-night stay in hospital. Recruitment bias was avoided through an ethical waiver to patient consent; a mixture of rural, urban, district, and university hospitals participated. We compared subjective assessment with 3 previously published, open-access objective risk tools for predicting 30-day mortality: the Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality (P-POSSUM), Surgical Risk Scale (SRS), and Surgical Outcome Risk Tool (SORT). We then developed a logistic regression model combining subjective assessment and the best objective tool and compared its performance to each constituent method alone. We included 22,631 patients in the study: 52.8% were female, median age was 62 years (interquartile range [IQR] 46 to 73 years), median postoperative length of stay was 3 days (IQR 1 to 6), and inpatient 30-day mortality was 1.4%. Clinicians used subjective assessment alone in 88.7% of cases. All methods overpredicted risk, but visual inspection of plots showed the SORT to have the best calibration. The SORT demonstrated the best discrimination of the objective tools (SORT Area Under Receiver Operating Characteristic curve [AUROC] = 0.90, 95% confidence interval [CI]: 0.88–0.92; P-POSSUM = 0.89, 95% CI 0.88–0.91; SRS = 0.85, 95% CI 0.82–0.87). Subjective assessment demonstrated good discrimination (AUROC = 0.89, 95% CI: 0.86–0.91) that was not different from the SORT (p = 0.309). Combining subjective assessment and the SORT improved discrimination (bootstrap optimism-corrected AUROC = 0.92, 95% CI: 0.90–0.94) and demonstrated continuous Net Reclassification Improvement (NRI = 0.13, 95% CI: 0.06–0.20, p < 0.001) compared with subjective assessment alone. Decision-curve analysis (DCA) confirmed the superiority of the SORT over other previously published models, and the SORT–clinical judgement model again performed best overall. Our study is limited by the low mortality rate, by the lack of blinding in the ‘subjective’ risk assessments, and because we only compared the performance of clinical risk scores as opposed to other prediction tools such as exercise testing or frailty assessment. Conclusions: In this study, we observed that the combination of subjective assessment with a parsimonious risk model improved perioperative risk estimation. This may be of value in helping clinicians allocate finite resources such as critical care and to support patient involvement in clinical decision-making

Asymptotic Improvement of Resummation and Perturbative Predictions in Quantum Field Theory

The improvement of resummation algorithms for divergent perturbative expansions in quantum field theory by asymptotic information about perturbative coefficients is investigated. Various asymptotically optimized resummation prescriptions are considered. The improvement of perturbative predictions beyond the reexpansion of rational approximants is discussed.Comment: 21 pages, LaTeX, 3 tables; title shortened; typographical errors corrected; minor changes of style; 2 references adde

The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial a training intervention for community mental health teams in recovery-oriented practice

Background: Recovery features strongly in Australian mental health policy; however, evidence is limited for the efficacy of recovery-oriented practice at the service level. This paper describes the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care trial protocol for a recovery-oriented practice training intervention delivered to specialist mental health services staff. The primary aim is to evaluate whether adult consumers accessing services where staff have received the intervention report superior recovery outcomes compared to adult consumers accessing services where staff have not yet received the intervention. A qualitative sub-study aims to examine staff and consumer views on implementing recovery-oriented practice. A process evaluation sub-study aims to articulate important explanatory variables affecting the interventions rollout and outcomes. Methods: The mixed methods design incorporates a two-step stepped-wedge cluster randomized controlled trial (cRCT) examining cross-sectional data from three phases, and nested qualitative and process evaluation sub-studies. Participating specialist mental health care services in Melbourne, Victoria are divided into 14 clusters with half randomly allocated to receive the staff training in year one and half in year two. Research participants are consumers aged 18-75 years who attended the cluster within a previous three-month period either at baseline, 12 (step 1) or 24 months (step 2). In the two nested sub-studies, participation extends to cluster staff. The primary outcome is the Questionnaire about the Process of Recovery collected from 756 consumers (252 each at baseline, step 1, step 2). Secondary and other outcomes measuring well-being, service satisfaction and health economic impact are collected from a subset of 252 consumers (63 at baseline; 126 at step 1; 63 at step 2) via interviews. Interview based longitudinal data are also collected 12 months apart from 88 consumers with a psychotic disorder diagnosis (44 at baseline, step 1; 44 at step 1, step 2). cRCT data will be analyzed using multilevel mixed-effects modelling to account for clustering and some repeated measures, supplemented by thematic analysis of qualitative interview data. The process evaluation will draw on qualitative, quantitative and documentary data. Discussion: Findings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery

Police Strategies and Suspect Responses in Real-Life Serious Crime Interviews

This research focuses exclusively on real-life taped interviews with serious crime suspects and examines the strategies used and types of questions asked by police, and suspects’ responses to these. The information source was audio-tape-recorded interviews with 56 suspects. These recordings were obtained from 11 police services across England and Wales and were analysed using a specially designed coding frame. It was found that interviewers employed a range of strategies with presentation of evidence and challenge the most frequently observed. Closed questions were by far the most frequently used, and open questions, although less frequent, were found to occur more during the opening phases of the interviews. The frequency of ineffective question types (e.g. negative, repetitive, multiple) was low. A number of significant associations were observed between interviewer strategies and suspect responses. Rapport/empathy and open-type questions were associated with an increased likelihood of suspects admitting the offence whilst describing trauma, and negative questions were associated with a decreased likelihood

Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: A revised measure of psychological flexibility and acceptance.

The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78 - .88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates,that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r = .97), but with better psychometric consistency