Simulation of the governance of complex systems (SimCo)

The current paper is positioned at the intersection of computer simulation, governance research, and research on infrastructure systems, such as transportation or energy. It proposes a simulation framework, “Simulation of the governance of complex systems” (SimCo), to study the governability of complex socio-technical systems experimentally by means of agent-based modelling (ABM). SimCo is rooted in a sociological macro-micro-macro model of a socio-technical system, taking into account the interplay of agents’ choices (micro) and situational constraints (macro). The paper presents the conceptualization of SimCo, its elements and subsystems as well as their interactions. SimCo depicts the daily routines of users performing their tasks (e.g. going to work) by choosing among different technologies (e.g. modes of transportation), occasionally deciding to replace a worn-out technology. All components entail different dimensions that can be adjusted, thus allowing operators to purposefully intervene, for instance in the case of risk management (e.g. preventing congestion) or system transformation (e.g. towards sustainable mobility). Experiments with a basic scenario of an urban road transport system demonstrate the effects of different modes of governance (soft control, strong control and a combination of both), revealing that soft control may be the best strategy to govern a complex socio-technical system

The era of the digital natives is approaching: Insights into online peer-to-peer support for persons affected by prostate cancer

Background!#!Optimal detection and surveillance of bladder cancer (BCa) rely primarily on the cystoscopic visualization of bladder lesions. AI-assisted cystoscopy may improve image recognition and accelerate data acquisition.!##!Objective!#!To provide a comprehensive review of machine learning (ML), deep learning (DL) and convolutional neural network (CNN) applications in cystoscopic image recognition.!##!Evidence acquisition!#!A detailed search of original articles was performed using the PubMed-MEDLINE database to identify recent English literature relevant to ML, DL and CNN applications in cystoscopic image recognition.!##!Evidence synthesis!#!In total, two articles and one conference abstract were identified addressing the application of AI methods in cystoscopic image recognition. These investigations showed accuracies exceeding 90% for tumor detection; however, future work is necessary to incorporate these methods into AI-aided cystoscopy and compared to other tumor visualization tools. Furthermore, we present results from the RaVeNNA-4pi consortium initiative which has extracted 4200 frames from 62 videos, analyzed them with the U-Net network and achieved an average dice score of 0.67. Improvements in its precision can be achieved by augmenting the video/frame database.!##!Conclusion!#!AI-aided cystoscopy has the potential to outperform urologists at recognizing and classifying bladder lesions. To ensure their real-life implementation, however, these algorithms require external validation to generalize their results across other data sets

Murine Model of Infection by Tropheryma whipplei

We developed an animal model reproducing several aspects of Whipple's disease. Immunocompetent mice were persistently infected with Tropheryma whipplei, its etiological agent, and developed liver granulomas. SCID mice were infected similarly but did not develop tissue lesions. The delayed clearance of T. whipplei suggests a protective role for innate immunity

Decision-making in localized prostate cancer: lessons learned from an online support group

Huber J, Ihrig A, Peters T, et al. Decision-making in localized prostate cancer: lessons learned from an online support group. BJU International. 2011;107(10):1570-1575.Study Type – Patient (preference/ecological) Level of Evidence 2c What's known on the subject? and What does the study add? Social support plays a major role for decision-making in localized prostate cancer and the importance of online resources has become increasingly recognized. However, so far most of the knowledge has been generated on formal and stylistic aspects. The study adds to understanding the content and the dynamics of peer-to-peer counselling in an online support group. OBJECTIVE • To investigate patient-to-patient communication with regard to decision-making in localized prostate cancer; as most of it is done in private, online support groups are a unique means for this task. PATIENTS AND METHODS • Over a 32-month period, we screened 501 threads in the largest German online support group for prostate cancer. • Threads started by questioners newly diagnosed with localized prostate cancer and stating decision-making as the key topic were included; in all, 82 (16.4%) threads met these criteria. • Two independent investigators characterized every thread following a standardized protocol. • Fisher’s exact test and Mann–Whitney U-test were applied for group analyses. A complementary qualitative linguistic approach was chosen. RESULTS • Threads were most commonly started to ask for therapy recommendations (66%), information on the course of treatment (46%) and emotional support (46%). • Answers consisted of treatment recommendations (40%), emotional support (37%) and personal experiences (28%). • A second opinion on the biopsy cores (51%) and additional imaging (40%) were common suggestions. • The rate of advice for radical prostatectomy (RP) vs radiotherapy was 67 vs 82%. Thus, surgery was less recommended in our sample (P= 0.01); 75% of the men with an initial therapeutic preference were finally confirmed herein. • Linguistic analysis showed that posters frequently use a tentative language style and that common language is avoided. CONCLUSIONS • Patients readily receive information, advice and emotional support as part of an online support group. • The scientific evaluation of an online support group is a complementary way of getting to know our patients’ needs and worries. • Patient–physician contact can benefit from this knowledge

The Treatment Decision-making Preferences of Patients with Prostate Cancer Should Be Recorded in Research and Clinical Routine: a Pooled Analysis of Four Survey Studies with 7169 Patients

Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes

Patient expectations are better for immunotherapy than traditional chemotherapy for cancer

Purpose!#!The main aim of the study was to explore the expectations and knowledge of advanced-stage cancer patients about immunotherapy.!##!Methods!#!This mixed methods study included 53 cancer patients on immune checkpoint inhibitors (ICIs), 55 cancer patients undergoing chemotherapy (CT), and 53 non-cancer patients. Participants' expectations about ICIs and CT were compared. Additional qualitative data were derived from semi-structured interviews.!##!Results!#!Among patients who did not receive ICIs, 63 (58%) had never heard of ICIs and 94 (87%) had large gaps in their knowledge of ICIs. Among ICI patients, 33 (62%) simply described ICIs without errors. ICI perception was positive, regardless of whether respondents received or had heard of ICIs, which became particularly evident when compared to CT. ICIs were rated as more promising, and all adverse effects were expected to be significantly lower than those of CT. Knowledge about ICIs was also limited in the interviewed ICI patients. Some patients reported adverse effects of ICIs that were mostly mild and well-tolerated or easily treated.!##!Conclusions!#!The lack of understanding of ICIs should be improved by activities to increase the knowledge of ICI patients and the general population. In contrast to CT, ICIs invoked fewer negative associations with efficacy and toxicity. Therefore, attention should be paid to risk awareness when educating patients. (Clinical trial registration number: DRKS00011868) Trial Registration: German clinical trials register, www.germanctr.de , number DRKS00011868

Barriers to access cancer‐related services for men in high‐income countries: A narrative review looking beyond socioeconomic disadvantages

Abstract Introduction Cancer screening programs are routinely available in high‐income countries, but participation rates are low, especially among men. This narrative review aims to identify male‐specific access barriers to cancer‐related healthcare in high‐income countries that offer statutory insurance/subsidized health care. Methods We searched PubMed, Science Direct, and Web of Science for peer‐reviewed journal articles published within the past 10 years on cancer healthcare access, help‐seeking behavior, and men. Step‐wise screening of title, abstract, and full text resulted in 23 studies that fit the selection criteria for findings in high‐income countries. The results were analyzed descriptively using qualitative thematic synthesis. Results In the reviewed studies, barriers for men in accessing cancer‐related healthcare offers could be broadly categorized under sociocultural norms, personal behaviors, and structural problems. The most common barriers were related to sociocultural influences and included notions of masculinity, distrust in the medical system, and personnel/social commitments. Major personal barriers included fear of getting cancer or screening methods, lack of awareness about cancer, and problems in communication with healthcare professionals. Accessibility and lack of insurance were reported as common structural barriers. Conclusions The reluctance of men in approaching medical help was rooted in sociocultural norms of traditional masculinity with direct and indirect consequences such as fear, lack of awareness, distrust of medical personnel, and problems in communicating with healthcare professionals. Gender‐specific, male‐oriented information via digital, anonymous interventions may be helpful for increasing participation of men in cancer care