What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment

Background:Early diagnosis and improved treatment outcomes have increased breast cancer survival rates that, in turn, have led to increased numbers of women undergoing follow-up after completion of primary treatment. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important; yet, currently we know little about patient preferences. The aim of this study was to explore the preferences of Australian breast cancer survivors for alternative modes of delivery of follow-up services.Methods:A self-administered questionnaire (online or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency and method of delivery of routine follow-up care in years 3, 4 and 5 after diagnosis, as well as the perceived value of \u27drop-in\u27 clinics providing additional support. Participants were recruited throughout Australia over a 6-month period from May to October 2012. Preference scores and choice probabilities were used to rank the top 10 most preferred follow-up scenarios for respondents.Results:A total of 836 women participated in the study, of whom 722 (86.4%) completed the DCE. In the absence of specialist follow-up, the 10 most valued surveillance scenarios all included a Breast Physician as the provider of follow-up care. The most preferred scenario is a face-to-face local breast cancer follow-up clinic held every 6 months and led by a Breast Physician, where additional clinics focused on the side effects of treatment are also provided.Conclusion:Beyond the first 2 years from diagnosis, in the absence of a specialist led follow-up, women prefer to have their routine breast cancer follow-up by a Breast Physician (or a Breast Cancer Nurse) in a dedicated local breast cancer clinic, rather than with their local General Practitioner. Drop-in clinics for the management of treatment related side effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors. 2014 Cancer Research UK

How predictable is high bivalve recruitment in the Wadden Sea after a severe winter?

Higher than average recruitment among bivalves on the intertidal flats of the Wadden Sea was observed many times after severe winters in the period 1940 - 1995. The occurrence of another severe winter in 1995/96 prompted us to test the hypothesis of severe winters leading to universally high bivalve recruitment on a large geographic scale (500 km coastline) in temperate shallow waters. We analysed data sets on bivalve abundance from seven areas in the Dutch, German and Danish Wadden Sea. The longer data sets showed generally higher bivalve recruitment in the 1970Žs and 1980Žs than in the 1990Žs which may be related to the near absence of severe winters since 1987. Considering the period 1988 onwards (the longest possible period in which 1995/96 was the only severe winter), recruitment of Cerastoderma edule was in 1996 - in agreement with our hypothesis - above average at all seven investigated areas. In contrast, recruitment of Macoma balthica and Mya arenaria was for the same period above average only in the southern Wadden Sea (south-west of Jade Bay) but not in the northern Wadden Sea (north of Eiderstedt peninsula). These regional differences may be related to (i) the different topography of the northern Wadden Sea (with barrier islands westwards to the mainland) compared to the southern Wadden Sea (with barrier islands northwards to the mainland) and subsequent differential effects of wind induced currents on bivalve recruitment, (ii) differences in biotic factors such as standing stocks, larval supply or epibenthic predation or (iii) changes in environmental conditions. Our results demonstrate that large-scale comparisons along coasts are an indispensable addition to insights derived from local studies alone

Semantically Consistent Hierarchical Decomposition of Virtual Urban Environments

International audienceWhen planning a path in their environment, humans reason on a hierarchical representation of this environment. They rst plan a path troughcoarse zones, then rene this path during navigation, as relevant information is perceived. In this article, we propose a method that automatically generates a semantically consistent hierarchical decomposition of an urban environment. We also present a path planning process that takesadvantage of this representation to delay some decisions and propose path options that enable a smart path adaptation when unexpected events occur

Towards Social Behavior in Virtual-Agent Navigation

We present Social Groups and Navigation (SGN), a method to simulate the walking behavior of small pedestrian groups in virtual environments. SGN is the first method to simulate group behavior on both global and local levels of an underlying planning hierarchy. We define quantitative metrics to measure the coherence and the sociality of a group based on existing empirical data of real crowds. SGN does not explicitly model coherent and social formations, but it lets such formations emerge from simple geometric rules. In addition to a previous version, SGN also handles group-splitting to smaller groups throughout navigation as well as social sub-group behavior whenever a group has to temporarily split up to re-establish its coherence. For groups of four, SGN generates between 13% and 53% more socially-friendly behavior than previous methods, measured over the lifetime of a group in the simulation. For groups of three, the gain is between 15% and 31%, and for groups of two, the gain is between 1% and 4%. SGN is designed in a flexible way, and it can be integrated into any crowd-simulation framework that handles global path planning and any path following as separate steps. Experiments show that SGN enables the simulation of thousands of agents in real time