Determining the date of diagnosis – is it a simple matter? The impact of different approaches to dating diagnosis on estimates of delayed care for ovarian cancer in UK primary care

Background Studies of cancer incidence and early management will increasingly draw on routine electronic patient records. However, data may be incomplete or inaccurate. We developed a generalisable strategy for investigating presenting symptoms and delays in diagnosis using ovarian cancer as an example. Methods The General Practice Research Database was used to investigate the time between first report of symptom and diagnosis of 344 women diagnosed with ovarian cancer between 01/06/2002 and 31/05/2008. Effects of possible inaccuracies in dating of diagnosis on the frequencies and timing of the most commonly reported symptoms were investigated using four increasingly inclusive definitions of first diagnosis/suspicion: 1. "Definite diagnosis" 2. "Ambiguous diagnosis" 3. "First treatment or complication suggesting pre-existing diagnosis", 4 "First relevant test or referral". Results The most commonly coded symptoms before a definite diagnosis of ovarian cancer, were abdominal pain (41%), urogenital problems(25%), abdominal distension (24%), constipation/change in bowel habits (23%) with 70% of cases reporting at least one of these. The median time between first reporting each of these symptoms and diagnosis was 13, 21, 9.5 and 8.5 weeks respectively. 19% had a code for definitions 2 or 3 prior to definite diagnosis and 73% a code for 4. However, the proportion with symptoms and the delays were similar for all four definitions except 4, where the median delay was 8, 8, 3, 10 and 0 weeks respectively. Conclusion Symptoms recorded in the General Practice Research Database are similar to those reported in the literature, although their frequency is lower than in studies based on self-report. Generalisable strategies for exploring the impact of recording practice on date of diagnosis in electronic patient records are recommended, and studies which date diagnoses in GP records need to present sensitivity analyses based on investigation, referral and diagnosis data. Free text information may be essential in obtaining accurate estimates of incidence, and for accurate dating of diagnoses

Design Patterns for Description-Driven Systems

In data modelling, product information has most often been handled separately from process information. The integration of product and process models in a unified data model could provide the means by which information could be shared across an enterprise throughout the system lifecycle from design through to production. Recently attempts have been made to integrate these two separate views of systems through identifying common data models. This paper relates description-driven systems to multi-layer architectures and reveals where existing design patterns facilitate the integration of product and process models and where patterns are missing or where existing patterns require enrichment for this integration. It reports on the construction of a so-called description-driven system which integrates Product Data Management (PDM) and Workflow Management (WfM) data models through a common meta-model.Comment: 14 pages, 13 figures. Presented at the 3rd Enterprise Distributed Object Computing EDOC'99 conference. Mannheim, Germany. September 199

The Reification of Patterns in the Design of Description-Driven Systems

To address the issues of reusability and evolvability in designing self- describing systems, this paper proposes a pattern-based, object-oriented, description-driven system architecture. The proposed architecture embodies four pillars - first, the adoption of a multi-layered meta-modeling architecture and reflective meta-level architecture, second, the identification of four data modeling relationships that must be made explicit such that they can be examined and modified dynamically, third, the identification of five design patterns which have emerged from practice and have proved essential in providing reusable building blocks for data management, and fourth, the encoding of the structural properties of the five design patterns by means of one pattern, the Graph pattern. The CRISTAL research project served as the basis onto which the pattern-based meta-object approach has been applied. The proposed architecture allows the realization of reusability and adaptability, and is fundamental in the specification of self-describing data management components.Comment: 10 pages 11 figure

Off-diagonal Interactions, Hund's Rules and Pair-binding in Hubbard Molecules

We have studied the effect of including nearest-neighbor, electron-electron interactions, in particular the off-diagonal (non density-density) terms, on the spectra of truncated tetrahedral and icosahedral ``Hubbard molecules,'' focusing on the relevance of these systems to the physics of doped C$_{60}$. Our perturbation theoretic and exact diagonalization results agree with previous work in that the density-density term suppresses pair-binding. However, we find that for the parameter values of interest for $C_{60}$ the off-diagonal terms {\em enhance} pair-binding, though not enough to offset the suppression due to the density-density term. We also find that the critical interaction strengths for the Hund's rules violating level crossings in C$_{60}^{-2}$, C$_{60}^{-3}$ and C$_{60}^{-4}$ are quite insensitive to the inclusion of these additional interactions.Comment: 20p + 5figs, Revtex 3.0, UIUC preprint P-94-10-08

Meta-Data Objects as the Basis for System Evolution

One of the main factors driving object-oriented software development in the Web- age is the need for systems to evolve as user requirements change. A crucial factor in the creation of adaptable systems dealing with changing requirements is the suitability of the underlying technology in allowing the evolution of the system. A reflective system utilizes an open architecture where implicit system aspects are reified to become explicit first-class (meta-data) objects. These implicit system aspects are often fundamental structures which are inaccessible and immutable, and their reification as meta-data objects can serve as the basis for changes and extensions to the system, making it self- describing. To address the evolvability issue, this paper proposes a reflective architecture based on two orthogonal abstractions - model abstraction and information abstraction. In this architecture the modeling abstractions allow for the separation of the description meta-data from the system aspects they represent so that they can be managed and versioned independently, asynchronously and explicitly. A practical example of this philosophy, the CRISTAL project, is used to demonstrate the use of meta-data objects to handle system evolution

Polarized Neutron Inelastic Scattering Study of the Anisotropic Magnetic Fluctuations in the Quasi-1D Ising-like Antiferromagnet TlCoCl3_3

Polarized neutron inelastic scattering experiments have been carried out in the quasi-1D Ising-like antiferromagnet TlCoCl$_3$. We observed the longitudinal magnetic fluctuation $S_{zz} (Q, \omega)$ for the spin-wave excitation continuum, which has not been observed in the unpolarized neutron inelastic scattering experiments of the quasi-1D Ising-like antiferromagnets CsCoCl$_3$ and TlCoCl$_3$ so far, together with the transverse magnetic fluctuation $S_{xx} (Q, \omega)$. We compared both obtained intensities of $S_{xx} (Q, \omega)$ and $S_{zz} (Q, \omega)$ with the perturbation theory from the pure Ising limit by Ishimura and Shiba, and a semi-quantitative agreement was found.Comment: 5 pages, 5 figures, jpsj2.cls, to be published in J. Phys. Soc. Jpn. Vol. 75 (2006) No.