Toward Timely Data for Cancer Research: Assessment and Reengineering of the Cancer Reporting Process

Background Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data are often unavailable for months to years after diagnosis, limiting its utility. Objective The objective of this study was to identify the barriers to rapid cancer reporting and identify ways to shorten the turnaround time. Methods Certified cancer registrars reporting to the Indiana State Department of Health cancer registry participated in a semistructured interview. Registrars were asked to describe the reporting process, estimate the duration of each step, and identify any barriers that may impact the reporting speed. Qualitative data analysis was performed with the intent of generating recommendations for workflow redesign. The existing and redesigned workflows were simulated for comparison. Results Barriers to rapid reporting included access to medical records from multiple facilities and the waiting period from diagnosis to treatment. The redesigned workflow focused on facilitating data sharing between registrars and applying a more efficient queuing technique while registrars await the delivery of treatment. The simulation results demonstrated that our recommendations to reduce the waiting period and share information could potentially improve the average reporting speed by 87 days. Conclusions Knowing the time elapsing at each step within the reporting process helps in prioritizing the needs and estimating the impact of future interventions. Where some previous studies focused on automating some of the cancer reporting activities, we anticipate much shorter reporting by leveraging health information technologies to target this waiting period

Settlement and landscape development in the Homs Region, Syria: research questions, preliminary results 1999-2000 and future potential

This report describes the results of the first and second seasons of field work by an interdisciplinary research team studying the landscape history of the upper Orontes Valley near Homs in western Syria. Initial discussions address the value of survey data to Syrian archaeology, the research aims of the project and describe the survey area. The project methodology, which includes a combination of both extensive and intensive survey methods, is outlined, and the use of satellite imagery as a means of site location discussed. Work on geomorphological processes and off-site artefact distributions has facilitated the development of sampling strategies for intensive surface collection planned for 2002 and 2003. A test core has established that pollen is well-preserved in the silts of Lake Qattine, which appear to offer a west Syrian palaeoenvironmental sequence. Preliminary work in the basalt terrain west of Homs has allowed the refinement of methodologies for the mapping and analysis of cairns and field systems which predominate in this area, and has highlighted the threat resulting from current bulldozing. The report concludes with some preliminary observations on the main trends as these are emerging from the data

Geodynamic evolution of the lithosphere and upper mantle beneath the Alboran region of the western Mediterranean: Constraints from travel time tomography

An edited version of this paper was published by the American Geophysical Union. Copyright 2000, AGU. See also: http://www.agu.org/pubs/crossref/2000/2000JB900024.shtml; http://atlas.geo.cornell.edu/morocco/publications/calvert2000.htmA number of different geodynamic models have been proposed to explain the extension that occurred during the Miocene in the Alboran Sea region of the western Mediterranean despite the continued convergence and shortening of northern Africa and southern Iberia. In an effort to provide additional geophysical constraints on these models, we performed a local, regional, and teleseismic tomographic travel time inversion for the lithospheric and upper mantle velocity structure and earthquake locations beneath the Alboran region in an area of 800 x 800 km^2. We picked P and S arrival times from digital and analog seismograms recorded by 96 seismic stations in Morocco and Spain between 1989 and 1996 and combined them with arrivals carefully selected from local and global catalogs (1964-1998) to generate a starting data set containing over 100,000 arrival times. Our results indicate that a N-S line of intermediate depth earthquakes extending from crustal depths significantly inland from the southern Iberian coat to depths of over 100 km beneath the center of the Alboran Sea coincided with a W to E transition from high to low velocities imaged in the uppermost mantle. A high-velocity body, striking approximately NE-SW, is imaged to dip southeastwards from lithospheric depths beneath the low-velocity region to depths of ~350 km. Between 350 and 500 km the imaged velocity anomalies become more diffuse. However, pronounced high-velocity anomalies are again imaged at 600 km near an isolated cluster of deep earthquakes. In addition to standard tomographic methods of error assessment, the effects of systematic and random errors were assessed using block shifting and bootstrap resampling techniques, respectively. We interpret the upper mantle high-velocity anomalies as regions of colder mantle that originate from lithospheric depths. These observations, when combined with results from other studies, suggest that delamination of a continental lithosphere played an important role in the Neogene and Quaternary evolution of the region

Propagation of regional seismic phases (Lg and Sn) and Pn velocity structure along the Africa-Iberia plate boundary zone

An edited version of this paper was published by Blackwell Publishing. Copyright 2000, Blackwell Publishing. See also: http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-246x.2000.00160.x; http://atlas.geo.cornell.edu/morocco/publications/calvert2000GJI.htmWe used over 1000 regional waveforms recorded by 60 seismic stations located in northwest Africa and Iberia to map the efficiency of L g and Sn wave propagation beneath the Gulf of Cadiz, Alboran Sea and bounding Betic, Rif and Atlas mountain belts. Crustal attenuation is inferred from the tomographic inversion of L g/Pg amplitude ratios. Upper mantle attenuation is inferred from maps of Sn propagation efficiency derived by inversion of well-defined qualitative efficiency assignments based on waveform characteristics. Regions of L g attenuation correlate well with areas of thinned continental or oceanic crust, significant sedimentary basins, and lateral crustal variations. Comparison of the Sn efficiency results with velocities obtained from an anisotropic Pn traveltime inversion shows a fairly good correlation between regions of poor Sn efficiency and low Pn velocity. A low Pn velocity (7.6?7.8 km s-1) and significant Sn attenuation in the uppermost mantle is imaged beneath the Betics in southern Spain, in sharp contrast to the relatively normal Pn velocity (8.0?8.1 km s-1) and efficient Sn imaged beneath the Alboran Sea. Slow Pn velocity anomalies are also imaged beneath the Rif and Middle Atlas in Morocco. We do not identify any conclusive evidence of lithospheric-scale upper mantle attenuation beneath the Rif, although the crust in the Gibraltar region appears highly attenuating, making observations at stations in this region ambiguous. Paths crossing the Gulf of Cadiz, eastern Atlantic and the Moroccan and Iberian mesetas show very efficient Sn propagation and are imaged with high Pn velocities (8.1?8.2 km s-1). The spatial distribution of attenuation and velocity anomalies lead us to conclude that some recovery of the mantle lid beneath the Alboran Sea must have occurred since the early Miocene episode of extension and volcanism. We interpret the low velocity and attenuating regions beneath the Betics and possibly the Rif as indicating the presence of partial melt in the uppermost mantle which may be underlain by faster less attenuating mantle. In the light of observations from other geophysical and geological studies, the presence of melt at the base of the Betic crust may be an indication that delamination of continental lithosphere has played a role in the Neogene evolution of the Alboran Sea region

Fibrossarcoma epitelióide esclerosante: relato de caso.

O fibrossarcoma epitelióide esclerosante (FEE) pode ser conceituado como uma neoplasia maligna constituída por ninhos e cordões de pequenas células arredondadas, poligonais e ovóides, de citoplasma claro e escasso, hialinização exuberante e alto grau de esclerose. Compromete mais freqüentemente extremidades, tronco e pescoço. O FEE é considerado um sarcoma de baixo grau e demonstra imunorreatividade ao P 53, sugerindo um papel de destaque deste fator. A recorrência local está relacionada com a ressecção com margem de segurança insuficiente. O diagnóstico diferencial é vasto e inclui tumores e proliferações fibrosas, como fasciíte nodular, miosite ossificante, desmóides, leiomioma hialinizante e histiocitoma fibroso, fibrossarcoma sinovial, sarcoma de células claras de tendões e aponeuroses, osteosarcoma de pequenas células, rabdomiosarcoma alveolar. Os tumores localizados no tronco, as lesões volumosas e em homens comprometem o diagnóstico.Os autores relatam um caso de um paciente de 44 anos, com tumoração localizada em face ântero-medial do braço direito, com evolução em 3 meses, cuja biópsia incisional revelou tratar-se de FEE. Serão discutidos aspectos anatomopatológicos, quadro clínico e tratamento instituído para o caso