Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes.

Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis

Value of hospital antimicrobial stewardship programs [ASPs]:a systematic review

Abstract Background Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods An update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range:$2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention

an introduction to personalized ehealth

Personalized medicine can be defined as the adaptation of medical treatments to the specific characteristics of patients. This approach allows health providers to develop therapies and interventions by taking into account the heterogeneity of illnesses and external factors such as the environment, patients' needs, and lifestyle. Technology could play an important role to achieve this new approach to medicine. An example of technology's utility regards real-time monitoring of individual well-being (subjective and objective), in order to improve disease management through data-driven personalized treatment recommendations. Another important example is an interface designed based on patient's capabilities and preferences. These could improve patient-doctor communication: on one hand, patients have the possibility to improve health decision-making; on the other hand, health providers could coordinate care services more easily, because of continual access to patient's data. This contribution deepens these technologies and related opportunities for health, as well as recommendation for successful development and implementation

Territorial and human geography challenges: How can smart villages support rural development and population inclusion?

Rural areas are significantly affected by spatial vulnerability, the digital gap, depopulation, and population ageing. Marginalized populations are seeking collective well-being, social inclusion, and local development in smart villages, an increasingly important area of interest for scholars and practitioners as well as rural areas and communities. This article attempts to highlight the dominant trends in smart villages planning and depict the characteristics of Greek rural areas and populations alongside the implemented localized smart actions. To achieve this aim, the research utilized the existing literature through bibliometric analysis by extracting data from the Web of Science database. Building upon the bibliometrics, the research focused on identifying localized implemented interventions in the Greek rural areas. The results suggest that innovation, knowledge, growth, and management appear to impact rural smart planning, while the limited interventions of smart villages in Greece focus on social innovation and local development. The study argues that in Greece, a single holistic smart villages model cannot be proposed, due to the country’s geographical and demographical variability. The proposed trends, though, can be implemented locally to encourage rural development and population inclusion; therefore it is recommended to increase local stakeholders’ awareness and active engagement. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Towards Open Domain Event Extraction from Twitter: REVEALing Entity Relations

Abstract. In the past years social media services received content contributions from millions of users, making them a fruitful source for data analysis. In this paper we present a novel approach for mining Twitter data in order to extract factual information concerning trending events. Our approach is based on relation extraction between named entities, such as people, organizations and locations. The experiments and the obtained results suggest that relation extraction can help in extracting events in social media, when combined with pre and post-processing steps

Reputation Management in the Tourism Industry

This article will discuss reputational risk, its implications for companies involved in the tourism industry, and how companies’ supervisors assess the management’s ability to measure and monitor this risk. Reputational risk is defined as the potential impacts of negative publicity related to an institution’s/company’s/country’s business practices, regardless true or not; those impacts can range from a decline in the customer base or revenue reductions to costly litigations. Also, destination reputation is the public’s general feeling, impression and cognition of it. A good reputation is an intangible asset for tourism destinations and a vital aspect of sustainable development. Reserving a good reputation revolves around effectively communicating and building solid relationships. Reputational risk is managed through strong corporate governance. How should reputational risk be managed internally in tourism industry companies? The following are just a few examples of key elements for managing reputational risk: Maintaining timely and efficient communications amongst government, customers, boards of directors of companies in tourism industry, and employeesEstablishing strong enterprise risk management policies and procedures throughout the organization, including an effective anti-fraud programReinforcing a risk management culture by creating awareness at all staff levelsInstilling ethics throughout the organisation by enforcing a code of conduct for the board, management, and staffDeveloping a comprehensive system of internal controls and practices, including those related to computer systems and transactional websitesComplying with current laws and regulations and enforcing existing policies and proceduresImplementing independent testing and transactional testing on a regular basisEstablishing a crisis management team in the event there is a significant action that may trigger a negative impact on the organization and the touristic destination as a whole.Although building a destination’s reputation may take years, it can certainly be damaged or even destroyed very quickly. Reputational risk depends on a combination of factors daily facing the tourism industry. Governments, local authorities and senior management are responsible for measuring and monitoring reputational risk and therefore must remain vigilant and active in providing the safeguards to prevent loss of reputation. © 2019, Springer Nature Switzerland AG