Dual-Perspective Modeling of Patient Pathways: A Case Study on Kidney Cancer

Patient pathway has become a key concept in the organization of healthcare. However, the materialization and operationalization of pathways often focus on work processes of health personnel, clinical decision-making, and deadlines, contradicting the strong patient-oriented perspective that is inherent in their definition. In this paper, we introduce a patient-centered perspective of kidney cancer pathways, reporting on a dual-perspective strategy to map and model patient pathways. Utilizing a multi-method approach, we map and model pathways from the perspectives of both healthcare personnel and patients and investigate the feasibility of the Customer Journey Modeling Language (CJML) for modeling patient pathways. To prevent confusion, the planned pathway as seen from the hospital perspective and the actual pathway experienced by the patient are referred to as ‘pathway’ and ‘journey’, respectively. In the paper, we describe methods to engage with healthcare professionals and patients to collect the necessary information to create precise models, and we show how precise modeling of patient pathways requires the integration of several information sources. Moreover, the study underlines the value of examining pathways from a dual perspective, as the two perspectives corroborate and supplement each other, illustrating the complexity of patient journeys. Finally, the findings provide insights into the feasibility of CJML, firstly underlining that the usefulness of visual models is context-dependent, and secondly, suggesting that the methods and subsequent visualizations may be useful as organizational, instructional, and communicative tools.publishedVersio

Using exomarkers to assess mitochondrial reactive species in vivo

Background: The ability to measure the concentrations of small damaging and signalling molecules such as reactive oxygen species (ROS) in vivo is essential to understanding their biological roles. While a range of methods can be applied to in vitro systems, measuring the levels and relative changes in reactive species in vivo is challenging. Scope of review: One approach towards achieving this goal is the use of exomarkers. In this, exogenous probe compounds are administered to the intact organism and are then transformed by the reactive molecules in vivo to produce a diagnostic exomarker. The exomarker and the precursor probe can be analysed ex vivo to infer the identity and amounts of the reactive species present in vivo. This is akin to the measurement of biomarkers produced by the interaction of reactive species with endogenous biomolecules. Major conclusions and general significance: Our laboratories have developed mitochondria-targeted probes that generate exomarkers that can be analysed ex vivo by mass spectrometry to assess levels of reactive species within mitochondria in vivo. We have used one of these compounds, MitoB, to infer the levels of mitochondrial hydrogen peroxide within flies and mice. Here we describe the development of MitoB and expand on this example to discuss how better probes and exomarkers can be developed. This article is part of a Special Issue entitled Current methods to study reactive oxygen species - pros and cons and biophysics of membrane proteins. Guest Editor: Christine Winterbourn. Abbreviations: EPR, electron paramagnetic resonance; GFP, green fluorescent protein; 4-HNE, 4-hydroxynonenal; MitoB, 3-(dihydroxyboronyl)benzyltriphenylphosphonium bromide; MitoP, (3-hydroxybenzyl)triphenylphosphonium bromide; ROS, reactive oxygen species; SOD, superoxide dismutase; TPMP, methyltriphenylphosphonium; TPP, triphenylphosphonium catio

Broadband UBVRI Photometry of Horizontal-Branch and Metal-Poor Candidates from the HK and Hamburg/ESO Surveys. I

We report broadband UBV and/or BVRI CCD photometry for a total of 1857 stars in the thick-disk and halo populations of the Galaxy. The majority of our targets were selected as candidate field horizontal-branch or other A-type stars (FHB/A, N = 576), or candidate low-metallicity stars (N = 1221), from the HK and Hamburg/ESO objective-prism surveys. Similar data for a small number of additional stars from other samples are also reported. These data are being used for several purposes. In the case of the FHB/A candidates they are used to accurately separate the lower-gravity FHB stars from various higher-gravity A-type stars, a subsample that includes the so-called Blue Metal Poor stars, halo and thick-disk blue stragglers, main-sequence A-type dwarfs, and Am and Ap stars. These data are also being used to derive photometric distance estimates to high-velocity hydrogen clouds in the Galaxy and for improved measurements of the mass of the Galaxy. Photometric data for the metal-poor candidates are being used to refine estimates of stellar metallicity for objects with available medium-resolution spectroscopy, to obtain distance estimates for kinematic analyses, and to establish initial estimates of effective temperature for analysis of high-resolution spectroscopy of the stars for which this information now exists.Comment: 22 pages, including 3 figures, 5 tables, and two ascii files of full data, accepted for publication in the Astrophysical Journal (Supplements

Broadband UBVR_CI_C Photometry of Horizontal-Branch and Metal-poor Candidates from the HK and Hamburg/ESO Surveys. I.

We report broadband UBV and/or BVR_CI_C CCD photometry for a total of 1857 stars in the thick-disk and halo populations of the Galaxy. The majority of our targets were selected as candidate field horizontal-branch or other A-type stars (FHB/A, N = 576), or candidate low-metallicity stars (N = 1221), from the HK and Hamburg/ESO objective-prism surveys. Similar data for a small number of additional stars from other samples are also reported. These data are being used for several purposes. In the case of the FHB/A candidates they are used to accurately separate the lower gravity FHB stars from various higher gravity A-type stars, a subsample that includes the so-called blue metal poor stars, halo and thick-disk blue stragglers, main-sequence A-type dwarfs, and Am and Ap stars. These data are also being used to derive photometric distance estimates to high-velocity hydrogen clouds in the Galaxy and for improved measurements of the mass of the Galaxy. Photometric data for the metal-poor candidates are being used to refine estimates of stellar metallicity for objects with available medium-resolution spectroscopy, to obtain distance estimates for kinematic analyses, and to establish initial estimates of effective temperature for analysis of high-resolution spectroscopy of the stars for which this information now exists

First-order flow equations for extremal black holes in very special geometry

We construct interpolating solutions describing single-center static extremal non-supersymmetric black holes in four-dimensional N=2 supergravity theories with cubic prepotentials. To this end, we derive and solve first-order flow equations for rotating electrically charged extremal black holes in a Taub-NUT geometry in five dimensions. We then use the connection between five- and four-dimensional extremal black holes to obtain four-dimensional flow equations and we give the corresponding solutions.Comment: 21 pages. v2: Summary section adde