Improving pathology reports using business intelligence techniques: An experimental study

Health professionals use pathology reports to monitor and manage a patient’s health. Typically, pathologists diagnose patients’ conditions and produce these reports which are then used as reference by clinicians and eventually shared with the patient. Pathology reports are difficult to interpret as the reports are written using complex medical terminology. As patients only see their doctors for a limited time, the complexity of report content and the manner in which the information is presented in the reports may hinder patients’ understanding of their medical condition and prognosis. The objective of this study was to compare patient comprehension of results from two pathology-reporting styles: the traditional format in current widespread use and new style developed using techniques common in business intelligence system (BI) development. The study found that the reports prepared using a “BI style” improve experimental subject’s understanding and satisfaction with the reports

Public Service Decentralisation : Governance Opportunities and Challenges

Background This discussion paper identifies and analyses a number of key governance issues that are relevant to ‘decentralisation’ as a concept in public sector reform. It explores, particularly within the context of contemporary Irish experience, some of the key opportunities and challenges for effective leadership and collegiality in a geographically decentralised Irish civil and public service: areas which may have been comparatively neglected, in both research and policy terms, in the past but which demand further attention for effective implementation of current initiatives. The research draws upon: · an extensive review of the national and international literature on civil/public service decentralisation, as well as effective leadership and positive collegiality in the commercial and non-commercial sectors; · in-depth discussions with those engaged, at a senior level, both in Ireland and elsewhere with developing and implementing decentralisation programmes; · in-depth discussions with the chief officers in a crosssection of Irish public bodies directly affected by the current programme, as well as senior trade union representatives and senior private sector managers; In this regard, it must be stressed that the geographical decentralisation programme currently in hand for the Irish public service will have a direct and/or indirect impact not just on those specific bodies identified for decentralisation under the current programme but will have an impact across the public service as well as in other sectors. Indeed the changes that are afoot are of a scale and character that should lead to a fundamental recasting of the Irish system of public administration. EXECUTIVE SUMMARY Policy context Since 1994, the Irish public service has been engaged upon a long-term programme of public service modernisation, also known as the Strategic Management Initiative (SMI), broadly along New Public Management (NPM) lines. While Ireland’s efforts at geographical decentralisation long predate the SMI and have not, until now, had significant, explicit implications for the modernisation agenda, a considerable sense of urgency has now been injected into this gradually, self-modernising administrative system. For, into a previously consensual and gradualist policy environment, the Minister for Finance in December 2003 announced the Irish government\u27s commitment to the voluntary decentralisation of over 10,300 posts in civil service departments/offices and agencies to over fifty locations across twenty-five counties throughout the country. Of this total, over 3,000 of the posts earmarked for relocation are in state agencies. Additionally, the government decided that, save in exceptional circumstances, any new agencies/bodies being established in the future should be located in areas compatible with this new programme. While decentralisation has not formed an explicit plank of either current or past Irish public service reform initiatives and while Ireland\u27s experience to date has demonstrated little devolution of fiscal and other high-level decision-making functions from central to local levels, the spatial decentralisation of Dublin-based public service employment and functions to non-metropolitan locations has been a feature of Irish administrative reorganisation at least since the 1960s. Broadly speaking, there have been two previous phases of geographical decentralisation in Ireland: (a) dispersal during the period 1967 to 1987; followed by (b) a complex period of dispersal, deconcentration and regionalisation (1988-2003). Thus, even before the new programme is implemented, previous national-level initiatives, together with the adoption of regional strategies by some departments/offices, have already resulted in a complex spatial mosaic of public service locations. Together with dispersed functional units, this complex mosaic includes regionalised and/or county-based offices supported by networks of branch, district and local offices. However, there is little doubt that, although it builds upon these earlier initiatives, the current decentralisation programme will present unprecedented management and operational challenges at the departmental/organisational and publicservice wide levels. It will also be important to learn from experiences in the past regarding leadership and collegiality in a geographically complex civil service in order to help plot the future. The current proposals will not only mean that the majority of civil service, as well as public service, posts will be based outside Dublin but no fewer than eight government departmental HQs will be located away from the capital, while the government itself and many other departments and stakeholder organisations will continue to operate from the centre. As a consequence, an entirely new approach to the governance of the service will be required and, in particular, new models of leadership and collegiality developed. This dramatic policy initiative, in the short-term, has not only reverberated throughout the administrative system, but, in the longer term, has the potential to present hitherto un-thought of opportunities for radical reform and improvements in the way the Irish public service operates. Learning from others A number of other countries have implemented decentralisation initiatives in the past number of decades. For example, in the Netherlands and UK up to the end of the 1980s the decentralisation of public service employment away from the capital had been used as part of a regional development strategy to relieve long-term unemployment in declining industrial areas. More recently, evidence from secondary sources indicates international experience of relocation and decentralisation in a wide range of countries and/or other public administrations; e.g. France, Germany, Norway, Japan and Canada (British Colombia). Internationally, the geographical decentralisation of the civil and public service is seen as an opportunity to secure improved efficiency on the back of business process reengineering (BPR), new working practices and modernisation. However, this research found that, although some useful inferences can be drawn from a review of available international evidence, it is difficult to identify in other public administrations in OECD a direct comparator for the current programme of Irish decentralisation. This lack of a comparator relates to the scale of the current programme, its scope, timing and, above all, its inclusion of proposals to relocate entire organisations in locations away from the capital city and centre of political life. For example, the UK approach specifically excludes the movement of head offices of government departments away from London. Leadership and collegiality Available research evidence suggests that both effective leadership and positive collegiality are key features of good governance and the significance of both these qualities is at a premium within the context of a geographically complex, decentralised civil and public service. Such qualities of good governance as leadership, effectiveness, participation, coherence, programme delivery and effective stakeholder engagement are particularly relevant in the context of the decentralisation programme given the continuing location of the Oireachtas and a number of departments in central Dublin and the particular challenges posed by the geographical decentralisation of others. Indeed, it is important to note that, as early as March 2004, the Decentralisation Implementation Group was beginning to acknowledge the importance of these qualities in forming ‘a post-decentralised civil service’: ‘The geographic relocation and dispersal of staff may help to reinforce existing moves towards greater devolution of authority and responsibility to, and within, organisations. There will be an onus on management at organisational and suborganisational level to exercise greater de facto responsibility for HR, finance and other organisational matters. A more geographically dispersed civil service needs to be balanced by sufficiently strong common values and culture to support effective system-wide co-operation and decision-making. It will be necessary to reinforce, and invest more heavily in corporate culture and ethos’ (First Report of the Decentralisation Implementation Group to Minister for Finance p.28). These opportunities and challenges are explored in this research at corporate/service-wide, interdepartmental and intradepartmental levels A review of the latest international literature and best practice management frameworks clearly highlights that not only is effective leadership the cornerstone upon which organisational excellence is built, it also: · gives strategic direction: it develops and communicates vision, mission and values; · achieves change and focuses efforts on customer service; · develops and implements a system for organisational management and performance review; · motivates and supports people, acting as a role model; · manages the relationships with politicians and other stakeholders, acting in a socially responsible manner. These qualities hold true across the public and private sectors. Effective and visible leadership is required to promote an emphasis on co-operation, consensus, persuasion and the like. A key quality of leadership is also the capacity to operate in a collegial manner and to support collegiality between and within organisations. Together with positive collegiality, these qualities of effective leadership apply at three levels: the corporate or service-wide; the inter- and the intra-departmental. The key research question for this study was to consider the extent to which these qualities of leadership and collegiality could be affected by the geographical dispersal of the public service organisations concerned and, specifically, to identify and discuss opportunities and challenges thus presented. Opportunities and challenges There is little doubt that the current decentralisation programme will have a profound impact on structures, communication frameworks, networking fora and the relationship interface between the civil service, the political and stakeholder systems. How this is managed is vital in terms of the effects on customer service and the efficiency of business processes during the transition phase and beyond. As such, if effectively managed and implemented, it could represent a unique opportunity to fundamentally revisit and restructure the ways in which the civil and wider public services conduct their business. There is little doubt that the movement of public service bodies away from Dublin will provide an unprecedented xiii opportunity for a fundamental overhaul of work done and the way it is done, through the use of business process reengineering and other techniques. Concerns from the past regarding blocked career progression for those in dispersed and regional civil service offices could be ameliorated by adopting a regional approach to facilitate promotion across public service bodies. Otherwise, a move away from Dublin would very definitely become a one-way journey. Because of the travel imperative for contact with the minister and meetings with other public servants, while the burden of travel will be greatly increased, especially when engaged in EU and other international work, it is very likely that both the frequency and management of meetings will become subject to stricter discipline. The use of ICT will help communication but it is expected to be only a limited substitute for face-to-face collegiality. The discussions that took place during this research also suggest that it could be timely to re-explore the potential benefits of a Senior Civil Service. Such an incremental step could support the development of leadership skills training and help sustain collegiality at the service-wide level. Respondents frequently expressed concern that local pressures could lead to a parochial mindset developing. For instance one respondent said: ‘Leadership has not historically been considered as a skill that can be learned - it has been regarded rather as Churchill described ‘greatness’: you can be born with it, achieve it or have it thrust upon you. Yet recent thinking in both the private and public sectors sees the development of the skills of leadership as essential to the effective delivery of any programme of change - and that all efficient organisations are in a state of ordered change’. It was outside the scope of this research to suggest or even less to prescribe firm recommendations for further action. That needs to be on the national agenda for another day. However, although no organisation is scheduled to decentralise before the end of 2006, there is little doubt that, if the current decentralisation programme is to rise above the very considerable logistical issues (around staffing/training and physical infrastructure) that have understandably pre-occupied the implementation agenda to date, then serious consideration of the governance opportunities and challenges arising from this programme need to rise up that agenda. Only two of these issues have been initially reviewed and discussed in this paper: namely effective leadership and positive collegiality. However, it is clear from this research that, if Ireland is to retain its hard won and justified reputation for first rate civil and public services, as well as its international standing, positive action is required across a wide front to turn leadership and collegiality challenges into opportunities. On the basis of this research evidence, such action should include constructive, informed and positive support being given to a wide range of issues, including: · Giving urgent attention to the development of a servicewide Knowledge Management initiative to minimise loss and open up new opportunities for knowledge sharing on a collegial basis, within, between and across those public service bodies significantly affected by the decentralisation programme. Allied to this is the need to map more clearly, and understand better, current formal and informal networks within the service. These will need to be significantly recast. Resort to ICT and large amounts of travel appear to only offer partial solutions. · Implementing a coherent, service-wide change management programme, which recognises and empowers leadership within and across the civil and wider public services. Again models appear to exist, based upon international best practice, which could inform this process, as could the more systematic indepth analysis of private sector experiences. It would appear also that the timing could be opportune for a revisiting and reassertion of core public service values that could help to maintain consistency in the considerably more geographically complex and younger service of the future. Allied and supportive of this approach could be the further examination of the implications for Ireland of the explicit development of a senior civil and public service. In summary, there is little doubt that the current leaders of the Irish public service have had decentralisation thrust upon them, even though it may be up to their successors to fully operationalise the resultant changes from new and diverse localities. While issues of staffing and infrastructure are understandably pre-occupying minds presently concerned with implementation, action will need to be commenced soon to rearticulate, and sustain, the values of the Irish public service and to cultivate the leadership skills necessary for the next generation of secretaries general and chief executives so that the modernisation programme set in motion a decade ago is sustained and re-invigorated. In a decade from now, a new generation of leaders should be leading an entirely recast, modernised civil and public service, in diverse places but with shared values

Femtosecond deep-infrared optical parametric oscillator pumped directly by a Ti:sapphire laser

We report a high-repetition-rate femtosecond optical parametric oscillator (OPO) for the deep-infrared (deep-IR) based on the nonlinear optical crystal, CdSiP2 (CSP), pumped directly by a Ti:sapphire laser, for the first time. By pumping CSP at <1 μm, we have achieved practical output powers at the longest wavelengths generated by any Ti:sapphire-pumped OPO. Using a combination of pump wavelength tuning, type-I critical phase-matching, and cavity delay tuning, we have generated continuously tunable radiation across 6654−8373 nm (1194−1503 cm-1) at 80.5 MHz repetition rate, providing up to 20 mW of average power at 7314 nm and <7 mW beyond 8000 nm, with idler spectra exhibiting bandwidths of 140−180 nm across the tuning range. Moreover, the near-IR signal is tunable across 1127−1192 nm, providing up to 37 mW of average power at 1150 nm. Signal pulses, characterised using intensity autocorrelation, have durations of ∼260–320 fs, with corresponding time-bandwidth product of ∆υ∆τ∼1. The idler and signal output exhibit a TEM00 spatial profile with single-peak Gaussian distribution. With an equivalent spectral brightness of ∼6.68×1020 photons s-1 mm-2 sr-1 0.1% BW-1, this OPO represents a viable table-top alternative to synchrotron and supercontinuum sources for deep-IR applications in spectroscopy, metrology and medical diagnostics.Peer ReviewedPostprint (author's final draft

Emergency endovascular repair of acute descending thoracic aortic dissection

Muhammad Anees Sharif, Mark Edward O&rsquo;Donnell, Paul Henry Blair, Peter KennedyDepartment of Vascular and Endovascular Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, United KingdomBackground: Acute descending thoracic aortic dissection is a life-threatening emergency. It is not often considered as the initial diagnosis in patients presenting with epigastric pain and could easily be missed in a busy casualty department.Aim: This case report is aimed to highlight the feasibility of the technique and the need for long-term surveillance following endovascular repair of acute thoracic aortic dissection.Results: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status. A computerized tomography (CT) scan demonstrated type B thoracic aortic dissection of the proximal descending thoracic aorta. A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.Conclusion: Thoracic aortic dissection should be considered as a differential diagnosis in patients presenting with epigastric and interscapular chest pain. Emergency endovascular repair of acute thoracic aortic dissection is feasible and relatively safe. Regular follow-up with CT scan is required to evaluate the long-term effi cacy and identify the need for re-intervention.Keywords: aortic, dissection, endovascular, thoraci

A new avenue in the search for <i>CP</i> violation:Mössbauer spectroscopy of ²²⁷ Ac

This work proposes a new avenue in the search for CP-violating odd-electric and even-magnetic nuclear moments. A promising candidate to find such moments in the ground state is the quadrupole-deformed and octupole-correlated nucleus 227-actinium. In this nucleus, the 27.4-keV $E1$~transition that connects the $3/2^+$ parity-doublet partner and the $3/2^-$ ground state is perfectly suited to apply the sensitive technique of recoil-free selfabsorption, commonly known as M\"ossbauer spectroscopy. In this experimental approach, the lifetime of the $3/2^+$ upper parity-doublet partner allows an estimate of the lower limit of $\Delta E = 2\cdot \Gamma_{\gamma}$= $23.7(1) \times 10^{-9}$ eV for the achievable energy resolution to be made. This resolution must be exceeded by the interaction of a CP-violating moment and the corresponding multipole moment of the field distribution in the lattice. This work presents the first ideas for patterns caused by CP-violating moments on the expected quadrupole splitting and nuclear Zeeman effect.Comment: 9 pages, 4 figure

Iterative focused screening with biological fingerprints identifies selective Asc-1 inhibitors distinct from traditional high throughput screening

N-methyl-d-aspartate receptors (NMDARs) mediate glutamatergic signaling that is critical to cognitive processes in the central nervous system, and NMDAR hypofunction is thought to contribute to cognitive impairment observed in both schizophrenia and Alzheimer’s disease. One approach to enhance the function of NMDAR is to increase the concentration of an NMDAR coagonist, such as glycine or d-serine, in the synaptic cleft. Inhibition of alanine–serine–cysteine transporter-1 (Asc-1), the primary transporter of d-serine, is attractive because the transporter is localized to neurons in brain regions critical to cognitive function, including the hippocampus and cortical layers III and IV, and is colocalized with d-serine and NMDARs. To identify novel Asc-1 inhibitors, two different screening approaches were performed with whole-cell amino acid uptake in heterologous cells stably expressing human Asc-1: (1) a high-throughput screen (HTS) of 3 M compounds measuring 35S l-cysteine uptake into cells attached to scintillation proximity assay beads in a 1536 well format and (2) an iterative focused screen (IFS) of a 45 000 compound diversity set using a 3H d-serine uptake assay with a liquid scintillation plate reader in a 384 well format. Critically important for both screening approaches was the implementation of counter screens to remove nonspecific inhibitors of radioactive amino acid uptake. Furthermore, a 15 000 compound expansion step incorporating both on- and off-target data into chemical and biological fingerprint-based models for selection of additional hits enabled the identification of novel Asc-1-selective chemical matter from the IFS that was not identified in the full-collection HTS

Double exchange magnets: Spin-dynamics in the paramagnetic phase

The electronic structure of perovskite manganese oxides is investigated in terms of a Kondo lattice model with ferromagnetic Hund coupling and antiferromagnetic exchange between $t_{2g}$-spins using a finite temperature diagonalization technique. Results for the dynamic structure factor are consistent with recent neutron scattering experiments for the bilayer manganite La$_{1.2}$Sr$_{1.8}$Mn$_2$O$_7$ . The susceptibility shows Curie-Weiss behaviour and is used to derive a phase diagram. In the paramagnetic phase carriers are characterized as ferromagnetic polarons in an antiferromagnetic spin liquid.Comment: Revtex, 4 pages with 5 postscript figures include

Trends in the Association of Parental History of Obesity over 60 Years

Objective: The association of familial as compared to genetic factors in the current obesogenic environment, compared to earlier, leaner time periods, is uncertain. Design and Methods Participants from the Framingham Heart Study were classified according to parental obesity status in the Original, Offspring, and Third Generation cohorts; mean BMI levels were estimated and we compared the association of parental history across generations. Finally, a genetic risk score comprised of 32 well-replicated single nucleotide polymorphisms for BMI was examined in association with BMI levels in 1948, 1971, and 2002. Results: BMI was 1.49 kg/m2 higher per each affected parent among the Offspring, and increased to 2.09 kg/m2 higher among the Third Generation participants (p-value for the cohort comparison=0.007). Parental history of obesity was associated with increased weight gain (p<0.0001) and incident obesity (p=0.009). Despite a stronger association of parental obesity with offspring BMI in more contemporary time periods, we observed no change in the effect size of a BMI genetic risk score from 1948 to 2002 (p=0.11 for test of trend across the time periods). Conclusions: The association of parental obesity has become stronger in more contemporary time period, whereas the association of a BMI genetic risk score has not changed

Low T-cell Receptor Diversity, High Somatic Mutation Burden, and High Neoantigen Load as Predictors of Clinical Outcome in Muscle-invasive Bladder Cancer

AbstractBackgroundThe success of cancer immunotherapies has highlighted the potent ability of local adaptive immune responses to eradicate cancer cells by targeting neoantigens generated by somatic alterations. However, how these factors interact to drive the natural history of muscle-invasive bladder cancer (MIBC) is not well understood.ObjectiveTo investigate the role of immune regulation in MIBC disease progression, we performed massively parallel T-cell receptor (TCR) sequencing of tumor-infiltrating T cells (TILs), in silico neoantigen prediction from exome sequences, and expression analysis of immune-related genes.Design, setting, and participantsWe analyzed 38 MIBC tissues from patients who underwent definitive surgery with a minimum clinical follow-up of 2 yr.Outcome measurements and statistical analysisRecurrence-free survival (RFS) was determined. TCR diversity was quantified using Simpson's diversity index. The main analyses involved the Mann-Whitney U test, Kaplan-Meier survival analysis, and Cox proportional hazards models.Results and limitationsLow TCRβ chain diversity, correlating with oligoclonal TIL expansion, was significantly correlated with longer RFS, even after adjustment for pathologic tumor stage, node status, and receipt of adjuvant chemotherapy (hazard ratio 2.67, 95% confidence interval 1.08–6.60; p=0.03). Patients with both a high number of neoantigens and low TCRβ diversity had longer RFS compared to those with fewer neoantigens and high TCR diversity (median RFS 275 vs 30 wk; p=0.03). Higher expression of immune cytolytic genes was associated with nonrecurrence among patients with low TCR diversity or fewer neoantigens. Limitations include the sample size and the inability to distinguish CD8+ and CD4+ T cells using TCR sequencing.ConclusionsThese findings are the first to show that detailed tumor immune-genome analysis at definitive surgery can identify molecular patterns of antitumor immune response contributing to better clinical outcomes in MIBC.Patient summaryWe discovered that clonal expansion of certain T cells in tumor tissue, possibly targeting cancer-specific antigens, contributes to prevention of bladder cancer recurrence

Semantic Search in Psychosis: Modeling Local Exploitation and Global Exploration

Impairments in category verbal fluency task (VFT) performance have been widely documented in psychosis. These deficits may be due to disturbed “cognitive foraging” in semantic space, in terms of altered salience of cues that influence individuals to search locally within a subcategory of semantically related responses (“clustering”) or globally between subcategories (“switching”). To test this, we conducted a study in which individuals with schizophrenia (n = 21), schizotypal personality traits (n = 25), and healthy controls (n = 40) performed VFT with “animals” as the category. Distributional semantic model Word2Vec computed cosine-based similarities between words according to their statistical usage in a large text corpus. We then applied a validated foraging-based search model to these similarity values to obtain salience indices of frequency-based global search cues and similarity-based local cues. Analyses examined whether diagnosis predicted VFT performance, search strategies, cue salience, and the time taken to switch between vs search within clusters. Compared to control and schizotypal groups, individuals with schizophrenia produced fewer words, switched less, and exhibited higher global cue salience, indicating a selection of more common words when switching to new clusters. Global cue salience negatively associated with vocabulary ability in controls and processing speed in schizophrenia. Lastly, individuals with schizophrenia took a similar amount of time to switch to new clusters compared to control and schizotypal groups but took longer to transition between words within clusters. Findings of altered local exploitation and global exploration through semantic memory provide preliminary evidence of aberrant cognitive foraging in schizophrenia