The Tissue Systems Pathology Test Outperforms Pathology Review in Risk Stratifying Patients With Low-Grade Dysplasia

BACKGROUND & AIMS: Low-grade dysplasia (LGD) is associated with an increased risk of progression in Barrett’s esophagus (BE); however, the diagnosis of LGD is limited by substantial interobserver variability. Multiple studies have shown that an objective tissue systems pathology test (TissueCypher Barrett’s Esophagus Test, TSP-9), can effectively predict neoplastic progression in patients with BE. This study aimed to compare the risk stratification performance of the TSP-9 test vs benchmarks of generalist and expert pathology. METHODS: A blinded cohort study was conducted in the screening cohort of a randomized controlled trial of patients with BE with community-based LGD. Biopsies from the first endoscopy with LGD were assessed by the TSP-9 test and independently reviewed by 30 pathologists from 5 countries per standard practice. The accuracy of the test and the diagnoses in predicting high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) were compared. RESULTS: A total of 154 patients with BE (122 men), mean age 60.9 ± 9.8 years were studied. Twenty-four patients progressed to HGD/EAC within 5 years (median time of 1.7 years) and 130 did not progress to HGD/EAC within 5 years (median 7.8 years follow-up). The TSP-9 test demonstrated higher sensitivity (71% vs mean 63%, range 33%–88% across 30 pathologists), than the pathology review in detecting patients who progressed (P = .01186). CONCLUSIONS: The TSP-9 test outperformed the pathologists in risk stratifying patients with BE with LGD. Care guided by the test can provide an effective solution to variable pathology review of LGD, improving health outcomes by upstaging care to therapeutic intervention for patients at high risk for progression, while reducing unnecessary interventions in low-risk patients

Development and Validation of a Surgical Workload Measure: The Surgery Task Load Index (SURG-TLX)

Background: The purpose of the present study was to develop and validate a multidimensional, surgery-specific workload measure (the SURG-TLX), and to determine its utility in providing diagnostic information about the impact of various sources of stress on the perceived demands of trained surgical operators. As a wide range of stressors have been identified for surgeons in the operating room, the current approach of considering stress as a unidimensional construct may not only limit the degree to which underlying mechanisms may be understood but also the degree to which training interventions may be successfully matched to particular sources of stress. Methods: The dimensions of the SURG-TLX were based on two current multidimensional workload measures and developed via focus group discussion. The six dimensions were defined as mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. Thirty novices were trained on the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task and then completed the task under various conditions designed to manipulate the degree and source of stress experienced: task novelty, physical fatigue, time pressure, evaluation apprehension, multitasking, and distraction. Results: The results were supportive of the discriminant sensitivity of the SURG-TLX to different sources of stress. The sub-factors loaded on the relevant stressors as hypothesized, although the evaluation pressure manipulation was not strong enough to cause a significant rise in situational stress. Conclusions: The present study provides support for the validity of the SURG-TLX instrument and also highlights the importance of considering how different stressors may load surgeons. Implications for categorizing the difficulty of certain procedures, the implementation of new technology in the operating room (man-machine interface issues), and the targeting of stress training strategies to the sources of demand are discussed. Modifications to the scale to enhance clinical utility are also suggested. © 2011 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Blueprints of Effective Biodiversity and Conservation Knowledge Products That Support Marine Policy

Biodiversity and conservation data are generally costly to collect, particularly in the marine realm. Hence, data collected for a given—often scientific—purpose are occasionally contributed toward secondary needs, such as policy implementation or other types of decision-making. However, while the quality and accessibility of marine biodiversity and conservation data have improved over the past decade, the ways in which these data can be used to develop and implement relevant management and conservation measures and actions are not always explicit. For this reason, there are a number of scientifically-sound datasets that are not used systematically to inform policy and decisions. Transforming these marine biodiversity and conservation datasets into knowledge products that convey the information required by policy- and decision-makers is an important step in strengthening knowledge exchange across the science-policy interface. Here, we identify seven characteristics of a selection of online biodiversity and conservation knowledge products that contribute to their ability to support policy- and decision-making in the marine realm (as measured by e.g., mentions in policy resolutions/decisions, or use for reporting under selected policy instruments; use in high-level screening for areas of biodiversity importance). These characteristics include: a clear policy mandate; established networks of collaborators; iterative co-design of a user-friendly interface; standardized, comprehensive and documented methods with quality assurance; consistent capacity and succession planning; accessible data and value-added products that are fit-for-purpose; and metrics of use collated and reported. The outcomes of this review are intended to: (a) support data creators/owners/providers in designing and curating biodiversity and conservation knowledge products that have greater influence, and hence impact, in policy- and decision-making, and (b) provide recommendations for how decision- and policy-makers can support the development, implementation, and sustainability of robust biodiversity and conservation knowledge products through the framing of marine policy and decision-making frameworks.This is a contribution to the “Building the European Biodiversity Observation Network” (EU BON) project (www.eubon.eu), a 7th Framework Programme funded by the European Union under grant agreement No. 308454. The authors would also like to acknowledge the Proteus Partnership, the European Commission, the CITES Secretariat, UN Environment, the World Conservation Monitoring Centre, the International Union for Conservation of Nature and the national agencies contributing to GBIF core funds for their financial contributions toward developing and maintaining these knowledge products

Blueprints of Effective Biodiversity and Conservation Knowledge Products That Support Marine Policy

Biodiversity and conservation data are generally costly to collect, particularly in the marine realm. Hence, data collected for a given—often scientific—purpose are occasionally contributed toward secondary needs, such as policy implementation or other types of decision-making. However, while the quality and accessibility of marine biodiversity and conservation data have improved over the past decade, the ways in which these data can be used to develop and implement relevant management and conservation measures and actions are not always explicit. For this reason, there are a number of scientifically-sound datasets that are not used systematically to inform policy and decisions. Transforming these marine biodiversity and conservation datasets into knowledge products that convey the information required by policy- and decision-makers is an important step in strengthening knowledge exchange across the science-policy interface. Here, we identify seven characteristics of a selection of online biodiversity and conservation knowledge products that contribute to their ability to support policy- and decision-making in the marine realm (as measured by e.g., mentions in policy resolutions/decisions, or use for reporting under selected policy instruments; use in high-level screening for areas of biodiversity importance). These characteristics include: a clear policy mandate; established networks of collaborators; iterative co-design of a user-friendly interface; standardized, comprehensive and documented methods with quality assurance; consistent capacity and succession planning; accessible data and value-added products that are fit-for-purpose; and metrics of use collated and reported. The outcomes of this review are intended to: (a) support data creators/owners/providers in designing and curating biodiversity and conservation knowledge products that have greater influence, and hence impact, in policy- and decision-making, and (b) provide recommendations for how decision- and policy-makers can support the development, implementation, and sustainability of robust biodiversity and conservation knowledge products through the framing of marine policy and decision-making frameworks.This is a contribution to the “Building the European Biodiversity Observation Network” (EU BON) project (www.eubon.eu), a 7th Framework Programme funded by the European Union under grant agreement No. 308454. The authors would also like to acknowledge the Proteus Partnership, the European Commission, the CITES Secretariat, UN Environment, the World Conservation Monitoring Centre, the International Union for Conservation of Nature and the national agencies contributing to GBIF core funds for their financial contributions toward developing and maintaining these knowledge products

Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

<p>Abstract</p> <p>Background</p> <p>Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups.</p> <p>Methods/Design</p> <p>A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes.</p> <p>Discussion</p> <p>This trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12609000834257.aspx">ACTRN12609000834257</a>.</p

Perspectives and Integration in SOLAS Science

Why a chapter on Perspectives and Integration in SOLAS Science in this book? SOLAS science by its nature deals with interactions that occur: across a wide spectrum of time and space scales, involve gases and particles, between the ocean and the atmosphere, across many disciplines including chemistry, biology, optics, physics, mathematics, computing, socio-economics and consequently interactions between many different scientists and across scientific generations. This chapter provides a guide through the remarkable diversity of cross-cutting approaches and tools in the gigantic puzzle of the SOLAS realm. Here we overview the existing prime components of atmospheric and oceanic observing systems, with the acquisition of ocean–atmosphere observables either from in situ or from satellites, the rich hierarchy of models to test our knowledge of Earth System functioning, and the tremendous efforts accomplished over the last decade within the COST Action 735 and SOLAS Integration project frameworks to understand, as best we can, the current physical and biogeochemical state of the atmosphere and ocean commons. A few SOLAS integrative studies illustrate the full meaning of interactions, paving the way for even tighter connections between thematic fields. Ultimately, SOLAS research will also develop with an enhanced consideration of societal demand while preserving fundamental research coherency. The exchange of energy, gases and particles across the air-sea interface is controlled by a variety of biological, chemical and physical processes that operate across broad spatial and temporal scales. These processes influence the composition, biogeochemical and chemical properties of both the oceanic and atmospheric boundary layers and ultimately shape the Earth system response to climate and environmental change, as detailed in the previous four chapters. In this cross-cutting chapter we present some of the SOLAS achievements over the last decade in terms of integration, upscaling observational information from process-oriented studies and expeditionary research with key tools such as remote sensing and modelling. Here we do not pretend to encompass the entire legacy of SOLAS efforts but rather offer a selective view of some of the major integrative SOLAS studies that combined available pieces of the immense jigsaw puzzle. These include, for instance, COST efforts to build up global climatologies of SOLAS relevant parameters such as dimethyl sulphide, interconnection between volcanic ash and ecosystem response in the eastern subarctic North Pacific, optimal strategy to derive basin-scale CO2 uptake with good precision, or significant reduction of the uncertainties in sea-salt aerosol source functions. Predicting the future trajectory of Earth’s climate and habitability is the main task ahead. Some possible routes for the SOLAS scientific community to reach this overarching goal conclude the chapter