170 research outputs found

    Quality indicators for bladder cancer services : a collaborative review

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    Context There is a lack of accepted consensus on what should constitute appropriate quality-of-care indicators for bladder cancer. Objective To evaluate the optimal management of bladder cancer and propose quality indicators (QIs). Evidence acquisition A systematic review was performed to identify literature on current optimal management and potential quality indicators for both non–muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer. A panel of experts was convened to select a recommended list of QIs. Evidence synthesis For NMIBC, preoperative QIs include tobacco cessation counselling and appropriate imaging before initial transurethral resection of bladder tumour (TURBT). Intraoperative QIs include administration of antibiotics, proper safe conduct of TURBT using a checklist, and performing restaging TURBT with biopsy of the prostatic urethra in appropriate cases. Postoperative QIs include appropriate receipt of perioperative adjuvant therapy, risk-stratified surveillance, and appropriate decision to change therapy when indicated (eg, unresponsive to bacillus Calmette-Guerin). For MIBC, preoperative QIs include multidisciplinary care, selection for candidates for continent urinary diversion, receipt of neoadjuvant cisplatin-based chemotherapy, time to commencing radical treatment, consideration of trimodal therapy as a bladder-sparing alternative in select patients, preoperative counselling with stoma marking, surgical volume of radical cystectomy, and enhanced recovery after surgery protocols. Intraoperative QIs include adequacy of lymphadenectomy, blood loss, and operative time. Postoperative QIs include prospective standardised monitoring of morbidity and mortality, negative surgical margins for pT2 disease, appropriate surveillance after primary treatment, and adjuvant cisplatin-based chemotherapy in appropriate cases. Participation in clinical trials was highlighted as an important component indicating high quality of care. Conclusions We propose a set of QIs for both NMIBC and MIBC based on established clinical guidelines and the available literature. Measurement of these QIs could aid in improvement and benchmarking of optimal care of bladder cancer. Patient summary After a systematic review of existing guidelines and literature, a panel of experts has recommended a set of quality indicators that can help providers and patients measure and strive towards optimal outcomes for bladder cancer care

    A thread calculus with molecular dynamics

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    We present a theory of threads, interleaving of threads, and interaction between threads and services with features of molecular dynamics, a model of computation that bears on computations in which dynamic data structures are involved. Threads can interact with services of which the states consist of structured data objects and computations take place by means of actions which may change the structure of the data objects. The features introduced include restriction of the scope of names used in threads to refer to data objects. Because that feature makes it troublesome to provide a model based on structural operational semantics and bisimulation, we construct a projective limit model for the theory.Comment: 47 pages; examples and results added, phrasing improved, references replace

    The nature of an object-oriented program:how do practitioners understand the nature of what they are creating?

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    Object-oriented programming is seen as a difficult skill to master. There is considerable debate about the most appropriate way to introduce novice programmers to object-oriented concepts. Is it possible to uncover what the critical aspects or features are that enhance the learning of object-oriented programming? Practitioners have differing understandings of the nature of an object-oriented program. Uncovering these different ways of understanding leads to agreater understanding of the critical aspects and their relationship tothe structure of the program produced. A phenomenographic studywas conducted to uncover practitioner understandings of the nature of an object-oriented program. The study identified five levels of understanding and three dimensions of variation within these levels. These levels and dimensions of variation provide a framework for fostering conceptual change with respect to the nature of an object-oriented program

    Empathy matters: ERP evidence for inter-individual differences in social language processing

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    When an adult claims he cannot sleep without his teddy bear, people tend to react surprised. Language interpretation is, thus, influenced by social context, such as who the speaker is. The present study reveals inter-individual differences in brain reactivity to social aspects of language. Whereas women showed brain reactivity when stereotype-based inferences about a speaker conflicted with the content of the message, men did not. This sex difference in social information processing can be explained by a specific cognitive trait, one’s ability to empathize. Individuals who empathize to a greater degree revealed larger N400 effects (as well as a larger increase in γ-band power) to socially relevant information. These results indicate that individuals with high-empathizing skills are able to rapidly integrate information about the speaker with the content of the message, as they make use of voice-based inferences about the speaker to process language in a top-down manner. Alternatively, individuals with lower empathizing skills did not use information about social stereotypes in implicit sentence comprehension, but rather took a more bottom-up approach to the processing of these social pragmatic sentences

    The Alaska Arctic Vegetation Archive (AVA-AK)

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    The Alaska Arctic Vegetation Archive (AVA-AK, GIVD-ID: NA-US-014) is a free, publically available database archive of vegetation-plot data from the Arctic tundra region of northern Alaska. The archive currently contains 24 datasets with 3,026 non-overlapping plots. Of these, 74% have geolocation data with 25-m or better precision. Species cover data and header data are stored in a Turboveg database. A standardized Pan Arctic Species List provides a consistent nomenclature for vascular plants, bryophytes, and lichens in the archive. A web-based online Alaska Arctic Geoecological Atlas (AGA-AK) allows viewing and downloading the species data in a variety of formats, and provides access to a wide variety of ancillary data. We conducted a preliminary cluster analysis of the first 16 datasets (1,613 plots) to examine how the spectrum of derived clusters is related to the suite of datasets, habitat types, and environmental gradients. Here, we present the contents of the archive, assess its strengths and weaknesses, and provide three supplementary files that include the data dictionary, a list of habitat types, an overview of the datasets, and details of the cluster analysis

    TeV Gamma-ray Observations of the Crab and Mkn 501 during Moonshine and Twilight

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    TeV Gamma-ray signals from the Crab Nebula and Mkn 501 were detected with the HEGRA CT1 imaging Cerenkov telescope during periods when the moon was shining and during twilight. This was accomplished by lowering the high voltage supply of the photomutipliers in fixed steps up to 13%. No other adjustments were made and no filters were used. Laser runs could not establish any non-linearity in the gain of the individual pixels, and the trigger rate was uniform over the whole camera. The energy threshol was increased by up to a factor of two, depending on the amount of HV reduction. In a series of observations lasting 11.7 hours, a signal with a 3.4 sigma significance was detected from the Crab. During the 1997 multiple flare episode of Mkn 501 a 26 sigma combined excess has been recorded during 134 hours of observations under various moonshine/twilight conditions. The results show that this technique can easily be adapted to increase the exposure of a source, which is important for sources showing rapid time variability such as AGNs or GRBs. Observations can be made up to ~20 deg. angular separation from the moon and until the moon is 85% illuminated (ten to eleven days before and after new moon), as well as during 20 to 40 minutes during twilight, before the commencement of astronomical darkness.Comment: 16 pages, 5 figures, submitted to Astroparticle Physic
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