Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma

Author version made available following 12 month embargo from date of publication according to publisher copyright policy.Barrett's esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability

Wiki-based clinical practice guidelines for the management of adult onset sarcoma: a new paradigm in sarcoma evidence.

In 2013 Australia introduced Wiki-based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma. These guidelines utilized a customized MediaWiki software application for guideline development and are the first evidence-based guidelines for clinical management of sarcoma. This paper presents our experience with developing and implementing web-based interactive guidelines and reviews some of the challenges and lessons from adopting an evidence-based (rather than consensus-based) approach to clinical sarcoma guidelines. Digital guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated. They provide an accessible method of enabling clinicians and consumers to access evidence-based clinical practice recommendations and, as evidenced by over 2000 views in the first four months after release, with 49% of those visits being from countries outside of Australia. The lessons learned have relevance to other rare cancers in addition to the international sarcoma community

Automated Detection of Refactorings in Evolving Components

One of the costs of reusing software components is migrating applications to use the new version of the components. Migrating an application can be error-prone, tedious, and disruptive of the development process. Our previous work shows that more than 80% of the disruptive changes in four different components were caused by refactorings. If the refactorings that happened between two versions of a component could be automatically detected, a refactoring tool could replay them on applications. We present an algorithm that detects refactorings performed during component evolution. Our algorithm uses a combination of a fast syntactic analysis to detect refactoring candidates and a more expensive semantic analysis to refine the results. The experiments on codebases ranging from 17 KLOC to 350 KLOC show that our algorithm detects refactorings in real-world components with accuracy over 85%

Effects of propofol anesthesia on the processing of noxious stimuli in the spinal cord and the brain

Drug-induced unconsciousness is an essential component of general anesthesia, commonly attributed to attenuation of higher-order processing of external stimuli and a resulting loss of information integration capabilities of the brain. In this study, we investigated how the hypnotic drug propofol at doses comparable to those in clinical practice influences the processing of somatosensory stimuli in the spinal cord and in primary and higher-order cortices. Using nociceptive reflexes, somatosensory evoked potentials and functional magnet resonance imaging (fMRI), we found that propofol abolishes the processing of innocuous and moderate noxious stimuli at low to medium concentration levels, but that intense noxious stimuli evoked spinal and cerebral responses even during deep propofol anesthesia that caused profound electroencephalogram (EEG) burst suppression. While nociceptive reflexes and somatosensory potentials were affected only in a minor way by further increasing doses of propofol after the loss of consciousness, fMRI showed that increasing propofol concentration abolished processing of intense noxious stimuli in the insula and secondary somatosensory cortex and vastly increased processing in the frontal cortex. As the fMRI functional connectivity showed congruent changes with increasing doses of propofol – namely the temporal brain areas decreasing their connectivity with the bilateral pre-/postcentral gyri and the supplementary motor area, while connectivity of the latter with frontal areas is increased – we conclude that the changes in processing of noxious stimuli during propofol anesthesia might be related to changes in functional connectivity

Die wasserrechtliche Fachbetriebspflicht Schwachstellenanalyse und Vorschlaege zur Steigerung ihrer Effizienz

The Water Protection Act ('Wasserhaushaltsgesetz'-WHG), relating to process installations, defines a requirement that some specific activities may only be performed by 'qualified enterprises' ('Fachbetriebe'). These enterprises must have knowledge, personnel and equipment to use the technical methods to protect the water from hazardous substances. The regulations have been in force in their current form since 1986. This research was instigated due to the reportedly high frequency of audit Faults at process installations where these 'qualified enterprises' had been employed. A survey of the current opinion of involved parties (including authorities, operating companies and expert bodies) was carried out by means of questionnaires. General support for the concept of 'qualified enterprises' was confirmed from this. The WHG allows two implementation routes; using the Technical Monitoring organisations recognised in Water Protection legislation, or using the Goods- and Monitoring Associations acknowledged in construction regulations. On the other hand the analysis showed that the two types of organisation are generally equal in terms of effectiveness. However instances were found where significant differences can exist between the two types of organisations. The consensus of the participants clearly endorsed preservations of both forms of organisations because each demonstrates specific advantages. (orig.)SIGLEAvailable from TIB Hannover: RN 8422(2003,70) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Umwelt, Naturschutz und Reaktorsicherheit, Bonn (Germany)DEGerman