Technology for large-scale translation of clinical practice guidelines : a pilot study of the performance of a hybrid human and computer-assisted approach

Background: The construction of EBMPracticeNet, a national electronic point-of-care information platform in Belgium, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The project involved, among other tasks, the translation of 940 EBM Guidelines of Duodecim Medical Publications from English into Dutch and French. Considering the scale of the translation process, it was decided to make use of computer-aided translation performed by certificated translators with limited expertise in medical translation. Our consortium used a hybrid approach, involving a human translator supported by a translation memory (using SDL Trados Studio), terminology recognition (using SDL Multiterm termbases) from medical termbases and support from online machine translation. This has resulted in a validated translation memory which is now in use for the translation of new and updated guidelines. Objective: The objective of this study was to evaluate the performance of the hybrid human and computer-assisted approach in comparison with translation unsupported by translation memory and terminology recognition. A comparison was also made with the translation efficiency of an expert medical translator. Methods: We conducted a pilot trial in which two sets of 30 new and 30 updated guidelines were randomized to one of three groups. Comparable guidelines were translated (a) by certificated junior translators without medical specialization using the hybrid method (b) by an experienced medical translator without this support and (c) by the same junior translators without the support of the validated translation memory. A medical proofreader who was blinded for the translation procedure, evaluated the translated guidelines for acceptability and adequacy. Translation speed was measured by recording translation and post-editing time. The Human Translation Edit Rate was calculated as a metric to evaluate the quality of the translation. A further evaluation was made of translation acceptability and adequacy. Results: The average number of words per guideline was 1,195 and the mean total translation time was 100.2 min/1,000 words. No meaningful differences were found in the translation speed for new guidelines. The translation of updated guidelines was 59 min/1,000 words faster (95% CI 2-115; P=.044) in the computer-aided group. Revisions due to terminology accounted for one third of the overall revisions by the medical proofreader. Conclusions: Use of the hybrid human and computer-aided translation by a non-expert translator makes the translation of updates of clinical practice guidelines faster and cheaper because of the benefits of translation memory. For the translation of new guidelines there was no apparent benefit in comparison with the efficiency of translation unsupported by translation memory (whether by an expert or non-expert translator

Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms

In social insurance systems that grant workers paid sick leave, physicians act as gatekeepers, supposedly granting sickness certificates to the sick and not to shirkers. Previous research has emphasized the physician's superior ability to judge patients' need of treatment and potential collusion with the patient vis‐á‐vis an insurer. What is less well understood is the role of patients' private information. We explore the case where patients have private information about the presence of nonverifiable symptoms. Anyone can then claim to experience such symptoms, reducing physicians' ability to distinguish between sick patients and shirkers. Doubting a patients' reported symptoms may prevent good medical treatment of the truly sick. We show that for all parameter values, the Bayesian Nash equilibrium is that some physicians trust all claims of nonverifiable symptoms, sicklisting shirkers as well as sick; for many values, every physician is trusting. In particular, if physician strategies are observable by patients, extremely strong gatekeeping preferences are required to make physicians mistrust. To limit unwarranted sicklisting, policies reducing the benefits of shirking for healthy workers may be better suited than attempts to convince physicians to be strict.publishedVersio

Fibrations on four-folds with trivial canonical bundles

Four-folds with trivial canonical bundles are divided into six classes according to their holonomy group. We consider examples that are fibred by abelian surfaces over the projective plane. We construct such fibrations in five of the six classes, and prove that there is no such fibration in the sixth class. We classify all such fibrations whose generic fibre is the Jacobian of a genus two curve.Comment: 28 page

Silicon Pad Detectors for the PHOBOS Experiment at RHIC

The PHOBOS experiment is well positioned to obtain crucial information about relativistic heavy ion collisions at RHIC, combining a multiplicity counter with a multi-particle spectrometer. The multiplicity arrays will measure the charged particle multiplicity over the full solid angle. The spectrometer will be able to identify particles at mid-rapidity. The experiment is constructed almost exclusively of silicon pad detectors. Detectors of nine different types are configured in the multiplicity and vertex detector (22,000 channels) and two multi-particle spectrometers (120,000 channels). The overall layout of the experiment, testing of the silicon sensors and the performance of the detectors during the engineering run at RHIC in 1999 are discussed.Comment: 7 pages, 7 figures, 1 table, Late

Energy dependence of particle multiplicities in central Au+Au collisions

We present the first measurement of the pseudorapidity density of primary charged particles in Au+Au collisions at sqrt(s_NN) = 200GeV. For the 6% most central collisions, we obtain dN_ch/deta|_|eta|<1 = 650 +/- 35 (syst). Compared to collisions at sqrt(s_NN) = 130GeV, the highest energy studied previously, an increase by a factor of 1.14 +/- 0.05 is found. The energy dependence of the pseudorapidity density is discussed in comparison with data from proton-induced collisions and theoretical predictions.Comment: 4 pages, 6 figures, submitted to PR

Collision geometry scaling of Au+Au pseudorapidity density from sqrt(s_NN) = 19.6 to 200 GeV

The centrality dependence of the midrapidity charged particle multiplicity in Au+Au collisions at sqrt(s_NN) = 19.6 and 200 GeV is presented. Within a simple model, the fraction of hard (scaling with number of binary collisions) to soft (scaling with number of participant pairs) interactions is consistent with a value of x = 0.13 +/- 0.01(stat) +/- 0.05(syst) at both energies. The experimental results at both energies, scaled by inelastic p(pbar)+p collision data, agree within systematic errors. The ratio of the data was found not to depend on centrality over the studied range and yields a simple linear scale factor of R_(200/19.6) = 2.03 +/- 0.02(stat) +/- 0.05(syst).Comment: 5 pages, 4 figures, submitted to PRC-R

Pseudorapidity and centrality dependence of the collective flow of charged particles in Au+Au collisions at sqrt{s_NN} = 130 GeV

This paper describes the measurement of collective flow for charged particles in Au+Au collisions at sqrt{s_NN}} = 130 GeV using the PHOBOS detector at the Relativistic Heavy Ion Collider (RHIC). An azimuthal anisotropy is observed in the charged particle hit distribution in the PHOBOS multiplicity detector. This anisotropy is presented over a wide range of pseudorapidity (eta) for the first time at this energy. The size of the anisotropy (v_{2}) is thought to probe the degree of equilibration achieved in these collisions. The result here,averaged over momenta and particle species, is observed to reach 7% for peripheral collisions at mid-rapidity, falling off with centrality and increasing |eta|. Data are presented as a function of centrality for |eta|<1.0 and as a function of eta, averaged over centrality, in the angular region -5.0<eta<5.3. These results call into question the common assumption of longitudinal boost invariance over a large region of rapidity in RHIC collisions.Comment: 5 pages, 4 figures, submitted to Physical Review Letter

Pseudorapidity Distributions of Charged Particles in d + Au and p + p Collisions at sNN\sqrt{s_{_{NN}}} = 200GeV

The measured pseudorapidity distributions of primary charged particles are presented for d + Au and p + p collisions at ${\sqrt{s_{_{NN}}} =}$ 200 GeV over a wide pseudorapidity range of ${\rm \mid \eta \mid \le}$ 5.4. The results for d + Au collisions are presented for minimum-bias events and as a function of collision centrality. The measurements for p + p collisions are shown for minimum-bias events. The ratio of the charged particle multiplicity in d + Au and p + A collisions relative to that for inelastic p + p collisions is found to depend only on ${}$, and it is remarkably independent of collision energy and system mass. The deuteron and gold fragmentation regions in d + Au collisions are in good agreement with proton nucleus data at lower energies.Comment: 4 pages, 3 figures. To appear in the proceedings of Seventeenth International Conference on Ultra-Relativistic Nucleus-Nucleus Collisions (Quark Matter 2004), Oakland, California from January 11-17, 2004. Submitted to Journal of Physics G: Nuclear and Particle Physic