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

Implementing tablets in Norwegian primary schools: Examining the outcome measures in the second cohort

This study examines the implementation of tablets in primary schools in Norway. The outcome measures in the study are external for the intervention and are recorded data from national tests (National reading, arithmetic and English Tests, Classes 5, 8 and 9; National Mapping Tests for reading and arithmetic, Classes 1–3; and the 2014–2017 National Pupil Survey). The entire study (N=15, 708) relies on an explanatory, sequential mixed-methods design (Fetters, Curry, & Creswell 2013), and in this study we examine the quantitative effects of this implementation. The results indicate that the impact of tablets on pupils’ school achievement varies. It seems that tablets contribute more positively to boys’ school achievements than to girls’ school achievements. However, we cannot rule out that a grade effect may also have an impact on the results, and we therefore request that the results be read with this reservation.publishedVersio

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

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

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

Ratios of charged antiparticles to particles near mid-rapidity in Au+Au collisions at sqrt(s_NN) = 130 GeV

We have measured the ratios of antiparticles to particles for charged pions, kaons and protons near mid-rapidity in central Au+Au collisions at sqrt(s_NN) = 130 GeV. For protons, we observe pbar/p = 0.60 +/- 0.04 (stat.) +/- 0.06 (syst.) in the transverse momentum range 0.15 < p_T < 1.0 GeV/c. This leads to an estimate of the baryo-chemical potential mu_B of 45 MeV, a factor of 5-6 smaller than in central Pb+Pb collisions at sqrt(s_NN) = 17.2 GeV.Comment: 4 page

Centrality and pseudorapidity dependence of elliptic flow for charged hadrons in Au+Au collisions at sqrt(sNN) = 200 GeV

This paper describes the measurement of elliptic flow for charged particles in Au+Au collisions at sqrt(sNN)=200 GeV using the PHOBOS detector at the Relativistic Heavy Ion Collider (RHIC). The measured azimuthal anisotropy is presented over a wide range of pseudorapidity for three broad collision centrality classes for the first time at this energy. Two distinct methods of extracting the flow signal were used in order to reduce systematic uncertainties. The elliptic flow falls sharply with increasing eta at 200 GeV for all the centralities studied, as observed for minimum-bias collisions at sqrt(sNN)=130 GeV.Comment: Final published version: the most substantive change to the paper is the inclusion of a complete description of how the errors from the hit-based and track-based analyses are merged to produce the 90% C.L. errors quoted for the combined results shown in Fig.

Elliptic Flow in Au+Au Collisions at RHIC

Elliptic flow is an interesting probe of the dynamical evolution of the dense system formed in the ultrarelativistic heavy ion collisions at the Relativistic Heavy Ion Collider (RHIC). The elliptic flow dependences on transverse momentum, centrality, and pseudorapidity were measured using data collected by the PHOBOS detector, which offers a unique opportunity to study the azimuthal anisotropies of charged particles over a wide range of pseudorapidity. These measurements are presented, together with an overview of the analysis methods and a discussion of the results.Comment: Presented at Hot Quarks 2004; 7 pages, 6 figure