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

La abundancia y la ecología del comportamiento del blenny Ophioblennius trinitatis (Teleostei: Blenniidae) en un archipiélago oceánico de Brasil (Atlántico)

Local patterns of fish density, microhabitat use, feeding behaviour, bite rate, territory area and agonistic interactions were recorded for Ophioblennius trinitatis at an oceanic archipelago (southwestern Atlantic). Rugosity, number of crevices and benthic diversity positively predicted the distribution of O. trinitatis. Turf algae was the preferred food item at all sites, but given its high availability inside and outside territory boundaries, it did not seem to be a limiting factor on the density of this blenny, as opposed to substrate heterogeneity. Bite rate was higher in the afternoon and for smaller individuals (juveniles). Territory size showed local variation and, although larger territories may be an effect of density-dependent conditions (more available space in low-density areas), we propose that individuals expand territories to compensate for residing in areas of lower quality (i.e. of low structural complexity). Larger individuals defended larger territories and residents responded differently to intruders, with higher rates of agonistic interactions towards potential competitors. Higher agonistic rates were also observed in larger territories and at low-complexity sites.En este trabajo se han estudiado las pautas en la densidad, la utilización del micro hábitat, el comportamiento alimentario, las tasas de mordisqueo, la superficie del territorio y las interacciones agonísticas de Ophioblennius trinitatis en un archipiélago oceánico del SO Atlántico. Los mejores predictores de la distribución de O. trinitatus fueron la rugosidad, el número de grietas y la diversidad bentónica. El turf algal es el alimento preferido de este pez en todos los lugares, pero dada su elevada disponibilidad, dentro y fuera de los territorios, no pareció ser un factor limitante para este blénido como lo fue la heterogeneidad del substrato. La tasa de mordisqueo resultó ser más elevada entre los peces pequeños (juveniles) y especialmente por la tarde. La superficie del territorio presentó notables variaciones locales y, a pesar de que los territorios mayores pueden ser el resultado de un efecto denso-dependiente (al haber más espacio disponible en la zonas con densidades bajas), proponemos que los individuos expanden su territorio para compensar la baja calidad ambiental de ciertas zonas (una baja complejidad estructural). Los ejemplares mayores defendían territorios más extensos y respondían de manera diferente ante los intrusos, con una mayor tasa de interacciones agonísticas hacia los potenciales intrusos. Las interacciones agonísticas también fueron más elevadas en los territorios más amplios y con una baja complejidad

Sangrado rectal tras la administración de Dabigatrán

Presentamos el caso de tres pacientes intervenidos de prótesis total de cadera, que tras la administración protocolaria de tromboprofilaxis con Dabigatrán, presentaron un sangrado rectal importante, siendo este la primera manifestación de un cáncer colorrectal. Todos los casos se trataron durante el postoperatorio inmediato mediante cirugía tratamiento adyuvante. En el caso de un sangrado rectal tras la administración de los nuevos fármacos anticoagulantes es obligatorio descartar patología pre-existente antes de, simplemente, sustituir o suspender la medicación.We observed rectal bleeding in three asymptomatic patients after administration of Dabigatran in the postoperative period, being this the first manifestation of rectal cancer. In all cases Dabigatran was used as DVT prophylaxis. The cause of bleeding in the three cases was an asymptomatic and previously unknown colo-rectal cancer. All patients underwent tumoral resection surgery. With rectal bleeding in the inmediate postoperatory period after administration of oral anticoagulants, rectal cancer screening must be performed

Removal and survival of fecal indicators in a constructed wetland after uasb pre-treatment

The experimentation plant, based on a sub-surface horizontal flow phytodepuration (SSHFP) unit with a pre-treatment by an upflow anaerobic sludge blanket (UASB) reactor, proved valuable in treating the sewage of a small rural community located in north Brazil. During a six-month trial, the plant achieved an average removal efficiency of 98.2% (1.74 log removal) for fecal coliforms (FC) and 96.0% (1.40 log removal) for Enterococci (EN), as well as 95.6% for BOD5, 91.0% for COD,00 and 95.4% for suspended solids (SS). The contribution of the UASB reactor to this overall performance was very significant as, alone, it achieved a yield of 62.7% for FC and 60% for EN, in addition to 65.2% for BOD5 and 65.0% for SS. EN was chosen, in addition to FC, because of its higher specificity and strong environmental persistence, leading to an increased risk to human health. In fact, the experimental results confirmed its lower removal efficiency compared to FC. The mechanical and biological mechanisms that led to such a removal efficiency of the two fecal indicators (FIs) are outlined in the article. The same mechanisms led to a good level of equivalence between the removal efficiency of the two FIs with the removal efficiency of SS and BOD5, for both the whole plant and the UASB reactor alone. The research demonstrated the close correlation between the concentrations of EN and FC for the plant effluent. This correlation can be explained by the following mathematical expression of the regression line Log EN = 0.2571 Log FC + 3.5301, with a coefficient of determination R-2 = 0.912. This implies that the concentration of the more specific indicator EN could be calculated, with acceptable approximation, from the simple analysis of FC and vice versa. The experimental plant brought important health benefits to the local population. In particular, there were no significant odor emissions; moreover, the risk of fecal pathogenic diseases was drastically reduced; finally, there was no proliferation of insects and other disease vectors, due to the absence of stagnant or semi-stagnant water exposed to the atmosphere

The sensitivity of a specific denitrification rate under the dissolved oxygen pressure

The biological denitrification process is extensively discussed in scientific literature. The process requires anoxic conditions, but the influence of residual dissolved oxygen (DO) on the efficiency is not yet adequately documented. The present research aims to fill this gap by highlighting the effects of DO on the specific denitrification rate (SDNR) and consequently on the efficiency of the process. SDNR at a temperature of 20◦C (SDNR20◦C) is the parameter normally used for the sizing of the denitrification reactor in biological-activated sludge processes. A sensitivity analysis of SNDR20◦C to DO variations is developed. For this purpose, two of the main empirical models illustrated in the scientific literature are taken into consideration, with the addition of a deterministic third model proposed by the authors and validated by recent experimentations on several full-scale plants. In the first two models, SDNR20◦C is expressed as a function of the only variable food:microrganism ratio in denitrification (F:MDEN), while in the third one, the dependence on DO is made explicit. The sensitivity analysis highlights all the significant dependence of SDNR20◦C on DO characterized by a logarithmic decrease with a very pronounced gradient in correspondence with low DO concentrations. Moreover, the analysis demonstrates the relatively small influence of F:MDEN on the SDNR20◦C and on the correlation between SDNR20◦C and DO. The results confirm the great importance of minimizing DO and limiting, as much as possible, the transport of oxygen in the denitrification reactor through the incoming flows and mainly the mixed liquor recycle. Solutions to achieve this result in full-scale plants are reported

Innovative Biogas Multi-Stage Biogas Plant and Novel Analytical System

AbstractThe here presented applied research and development project is targeted to the development and application of new and improved techniques in plant design, performance analysis and process control. Hereto following the required steps are illustrated and the goals are outlined. The project covers the development of a previously patented anaerobic digestion process, adaption of flow cytometry as an analytical instrument and investigation of innovative ways of disposal of solid fermentation wastes. The preliminary experiences with a newly built research plant employing a novel anaerobic biogas digestion technique are discussed. In this paper the first outcomes concerning the construction and operation are discussed. A novel method of disposal of the fermentation wastes is also discussed and first results are shown

Stability Matrix Designs: A Boon For Stability Testing of Pharmaceutical Drug Products.

Long term stability is done in a matrix approach after manufacturing of drug for ensuring the stability of drugs. Using the matrix basic design which is useful for testing 3 lots under one storage condition can be expanded to multiple presentation of products or multiple storage conditions. The design shows full testing at the end points (0 and 36 months) and shows partial testing at the interim time points (3, 6, 9, 12, 18 &24 min). With the assistance of a statistical search algorithm, the test points are selected . 37.5%  reduction in analytical testing, while permitting a reliable interim expiry estimate. Based on 12 months stability data it is provided by the proposed matrix design. The matrix approach obtained by expiration dating periods is typically more conservative than the approaches derived from the full testing estimate. The comparison of expiration dating estimate for meter dose inhaler and capsules is presented using the matrixed and full testing approaches

Bone metastases from osteosarcoma

Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. Three remain alive with no evidence of disease at 5, 7 and 8 years follow-up respectively. Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative