Modular Moose: A new generation software reverse engineering environment

Advanced reverse engineering tools are required to cope with the complexity of software systems and the specific requirements of numerous different tasks (re-architecturing, migration, evolution). Consequently, reverse engineering tools should adapt to a wide range of situations. Yet, because they require a large infrastructure investment, being able to reuse these tools is key. Moose is a reverse engineering environment answering these requirements. While Moose started as a research project 20 years ago, it is also used in industrial projects, exposing itself to all these difficulties. In this paper we present ModMoose, the new version of Moose. ModMoose revolves around a new meta-model, modular and extensible; a new toolset of generic tools (query module, visualization engine, ...); and an open architecture supporting the synchronization and interaction of tools per task. With ModMoose, tool developers can develop specific meta-models by reusing existing elementary concepts, and dedicated reverse engineering tools that can interact with the existing ones

Real-life assessment of chronic rhinosinusitis patients using mobile technology : The mySinusitisCoach project by EUFOREA

Background Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS. Methods This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria. Results The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell. Conclusion Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.Peer reviewe

Unanticipated admission after ambulatory surgery in the pediatric population : a single-center retrospective analysis

Introduction The incidence of adverse events in day surgery is an important quality indicator. This retrospective study investigated factors independently associated with unanticipated admission of pediatric patients after ambulatory surgery. Patients and methods Ambulatory pediatric patients requiring unanticipated admission between January 2016 and December 2018 were compared to ambulatory pediatric patients who were discharged home after a planned surgery. Demographic data, organizational data, American Society of Anesthesiologists (ASA) classification, type of surgery, type of anesthesia, length of surgery, time of completion of the surgery, campus site, and season were collected in both groups. The reason for unexpected admission was classified according to four subtypes: anesthetic, medical, social/organizational and surgical reason, respectively. Multivariate logistic regression was used to identify independent factors associated with unanticipated admission. Results From a total of 4235 pediatric patients, 78 children (1.9%) required unanticipated admission. The reasons for admission were anesthetic n = 29 (37.3%), surgical n = 20 (25.6%), medical n = 16 (20.5%) and social/organizational n = 13 (16.6%). Age 2 h (OR 3.056; CI 1.829-5.107); completion of surgery > 2:30 PM (OR 3.507; CI 1.854-6.633) and campus site (OR 3.628; CI 1.991-6.610) were factors significantly associated with unanticipated admission. Conclusion Children are less likely to be admitted after ambulatory surgery when preoperatively carefully selected and when prioritized considering age, general health condition and invasiveness of the surgery

From GWT to Angular: An Experiment Report on Migrating a Legacy Web Application

International audienceBerger-Levrault is an international company that developed applications in GWT for more than 10 years. However, GWT is no longer actively maintained, with only one major update since 2015. To avoid being stuck with legacy technology, the company decided to migrate its applications to Angular. However, because of the size of the applications (more than 500 web pages per application), rewriting from scratch is not desirable. To ease the migration, we designed a semi-automated migration approach that helps developers migrate applications' front-end from GWT to Angular and a tool that performs the migration. In this paper, we present our approach and tool. We validated the approach on concrete application migration and compared its benefits to redeveloping the application manually. We report that the semi-automated migration offers an effort reduction over a manual migration. Finally, we present recommendations for future migration projects

Modular Moose: A new generation software reverse engineering environment

International audienceAdvanced reverse engineering tools are required to cope with the complexity of software systems and the specific requirements of numerous different tasks (re-architecturing, migration, evolution). Consequently , reverse engineering tools should adapt to a wide range of situations. Yet, because they require a large infrastructure investment, being able to reuse these tools is key. Moose is a reverse engineering environment answering these requirements. While Moose started as a research project 20 years ago, it is also used in industrial projects, exposing itself to all these difficulties. In this paper we present ModMoose, the new version of Moose. ModMoose revolves around a new meta-model, modular and extensible; a new toolset of generic tools (query module, visualization engine, ...); and an open architecture supporting the synchronization and interaction of tools per task. With ModMoose, tool developers can develop specific meta-models by reusing existing elementary concepts, and dedicated reverse engineering tools that can interact with the existing ones

What is appropriate care? A qualitative study into the perceptions of healthcare professionals in Flemish university hospital intensive care units

Aim: This study examines when healthcare professionals consider intensive care as appropriate care. Background: Despite attempts to conceptualize appropriate care in prior research, there is a lack of insight into its meaning and implementation in practice. This is an important issue because healthcare professionals as well as patients and relatives report inappropriate care in the intensive care unit (ICU) on a regular basis. Methods: A qualitative study was designed, based on principles of grounded theory. Seventeen semi-structured interviews were conducted with nurses, doctors and doctors in training from three Flemish university hospitals. Analyses followed the Quagol method; insights were gained by means of the constant comparative method. Results: Healthcare professionals described appropriate care as socially sustainable care, high-quality care, patient-oriented care, dignified care and meaningful care. They considered it important that care is not only proportional to the expected survival and quality of life of the patient and in line with the patient's or relatives’ wishes, but also that the pursuit of the care goals is proportional to the patient's suffering. Although healthcare professionals indicated the same elements of appropriate care, they were defined and interpreted in individual and therefore different ways. This diversity lies at the basis of fields of tension and frustrations among healthcare professionals. Conclusion: Appropriate care is defined and interpreted in individual and therefore different ways. In order to decide which type of care is appropriate for a specific patient, a process of open and constructive communication in a team is recommended

Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium

Background: The twelve Integrated Care Program pilot projects (ICPs) created by the government plan ‘Integrated Care for Better Health’ aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The aim of this article is to present the development of a mixed methods realist evaluation of this large-scale, whole system change programme. Methods: A scientific team was commissioned to co-design and implement an evaluation protocol in close collaboration with the government, the ICPs and several other involved stakeholders. Results: A protocol for a mixed methods realist evaluation was developed to gain insights into the mechanisms that foster successful results in ICPs. The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. Processes and outcomes of all the projects will be monitored using indicators based on administrative data on population health and the quality and costs of care. A yearly survey will be organized to collect data on patient-reported outcomes and experiences and on provider-reported measures of inter-professional collaboration and proper wellbeing. Using both quantitative and qualitative data, we will develop theories about the mechanisms and the associated contextual factors that lead to integrated care and the Quadruple Aim outcomes. Discussion: The objective of this study is to deliver policy recommendations on strategies and best practices to improve care integration in Belgium and to implement a sustainable monitoring system that serves both policy makers and the stakeholders within the ICPs. Some challenges due to the large scale of the project and the multiple stakeholders involved may impede the successful implementation of this proposal.FAITH.be - Federated consortium for Appraisal of Integrated care Teams in Health in Belgiu

Management of patients with carcinoma of the right colon invading the duodenum or pancreatic head

International audienceBackground Only few case series have been published about locally advanced carcinoma of the right colon invading the duodenum or pancreas (CRCDP). We report results of a retrospective study about this rare entity focusing on management and prognosis. Methods We reviewed the complete data of patients operated for CRCDP between 1988 and 2005 in four French digestive-surgery departments. Results Fifteen patients were managed [12 men, 3 women, mean age 63 years (43–86)]. These patients underwent attempted curative en bloc resection including right colectomy: 12 were treated by partial duodenectomy (tumours involving only a part of the duodenum); 3 were treated by pancreaticoduodenectomy. All tumours resected had clear resection margins (R0). About 53% of patients had hepatic metastases, duodenocolic fistula, carcinomatosis, abscess or perforation at presentation. Surgery was performed in emergency in 26% of cases. About 20% of patients had serious postoperative complications (heart failure, bile duct necrosis, septic shock), and three other patients had postoperative anastomotic leaks. No patient experienced duodenal fistula after partial duodenectomy. The mean median survival in resected patients was 22 months (0–122). Overall 1 and 3 years survival were 68% (n = 7) and 56% (n = 4). Despite clear resection margins in all patients, 26% of patients developed recurrence (duodenal wall resection n = 3; pancreaticoduodenectomy n = 1). Conclusion Morbidity and mortality after colectomy and en bloc partial duodenectomy or pancreaticoduodenectomy are high but in selected cases could offer prolonged survival. Aggressive surgery including major resection should be performed to obtain clear resection margins even in case of complicated forms.</p