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Sample records for cross-disciplinary multi-institute approach

  1. RMS: a platform for managing cross-disciplinary and multi-institutional research project collaboration.

    Science.gov (United States)

    Luo, Jake; Apperson-Hansen, Carolyn; Pelfrey, Clara M; Zhang, Guo-Qiang

    2014-11-30

    Cross-institutional cross-disciplinary collaboration has become a trend as researchers move toward building more productive and innovative teams for scientific research. Research collaboration is significantly changing the organizational structure and strategies used in the clinical and translational science domain. However, due to the obstacles of diverse administrative structures, differences in area of expertise, and communication barriers, establishing and managing a cross-institutional research project is still a challenging task. We address these challenges by creating an integrated informatics platform to reduce the barriers to biomedical research collaboration. The Request Management System (RMS) is an informatics infrastructure designed to transform a patchwork of expertise and resources into an integrated support network. The RMS facilitates investigators' initiation of new collaborative projects and supports the management of the collaboration process. In RMS, experts and their knowledge areas are categorized and managed structurally to provide consistent service. A role-based collaborative workflow is tightly integrated with domain experts and services to streamline and monitor the life-cycle of a research project. The RMS has so far tracked over 1,500 investigators with over 4,800 tasks. The research network based on the data collected in RMS illustrated that the investigators' collaborative projects increased close to 3 times from 2009 to 2012. Our experience with RMS indicates that the platform reduces barriers for cross-institutional collaboration of biomedical research projects. Building a new generation of infrastructure to enhance cross-disciplinary and multi-institutional collaboration has become an important yet challenging task. In this paper, we share the experience of developing and utilizing a collaborative project management system. The results of this study demonstrate that a web-based integrated informatics platform can facilitate and

  2. Librarians as Part of Cross-Disciplinary, Multi-Institutional Team Projects: Experiences from the VIVO Collaboration

    Science.gov (United States)

    Garcia-Milian, Rolando; Norton, Hannah F.; Auten, Beth; Davis, Valrie I.; Holmes, Kristi L.; Johnson, Margeaux; Tennant, Michele R.

    2013-01-01

    Cross-disciplinary, team-based collaboration is essential for addressing today’s complex research questions, and librarians are increasingly entering into such collaborations. This study identifies skills needed as librarians integrate into cross-disciplinary teams, based on the experiences of librarians involved in the development and implementation of VIVO, a research discovery and collaboration platform. Participants discussed the challenges, skills gained, and lessons learned throughout the project. Their responses were analyzed in the light of the science of team science literature, and factors affecting collaboration on the VIVO team were identified. Skills in inclusive thinking, communication, perseverance, adaptability, and leadership were found to be essential. PMID:23833333

  3. Linking Data and Publications: Towards a Cross-Disciplinary Approach

    Directory of Open Access Journals (Sweden)

    Maarten Hoogerwerf

    2013-06-01

    Full Text Available In this paper, we tackle the challenge of linking scholarly information in multi-disciplinary research infrastructures. There is a trend towards linking publications with research data and other information, but, as it is still emerging, this is handled differently by various initiatives and disciplines. For OpenAIRE, a European cross-disciplinary publication infrastructure, this poses the challenge of supporting these heterogeneous practices. Hence, OpenAIRE wants to contribute to the development of a common approach for discipline-independent linking practices between publications, data, project information and researchers. To this end, we constructed two demonstrators to identify commonalities and differences. The results show the importance of stable and unique identifiers, and support a ‘by reference’ approach of interlinking research results. This approach allows discipline-specific research information to be managed independently in distributed systems and avoids redundant maintenance. Furthermore, it allows these disciplinary systems to manage the specialized structures of their contents themselves.

  4. Contextualizing Corruption: A Cross-Disciplinary Approach to Studying Corruption in Organizations

    Directory of Open Access Journals (Sweden)

    Kanti Pertiwi

    2018-04-01

    Full Text Available This paper aims to establish how organization and management research, an extensive field that has contributed a great deal to research on corruption, could apply insights from other disciplines in order to advance the understanding of corruption, often considered as a form of unethical behavior in organizations. It offers an analysis of important contributions of corruption research, taking a ‘rationalist perspective’, and highlights the central tensions and debates within this vast body of literatures. It then shows how these debates can be addressed by applying insights from corruption studies, adopting anthropological lens. The paper thus proposes a cross-disciplinary approach, which focuses on studying corruption by looking at what it means to individuals implicated by the phenomenon while engaging in social relations and situated in different contexts. It also offers an alternative approach to the study of corruption amidst claims that anti-corruption efforts have failed to achieve desirable results.

  5. Curriculum Development for Technology-Based Entrepreneurship Education: A Cross-Disciplinary and Cross-Cultural Approach

    Science.gov (United States)

    Kazakeviciute, Agne; Urbone, Renata; Petraite, Monika

    2016-01-01

    University-based entrepreneurship education is facing a paradigm shift between the classical "business school" and the contemporary cross-disciplinary "technology venturing" approach, mainly advocated by engineering schools and other communities outside business schools. The conflict is between structured "business…

  6. A framing approach to cross-disciplinary research collaboration: experiences from a large-scale research project on adaptive water management

    NARCIS (Netherlands)

    Dewulf, A.; Francois, G.; Pahl-Wostl, C.; Taillieu, T.

    2007-01-01

    Although cross-disciplinary research collaboration is necessary to achieve a better understanding of how human and natural systems are dynamically linked, it often turns out to be very difficult in practice. We outline a framing approach to cross-disciplinary research that focuses on the different

  7. The Key Events Dose-Response Framework: A cross-Disciplinary Mode-of-Action Based Approach to Examining Does-Response and Thresholds

    Science.gov (United States)

    the ILSI Research Foundation conveded a cross-disciplinary working group to examine current approaches for assessing dose-response and identifying safe levels of intake or exposure for four categoreis of bioactive agents: food allergens, nutrients, pathogenic microorganisms, and ...

  8. A Cross-Disciplinary Successful Aging Intervention and Evaluation: Comparison of Person-to-Person and Digital-Assisted Approaches

    Directory of Open Access Journals (Sweden)

    Hui-Chuan Hsu

    2018-05-01

    Full Text Available Background: Successful aging has been the paradigm of old-age life. The purpose of this study was to implement and evaluate a cross-disciplinary intervention program using two approaches for community-based older adults in Taichung, Taiwan. Methods: The content of the intervention included successful aging concepts and preparation, physical activity, chronic disease and health management, dietary and nutrition information, cognitive training, emotional awareness and coping skills, family relationship and resilience, legal concepts regarding financial protection, and Internet use. The traditional person-to-person (P2P intervention approach was implemented among participants at urban centers, and the personal-and-digital (P&D intervention approach was implemented among participants at rural centers; before the P&D group received the intervention, participants were assessed as the control group for comparison. Results: Healthy behavior and nutrition improved for the P2P group, although not significantly. Strategies for adapting to old age and reducing ineffective coping were significantly improved in the P2P group. The ability to search for health information improved in the P&D group, and knowledge of finance-related law increased in the P2P group. Conclusion: A continuous, well-designed and evidence-based intervention program is beneficial for improving the health of older adults, or at least delaying its decline.

  9. Cross Disciplinary Biometric Systems

    CERN Document Server

    Liu, Chengjun

    2012-01-01

    Cross disciplinary biometric systems help boost the performance of the conventional systems. Not only is the recognition accuracy significantly improved, but also the robustness of the systems is greatly enhanced in the challenging environments, such as varying illumination conditions. By leveraging the cross disciplinary technologies, face recognition systems, fingerprint recognition systems, iris recognition systems, as well as image search systems all benefit in terms of recognition performance.  Take face recognition for an example, which is not only the most natural way human beings recognize the identity of each other, but also the least privacy-intrusive means because people show their face publicly every day. Face recognition systems display superb performance when they capitalize on the innovative ideas across color science, mathematics, and computer science (e.g., pattern recognition, machine learning, and image processing). The novel ideas lead to the development of new color models and effective ...

  10. {cross-disciplinary} Data CyberInfrastructure: A Different Approach to Developing Collaborative Earth and Environmental Science Research Platforms

    Science.gov (United States)

    Lenhardt, W. C.; Krishnamurthy, A.; Blanton, B.; Conway, M.; Coposky, J.; Castillo, C.; Idaszak, R.

    2017-12-01

    An integrated science cyberinfrastructure platform is fast becoming a norm in science, particularly where access to distributed resources, access to compute, data management tools, and collaboration tools are accessible to the end-user scientist without the need to spin up these services on their own. There platforms have various types of labels ranging from data commons to science-as-a-service. They tend to share common features, as outlined above. What tends to distinguish these platforms, however, is their affinity for particular domains, NanoHub - nanomaterials, iPlant - plant biology, Hydroshare - hydrology, and so on. The challenge still remains how to enable these platforms to be more easily adopted for use by other domains. This paper will provide an overview of RENCI's approach to creating a science platform that can be more easily adopted by new communities while also endeavoring to accelerate their research. At RENCI, we started with Hydroshare, but have now worked to generalize the methodology for application to other domains. This new effort is called xDCi, or {cross-disciplinary} Data CyberInfrastructure. We have adopted a broader approach to the challenge of domain adoption and includes two key elements in addition to the technology component. The first of these is how development is operationalized. RENCI implements a DevOps model of continuous development and deployment. This greatly increases the speed by which a new platform can come online and be refined to meet domain needs. DevOps also allows for migration over time, i.e. sustainability. The second element is a concierge model. In addition to the technical elements, and the more responsive development process, RENCI also supports domain adoption of the platform by providing a concierge service— dedicated expertise- in the following areas, Information Technology, Sustainable Software, Data Science, and Sustainability. The success of the RENCI methodology is illustrated by the adoption of the

  11. Clinical Immersion: An Approach for Fostering Cross-disciplinary Communication and Innovation in Nursing and Engineering Students.

    Science.gov (United States)

    Geist, Melissa J; Sanders, Robby; Harris, Kevin; Arce-Trigatti, Andrea; Hitchcock-Cass, Cary

    2018-05-24

    A faculty team from nursing and chemical engineering developed a course that brought together students from each discipline for cross-disciplinary, team-based clinical immersion and collaboration. Health care processes and devices are rapidly changing, and nurses are uniquely positioned to be bedside innovators to improve patient care delivery. During each clinical immersion, the student teams rotated through various hospital units where they identified problems and worked together in the university's makerspace (iMaker Space) to design and build prototypes to improve health outcomes. Data from the Critical thinking Assessment Test provided evidence of gains in critical-thinking and problem-solving skills, while the problems identified in the clinical setting and prototypes developed demonstrated the impact of bringing nursing and engineering students together to design innovations. When challenged to identify authentic problems during their clinical immersion, the teams of nursing and engineering students proposed creative solutions and developed commercially viable prototypes.

  12. Creating Cross-disciplinary Courses.

    Science.gov (United States)

    Reynolds, Elaine R

    2012-01-01

    Because of its focus on the biological underpinnings of action and behavior, neuroscience intersects with many fields of human endeavor. Some of these cross-disciplinary intersections have been long standing, while others, such as neurotheology or neuroeconomics, are more recently formed fields. Many undergraduate institutions have sought to include cross-disciplinary courses in their curriculum because this style of pedagogy is often seen as applicable to real world problems. However, it can be difficult for faculty with specialized training within their discipline to expand beyond their own fields to offer cross-disciplinary courses. I have been creating a series of multi- or cross-disciplinary courses and have found some strategies that have helped me successfully teach these classes. I will discuss general strategies and tools in developing these types of courses including: 1) creating mixed experience classrooms of students and contributing faculty 2) finding the right tools that will allow you to teach to a mixed population without prerequisites 3) examining the topic using multiple disciplinary perspectives 4) feeding off student experience and interest 5) assessing the impact of these courses on student outcomes and your neuroscience program. This last tool in particular is important in establishing the validity of this type of teaching for neuroscience students and the general student population.

  13. The Key Events Dose-Response Framework: a cross-disciplinary mode-of-action based approach to examining dose-response and thresholds.

    Science.gov (United States)

    Julien, Elizabeth; Boobis, Alan R; Olin, Stephen S

    2009-09-01

    The ILSI Research Foundation convened a cross-disciplinary working group to examine current approaches for assessing dose-response and identifying safe levels of intake or exposure for four categories of bioactive agents-food allergens, nutrients, pathogenic microorganisms, and environmental chemicals. This effort generated a common analytical framework-the Key Events Dose-Response Framework (KEDRF)-for systematically examining key events that occur between the initial dose of a bioactive agent and the effect of concern. Individual key events are considered with regard to factors that influence the dose-response relationship and factors that underlie variability in that relationship. This approach illuminates the connection between the processes occurring at the level of fundamental biology and the outcomes observed at the individual and population levels. Thus, it promotes an evidence-based approach for using mechanistic data to reduce reliance on default assumptions, to quantify variability, and to better characterize biological thresholds. This paper provides an overview of the KEDRF and introduces a series of four companion papers that illustrate initial application of the approach to a range of bioactive agents.

  14. Multiple approaches to understanding and preventing elder abuse: Introduction to the cross-disciplinary National Institutes of Health workshop.

    Science.gov (United States)

    Saylor, Katherine Witte

    2016-01-01

    On October 30, 2015, the National Institutes of Health (NIH) convened a workshop, "Multiple Approaches to Understanding and Preventing Elder Abuse," in Bethesda, Maryland. The workshop brought together experts from across disciplines to discuss research challenges, opportunities, and lessons learned from other fields. Participants included experts in elder abuse, child abuse, intimate partner violence (IPV), emergency medicine, and neuroscience. In this special issue of the Journal of Elder Abuse and Neglect, participants address topics explored before, during, and after the day-long workshop.

  15. "Bunched Black Swans" in Complex Geosystems: Cross-Disciplinary Approaches to the Additive and Multiplicative Modelling of Correlated Extreme Bursts

    Science.gov (United States)

    Watkins, N. W.; Rypdal, M.; Lovsletten, O.

    2012-12-01

    For all natural hazards, the question of when the next "extreme event" (c.f. Taleb's "black swans") is expected is of obvious importance. In the environmental sciences users often frame such questions in terms of average "return periods", e.g. "is an X meter rise in the Thames water level a 1-in-Y year event ?". Frequently, however, we also care about the emergence of correlation, and whether the probability of several big events occurring in close succession is truly independent, i.e. are the black swans "bunched". A "big event", or a "burst", defined by its integrated signal above a threshold, might be a single, very large, event, or, instead, could in fact be a correlated series of "smaller" (i.e. less wildly fluctuating) events. Several available stochastic approaches provide quantitative information about such bursts, including Extreme Value Theory (EVT); the theory of records; level sets; sojourn times; and models of space-time "avalanches" of activity in non-equilibrium systems. Some focus more on the probability of single large events. Others are more concerned with extended dwell times above a given spatiotemporal threshold: However, the state of the art is not yet fully integrated, and the above-mentioned approaches differ in fundamental aspects. EVT is perhaps the best known in the geosciences. It is concerned with the distribution obeyed by the extremes of datasets, e.g. the 100 values obtained by considering the largest daily temperature recorded in each of the years of a century. However, the pioneering work from the 1920s on which EVT originally built was based on independent identically distributed samples, and took no account of memory and correlation that characterise many natural hazard time series. Ignoring this would fundamentally limit our ability to forecast; so much subsequent activity has been devoted to extending EVT to encompass dependence. A second group of approaches, by contrast, has notions of time and thus possible non

  16. Cross-disciplinary consumer citizenship education

    DEFF Research Database (Denmark)

    Nielsen, Sanne Schnell; Gottschau, Jette

    2005-01-01

    and common everyday experience for both students and pupils: the living conditions, lifestyle choices and consumer behaviour connected to a lunchtime meal. The overall aim of the workshop is to develop transferable knowledge, attitudes and skills among the students. The students are supposed to apply......This paper examines a cross-disciplinary, problem-oriented workshop dealing with consumer issues. The workshop forms part of the four-year Danish teacher training course offered by the Copenhagen Day and Evening College of Teacher Training. The workshop covers issues related to civic, environmental...... and consumer education, along with pedagogical issues, with the aim of developing a holistic, integrated approach to consumer citizenship education. The workshop concept is based on the “IVAC” (Investigation, Visions, Actions & Changes) model (Jensen 1997). As our point of departure, we take a practical...

  17. Cross-Disciplinary Collaboration and Learning

    Directory of Open Access Journals (Sweden)

    Deana D. Pennington

    2008-12-01

    Full Text Available Complex environmental problem solving depends on cross-disciplinary collaboration among scientists. Collaborative research must be preceded by an exploratory phase of collective thinking that creates shared conceptual frameworks. Collective thinking, in a cross-disciplinary setting, depends on the facility with which collaborators are able to learn and understand each others' perspectives. This paper applies three perspectives on learning to the problem of enabling cross-disciplinary collaboration: Maslow's hierarchy of needs, constructivism, and organizational learning. Application of learning frameworks to collaboration provides insights regarding receptive environments for collaboration, and processes that facilitate cross-disciplinary interactions. These environments and interactions need time to develop and require a long phase of idea generation preceding any focused research effort. The findings highlight that collaboration is itself a complex system of people, scientific theory, and tools that must be intentionally managed. Effective management of the system requires leaders who are facilitators and are capable of orchestrating effective environments and interactions.

  18. Volcanic Supersites as cross-disciplinary laboratories

    Science.gov (United States)

    Provenzale, Antonello; Beierkuhnlein, Carl; Giamberini, Mariasilvia; Pennisi, Maddalena; Puglisi, Giuseppe

    2017-04-01

    Volcanic Supersites, defined in the frame of the GEO-GSNL Initiative, are usually considered mainly for their geohazard and geological characteristics. However, volcanoes are extremely challenging areas from many other points of view, including environmental and climatic properties, ecosystems, hydrology, soil properties and biogeochemical cycling. Possibly, volcanoes are closer to early Earth conditions than most other types of environment. During FP7, EC effectively fostered the implementation of the European volcano Supersites (Mt. Etna, Campi Flegrei/Vesuvius and Iceland) through the MED-SUV and FUTUREVOLC projects. Currently, the large H2020 project ECOPOTENTIAL (2015-2019, 47 partners, http://www.ecopotential-project.eu/) contributes to GEO/GEOSS and to the GEO ECO Initiative, and it is devoted to making best use of remote sensing and in situ data to improve future ecosystem benefits, focusing on a network of Protected Areas of international relevance. In ECOPOTENTIAL, remote sensing and in situ data are collected, processed and used for a better understanding of the ecosystem dynamics, analysing and modelling the effects of global changes on ecosystem functions and services, over an array of different ecosystem types, including mountain, marine, coastal, arid and semi-arid ecosystems, and also areas of volcanic origin such as the Canary and La Reunion Islands. Here, we propose to extend the network of the ECOPOTENTIAL project to include active Volcanic Supersites, such as Mount Etna and other volcanic Protected Areas, and we discuss how they can be included in the framework of the ECOPOTENTIAL workflow. A coordinated and cross-disciplinary set of studies at these sites should include geological, biological, ecological, biogeochemical, climatic and biogeographical aspects, as well as their relationship with the antropogenic impact on the environment, and aim at the global analysis of the volcanic Earth Critical Zone - namely, the upper layer of the Earth

  19. Innovative sport technology through cross-disciplinary research ...

    African Journals Online (AJOL)

    Innovative sport technology through cross-disciplinary research: Future of sport ... South African Journal for Research in Sport, Physical Education and Recreation ... of the advantages and disadvantages of innovative sport technology brought ...

  20. Cross-disciplinary research programs at the Cornell TRIGA reactor

    International Nuclear Information System (INIS)

    Clark, D.D.

    1995-01-01

    This paper describes cross-disciplinary research efforts at the Cornell TRIGA reactor. A new graduate laboratory course for nonspecialists was developed which brought in graduate students from many fields, and a weekly or bimonthly nuclear methods seminars are being held to describe research methods, sample preparation, irradiation, etc

  1. Cross-disciplinary Science and the Structure of Scientific Perspectives

    DEFF Research Database (Denmark)

    Alrøe, Hugo Fjelsted; Noe, Egon

    2014-01-01

    of science, focusing on the synchronic structure of scientific perspectives across disciplines and not on the diachronic, historical structure of shifting perspectives within single disciplines that has been widely discussed since Kuhn and Feyerabend. We show what kinds of cross-disciplinary disagreement...

  2. Lonergan's philosophy as grounding for cross-disciplinary research.

    Science.gov (United States)

    Kane, Anne

    2014-04-01

    Increasingly, nurses conduct scientific inquiry into complex health-care problems by collaborating on teams with researchers from other highly specialized fields. As cross-disciplinary research proliferates and becomes institutionalized globally, researchers will increasingly encounter the need to integrate their particular research perspectives within inquiries without sacrificing the potential contributions of their discipline-specific expertise. The work of the philosopher Bernard Lonergan (1904–1984) offers the necessary philosophical grounding. Here, I defend a role for philosophy in cross-disciplinary research and present selected ideas in Lonergan's work. These include: (1) a dynamic, normative pattern that each inquirer operates uniquely also forms the common core, or unity, in knowing; (2) the possibility of cross-disciplinary knowledge development is dependent on each researcher's consciousness of her or his attentiveness, intelligence, reasonableness, and responsibleness; and (3) shifts in researchers' viewpoints, or horizons, facilitate their collaborative inquiry and their grasp of the unity in knowing. The desire to know, shared by team members, drives their inquiry. Lonergan's stance is consistent with nursing values because it respects, but does not unconditionally privilege, any researcher or discipline. Arguments support a claim that Lonergan's perspective is well suited to guide nurse researchers participating on cross-disciplinary health research teams.

  3. Making It All Count: A Cross-Disciplinary Collaboration Model Incorporating Scholarship, Creative Activity, and Student Engagement

    Science.gov (United States)

    Dailey, Rocky; Hauschild-Mork, Melissa

    2017-01-01

    This study takes a grounded theory approach as a basis for a case study examining a cross-disciplinary artistic and academic collaborative project involving faculty from the areas of English, music, dance, theatre, design, and visual journalism resulting in the creation of research, scholarly, and creative activity that fosters student engagement…

  4. Cross-disciplinary research in cancer: an opportunity to narrow the knowledge-practice gap.

    Science.gov (United States)

    Urquhart, R; Grunfeld, E; Jackson, L; Sargeant, J; Porter, G A

    2013-12-01

    Health services researchers have consistently identified a gap between what is identified as "best practice" and what actually happens in clinical care. Despite nearly two decades of a growing evidence-based practice movement, narrowing the knowledge-practice gap continues to be a slow, complex, and poorly understood process. Here, we contend that cross-disciplinary research is increasingly relevant and important to reducing that gap, particularly research that encompasses the notion of transdisciplinarity, wherein multiple academic disciplines and non-academic individuals and groups are integrated into the research process. The assimilation of diverse perspectives, research approaches, and types of knowledge is potentially effective in helping research teams tackle real-world patient care issues, create more practice-based evidence, and translate the results to clinical and community care settings. The goals of this paper are to present and discuss cross-disciplinary approaches to health research and to provide two examples of how engaging in such research may optimize the use of research in cancer care.

  5. NASA's Platform for Cross-Disciplinary Microchannel Research

    Science.gov (United States)

    Son, Sang Young; Spearing, Scott; Allen, Jeffrey; Monaco, Lisa A.

    2003-01-01

    A team from the Structural Biology group located at the NASA Marshall Space Flight Center in Huntsville, Alabama is developing a platform suitable for cross-disciplinary microchannel research. The original objective of this engineering development effort was to deliver a multi-user flight-certified facility for iterative investigations of protein crystal growth; that is, Iterative Biological Crystallization (IBC). However, the unique capabilities of this facility are not limited to the low-gravity structural biology research community. Microchannel-based research in a number of other areas may be greatly accelerated through use of this facility. In particular, the potential for gas-liquid flow investigations and cellular biological research utilizing the exceptional pressure control and simplified coupling to macroscale diagnostics inherent in the IBC facility will be discussed. In conclusion, the opportunities for research-specific modifications to the microchannel configuration, control, and diagnostics will be discussed.

  6. Concept similarity in publications precedes cross-disciplinary collaboration.

    Science.gov (United States)

    Post, Andrew R; Harrison, James H

    2008-11-06

    Innovative science frequently occurs as a result of cross-disciplinary collaboration, the importance of which is reflected by recent NIH funding initiatives that promote communication and collaboration. If shared research interests between collaborators are important for the formation of collaborations,methods for identifying these shared interests across scientific domains could potentially reveal new and useful collaboration opportunities. MEDLINE represents a comprehensive database of collaborations and research interests, as reflected by article co-authors and concept content. We analyzed six years of citations using information retrieval based methods to compute articles conceptual similarity, and found that articles by basic and clinical scientists who later collaborated had significantly higher average similarity than articles by similar scientists who did not collaborate.Refinement of these methods and characterization of found conceptual overlaps could allow automated discovery of collaboration opportunities that are currently missed.

  7. Cross-Disciplinary Ethics Education in MBA Programs

    DEFF Research Database (Denmark)

    Rasche, Andreas; Gilbert, Dirk Ulrich; Schedel, Ingo

    2013-01-01

    This research-based essay offers a cross-disciplinary examination of ethics education in MBA programs. Based on data underlying the Beyond Grey Pinstripes (BGP) survey we find: that business schools doubled the number of ethics-related courses in different disciplines between 2005 and 2009......: business schools increasingly risk creating a gap between their upbeat rhetoric around ethics education and their actual MBA curriculum. Such decoupling is likely to emerge because schools face a tension between increasing institutional pressures to legitimize their MBA programs and internal impediments...... to fully integrate ethics into the curriculum. We suggest that more effective ethics education requires structural changes to the curriculum, in particular more mandatory ethics courses and a stronger integration of ethics-related debates into disciplines like finance and accounting....

  8. Cross-Disciplinary Ethics Education in MBA Programs

    DEFF Research Database (Denmark)

    Rasche, Andreas; Gilbert, Dirk Ulrich; Schedel, Ingo

    This research-based essay offers a cross-disciplinary examination of ethics education in MBA programs. Based on data underlying the Beyond Grey Pinstripes (BGP) survey we find: that business schools doubled the number of ethics-related courses in different disciplines between 2005 and 2009......: business schools increasingly risk creating a gap between their upbeat rhetoric around ethics education and their actual MBA curriculum. Such decoupling is likely to emerge because schools face a tension between increasing institutional pressures to legitimize their MBA programs and internal impediments...... to fully integrate ethics into the curriculum. We suggest that more effective ethics education requires structural changes to the curriculum, in particular more mandatory ethics courses and a stronger integration of ethics-related debates into disciplines like finance and accounting....

  9. Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience.

    Science.gov (United States)

    Raspagliesi, Francesco; Bogani, Giorgio; Spinillo, Arsenio; Ditto, Antonino; Bogliolo, Stefano; Casarin, Jvan; Leone Roberti Maggiore, Umberto; Martinelli, Fabio; Signorelli, Mauro; Gardella, Barbara; Chiappa, Valentina; Scaffa, Cono; Ferrero, Simone; Cromi, Antonella; Lorusso, Domenica; Ghezzi, Fabio

    2017-11-01

    To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  10. A Semantic Approach to Cross-Disciplinary Research Collaboration

    Directory of Open Access Journals (Sweden)

    Laurens De Vocht

    2012-11-01

    Full Text Available The latest developments in ICT, more specifically Social Media and Web 2.0 tools, facilitate the use of online services in research and education. This is also known as Research 2.0 and Technology Enhanced Learning. Web 2.0 tools are especially useful in cases where experts from different disciplines want to collaborate. We suggest an integrated method that embeds these services in research and learning processes, because it is a laborious task for researchers and learners to check and use all varying types of tools and services. We explain a flexible model that uses state-of-the-art semantic technologies to model both structured and unstructured research data. The research data is extracted from many online resources and Social Media. We implement learning objects as an abstraction of the semantically modeled research data. We propose an environment that improves the scientific research and learning process by allowing researchers to efficiently browse the information and concepts represented as learning objects.

  11. The “Shawshank Trail”: A Cross Disciplinary Study in Film Induced Tourism and Fan Culture

    Directory of Open Access Journals (Sweden)

    Richard Roberson

    2015-03-01

    Full Text Available Tourism, as a sustainable means of economic development, has attracted a considerable amount of attention from municipalities seeking to better understand their available development options. Film induced tourism has seen appreciable growth and represents a considerable opportunity for many communities to use filming locations seen in popular movies and/or television to draw additional visitors. These opportunities create an increasing need for communities and the organizers of events to better understand their attendees, the fans, in order to better serve their unique needs and desires. Fan culture studies, as an outgrowth of media studies, examine the nature and make up of fan communities. This article posits a cross disciplinary approach using fan studies to inform tourism research. This article reports on an analysis of attendees to an event celebrating of the 20th anniversary of the filming of the popular American film “The Shawshank Redemption.” Attendee characteristics, desired outcomes, and motivating factors were examined.

  12. Group Development and Integration in a Cross-Disciplinary and Intercultural Research Team

    Science.gov (United States)

    Kirk-Lawlor, Naomi; Allred, Shorna

    2017-04-01

    Cross-disciplinary research is necessary to solve many complex problems that affect society today, including problems involving linked social and environmental systems. Examples include natural resource management or scarcity problems, problematic effects of climate change, and environmental pollution issues. Intercultural research teams are needed to address many complex environmental matters as they often cross geographic and political boundaries, and involve people of different countries and cultures. It follows that disciplinarily and culturally diverse research teams have been organized to investigate and address environmental issues. This case study investigates a team composed of both monolingual and bilingual Chilean and US university researchers who are geoscientists, engineers and economists. The objective of this research team was to study both the natural and human parts of a hydrologic system in a hyper-arid region in northern Chile. Interviews ( n = 8) addressed research questions focusing on the interaction of cross-disciplinary diversity and cultural diversity during group integration and development within the team. The case study revealed that the group struggled more with cross-disciplinary challenges than with intercultural ones. Particularly challenging ones were instances the of disciplinary crosstalk, or hidden misunderstandings, where team members thought they understood their cross-disciplinary colleagues, when in reality they did not. Results showed that translation served as a facilitator to cross-disciplinary integration of the research team. The use of translation in group meetings as a strategy for effective cross-disciplinary integration can be extended to monolingual cross-disciplinary teams as well.

  13. Group Development and Integration in a Cross-Disciplinary and Intercultural Research Team.

    Science.gov (United States)

    Kirk-Lawlor, Naomi; Allred, Shorna

    2017-04-01

    Cross-disciplinary research is necessary to solve many complex problems that affect society today, including problems involving linked social and environmental systems. Examples include natural resource management or scarcity problems, problematic effects of climate change, and environmental pollution issues. Intercultural research teams are needed to address many complex environmental matters as they often cross geographic and political boundaries, and involve people of different countries and cultures. It follows that disciplinarily and culturally diverse research teams have been organized to investigate and address environmental issues. This case study investigates a team composed of both monolingual and bilingual Chilean and US university researchers who are geoscientists, engineers and economists. The objective of this research team was to study both the natural and human parts of a hydrologic system in a hyper-arid region in northern Chile. Interviews (n = 8) addressed research questions focusing on the interaction of cross-disciplinary diversity and cultural diversity during group integration and development within the team. The case study revealed that the group struggled more with cross-disciplinary challenges than with intercultural ones. Particularly challenging ones were instances the of disciplinary crosstalk, or hidden misunderstandings, where team members thought they understood their cross-disciplinary colleagues, when in reality they did not. Results showed that translation served as a facilitator to cross-disciplinary integration of the research team. The use of translation in group meetings as a strategy for effective cross-disciplinary integration can be extended to monolingual cross-disciplinary teams as well.

  14. Goal-Based Domain Modeling as a Basis for Cross-Disciplinary Systems Engineering

    Science.gov (United States)

    Jarke, Matthias; Nissen, Hans W.; Rose, Thomas; Schmitz, Dominik

    Small and medium-sized enterprises (SMEs) are important drivers for innovation. In particular, project-driven SMEs that closely cooperate with their customers have specific needs in regard to information engineering of their development process. They need a fast requirements capture since this is most often included in the (unpaid) offer development phase. At the same time, they need to maintain and reuse the knowledge and experiences they have gathered in previous projects extensively as it is their core asset. The situation is complicated further if the application field crosses disciplinary boundaries. To bridge the gaps and perspectives, we focus on shared goals and dependencies captured in models at a conceptual level. Such a model-based approach also offers a smarter connection to subsequent development stages, including a high share of automated code generation. In the approach presented here, the agent- and goal-oriented formalism i * is therefore extended by domain models to facilitate information organization. This extension permits a domain model-based similarity search, and a model-based transformation towards subsequent development stages. Our approach also addresses the evolution of domain models reflecting the experiences from completed projects. The approach is illustrated with a case study on software-intensive control systems in an SME of the automotive domain.

  15. Designing Research Services: Cross-Disciplinary Administration and the Research Lifecycle

    Science.gov (United States)

    Madden, G.

    2017-12-01

    The sheer number of technical and administrative offices involved in the research lifecycle, and the lack of shared governance and shared processes across those offices, creates challenges to the successful preservation of research outputs. Universities need a more integrated approach to the research lifecycle that allows us to: recognize a research project as it is being initiated; identify the data associated with the research project; document and track any compliance, security, access, and publication requirements associated with the research and its data; follow the research and its associated components across the research lifecycle; and finally recognize that the research has come to a close so we can trigger the various preservation, access, and communications processes that close the loop, inform the public, and promote the continued progress of science. Such an approach will require cooperation, communications, and shared workflow tools that tie together (often across many years) PIs, research design methodologists, grants offices, contract negotiators, central research administrators, research compliance specialists, desktop IT support units, server administrators, high performance computing facilities, data centers, specialized data transfer networks, institutional research repositories, institutional data repositories, and research communications groups, all of which play a significant role in the technical or administrative success of research. This session will focus on progress towards improving cross-disciplinary administrative and technical cooperation at Penn State University, with an emphasis on generalizable approaches that can be adopted elsewhere.

  16. Is there such a thing as online video game addiction? A cross-disciplinary review.

    NARCIS (Netherlands)

    Hellman, M.; Schoenmakers, T.M.; Nordstrom, B.R.; Holst, R.J. van

    2013-01-01

    Drawing on explanatory pluralism this cross-disciplinary theoretical study asks whether excessive compulsive online gaming can be called an addiction on the basis of what is known about the disorder. This article discusses the concept of addiction; the social seating of the problems and it reviews,

  17. Is there such a thing as online video game addiction? A cross-disciplinary review

    NARCIS (Netherlands)

    Hellman, Matilda; Schoenmakers, Tim M.; Nordstrom, Benjamin R.; van Holst, Ruth J.

    2013-01-01

    Drawing on explanatory pluralism this cross-disciplinary theoretical study asks whether excessive compulsive online gaming can be called an addiction on the basis of what is known about the disorder. This article discusses the concept of addiction; the social seating of the problems and it reviews,

  18. Developing Cross-Disciplinary Competencies through College Algebra

    Directory of Open Access Journals (Sweden)

    Reem Jaafar, PhD

    2012-08-01

    Full Text Available To argue for the importance of an integrative approach to learning in introductory STEM (Science, Technology, Engineering and Mathematics and other courses, we present a case study of a project incorporating cross-curricular skills in a college algebra course. We analyze student work on the project and responses to surveys, and find the assignment affects positively students’ mastery of specific quantitative skills, perceptions of learning, civic awareness, and sense of relevance of mathematical study. We use the analysis to suggest guidelines for designing other activities aiming to teach the whole student in introductory courses.

  19. Exploring Methodologies and Indicators for Cross-disciplinary Applications

    Science.gov (United States)

    Bernknopf, R.; Pearlman, J.

    2015-12-01

    Assessing the impact and benefit of geospatial information is a multidisciplinary task that involves the social, economic and environmental knowledge to formulate indicators and methods. There are use cases that couple the social sciences including economics, psychology, sociology that incorporate geospatial information. Benefit - cost analysis is an empirical approach that uses money as an indicator for decision making. It is a traditional base for a use case and has been applied to geospatial information and other areas. A new use case that applies indicators is Meta Regression analysis, which is used to evaluate transfers of socioeconomic benefits from different geographic regions into a unifying statistical approach. In this technique, qualitative and quantitative variables are indicators, which provide a weighted average of value for the nonmarket good or resource over a large region. The expected willingness to pay for the nonmarket good can be applied to a specific region. A third use case is the application of Decision Support Systems and Tools that have been used for forecasting agricultural prices and analysis of hazard policies. However, new methods for integrating these disciplines into use cases, an avenue to instruct the development of operational applications of geospatial information, are needed. Experience in one case may not be broadly transferable to other uses and applications if multiple disciplines are involved. To move forward, more use cases are needed and, especially, applications in the private sector. Applications are being examined across a multidisciplinary community for good examples that would be instructive in meeting the challenge. This presentation will look at the results of an investigation into directions in the broader applications of use cases to teach the methodologies and use of indicators that have applications across fields of interest.

  20. Integrating Sustainability into the Curriculum: Crossing Disciplinary Boundaries

    Science.gov (United States)

    Pushnik, J.

    2012-12-01

    The next generation will confront an increased number of global issues that interface the complexities of socioeconomic perspectives, environmental stability, poverty and development. Recently California State University Chico undertook a general education reform, providing a unique opportunity to craft a general education pathway to prepare students for these challenges by focusing a curriculum on sustainability. The Sustainability Pathway emphasizes a system thinking approach to help students understand and be able to address a set of problems involving the biosphere processes, human institutions and the economic vitality. The curriculum intentionally integrates courses from across the disciplines of natural sciences, social sciences, agriculture, engineering, economics, arts and humanities into a central focused theme of sustainability. The diverse backgrounds and academic focus of the participating faculty has necessitate the development of a common language and a cohesion within the curriculum. To address these needs a faculty learning community (FLC) was established to build on a common set of case studies. Three regional environmental water related issues were selected that had demonstrable socioeconomic, equity/ethical dimensions and environmental consequences. These case studies are Klamath River basin in northern California, the Bay-Delta project in the central part of the state and the Sultan Sea in southern California. Members of the FLC has contributed a perspective from their academic discipline which includes proposed reading lists, web based resources and PowerPoint presentations which are housed in common web- based resource repository. The pedagogical rational is to create linkages and cohesion among the courses in the curriculum by iteratively examining these case studies as basis for development of a multidisciplinary perspective as students progress through their general education.

  1. The Bridge: Experiments in Science and Art, Experiences from the 2017 SciArt Center Cross-Disciplinary Residency Program

    Science.gov (United States)

    Shipman, J. S.; Chalmers, R.; Buntaine, J.

    2017-12-01

    Cross-disciplinary programs create the opportunity to explore new realms for scientists and artists alike. Through the collaborative process, artistic insights enable innovative approaches to emotionally connect to and visualize the world around us. Likewise, engagement across the art-science spectrum can lead to shifts in scientific thinking that create new connections in data and drive discoveries in research. The SciArt Center "The Bridge Residency Program" is a four-month long virtual residency open internationally for professionals in the arts and sciences to facilitate cross-disciplinary work and to bring together like-minded participants. The SciArt Center provides a virtual space to record and showcase the process and products of each collaboration. The work is facilitated with biweekly Skype calls and documented with weekly blog posts. Residents create either digital or physical products and share via video, images, or direct mailing with their collaborators. Past projects have produced call and response discussion, websites, skills and conference presentations, science-art studies, virtual exhibits, art shows, dance performances, and research exchange. Here we present the creative process and outcomes of one of the four collaborative teams selected for the 2017 residency. Jill Shipman, a Ph.D. Candidate in Volcanology who is also active in filmmaking and theatrical productions and Rosemary Chalmers, a UK-based lecturer, concept artist, and illustrator with a specialty in creature design. They were paired together for their shared interest in storytelling, illustration, and unique geological and environmental habitats and the life that occupies them. We will discuss the collaborative project developed by this team during their recent residency and illustrate how a virtual program can bridge the distance between geographical location to foster science and art collaboration. To follow the progress of the residency please visit: http://www.sciartcenter.org/the-bridge.html

  2. EarthServer: Cross-Disciplinary Earth Science Through Data Cube Analytics

    Science.gov (United States)

    Baumann, P.; Rossi, A. P.

    2016-12-01

    The unprecedented increase of imagery, in-situ measurements, and simulation data produced by Earth (and Planetary) Science observations missions bears a rich, yet not leveraged potential for getting insights from integrating such diverse datasets and transform scientific questions into actual queries to data, formulated in a standardized way.The intercontinental EarthServer [1] initiative is demonstrating new directions for flexible, scalable Earth Science services based on innovative NoSQL technology. Researchers from Europe, the US and Australia have teamed up to rigorously implement the concept of the datacube. Such a datacube may have spatial and temporal dimensions (such as a satellite image time series) and may unite an unlimited number of scenes. Independently from whatever efficient data structuring a server network may perform internally, users (scientist, planners, decision makers) will always see just a few datacubes they can slice and dice.EarthServer has established client [2] and server technology for such spatio-temporal datacubes. The underlying scalable array engine, rasdaman [3,4], enables direct interaction, including 3-D visualization, common EO data processing, and general analytics. Services exclusively rely on the open OGC "Big Geo Data" standards suite, the Web Coverage Service (WCS). Conversely, EarthServer has shaped and advanced WCS based on the experience gained. The first phase of EarthServer has advanced scalable array database technology into 150+ TB services. Currently, Petabyte datacubes are being built for ad-hoc and cross-disciplinary querying, e.g. using climate, Earth observation and ocean data.We will present the EarthServer approach, its impact on OGC / ISO / INSPIRE standardization, and its platform technology, rasdaman.References: [1] Baumann, et al. (2015) DOI: 10.1080/17538947.2014.1003106 [2] Hogan, P., (2011) NASA World Wind, Proceedings of the 2nd International Conference on Computing for Geospatial Research

  3. Trust Management - Building Trust for International Cross Disciplinary Collaboration on Climate Change

    Science.gov (United States)

    Oakley, K. V.; Gurney, R. J.

    2014-12-01

    Successful communication and collaboration entails mutual understanding, and transfer, of information. The risk of misunderstanding and/or miscommunication between collaborating groups is tackled in different ways around the globe; some are well documented whereas others may be unknown outside particular groups, whether defined geographically or by specialism. For example; in some countries legally binding contracts define the terms of collaboration. Some regions place greater emphasis on developing trust relationships, and sometimes an official agreement is implied, such as many electronic data transfers on the web. International collaboration on climate change increasingly involves electronic data exchange (e.g. open access publications, shared documents, data repositories etc.) and with this increased reliance on electronic data a need has arisen for scientists to collaborate both internationally and cross-disciplinarily particularly with information technology and data management specialists. Trust of data and metadata on the internet (e.g. privacy, legitimacy etc.) varies, possibly due to a lack of internationally agreed standards for data governance and management, leaving many national, regional and institutional practices tailored to the needs of that group only. It is proposed that building trust relationships between cross-disciplinary and international groups could help facilitate further communication, understanding and benefits from the relationship, while still maintaining independence as separate groups. Complex international cross-disciplinary group relationship dynamics are not easily mapped and producing a set of trust building rules that can be applied to any current and future collaboration with equal validity may be unfeasible. An alternative to such a set of rules may be found in a Trust Manager, whose role is to improve mutually beneficial knowledge exchange between groups, build trust and increase future collaborative potential. This

  4. Cross-disciplinary working in the sciences and humanities: historical data rescue activities in Southeast Asia and beyond

    Directory of Open Access Journals (Sweden)

    Fiona Williamson

    2016-11-01

    Full Text Available Abstract This paper argues that more work is needed to facilitate cross-disciplinary collaborations by scholars across the physical sciences and humanities to improve Data Rescue Activities (DARE. Debate over the scale and potential impact of anthropogenic global warming is one of the dominant narratives of the twenty-first century. Predicting future climates and determining how environment and society might be affected by climate change are global issues of social, economic and political importance. They require responses from different research communities and necessitate closer inter-disciplinary working relationships for an integrated approach. Improving the datasets required for long-term climate models is an important part of this process. Establishing a multi-disciplinary dialogue and approach to DARE activities is increasingly being recognised as the best way to achieve this. This paper focuses on the recovery of the long-term instrumental weather observations used for models and reconstructions of the climate over the past two-hundred years. Written from the perspective of an historian working in the field, it does not seek to explore the reconstructions themselves but the process of data gathering, advocating a closer working relationship between the arts, social sciences, and sciences to extend the geographic and temporal coverage of extant datasets. This is especially important for regions where data gaps exist currently. First, it will offer a justification for extending data recovery activities for Southeast Asia and the China Seas region. Second, it will offer a brief overview of the data recovery projects currently operating in that area and the typesof historic source material that are used. Third, it will explore the work currently being undertaken for Southeast Asia and China under the Atmospheric Circulation Reconstructions over the Earth initiative as an example of a successful cross-disciplinary program. Finally, it will

  5. Cross-disciplinary working in the sciences and humanities: historical data rescue activities in Southeast Asia and beyond

    Science.gov (United States)

    Williamson, Fiona

    2016-12-01

    This paper argues that more work is needed to facilitate cross-disciplinary collaborations by scholars across the physical sciences and humanities to improve Data Rescue Activities (DARE). Debate over the scale and potential impact of anthropogenic global warming is one of the dominant narratives of the twenty-first century. Predicting future climates and determining how environment and society might be affected by climate change are global issues of social, economic and political importance. They require responses from different research communities and necessitate closer inter-disciplinary working relationships for an integrated approach. Improving the datasets required for long-term climate models is an important part of this process. Establishing a multi-disciplinary dialogue and approach to DARE activities is increasingly being recognised as the best way to achieve this. This paper focuses on the recovery of the long-term instrumental weather observations used for models and reconstructions of the climate over the past two-hundred years. Written from the perspective of an historian working in the field, it does not seek to explore the reconstructions themselves but the process of data gathering, advocating a closer working relationship between the arts, social sciences, and sciences to extend the geographic and temporal coverage of extant datasets. This is especially important for regions where data gaps exist currently. First, it will offer a justification for extending data recovery activities for Southeast Asia and the China Seas region. Second, it will offer a brief overview of the data recovery projects currently operating in that area and the typesof historic source material that are used. Third, it will explore the work currently being undertaken for Southeast Asia and China under the Atmospheric Circulation Reconstructions over the Earth initiative as an example of a successful cross-disciplinary program. Finally, it will argue the importance of

  6. Designing a CTSA-Based Social Network Intervention to Foster Cross-Disciplinary Team Science.

    Science.gov (United States)

    Vacca, Raffaele; McCarty, Christopher; Conlon, Michael; Nelson, David R

    2015-08-01

    This paper explores the application of network intervention strategies to the problem of assembling cross-disciplinary scientific teams in academic institutions. In a project supported by the University of Florida (UF) Clinical and Translational Science Institute, we used VIVO, a semantic-web research networking system, to extract the social network of scientific collaborations on publications and awarded grants across all UF colleges and departments. Drawing on the notion of network interventions, we designed an alteration program to add specific edges to the collaboration network, that is, to create specific collaborations between previously unconnected investigators. The missing collaborative links were identified by a number of network criteria to enhance desirable structural properties of individual positions or the network as a whole. We subsequently implemented an online survey (N = 103) that introduced the potential collaborators to each other through their VIVO profiles, and investigated their attitudes toward starting a project together. We discuss the design of the intervention program, the network criteria adopted, and preliminary survey results. The results provide insight into the feasibility of intervention programs on scientific collaboration networks, as well as suggestions on the implementation of such programs to assemble cross-disciplinary scientific teams in CTSA institutions. © 2015 Wiley Periodicals, Inc.

  7. Measuring the evolution and output of cross-disciplinary collaborations within the NCI Physical Sciences–Oncology Centers Network

    Science.gov (United States)

    Basner, Jodi E.; Theisz, Katrina I.; Jensen, Unni S.; Jones, C. David; Ponomarev, Ilya; Sulima, Pawel; Jo, Karen; Eljanne, Mariam; Espey, Michael G.; Franca-Koh, Jonathan; Hanlon, Sean E.; Kuhn, Nastaran Z.; Nagahara, Larry A.; Schnell, Joshua D.; Moore, Nicole M.

    2013-01-01

    Development of effective quantitative indicators and methodologies to assess the outcomes of cross-disciplinary collaborative initiatives has the potential to improve scientific program management and scientific output. This article highlights an example of a prospective evaluation that has been developed to monitor and improve progress of the National Cancer Institute Physical Sciences—Oncology Centers (PS-OC) program. Study data, including collaboration information, was captured through progress reports and compiled using the web-based analytic database: Interdisciplinary Team Reporting, Analysis, and Query Resource. Analysis of collaborations was further supported by data from the Thomson Reuters Web of Science database, MEDLINE database, and a web-based survey. Integration of novel and standard data sources was augmented by the development of automated methods to mine investigator pre-award publications, assign investigator disciplines, and distinguish cross-disciplinary publication content. The results highlight increases in cross-disciplinary authorship collaborations from pre- to post-award years among the primary investigators and confirm that a majority of cross-disciplinary collaborations have resulted in publications with cross-disciplinary content that rank in the top third of their field. With these evaluation data, PS-OC Program officials have provided ongoing feedback to participating investigators to improve center productivity and thereby facilitate a more successful initiative. Future analysis will continue to expand these methods and metrics to adapt to new advances in research evaluation and changes in the program. PMID:24808632

  8. Tweet My Street: A Cross-Disciplinary Collaboration for the Analysis of Local Twitter Data

    Directory of Open Access Journals (Sweden)

    Graeme Mearns

    2014-05-01

    Full Text Available Tweet My Street is a cross-disciplinary project exploring the extent to which data derived from Twitter can reveal more about spatial and temporal behaviours and the meanings attached to these locally. This is done with a longer-term view to supporting the coproduction and delivery of local services, complaint mechanisms and horizontal community support networks. The project has involved the development of a web-based software application capable of retrieving, storing and visualising geo-located “tweets” (and associated digital content from Twitter’s Firehose. This has been piloted in Newcastle upon Tyne (UK and has proven a scalable tool that can aid the analysis of social media data geographically. Beyond explaining efforts to analyse pilot data via this software, this paper elucidates three methodological challenges encountered during early collaboration. These include issues relating to “proximity” with subjects, ethics and critical questions about scholars’ digital responsibilities during the neogeographic turn.

  9. [Exploration of nursing art and aesthetic experiences: cross-disciplinary links and dialogues].

    Science.gov (United States)

    Sheu, Shuh-Jen

    2013-08-01

    Interdisciplinary understanding is crucial for readers today. This article integrates the ideas of four care-aesthetics-column writers in order to illustrate and discuss nursing art and aesthetic care experiences in a cross-disciplinary conversation. This article reflects critically on the art, culture, and nature of nursing in the five themes of: 1) the shape of nursing knowledge, "science" or "art"?; 2) the caring arts: passively regulative or consciously creative labor?; 3) busy hospital workers: a landscape of persons and objects or the creators of the scenery?; 4) nursing skills, arts, and the Tao; and 5) art liberation: is the nursing profession in need of a revolution or fundamental reform? This article utilizes diverse and occasionally contradictory points of view together with practical examples in order to encourage readers to interlink their disparate professional nursing skills and draw aesthetic knowledge from multiple sources and experiences.

  10. The Science Semester: Cross-Disciplinary Inquiry for Prospective Elementary Teachers

    Science.gov (United States)

    Ford, Danielle J.; Fifield, Steve; Madsen, John; Qian, Xiaoyu

    2013-10-01

    We describe the Science Semester, a semester-long course block that integrates three science courses and a science education methods course for elementary teacher education majors, and examine prospective elementary teachers’ developing conceptions about inquiry, science teaching efficacy, and reflections on learning through inquiry. The Science Semester was designed to provide inquiry-oriented and problem-based learning experiences, opportunities to examine socially relevant issues through cross-disciplinary perspectives, and align with content found in elementary curricula and standards. By the end of the semester, prospective elementary teachers moved from naïve to intermediate understandings of inquiry and significantly increased self-efficacy for science teaching as measured on one subscore of the STEBI-B. Reflecting on the semester, prospective teachers understood and appreciated the goals of the course and the PBL format, but struggled with the open-ended and student-directed elements of the course.

  11. Space Geodesy: The Cross-Disciplinary Earth science (Vening Meinesz Medal Lecture)

    Science.gov (United States)

    Shum, C. K.

    2012-04-01

    Geodesy during the onset of the 21st Century is evolving into a transformative cross-disciplinary Earth science field. The pioneers before or after the discipline Geodesy was defined include Galileo, Descartes, Kepler, Newton, Euler, Bernoulli, Kant, Laplace, Airy, Kelvin, Jeffreys, Chandler, Meinesz, Kaula, and others. The complicated dynamic processes of the Earth system manifested by interactions between the solid Earth and its fluid layers, including ocean, atmosphere, cryosphere and hydrosphere, and their feedbacks are linked with scientific problems such as global sea-level rise resulting from natural and anthropogenic climate change. Advances in the precision and stability of geodetic and fundamental instrumentations, including clocks, satellite or quasar tracking sensors, altimetry and lidars, synthetic aperture radar interferometry (InSAR), InSAR altimetry, gravimetry and gradiometry, have enabled accentuate and transformative progress in cross-disciplinary Earth sciences. In particular, advances in the measurement of the gravity with modern free-fall methods have reached accuracies of 10-9 g (~1 μGal or 10 nm/s2) or better, allowing accurate measurements of height changes at ~3 mm relative to the Earth's center of mass, and mass transports within the Earth interior or its geophysical fluids, enabling global quantifications of climate-change signals. These contemporary space geodetic and in situ sensors include, but not limited to, satellite radar and laser altimetry/lidars, GNSS/SLR/VLBI/DORIS, InSAR, spaceborne gravimetry from GRACE (Gravity Recovery And Climate Experiment twin-satellite mission) and gradiometry from GOCE (Global Ocean Circulation Experiment), tide gauges, and hydrographic data (XBT/MBT/Argo). The 2007 Intergovernmental Panel for Climate Change (IPCC) study, the Fourth Assessment Report (AR4), substantially narrowed the discrepancy between observation and the known geophysical causes of sea-level rise, but significant uncertainties

  12. Cross-disciplinary Participatory & Contextual Design Research: Creating a Teacher Dashboard Application

    Directory of Open Access Journals (Sweden)

    Troy D. Abel

    2014-02-01

    Full Text Available Concepts of Human Computer Interaction have crossed disciplinary boundaries allowing the discovery of underlying stakeholder affordances to emerge during the design research phase of system design. For the current scenario, middle school mathematics teachers as data-driven decision makers are inundated with diagnostic and assessment data, resulting in data deluge. The situation is unlikely to subside as digital technologies and media are broadly adopted for instruction and learning. Teachers could benefit from tools to quickly sift through this data to inform classroom instruction. Data should be visualized in a way that teachers can make real-time formative and summative assessments of student progress. The purpose of this article is to introduce a mixed-method mode of discovery to uncover affordances innate to classroom teachers during the design of an iPad data visualization application. These technology-assisted “dashboard” platforms could serve as efficient and effective interventions to deal with the copious amounts of data streams now available to teachers.

  13. Nurturing Opportunity Identification for Business Sophistication in a Cross-disciplinary Study Environment

    Directory of Open Access Journals (Sweden)

    Karine Oganisjana

    2012-12-01

    Full Text Available Opportunity identification is the key element of the entrepreneurial process; therefore the issue of developing this skill in students is a crucial task in contemporary European education which has recognized entrepreneurship as one of the lifelong learning key competences. The earlier opportunity identification becomes a habitual way of thinking and behavior across a broad range of contexts, the more likely that entrepreneurial disposition will steadily reside in students. In order to nurture opportunity identification in students for making them able to organize sophisticated businesses in the future, certain demands ought to be put forward as well to the teacher – the person who is to promote these qualities in their students. The paper reflects some findings of a research conducted within the frameworks of a workplace learning project for the teachers of one of Riga secondary schools (Latvia. The main goal of the project was to teach the teachers to identify hidden inner links between apparently unrelated things, phenomena and events within 10th grade study curriculum and connect them together and create new opportunities. The creation and solution of cross-disciplinary tasks were the means for achieving this goal.

  14. Bebop on the Hockey pitch: Cross-disciplinary creativity and skills transfer

    Directory of Open Access Journals (Sweden)

    Clive Maxwell Harrison

    2016-02-01

    Full Text Available This paper generalises task-specific (but dissimilar skills, from the jazz concert stage and from the hockey field, into the domain of creativity research. What is sought are clues to what skills or creativities are transferable across dissimilar domains. It is argued that certain domain-general skills are transferable across domains, but a domain-general or ‘c’ creative capacity, is not. Rather than transferring some over-arching capacity to be universally creative, this research highlights factors likely to facilitate successful cross-disciplinary creative expression and posits a correlation between the capacities for discriminant pattern-recognition, task-specific expertise, and sensory data-collection, and the transferability of creativity. Of particular significance is the capacity for informed, selective pattern-breaking based on the ‘depth’ or ‘insider’ perspective of the domain expert; such ‘expert variation and selective retention’ (EVSR provides creative choices and responses that are likely to be perceived by the field as creative: valuable, novel and surprising. The author is a renowned Australian studio bassist, jazz musician, and music educator who also plays field hockey for Australia at Masters level. His recently completed PhD thesis, based on a performance and composition career spanning 46 years, takes the form of an analytical autoethnography drawn from personal field notes, diaries and interviews as well as published record albums.

  15. A cross disciplinary study of link decay and the effectiveness of mitigation techniques.

    Science.gov (United States)

    Hennessey, Jason; Ge, Steven

    2013-01-01

    The dynamic, decentralized world-wide-web has become an essential part of scientific research and communication. Researchers create thousands of web sites every year to share software, data and services. These valuable resources tend to disappear over time. The problem has been documented in many subject areas. Our goal is to conduct a cross-disciplinary investigation of the problem and test the effectiveness of existing remedies. We accessed 14,489 unique web pages found in the abstracts within Thomson Reuters' Web of Science citation index that were published between 1996 and 2010 and found that the median lifespan of these web pages was 9.3 years with 62% of them being archived. Survival analysis and logistic regression were used to find significant predictors of URL lifespan. The availability of a web page is most dependent on the time it is published and the top-level domain names. Similar statistical analysis revealed biases in current solutions: the Internet Archive favors web pages with fewer layers in the Universal Resource Locator (URL) while WebCite is significantly influenced by the source of publication. We also created a prototype for a process to submit web pages to the archives and increased coverage of our list of scientific webpages in the Internet Archive and WebCite by 22% and 255%, respectively. Our results show that link decay continues to be a problem across different disciplines and that current solutions for static web pages are helping and can be improved.

  16. Configurable User Interface Framework for Data Discovery in Cross-Disciplinary and Citizen Science

    Science.gov (United States)

    Rozell, E.; Wang, H.; West, P.; Zednik, S.; Fox, P.

    2012-04-01

    Use cases for data discovery and analysis vary widely when looking across disciplines and levels of expertise. Domain experts across disciplines may have a thorough understanding of self-describing data formats, such as netCDF, and the software packages that are compatible. However, they may be unfamiliar with specific vocabulary terms used to describe the data parameters or instrument packages in someone else's collection, which are often useful in data discovery. Citizen scientists may struggle with both expert vocabularies and knowledge of existing tools for analyzing and visualizing data. There are some solutions for each problem individually. For expert vocabularies, semantic technologies like the Resource Description Framework (RDF) have been used to map terms from an expert vocabulary to layperson terminology. For data analysis and visualization, tools can be mapped to data products using semantic technologies as well. This presentation discusses a solution to both problems based on the S2S Framework, a configurable user interface (UI) framework for Web services. S2S unifies the two solutions previously described using a data service abstraction ("search services") and a UI abstraction ("widgets"). Using the OWL Web Ontology Language, S2S defines a vocabulary for describing search services and their outputs, and the compatibility of those outputs with UI widgets. By linking search service outputs to widgets, S2S can automatically compose UIs for search and analysis of data, making it easier for citizen scientists to manipulate data. We have also created Linked Data widgets for S2S, which can leverage distributed RDF resources to present alternative views of expert vocabularies. This presentation covers some examples where we have applied these solutions to improve data discovery for both cross-disciplinary and non-expert users.

  17. Cross-disciplinary thermoregulation and sweat analysis laboratory experiences for undergraduate Chemistry and Exercise Science students.

    Science.gov (United States)

    Mulligan, Gregory; Taylor, Nichole; Glen, Mary; Tomlin, Dona; Gaul, Catherine A

    2011-06-01

    Cross-disciplinary (CD) learning experiences benefit student understanding of concepts and curriculum by offering opportunities to explore topics from the perspectives of alternate fields of study. This report involves a qualitative evaluation of CD health sciences undergraduate laboratory experiences in which concepts and students from two distinct disciplines [chemistry (CHEM) and exercise physiology (EPHE)] combined to study exercise thermoregulation and sweat analysis. Twenty-eight senior BSc Kinesiology (EPHE) students and 42 senior BSc CHEM students participated as part of their mutually exclusive, respective courses. The effectiveness of this laboratory environment was evaluated qualitatively using written comments collected from all students as well as from formal focus groups conducted after the CD laboratory with a representative cohort from each class (n = 16 CHEM students and 9 EPHE students). An open coding strategy was used to analyze the data from written feedback and focus group transcripts. Coding topics were generated and used to develop five themes found to be consistent for both groups of students. These themes reflected the common student perceptions that the CD experience was valuable and that students enjoyed being able to apply academic concepts to practical situations as well as the opportunity to interact with students from another discipline of study. However, students also reported some challenges throughout this experience that stemmed from the combination of laboratory groups from different disciplines with limited modification to the design of the original, pre-CD, learning environments. The results indicate that this laboratory created an effective learning opportunity that fostered student interest and enthusiasm for learning. The findings also provide information that could inform subsequent design and implementation of similar CD experiences to enhance engagement of all students and improve instructor efficacy.

  18. A multi-institutional Stellarator Configuration Study

    Science.gov (United States)

    Gates, David

    2017-10-01

    A multi-institutional study aimed at mapping the space of quasi-axisymmetric stellarators has begun. The goal is to gain improved understanding of the dependence of important physics and engineering parameters (e.g. bootstrap current, stability, coil complexity, etc.) on plasma shape (average elongation, aspect ratio, number of periods). In addition, the stellarator optimization code STELLOPT will be upgraded with new capabilities such as improved coil design algorithms such as COILOPT + + and REGCOIL, divertor optimization options, equilibria with islands using the SPEC code, and improved bootstrap current calculations with the SFINCS code. An effort is underway to develop metrics for divertor optimization. STELLOPT has also had numerous improvements to numerical algorithms and parallelization capabilities. Simultaneously, we also are pursuing the optimization of turbulent transport according to the method of proxy functions. Progress made to date includes an elongation scan on quasi-axisymmetric equilibria and an initial comparison between the SFINCS code and the BOOTSJ calculation of bootstrap current currently available in STELLOPT. Further progress on shape scans and subsequent physics analysis will be reported. The status of the STELLOPT upgrades will be described. The eventual goal of this exercise is to identify attractive configurations for future US experimental facilities.. This work is supported by US DoE Contract Number DE-AC02-09CH11466.

  19. The History of the English Language Course: A Cross-Disciplinary Approach to the Humanities

    Science.gov (United States)

    Dressman, Michael R.

    2007-01-01

    The study of the history of the English language can help students become aware of major issues in several academic fields, including history, literature, political science, anthropology, communication, economics, the Arts, and, of course, languages and linguistics. Even though instructors may not have an especially broad background in the…

  20. Looking across the Divide: Analyzing Cross-Disciplinary Approaches for Teaching Business Communication

    Science.gov (United States)

    Laster, Nicole M.; Russ, Travis L.

    2010-01-01

    This study elucidates pedagogical differences and similarities between the ways in which instructors from business and communication disciplines teach the introductory business communication course. During the spring of 2008, the authors surveyed 444 instructors teaching this course at colleges and universities across the United States. Their…

  1. Enterprise strategic alignment method: a cross-disciplinary capability-driven approach

    NARCIS (Netherlands)

    Aldea, Adina

    2017-01-01

    The environment of organisations is changing more rapidly in the recent years, which makes it increasingly more difficult to stay competitive. Organisations need to ensure that when they make transformations, they focus on maintaining or improving their strategic alignment. However, the current

  2. Post It!--A Cross-Disciplinary Approach to Teach Socioscientific Issues

    Science.gov (United States)

    Rundgren, Shu-Nu Chang

    2011-01-01

    Various socioscientific issues (SSIs) are emerging in today's science--and technology--dominant society, e.g. genetically modified organisms and global warming. To achieve the goal of scientific literacy, more and more science educators have devoted their attention to enhancing students' understanding of the multidimensional aspects of SSIs as…

  3. Multi-Institution Research Centers: Planning and Management Challenges

    Science.gov (United States)

    Spooner, Catherine; Lavey, Lisa; Mukuka, Chilandu; Eames-Brown, Rosslyn

    2016-01-01

    Funding multi-institution centers of research excellence (CREs) has become a common means of supporting collaborative partnerships to address specific research topics. However, there is little guidance for those planning or managing a multi-institution CRE, which faces specific challenges not faced by single-institution research centers. We…

  4. Multi-Institutional Development of a Mastoidectomy Performance Evaluation Instrument.

    Science.gov (United States)

    Kerwin, Thomas; Hittle, Brad; Stredney, Don; De Boeck, Paul; Wiet, Gregory

    A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium. Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15-element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14-element checklist focusing on the concept of safety after using it to rate a large and varied population of performances. Twelve otolaryngological surgical training programs in the United States. A total of 14 surgeons from 12 different institutions took part in the construction of the instrument. By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize "safe" as opposed to "proper" technique. A second rating instrument was developed based on this feedback. Using a consensus-building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. Challenges for a cross-disciplinary geoarchaeology: The intersection between environmental history and geomorphology

    Science.gov (United States)

    Butzer, Karl W.

    2008-10-01

    Geoarchaeology is a growing subfield of cross-disciplinary research at the intersection between geomorphology, environmental history, and archaeology. This prospective essay does not aim to analyze the nature or evolution of geoarachaeology, or to review available techniques and methods. Instead it addresses challenges. Exciting challenges confront geoarchaeology in the form of persistent problems that demand satisfactory solutions, despite improving skills and innovative technologies. Drawing from the full record of human history, a number of practical issues can be highlighted to explicate these challenges: Open-air archaeological sites are the main object of study for the Early to Mid-Pleistocene, even though they represent open systems that raise fundamental questions about archaeo-taphonomic integrity. How were sites buried and then modified by selective preservation, horizontal or vertical disturbance, and the role of carnivores? Is it possible to determine the degree to which such sites accurately record prehistoric human behavior, prior to the Late Pleistocene when hearths and living structures lend better definition to occupation surfaces? Can non-primary open-air sites also shed light on human activities and environmental history? Cave sites have long been favored by archaeologists because of the impression that they represent relatively complete and undisturbed archaeostratigraphic sequences. But serious problems also exist here in regard to the nature of accumulation and the sources of mineral and biogenic sediments in what were open systems, liable to disturbance, despite comparatively low-energy processes. Less familiar are urban and other architectural sites, where processes of formation and degradation mimic natural sedimentation and erosion. Such a geoarchaeology can be highly informative for urban processes, demographic cycles, or the intersection between sites and their surrounding landscapes. Spatial components of geoarchaeological research need

  6. Cross-Disciplinary Collaboration: Fostering Professional Communication Skills in a Graduate Accounting Certificate Program

    Science.gov (United States)

    Brizee, Allen; Langmead, Joseph

    2014-01-01

    For decades, scholars and working professionals have known that accountants struggle with communication. Experts agree that integrating communication pedagogy into accounting courses is the most effective way of addressing this problem, but an integrated approach is not always possible. In this programmatic and pedagogical article, we address this…

  7. Social technologies : Cross-disciplinary reflections on technologies in and from the social sciences Introduction

    NARCIS (Netherlands)

    Derksen, Maarten; Vikkelso, Signe; Beaulieu, Anne

    In this introduction, we explore the relevance to critical psychology of the ideas about technology that have come from science and technology studies (STS), which we argue allow a new look at a classic theme in critical approaches in psychology. Rather than seeing psychical and social reality as

  8. Variations in Textualization: A Cross-generic and Cross-disciplinary Study, Implications for Readability of the Academic Discourse

    Directory of Open Access Journals (Sweden)

    Mina Abbasi Bonabi

    2018-01-01

    Full Text Available According to discoursal views on language, variations in textualization strategies are always socio-contextually motivated and never happen at random. The textual forms employed in a text, along with many other discoursal and contextual factors, could certainly affect the readability of the text, making it more or less processable for the same reader. On the basis of these assumptions, the present study set out to examine how our data varied across genres and disciplines in terms of our target textual forms. These forms are as follows: the magnitude of T-unit (MOTU, the degree of embeddedness of the main verb in T-unit (DE, the physical distance between the verb and its satellite elements (PD, the magnitude of the noun phrase appearing before the verb (MOX, and the magnitude of noun phrase appearing after the verb (MOY. Our data consisted of 20 research articles randomly selected from two different disciplines of Biology and Applied Linguistics, to be analyzed in terms of the above-named textual strategies. One way ANOVA and post hoc Tukey tests were used for data analyses. The results revealed cross-generic as well as cross-disciplinary differences in the employment of the above textual forms. These findings were discussed in terms of the academic concepts and discourse on the one hand and the possible effect of the required textual forms on the readability of the text on the other hand.

  9. TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial.

    Science.gov (United States)

    Wittmann, D; Mehta, A; Northouse, L; Dunn, R; Braun, T; Duby, A; An, L; Arab, L; Bangs, R; Bober, S; Brandon, J; Coward, M; Dunn, M; Galbraith, M; Garcia, M; Giblin, J; Glode, M; Koontz, B; Lowe, A; Mitchell, S; Mulhall, J; Nelson, C; Paich, K; Saigal, C; Skolarus, T; Stanford, J; Walsh, T; Pollack, C E

    2017-10-02

    of patient characteristics with both outcomes. The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship. Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

  10. Incommensurability in Cross-Disciplinary Research: A Call for Cultural Negotiation

    Directory of Open Access Journals (Sweden)

    Anne MacCleave

    2006-06-01

    Full Text Available What happens when a clinical psychologist, a grounded theorist, an ethnographer, and a phenomenologist meet to collaborate on an interdisciplinary grant proposal on childhood loneliness? Excerpts of an imaginary dialogue reveal how different disciplines can be thought of as different “cultures,” because each has its own way of doing things, deeply embedded assumptions about knowledge and the construction/representation of reality, and different specialized languages. Some of these differences might be incommensurable and call for cultural negotiation if a coherent approach is to be adopted. Cultural negotiation helps to make differences more accessible and understandable rather than creating inflexible or polarized ideological camps. This process might help methodologists think about researching across disciplines in new and more effective ways.

  11. Uniqueness of family therapists as family business systems consultants: a cross-disciplinary investigation.

    Science.gov (United States)

    Lee, Jinhee; Danes, Sharon M

    2012-06-01

    The purpose of this study is to address how the consulting approaches of family therapists working with family businesses differ from those of business consultants. The logic of analytic induction was used to analyze qualitative data from family business consultants with and without training in family therapy. Consultants were asked to respond to two vignettes: one emphasized primarily family system problems, whereas the other emphasized business problems with influencing issues at the family/business intersection. Both similarities and differences were found in reference to problem assessment, consulting goal orientation, intervention strategy focus, consultant role and function, and consulting setting preference between consultants with and without family therapy training. Results indicate that consultants of each discipline provide a unique perspective and expertise that allow them to successfully address the spectrum of issues that family firms face. Further, findings highlight the unique contribution of family therapists to an interdisciplinary consulting team. © 2012 American Association for Marriage and Family Therapy.

  12. Interprofessional Clinical Ethics Education: The Promise of Cross-Disciplinary Problem-Based Learning.

    Science.gov (United States)

    Kurtz, Melissa J; Starbird, Laura E

    2016-09-01

    A review of Lin et al.'s pilot study exploring the effects of an interprofessional, problem-based learning clinical ethics curriculum on Taiwanese medical and nursing students' attitudes towards interprofessional collaboration highlights the benefits of interprofessional collaboration and offers insight into how problem-based learning might be universally applied in ethics education. Interprofessional collaboration is an ideal approach for exploring ethical dilemmas because it involves all relevant professionals in discussions about ethical values that arise in patient care. Interprofessional ethics collaboration is challenging to implement, however, given time constraints and organizational and practice demands. Nevertheless, we suggest that when professionals collaborate, they can collectively express greater commitment to the patient. We also suggest future research avenues that can explore additional benefits of interprofessional collaboration in clinical ethics. © 2016 American Medical Association. All Rights Reserved.

  13. Enabling cross-disciplinary research by linking data to Open Access publications

    Science.gov (United States)

    Rettberg, N.

    2012-04-01

    Open Access services, taking into account the variety within research approaches. Adopting Linked Data mechanisms on top of citation and content mining, it will approach the interchange of data between generic infrastructures such as OpenAIREplus and subject specific service providers. The paper will also touch on the other challenges envisaged in the project with regard to the culture of sharing data, as well as IPR, licensing and organisational issues.

  14. Integrative studies of cultural evolution: crossing disciplinary boundaries to produce new insights.

    Science.gov (United States)

    Kolodny, Oren; Feldman, Marcus W; Creanza, Nicole

    2018-04-05

    Culture evolves according to dynamics on multiple temporal scales, from individuals' minute-by-minute behaviour to millennia of cultural accumulation that give rise to population-level differences. These dynamics act on a range of entities-including behavioural sequences, ideas and artefacts as well as individuals, populations and whole species-and involve mechanisms at multiple levels, from neurons in brains to inter-population interactions. Studying such complex phenomena requires an integration of perspectives from a diverse array of fields, as well as bridging gaps between traditionally disparate areas of study. In this article, which also serves as an introduction to the current special issue, we highlight some specific respects in which the study of cultural evolution has benefited and should continue to benefit from an integrative approach. We showcase a number of pioneering studies of cultural evolution that bring together numerous disciplines. These studies illustrate the value of perspectives from different fields for understanding cultural evolution, such as cognitive science and neuroanatomy, behavioural ecology, population dynamics, and evolutionary genetics. They also underscore the importance of understanding cultural processes when interpreting research about human genetics, neuroscience, behaviour and evolution.This article is part of the theme issue 'Bridging cultural gaps: interdisciplinary studies in human cultural evolution'. © 2018 The Author(s).

  15. Environmental law. A course of lectures for a cross-disciplinary audience

    International Nuclear Information System (INIS)

    Schulte, H.

    1999-01-01

    Readers interested in getting more insight in the legal framework available for supporting environmental protection policy will find a comprehensive picture of the environmental law applicable in Germany. The format chosen for the book is that of a lecture series, so that the reader is given step-by-step orientation and systematic guidance in approaching the complex material. The positive law and the underlying scientific systems are explained. An introductory part discusses the legal instruments available for enforcement of environmental law, the position of environmental law within the entire legal system of Germany, as well as relevant aspects of the law of the European Union, and international law. The subsequent chapters present an exhaustive survey of the subjects and objectives of German environmental law, as well as the legal practice and the issues involved. The chapters' headings read as follows: Abatement and control of emissions; the structure and functions of the state; administrative powers and action; civil rights and environmental protection; atomic energy law; water protection; waste management; nature conservation; the law on chemicals; the law relating to genetic engineering. The final chapter discusses aspects of environmental liability. (orig./CB) [de

  16. The Proteomics Stock Market Project. A Cross-Disciplinary Collaboration in Biochemistry and Business Education

    Science.gov (United States)

    Keller, Heath; Cox, James R.

    2004-04-01

    Students taking courses in different disciplines can work together to add unique elements to their educational experience. A model for this type of pedagogical approach has been established in the Proteomics Stock Market Project, a collaborative effort between instructors and students in the Department of Chemistry and Department of Management, Marketing, and Business Administration at Murray State University. Stage I involved biochemistry students investigating the topic of proteomics and choosing companies for potential investment based only on scientific investigation. Marketing and management students completed Stage II and provided an investment analysis on the companies selected in Stage I. In Stage III, the biochemistry students focused on a particular company and investigated a protein-based therapeutic product. Blackboard software was utilized in each stage of the project to facilitate the exchange of information and electronic documents. This project was designed to give biochemistry students an appreciation for the emerging field of proteomics and the marketing and management students a flavor for real-world applications of business principles. During the project, students were exposed to ideas and concepts not typically covered in their courses. With this involvement, the students had the opportunity to gain a broader perspective of course content compared to a more traditional curriculum.

  17. Information extraction from multi-institutional radiology reports.

    Science.gov (United States)

    Hassanpour, Saeed; Langlotz, Curtis P

    2016-01-01

    The radiology report is the most important source of clinical imaging information. It documents critical information about the patient's health and the radiologist's interpretation of medical findings. It also communicates information to the referring physicians and records that information for future clinical and research use. Although efforts to structure some radiology report information through predefined templates are beginning to bear fruit, a large portion of radiology report information is entered in free text. The free text format is a major obstacle for rapid extraction and subsequent use of information by clinicians, researchers, and healthcare information systems. This difficulty is due to the ambiguity and subtlety of natural language, complexity of described images, and variations among different radiologists and healthcare organizations. As a result, radiology reports are used only once by the clinician who ordered the study and rarely are used again for research and data mining. In this work, machine learning techniques and a large multi-institutional radiology report repository are used to extract the semantics of the radiology report and overcome the barriers to the re-use of radiology report information in clinical research and other healthcare applications. We describe a machine learning system to annotate radiology reports and extract report contents according to an information model. This information model covers the majority of clinically significant contents in radiology reports and is applicable to a wide variety of radiology study types. Our automated approach uses discriminative sequence classifiers for named-entity recognition to extract and organize clinically significant terms and phrases consistent with the information model. We evaluated our information extraction system on 150 radiology reports from three major healthcare organizations and compared its results to a commonly used non-machine learning information extraction method. We

  18. Science and Theatre Education: A Cross-Disciplinary Approach of Scientific Ideas Addressed to Student Teachers of Early Childhood Education

    Science.gov (United States)

    Tselfes, Vasilis; Paroussi, Antigoni

    2009-01-01

    There is, in Greece, an ongoing attempt to breach the boundaries established between the different teaching-learning subjects of compulsory education. In this context, we are interested in exploring to what degree the teaching and learning of ideas from the sciences' "internal life" (Hacking, in: Pickering (ed) "Science as practice…

  19. Communication in ecosystem management: a case study of cross-disciplinary integration in the assessment phase of the interior Columbia Basin Ecosystem Management Project.

    Science.gov (United States)

    Jakobsen, Christine Haugaard; McLaughlin, William J

    2004-05-01

    Effective communication is essential to the success of collaborative ecosystem management projects. In this paper, we investigated the dynamics of the Interior Columbia Basin Ecosystem Management Project's (ICBEMP) cross-disciplinary integration process in the assessment phase. Using a case study research design, we captured the rich trail of experience through conducting in-depth interviews and collecting information from internal and public documents, videos, and meetings related to the ICBEMP. Coding and analysis was facilitated by a qualitative analysis software, NVivo. Results include the range of internal perspectives on barriers and facilitators of cross-disciplinary integration in the Science Integration Team (SIT). These are arrayed in terms of discipline-based differences, organizational structures and activities, individual traits of scientists, and previous working relationships. The ICBEMP organization included a team of communication staffs (CT), and the data described the CT as a mixed group in terms of qualifications and educational backgrounds that played a major role in communication with actors external to the ICBEMP organization but a minor one in terms of internal communication. The data indicated that the CT-SIT communication was influenced by characteristics of actors and structures related to organizations and their cultures. We conclude that the ICBEMP members may not have had a sufficient level of shared understanding of central domains, such as the task at hand and ways and timing of information sharing. The paper concludes by suggesting that future ecosystem management assessment teams use qualified communications specialists to design and monitor the development of shared cognition among organization members in order to improve the effectiveness of communication and cross-disciplinary integration.

  20. 34 CFR 675.34 - Multi-Institutional job location and development programs.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Multi-Institutional job location and development... Location and Development Program § 675.34 Multi-Institutional job location and development programs. (a) An... location programs for its students with other participating institutions. (b) The agreement described in...

  1. Multi-Institutional Sharing of Electronic Health Record Data to Assess Childhood Obesity.

    Directory of Open Access Journals (Sweden)

    L Charles Bailey

    Full Text Available To evaluate the validity of multi-institutional electronic health record (EHR data sharing for surveillance and study of childhood obesity.We conducted a non-concurrent cohort study of 528,340 children with outpatient visits to six pediatric academic medical centers during 2007-08, with sufficient data in the EHR for body mass index (BMI assessment. EHR data were compared with data from the 2007-08 National Health and Nutrition Examination Survey (NHANES.Among children 2-17 years, BMI was evaluable for 1,398,655 visits (56%. The EHR dataset contained over 6,000 BMI measurements per month of age up to 16 years, yielding precise estimates of BMI. In the EHR dataset, 18% of children were obese versus 18% in NHANES, while 35% were obese or overweight versus 34% in NHANES. BMI for an individual was highly reliable over time (intraclass correlation coefficient 0.90 for obese children and 0.97 for all children. Only 14% of visits with measured obesity (BMI ≥95% had a diagnosis of obesity recorded, and only 20% of children with measured obesity had the diagnosis documented during the study period. Obese children had higher primary care (4.8 versus 4.0 visits, p<0.001 and specialty care (3.7 versus 2.7 visits, p<0.001 utilization than non-obese counterparts, and higher prevalence of diverse co-morbidities. The cohort size in the EHR dataset permitted detection of associations with rare diagnoses. Data sharing did not require investment of extensive institutional resources, yet yielded high data quality.Multi-institutional EHR data sharing is a promising, feasible, and valid approach for population health surveillance. It provides a valuable complement to more resource-intensive national surveys, particularly for iterative surveillance and quality improvement. Low rates of obesity diagnosis present a significant obstacle to surveillance and quality improvement for care of children with obesity.

  2. "Less Clicking, More Watching": Results from the User-Centered Design of a Multi-Institutional Web Site for Art and Culture.

    Science.gov (United States)

    Vergo, John; Karat, Clare-Marie; Karat, John; Pinhanez, Claudio; Arora, Renee; Cofino, Thomas; Riecken, Doug; Podlaseck, Mark

    This paper summarizes a 10-month long research project conducted at the IBM T.J. Watson Research Center aimed at developing the design concept of a multi-institutional art and culture web site. The work followed a user-centered design (UCD) approach, where interaction with prototypes and feedback from potential users of the web site were sought…

  3. From Multi-Sensors Observations Towards Cross-Disciplinary Study of Pre-Earthquake Signals. What have We Learned from the Tohoku Earthquake?

    Science.gov (United States)

    Ouzounov, D.; Pulinets, S.; Papadopoulos, G.; Kunitsyn, V.; Nesterov, I.; Hayakawa, M.; Mogi, K.; Hattori, K.; Kafatos, M.; Taylor, P.

    2012-01-01

    The lessons we have learned from the Great Tohoku EQ (Japan, 2011) how this knowledge will affect our future observation and analysis is the main focus of this presentation.We present multi-sensors observations and multidisciplinary research in our investigation of phenomena preceding major earthquakes. These observations revealed the existence of atmospheric and ionospheric phenomena occurring prior to theM9.0 Tohoku earthquake of March 11, 2011, which indicates s new evidence of a distinct coupling between the lithosphere and atmosphere/ionosphere, as related to underlying tectonic activity. Similar results have been reported before the catastrophic events in Chile (M8.8, 2010), Italy (M6.3, 2009) and Sumatra (M9.3, 2004). For the Tohoku earthquake, our analysis shows a synergy between several independent observations characterizing the state of the lithosphere /atmosphere coupling several days before the onset of the earthquakes, namely: (i) Foreshock sequence change (rate, space and time); (ii) Outgoing Long wave Radiation (OLR) measured at the top of the atmosphere; and (iii) Anomalous variations of ionospheric parameters revealed by multi-sensors observations. We are presenting a cross-disciplinary analysis of the observed pre-earthquake anomalies and will discuss current research in the detection of these signals in Japan. We expect that our analysis will shed light on the underlying physics of pre-earthquake signals associated with some of the largest earthquake events

  4. How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives.

    Science.gov (United States)

    Bogetz, Alyssa L; Orlov, Nicola; Blankenburg, Rebecca; Bhavaraju, Vasudha; McQueen, Alisa; Rassbach, Caroline

    2018-04-01

    Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified. We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback. In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory. Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions. Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

  5. Assessing Cross-disciplinary Efficiency of Soil Amendments for Agro-biologically, Economically, and Ecologically Integrated Soil Health Management

    Science.gov (United States)

    2010-01-01

    Preventive and/or manipulative practices will be needed to maintain soil's biological, physiochemical, nutritional, and structural health in natural, managed, and disturbed ecosystems as a foundation for food security and global ecosystem sustainability. While there is a substantial body of interdisciplinary science on understanding function and structure of soil ecosystems, key gaps must be bridged in assessing integrated agro-biological, ecological, economical, and environmental efficiency of soil manipulation practices in time and space across ecosystems. This presentation discusses the application of a fertilizer use efficiency (FUE) model for assessing agronomic, economic, ecological, environmental, and nematode (pest) management efficiency of soil amendments. FUE is defined as increase in host productivity and/or decrease in plant-parasitic nematode population density in response to a given fertilizer treatment. Using the effects of nutrient amendment on Heterodera glycines population density and normalized difference vegetative index (indicator of physiological activities) of a soybean cultivar ‘CX 252’, how the FUE model recognizes variable responses and separates nutrient deficiency and toxicity from nematode parasitism as well as suitability of treatments designed to achieve desired biological and physiochemical soil health conditions is demonstrated. As part of bridging gaps between agricultural and ecological approaches to integrated understanding and management of soil health, modifications of the FUE model for analyzing the relationships amongst nematode community structure, soil parameters (eg. pH, nutrients, %OM), and plant response to soil amendment is discussed. PMID:22736840

  6. Where High-Tech Meets High-Touch: an example of effective cross-disciplinary collaboration in education

    Science.gov (United States)

    Holzhauer, B.; Mooney, M. E.

    2012-12-01

    resources for teaching through formal STEM education, ALNC has combined the unique benefits of place-based outdoor citizen-science in the community setting with digital, multimedia, and interactive components to address local, regional, and global scientific concepts with all audiences of all ages. This innovative, replicable and broadly accessible approach, geared towards formal school groups and the general public in a non-formal educational setting, is being piloted, evaluated, and disseminated through a variety of networks and professional development in order to serve as a model of continued collaborative education.;

  7. Catalyzing Cross-Disciplinary Research and Education Within and Beyond the Environmental and Geosciences to Address Emerging, Societally-Relevant Issues

    Science.gov (United States)

    Cak, A. D.; Vigdor, L. J.; Vorosmarty, C. J.; Giebel, B. M.; Santistevan, C.; Chasteau, C.

    2017-12-01

    Tackling emergent, societally-relevant problems in the environmental sciences is hardly confined to a single research discipline, but rather requires collaborations that bridge diverse domains and perspectives. While new technologies (e.g., Skype) can in theory unite otherwise geographically distributed participation in collaborative research, physical distance nevertheless raises the bar on intellectual dialogue. Such barriers may reveal perceptions of or real differences across disciplines, reflecting particular traditions in their histories and academic cultures. Individual disciplines are self-defined by their scientific, epistemologic, methodologic, or philosophical traditions (e.g., difficulties in understanding processes occurring at different scales, insufficient research funding for interdisciplinary work), or cultural and discursive hurdles (e.g., navigating a new field's jargon). Coupled with these challenges is a considerable deficiency in educating the next generation of scientists to help them develop a sufficient comfort level with thinking critically across multiple disciplinary domains and conceptual frameworks. To address these issues, the City University of New York (CUNY), the largest public urban university in the U.S., made a significant investment in advancing cross-disciplinary research and education, culminating in the opening of the CUNY Advanced Science Research Center (ASRC) in New York City (NYC) in late 2014. We report here on our experiences incubating new collaborative efforts to address environmental science-related research as it is interwoven with the ASRC's five research initiatives (Environmental Sciences, Neuroscience, Structural Biology, Photonics, and Nanoscience). We describe the ASRC's overall structure and function as both a stand-alone interdisciplinary center and one that collaborates more broadly with CUNY's network of twenty-four campuses distributed across NYC's five boroughs. We identify challenges we have faced so

  8. Design thinking - crossing disciplinary borders

    CSIR Research Space (South Africa)

    Viljoen, NM

    2009-01-01

    Full Text Available as to call this loss with reality a ‘mathematical masturbation’. (This is particularly evident in the history of American OR society and to date American OR is deemed more ‘mathematical’ while European and British OR are more ‘practical’.) This perceived...

  9. IMRT QA using machine learning: A multi-institutional validation.

    Science.gov (United States)

    Valdes, Gilmer; Chan, Maria F; Lim, Seng Boh; Scheuermann, Ryan; Deasy, Joseph O; Solberg, Timothy D

    2017-09-01

    To validate a machine learning approach to Virtual intensity-modulated radiation therapy (IMRT) quality assurance (QA) for accurately predicting gamma passing rates using different measurement approaches at different institutions. A Virtual IMRT QA framework was previously developed using a machine learning algorithm based on 498 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3 mm with 10% threshold at Institution 1. An independent set of 139 IMRT measurements from a different institution, Institution 2, with QA data based on portal dosimetry using the same gamma index, was used to test the mathematical framework. Only pixels with ≥10% of the maximum calibrated units (CU) or dose were included in the comparison. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. The methodology predicted passing rates within 3% accuracy for all composite plans measured using diode-array detectors at Institution 1, and within 3.5% for 120 of 139 plans using portal dosimetry measurements performed on a per-beam basis at Institution 2. The remaining measurements (19) had large areas of low CU, where portal dosimetry has a larger disagreement with the calculated dose and as such, the failure was expected. These beams need further modeling in the treatment planning system to correct the under-response in low-dose regions. Important features selected by Lasso to predict gamma passing rates were as follows: complete irradiated area outline (CIAO), jaw position, fraction of MLC leafs with gaps smaller than 20 or 5 mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted average irregularity factor, and duty cycle. We have demonstrated that Virtual IMRT QA can predict passing rates using different measurement techniques and across multiple

  10. Managing an Open Access, Multi-Institutional, International Digital Library: The Digital Library of the Caribbean

    Science.gov (United States)

    Wooldridge, Brooke; Taylor, Laurie; Sullivan, Mark

    2009-01-01

    Developing an Open Access, multi-institutional, multilingual, international digital library requires robust technological and institutional infrastructures that support both the needs of individual institutions alongside the needs of the growing partnership and ensure continuous communication and development of the shared vision for the digital…

  11. A Multi-Institution Study of Student Demographics and Outcomes in Chemical Engineering

    Science.gov (United States)

    Lord, Susan M.; Layton, Richard A.; Ohland, Matthew W.; Brawner, Catherine E.; Long, Russell A.

    2014-01-01

    Using a large multi-institutional dataset, we describe demographics and outcomes for students starting in and transferring into chemical engineering (ChE). In this dataset, men outnumber women in ChE except among black students. While ChE starters graduate in ChE at rates comparable to or above their racial/ethnic population average for…

  12. Collaborative Teaching and Learning through Multi-Institutional Integrated Group Projects

    Science.gov (United States)

    Long, Suzanna K.; Carlo, Héctor J.

    2013-01-01

    This teaching brief describes an innovative multi-institutional initiative through which integrated student groups from different courses collaborate on a common course project. In this integrated group project, students are asked to design a decentralized manufacturing organization for a company that will manufacture industrial Proton-Exchange…

  13. Laparoscopy for bowel obstruction--a contradiction? Results of a multi-institutional survey in Germany.

    Science.gov (United States)

    Zimmermann, M; Hoffmann, M; Laubert, T; Bruch, H P; Keck, T; Benecke, C; Schlöricke, E

    2016-05-01

    The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals. To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care. Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %. This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.

  14. Gamma knife radiosurgery for trigeminal neuralgia. Analysis of a multi institutional study

    International Nuclear Information System (INIS)

    Takanashi, Masami; Ozaki, Yoshimaru; Satou, Kenichi; Oikawa, Mitsuteru; Nakamura, Hirohiko; Fukuoka, Seiji

    2013-01-01

    A multi-institutional study was conducted to evaluate the results of gamma knife radiosurgery (GKRS) for the treatment of trigeminal neuralgia. Eleven hundred and thirty-five patients at 39 centers were analyzed. Three hundred and sixty-nine patients had undergone percutaneous nerve block and 173 patients had undergone microvascular decompression (MVD) prior to GKRS. GKRS was performed for 69.4% of patients targeted at the nerve root entry zone (REZ) and for 20.4% of patients targeted at the retrogasserian region (RGR). The target dose of the GKRS used in the current study varied from 70 to 90 Gy (mean: 77.8 Gy). The median follow-up period after GKRS was 21.1 months (range 1 to 125 months). Six hundred and eighty-nine patients (66%) responded with excellent or good control (pain free), 157 (15%) obtained fair control (more than 50% relief), and 192 (19%) experienced treatment failure. After 3 years, 64% of cases were pain free and 80% had more than 50% pain relief. After 4 years, 37 patients underwent additional GKRS, 36 MVD and 36 percutaneous nerve block. Tolerable hypoesthesia or paresthesia occurred in 129 patients (11%), whereas bothersome symptoms developed in 8 patients (1%). But no patient developed deafferentation pain. Nine patients (1%) complained of dry eye, but no other abnormalities of the cornea and conjunctiva were found on ophthalmological examination. Higher maximum radiosurgical dose was associated with a significantly greater factor of complete pain relief (p=0.0101). GKRS is a safe and effective alternative treatment for trigeminal neuralgia, and is a minimally invasive treatment. In addition it provided benefit to a patient population unwilling or unable to undergo more invasive surgical approaches. (author)

  15. Overcoming Barriers to Public Engagement through a Multi-Institution Consortium

    Science.gov (United States)

    Lambert, K. F.; Weiss, M.; Garlick, S.

    2016-12-01

    A growing body of evidence suggests that public engagement with science (PES) can enhance the relevance and impact of science on society. At the same time, advances in our understanding of public engagement suggest that greater skills, resources, and time horizons are often required to create effective programs. Consequently, despite a proliferation of training programs, many scientists still face the challenge of balancing the demands of public engagement with the requirements of their disciplinary research. Novel institutions are emerging that bring together interdisciplinary networks of principle investigators with PES practitioners to overcome barriers to effective and sustained public engagement in the environmental sciences. We will use the Science Policy Exchange (SPE), a consortium housed at the Harvard Forest, Harvard University, to illustrate how PIs and PES practitioners can collaborate to design public engagement processes, conduct policy-relevant scientific syntheses, and implement science communication strategies. Results from two SPE case studies demonstrate how multi-institutional consortia can help scientists overcome barriers such as lack of knowledge of evidence-based PES approaches, limits on time and funding to implement PES projects, and the need to integrate PES activities with research. The case studies also show how SPE strives to achieve credibility, saliency, and legitimacy in different public policy contexts: (1) engagement between scientists and local stakeholders to develop scenarios of landscape change; and (2) engagement between scientists and policy makers to understand the relationship between power plant emission standards, and air quality, human health and ecosystem function. The presentation will conclude with examples of how SPE programs have led to institutional change (staffing and budget), cultural change (attitudes and expectations of senior leaders), and research change (development of research questions, funding proposals

  16. Conservative treatment of breast ductal carcinoma in situ: results of an Italian multi-institutional retrospective study

    International Nuclear Information System (INIS)

    Vidali, Cristiana; Neri, Stefano; Pietta, Nicoletta; Caffo, Orazio; Aristei, Cynthia; Bertoni, Filippo; Bonetta, Alberto; Guenzi, Marina; Iotti, Cinzia; Leonardi, Maria Cristina; Mussari, Salvatore

    2012-01-01

    The incidence of ductal carcinoma in situ (DCIS) has increased markedly in recent decades. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery followed by radiation therapy (RT) has become the standard approach. We present the final results of a multi-institutional retrospective study of an Italian Radiation Oncology Group for the study of conservative treatment of DCIS, characterized by a very long period of accrual, from February 1985 to March 2000, and a median follow-up longer than 11 years. A collaborative multi-institutional study was conducted in Italy in 10 Radiation Oncology Departments. A consecutive series of 586 women with DCIS histologically confirmed, treated between February 1985 and March 2000, was retrospectively evaluated. Median age at diagnosis was 55 years (range: 29–84); 32 patients were 40 years old or younger. All women underwent conservative surgery followed by whole breast RT. Irradiation was delivered to the entire breast, for a median total dose of 50 Gy; the tumour bed was boosted in 295 cases (50%) at a median dose of 10 Gy. After a median follow-up of 136 months (range: 16–292 months), 59/586 patients (10%) experienced a local recurrence: invasive in 37 cases, intraductal in 20 and not specified in two. Salvage mastectomy was the treatment of choice in 46 recurrent patients; conservative surgery in 10 and it was unknown in three patients. The incidence of local recurrence was significantly higher in women younger than 40 years (31.3%) (p= 0.0009). Five patients developed distant metastases. Furthermore 40 patients developed a contralateral breast cancer and 31 a second primary tumour in a different site. The 10-year actuarial overall survival (OS) was 95.5% and the 10-year actuarial disease-specific survival (DSS) was 99%. Our results are consistent with those reported in the literature. In particular it has been defined the importance of young age (40

  17. Modelling the fate of hydrophobic organic contaminants in a boreal forest catchment: A cross disciplinary approach to assessing diffuse pollution to surface waters

    International Nuclear Information System (INIS)

    Bergknut, Magnus; Meijer, Sandra; Halsall, Crispin; Agren, Anneli; Laudon, Hjalmar; Koehler, Stephan; Jones, Kevin C.; Tysklind, Mats; Wiberg, Karin

    2010-01-01

    The fate of hydrophobic organic compounds (HOCs) in soils and waters in a northern boreal catchment was explored through the development of a chemical fate model in a well-characterised catchment system dominated by two land types: forest and mire. Input was based solely on atmospheric deposition, dominated by accumulation in the winter snowpack. Release from soils was governed by the HOC concentration in soil, the soil organic carbon fraction and soil-water DOC content. The modelled export of selected HOCs in surface waters ranged between 11 and 250 ng day -1 during the snow covered period, compared to 200 and 9600 ng/d during snow-melt; highlighting the importance of the snow pack as a source of these chemicals. The predicted levels of HOCs in surface water were in reasonable agreement to a limited set of measured values, although the model tended to over predict concentrations of HOCs for the forested sub-catchment, by over an order of magnitude in the case of hexachlorobenzene and PCB 180. This possibly reflects both the heterogeneity of the forest soils and the complicated and changing hydrology experienced between the different seasons. - The fate of hydrophobic organic contaminants in a boreal forest catchment is connected to the flux of dissolved organic carbon and seasonal deposition.

  18. A quasi-experimental cross-disciplinary evaluation of the impacts of education outside the classroom on pupils' physical activity, well-being and learning: the TEACHOUT study protocol.

    Science.gov (United States)

    Nielsen, Glen; Mygind, Erik; Bølling, Mads; Otte, Camilla Roed; Schneller, Mikkel Bo; Schipperijn, Jasper; Ejbye-Ernst, Niels; Bentsen, Peter

    2016-10-24

    Education Outside the Classroom (EOTC) is a teaching method that aims to promote schoolchildren's learning, physical activity (PA), social relations, motivation, and well-being. EOTC activities are characterized by teachers using the local environment in their teaching, and involve innovative teaching methods, child-led approaches to problem-solving, experimentation, cooperation, PA, and play. EOTC has become common practice for many teachers in Scandinavia; however, only case studies have evaluated its impacts. The TEACHOUT study aims to evaluate the impacts of EOTC on Danish schoolchildren's PA, social relations, motivation, well-being, and learning. TEACHOUT is a quasi-experimental, cross-disciplinary study. Sixteen schools participated, containing 19 EOTC school classes and 19 parallel non-EOTC classes, with a total of 834 children aged 9 to 13 years. Measures of the children's social relations, motivation for school, well-being, and academic performance were collected at the beginning and end of the school year. Data on PA levels were collected over ten-day periods during the school year using accelerometers. The amount and characteristics of the actual EOTC provided in both EOTC and non-EOTC classes were monitored day-to-day throughout the school year, using an online teacher survey platform. The effects of EOTC are mainly analysed by comparing EOTC pupils to non-EOTC (i.e. control) pupils based on their scores on the outcome variables (i.e. school performance, well-being, motivation, and social relations) at the end of the school year, adjusting for the baseline values (from the beginning of the year). The impacts of EOTC on PA are evaluated by comparing the total as well as context-specific amounts of PA of children participating in EOTC to those of children in their parallel non-EOTC classes. Furthermore, the interdependencies between PA, social relations, well-being, motivation, and learning are explored using path analysis. To help describe and

  19. A quasi-experimental cross-disciplinary evaluation of the impacts of education outside the classroom on pupils’ physical activity, well-being and learning: the TEACHOUT study protocol

    Directory of Open Access Journals (Sweden)

    Glen Nielsen

    2016-10-01

    Full Text Available Abstract Background Education Outside the Classroom (EOTC is a teaching method that aims to promote schoolchildren’s learning, physical activity (PA, social relations, motivation, and well-being. EOTC activities are characterized by teachers using the local environment in their teaching, and involve innovative teaching methods, child-led approaches to problem-solving, experimentation, cooperation, PA, and play. EOTC has become common practice for many teachers in Scandinavia; however, only case studies have evaluated its impacts. The TEACHOUT study aims to evaluate the impacts of EOTC on Danish schoolchildren’s PA, social relations, motivation, well-being, and learning. Methods TEACHOUT is a quasi-experimental, cross-disciplinary study. Sixteen schools participated, containing 19 EOTC school classes and 19 parallel non-EOTC classes, with a total of 834 children aged 9 to 13 years. Measures of the children’s social relations, motivation for school, well-being, and academic performance were collected at the beginning and end of the school year. Data on PA levels were collected over ten-day periods during the school year using accelerometers. The amount and characteristics of the actual EOTC provided in both EOTC and non-EOTC classes were monitored day-to-day throughout the school year, using an online teacher survey platform. The effects of EOTC are mainly analysed by comparing EOTC pupils to non-EOTC (i.e. control pupils based on their scores on the outcome variables (i.e. school performance, well-being, motivation, and social relations at the end of the school year, adjusting for the baseline values (from the beginning of the year. The impacts of EOTC on PA are evaluated by comparing the total as well as context-specific amounts of PA of children participating in EOTC to those of children in their parallel non-EOTC classes. Furthermore, the interdependencies between PA, social relations, well-being, motivation, and learning are explored

  20. Revealing dynamics and consequences of fit and misfit between formal and informal networks in multi-institutional product development collaborations

    NARCIS (Netherlands)

    Kratzer, J.; Gemuenden, Hans G.; Lettl, Christopher

    The study presents a longitudinal examination about dynamics and consequences of fit and misfit between formally ascribed design interfaces and informal communication networks in two large multi-institutional product development collaborations in space industry. Findings: (1) formally ascribed

  1. The study of multi-institutional collaborations in high-energy physics

    International Nuclear Information System (INIS)

    1991-01-01

    Since World War II, the organizational framework for scientific research is increasingly the multi-institutional collaboration, especially in high-energy physics. A broad preliminary survey, into the functioning of research collaborations involving three or more institutions is described. The study is designed to identify patterns of collaborations, define the scope of the documentation problems, field-test possible solutions, recommend future actions, and build an archives of oral history interviews and other resources for scholarly use. Once the study is completed, its findings will be used to promote systems to document significant collaborative research

  2. The study of multi-institutional collaborations in high-energy physics

    Energy Technology Data Exchange (ETDEWEB)

    Warnow-Blewett, Joan

    1991-01-01

    Since World War II, the organizational framework for scientific research is increasingly the multi-institutional collaboration, especially in high-energy physics. A broad preliminary survey, into the functioning of research collaborations involving three or more institutions is described. The study is designed to identify patterns of collaborations, define the scope of the documentation problems, field-test possible solutions, recommend future actions, and build an archives of oral history interviews and other resources for scholarly use. Once the study is completed, its findings will be used to promote systems to document significant collaborative research.

  3. Development of radiation oncology learning system combined with multi-institutional radiotherapy database (ROGAD)

    International Nuclear Information System (INIS)

    Takemura, Akihiro; Iinuma, Masahiro; Kou, Hiroko; Harauchi, Hajime; Inamura, Kiyonari

    1999-01-01

    We have constructed and are operating a multi-institutional radiotherapy database ROGAD (Radiation Oncology Greater Area Database) since 1992. One of it's purpose is 'to optimize individual radiotherapy plans'. We developed Radiation oncology learning system combined with ROGAD' which conforms to that purpose. Several medical doctors evaluated our system. According to those evaluations, we are now confident that our system is able to contribute to improvement of radiotherapy results. Our final target is to generate a good cyclic relationship among three components: radiotherapy results according to ''Radiation oncology learning system combined with ROGAD.'; The growth of ROGAD; and radiation oncology learning system. (author)

  4. Robot-assisted laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: a multi-institutional experience.

    Science.gov (United States)

    Sivaraman, Ananthakrishnan; Leveillee, Raymond J; Patel, Manoj B; Chauhan, Sanket; Bracho, Jorge E; Moore, Charles R; Coelho, Rafael F; Palmer, Kenneth J; Schatloff, Oscar; Bird, Vincent G; Munver, Ravi; Patel, Vipul R

    2012-02-01

    To report a 6-year multi-institutional experience and outcomes with robot-assisted laparoscopic pyeloplasty (RLP) for the repair of ureteropelvic junction obstruction (UPJO). Between June 2002 and October 2008, 168 adult patients from 3 institutions underwent RLP for UPJO. A retrospective analysis of prospectively collected data were performed after institutional review board approval. Diagnosis was by intravenous urogram or computed tomography scan and diuretic renogram. All patients underwent RLP through a 4-port laparoscopic technique. Demographic, preoperative, operative, and postoperative endpoints for primary and secondary repair of UPJO were measured. Success was defined as a T½ of <20 minutes on diuretic renogram and symptom resolution. Pain resolution was assessed by subjective patient reports. Of 168 patients, 147 (87.5%) had primary repairs and 21 (12.5%) had secondary repairs. Of the secondary repairs, 57% had a crossing vessel etiology. Mean operative time was 134.9 minutes, estimated blood loss was 49 mL, and length of stay was 1.5 days. Mean follow-up was 39 months. Overall, 97.6% of patients had a successful outcome, with a 6.6% overall complication rate. To our knowledge, this review represents the largest multi-institutional experience of RLP with intermediate-term follow-up. RLP is a safe, efficacious, and viable option for either primary or secondary repair of UPJO with reproducible outcomes, a high success rate, and a low incidence of complications. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Development of efficiency indicators of operating room management for multi-institutional comparisons.

    Science.gov (United States)

    Tanaka, Masayuki; Lee, Jason; Ikai, Hiroshi; Imanaka, Yuichi

    2013-04-01

    The efficiency of a hospital's operating room (OR) management can affect its overall profitability. However, existing indicators that assess OR management efficiency do not take into account differences in hospital size, manpower and functional characteristics, thereby rendering them unsuitable for multi-institutional comparisons. The aim of this study was to develop indicators of OR management efficiency that would take into account differences in hospital size and manpower, which may then be applied to multi-institutional comparisons. Using administrative data from 224 hospitals in Japan from 2008 to 2010, we performed four multiple linear regression analyses at the hospital level, in which the dependent variables were the number of operations per OR per month, procedural fees per OR per month, total utilization times per OR per month and total fees per OR per month for each of the models. The expected values of these four indicators were produced using multiple regression analysis results, adjusting for differences in hospital size and manpower, which are beyond the control of process owners' management. However, more than half of the variations in three of these four indicators were shown to be explained by differences in hospital size and manpower. Using the ratio of observed to expected values (OE ratio), as well as the difference between the two values (OE difference) allows hospitals to identify weaknesses in efficiency with more validity when compared to unadjusted indicators. The new indicators may support the improvement and sustainment of a high-quality health care system. © 2012 Blackwell Publishing Ltd.

  6. Management of Field-Evolved Resistance to Bt Maize in Argentina: A Multi-Institutional Approach

    Science.gov (United States)

    Signorini, Ana M.; Abratti, Gustavo; Grimi, Damián; Machado, Marcos; Bunge, Florencia F.; Parody, Betiana; Ramos, Laura; Cortese, Pablo; Vesprini, Facundo; Whelan, Agustina; Araujo, Mónica P.; Podworny, Mariano; Cadile, Alejandro; Malacarne, María F.

    2018-01-01

    Evolution of resistance to control measures in insect populations is a natural process, and management practices are intended to delay or mitigate resistance when it occurs. During the 2012/13 season the first reports of unexpected damage by Diatraea saccharalis on some Bt maize hybrids occurred in the northeast of San Luis province, Argentina. The affected Bt technologies were Herculex I® (HX-TC1507) and VT3PRO® (MON 89034 × MON 88017*). Event TC1507 expresses Cry1F and event MON 89034 expresses Cry1A.105 and Cry2Ab2, whichr are all Bt proteins with activity against the lepidopterans D. saccharalis and Spodoptera frugiperda (MON 88017 expresses the protein Cry3Bb1 for control of coleopteran insects and the enzyme CP4EPSPS for glyphosate tolerance). The affected area is an isolated region surrounded by sierra systems to the northeast and west, with a hot semi-arid climate, long frost-free period, warm winters, hot dry summers, and woody shrubs as native flora. To manage and mitigate the development of resistance, joint actions were taken by the industry, growers and Governmental Agencies. Hybrids expressing Vip3A protein (event MIR162) and/or Cry1Ab protein (events MON 810 and Bt11) as single or stacked events are used in early plantings to control the first generations of D. saccharalis, and in later plantings date's technologies with good control of S. frugiperda. A commitment was made to plant the refuge, and pest damage is monitored. As a result, maize production in the area is sustainable and profitable with yields above the average. PMID:29888224

  7. Multi-institutional application of Failure Mode and Effects Analysis (FMEA) to CyberKnife Stereotactic Body Radiation Therapy (SBRT).

    Science.gov (United States)

    Veronese, Ivan; De Martin, Elena; Martinotti, Anna Stefania; Fumagalli, Maria Luisa; Vite, Cristina; Redaelli, Irene; Malatesta, Tiziana; Mancosu, Pietro; Beltramo, Giancarlo; Fariselli, Laura; Cantone, Marie Claire

    2015-06-13

    A multidisciplinary and multi-institutional working group applied the Failure Mode and Effects Analysis (FMEA) approach to assess the risks for patients undergoing Stereotactic Body Radiation Therapy (SBRT) treatments for lesions located in spine and liver in two CyberKnife® Centres. The various sub-processes characterizing the SBRT treatment were identified to generate the process trees of both the treatment planning and delivery phases. This analysis drove to the identification and subsequent scoring of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system. Novel solutions aimed to increase patient safety were accordingly considered. The process-tree characterising the SBRT treatment planning stage was composed with a total of 48 sub-processes. Similarly, 42 sub-processes were identified in the stage of delivery to liver tumours and 30 in the stage of delivery to spine lesions. All the sub-processes were judged to be potentially prone to one or more failure modes. Nineteen failures (i.e. 5 in treatment planning stage, 5 in the delivery to liver lesions and 9 in the delivery to spine lesions) were considered of high concern in view of the high RPN and/or severity index value. The analysis of the potential failures, their causes and effects allowed to improve the safety strategies already adopted in the clinical practice with additional measures for optimizing quality management workflow and increasing patient safety.

  8. Regional climate response collaboratives: Multi-institutional support for climate resilience

    Science.gov (United States)

    Averyt, Kristen; Derner, Justin D.; Dilling, Lisa; Guerrero, Rafael; Joyce, Linda A.; McNeeley, Shannon; McNie, Elizabeth; Morisette, Jeffrey T.; Ojima, Dennis; O'Malley, Robin; Peck, Dannele; Ray, Andrea J.; Reeves, Matt; Travis, William

    2018-01-01

    Federal investments by U.S. agencies to enhance climate resilience at regional scales grew over the past decade (2010s). To maximize efficiency and effectiveness in serving multiple sectors and scales, it has become critical to leverage existing agency-specific research, infrastructure, and capacity while avoiding redundancy. We discuss lessons learned from a multi-institutional “regional climate response collaborative” that comprises three different federally-supported climate service entities in the Rocky Mountain west and northern plains region. These lessons include leveraging different strengths of each partner, creating deliberate mechanisms to increase cross-entity communication and joint ownership of projects, and placing a common priority on stakeholder-relevant research and outcomes. We share the conditions that fostered successful collaboration, which can be transferred elsewhere, and suggest mechanisms for overcoming potential barriers. Synergies are essential for producing actionable research that informs climate-related decisions for stakeholders and ultimately enhances climate resilience at regional scales.

  9. Development of radiation oncology learning system combined with multi-institutional radiotherapy database (ROGAD)

    Energy Technology Data Exchange (ETDEWEB)

    Takemura, Akihiro; Iinuma, Masahiro; Kou, Hiroko [Kanazawa Univ. (Japan). School of Medicine; Harauchi, Hajime; Inamura, Kiyonari

    1999-09-01

    We have constructed and are operating a multi-institutional radiotherapy database ROGAD (Radiation Oncology Greater Area Database) since 1992. One of it's purpose is 'to optimize individual radiotherapy plans'. We developed Radiation oncology learning system combined with ROGAD' which conforms to that purpose. Several medical doctors evaluated our system. According to those evaluations, we are now confident that our system is able to contribute to improvement of radiotherapy results. Our final target is to generate a good cyclic relationship among three components: radiotherapy results according to ''Radiation oncology learning system combined with ROGAD.'; The growth of ROGAD; and radiation oncology learning system. (author)

  10. Multi-Institutional Validation of an OSATS for the Assessment of Cystoscopic and Ureteroscopic Skills.

    Science.gov (United States)

    Argun, Omer Burak; Chrouser, Kristin; Chauhan, Sanket; Monga, Manoj; Knudsen, Bodo; Box, Geoffrey N; Lee, David I; Gettman, Matthew T; Poniatowski, Lauren H; Wang, Qi; Reihsen, Troy E; Sweet, Robert M

    2015-10-01

    We evaluated the internal and construct validity of an assessment tool for cystoscopic and ureteroscopic cognitive and psychomotor skills at a multi-institutional level. Subjects included a total of 30 urology residents at Ohio State University, Columbus, Ohio; Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Mayo Clinic, Rochester, Minnesota. A single external blinded reviewer evaluated cognitive and psychomotor skills associated with cystoscopic and ureteroscopic surgery using high fidelity bench models. Exercises included navigation, basketing and relocation; holmium laser lithotripsy; and cystoscope assembly. Each resident received a total cognitive score, checklist score and global psychomotor skills score. Construct validity was assessed by calculating correlations between training year and performance scores (both cognitive and psychomotor). Internal validity was confirmed by calculating correlations between test components. The median total cognitive score was 91 (IQR 86.25, 97). For psychomotor performance residents had a median total checklist score of 7 (IQR 5, 8) and a median global psychomotor skills score of 21 (IQR 18, 24.5). Construct validity was supported by the positive and statistically significant correlations between training year and total cognitive score (r = 0.66, 95% CI 0.39-0.82, p = 0.01), checklist scores (r = 0.66, 95% CI 0.35-0.84, p = 0.32) and global psychomotor skills score (r = 0.76, 95% CI 0.55-0.88, p = 0.002). The internal validity of OSATS was supported since total cognitive and checklist scores correlated with the global psychomotor skills score. In this multi-institutional study we successfully demonstrated the construct and internal validity of an objective assessment of cystoscopic and ureteroscopic cognitive and technical skills, including laser lithotripsy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Karg, S. New projects within the FLAX Network. In: Karg S. (ed.) Flax (Linum usitatissimum L.) - a natural resource for food and textiles for 8000 years. Cross-disciplinary investigations on the evolution and cultural history of flax and linen. Programme and abstracts of the second

    DEFF Research Database (Denmark)

    Karg, Sabine

    2010-01-01

    Karg, S. New projects within the FLAX Network. In: Karg S. (ed.) Flax (Linum usitatissimum L.) - a natural resource for food and textiles for 8000 years. Cross-disciplinary investigations on the evolution and cultural history of flax and linen. Programme and abstracts of the second workshop 28...

  12. Flax (Linum usitatissimum L.) - a natural resource for food and textiles for 8000 years. Cross-disciplinary investigations on the evolution and cultural history of flax and linen. Programme and abstracts of the first workshop 24-26 November 2009 in the Carlsberg Academy Copenhagen, Denmark

    DEFF Research Database (Denmark)

    Karg, Sabine

    Flax (Linum usitatissimum L.) - a natural resource for food and textiles for 8000 years. Cross-disciplinary investigations on the evolution and cultural history of flax and linen. Programme and abstracts of the first workshop 24-26 November 2009 in the Carlsberg Academy Copenhagen, Denmark...

  13. Karg S. (ed.) Flax (Linum usitatissimum L.) - a natural resource for food and textiles for 8000 years. Cross-disciplinary investigations on the evolution and cultural history of flax and linen. Programme and abstracts of the second workshop 28-30 June 2010 at Sonnerupgaard and in the Land

    DEFF Research Database (Denmark)

    Karg, Sabine

    2010-01-01

    Karg S. (ed.) Flax (Linum usitatissimum L.) - a natural resource for food and textiles for 8000 years. Cross-disciplinary investigations on the evolution and cultural history of flax and linen. Programme and abstracts of the second workshop 28-30 June 2010 at Sonnerupgaard and in the Land...

  14. A trial of cross-disciplinary classes at the university and the high school on the seasonal transition and the seasonal feeling from autumn to winter in East Asia (joint activity of meteorology with Japanese classical literature, music and art)

    Science.gov (United States)

    Kato, K.; Sato, S.; Kato, H.; Akagi, R.; Sueishi, N.; Mori, T.; Nakakura, T.; Irie, I.

    2012-04-01

    There are many steps of the rapid seasonal transitions in East Asia influenced by the seasonal cycle of the Asian monsoon system, resulting in the variety of "seasonal feeling" there. For example, the extremely cold air flowing from the Siberian continent to the Japan Islands is transformed by the huge supply of heat and moisture from the underlying sea (the Japan Sea) in midwinter, which brings the large amount of snowfall in the Japan Sea side of the Japan Islands. However, although the air temperature there is still rather higher from November to early December than in the midwinter, such wintertime weather pattern often appears due to the early development of the Siberian high (however, the precipitation is brought not as in snow but as rain). The intermittent rainfall in such situation due to the shallow cumulus clouds from late autumn to early winter is called the word "Shi-gu-re" in Japanese. It is also well known that the "Shi-gu-re" is often used for expression of the "seasonal feeling" in the Japanese classical literature (especially we can see in the Japanese classic poems called "Wa-Ka"). The present study reports a trial of cross-disciplinary class on the seasonal cycle in East Asia in association with the "seasonal feeling" from autumn to winter, by the joint activity of meteorology with the Japanese classical literature, the music, and the art. Firstly, we will summarize the characteristics of the large-scale climate systems and the daily weather situations from autumn to winter. We will also introduce some examples of the expression of the weather situation found in the Japanese classical poems. Next the outline of the cross-disciplinary classes on such topics at the Faculty of Education, Okayama University, and those at Okayama-Ichinomiya High School and Attached Junior High School of Okayama University will be presented together with the analyses of these practices. We should note that the present trial of the classes might also contribute to

  15. Preparing culture change agents for academic medicine in a multi-institutional consortium: the C - change learning action network.

    Science.gov (United States)

    Pololi, Linda H; Krupat, Edward; Schnell, Eugene R; Kern, David E

    2013-01-01

    Research suggests an ongoing need for change in the culture of academic medicine. This article describes the structure, activities and evaluation of a culture change project: the C - Change Learning Action Network (LAN) and its impact on participants. The LAN was developed to create the experience of a culture that would prepare participants to facilitate a culture in academic medicine that would be more collaborative, inclusive, relational, and that supports the humanity and vitality of faculty. Purposefully diverse faculty, leaders, and deans from 5 US medical schools convened in 2 1/2-day meetings biannually over 4 years. LAN meetings employed experiential, cognitive, and affective learning modes; innovative dialogue strategies; and reflective practice aimed at facilitating deep dialogue, relationship formation, collaboration, authenticity, and transformative learning to help members experience the desired culture. Robust aggregated qualitative and quantitative data collected from the 5 schools were used to inform and stimulate culture-change plans. Quantitative and qualitative evaluation methods were used. Participants indicated that a safe, supportive, inclusive, collaborative culture was established in LAN and highly valued. LAN members reported a deepened understanding of organizational change, new and valued interpersonal connections, increased motivation and resilience, new skills and approaches, increased self-awareness and personal growth, emotional connection to the issues of diversity and inclusion, and application of new learnings in their work. A carefully designed multi-institutional learning community can transform the way participants experience and view institutional culture. It can motivate and prepare them to be change agents in their own institutions. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical

  16. COMPUTED TOMOGRAPHIC APPEARANCE OF THE TEMPOROMANDIBULAR JOINT IN 1018 ASYMPTOMATIC HORSES: A MULTI-INSTITUTION STUDY.

    Science.gov (United States)

    Carmalt, James L; Kneissl, Sibylle; Rawlinson, Jennifer E; Zwick, Timo; Zekas, Lisa; Ohlerth, Stefanie; Bienert-Zeit, Astrid

    2016-05-01

    Published descriptions of nonseptic arthritis of the equine temporomandibular joint (TMJ) are rare and large studies investigating variations in the TMJ for asymptomatic horses are lacking. The objectives of this cross-sectional, retrospective, multi-institutional study were to describe anatomical variations in the TMJ detected using computed tomography (CT) in an equid population asymptomatic for TMJ disease and determine whether these variations were associated with patient signalment, reason for CT examination, or CT slice width. Medical records at eight hospitals were searched for horses that had head/neck CT scans and no clinical signs of TMJ disease. Age, breed, sex, clinical presentation, and CT slice width data were recorded. Alterations in CT contour and density of the mandibular condyles, mandibular fossae, and TMJ intra-articular discs were described for each horse. Generalized logistic regression was used to test associations between anatomical variations and horse age. A total of 1018 horses were sampled. Anatomical variations were found in TMJ CT images for 40% of horses and 29% of joints. These were dichotomous with regard to age. Horses horses commonly had spherical hypodensities within the mandibular condyles consistent with bone cysts; and hyperdense regions of the intra-articular disc consistent with dystrophic mineralization. Findings indicated that TMJ anatomic variations were common in CT images of younger and older horses asymptomatic for TMJ disease. Future studies are needed to more definitively characterize these CT variations using gross pathology and histopathology. © 2016 American College of Veterinary Radiology.

  17. Using the CER Hub to ensure data quality in a multi-institution smoking cessation study.

    Science.gov (United States)

    Walker, Kari L; Kirillova, Olga; Gillespie, Suzanne E; Hsiao, David; Pishchalenko, Valentyna; Pai, Akshatha Kalsanka; Puro, Jon E; Plumley, Robert; Kudyakov, Rustam; Hu, Weiming; Allisany, Art; McBurnie, MaryAnn; Kurtz, Stephen E; Hazlehurst, Brian L

    2014-01-01

    Comparative effectiveness research (CER) studies involving multiple institutions with diverse electronic health records (EHRs) depend on high quality data. To ensure uniformity of data derived from different EHR systems and implementations, the CER Hub informatics platform developed a quality assurance (QA) process using tools and data formats available through the CER Hub. The QA process, implemented here in a study of smoking cessation services in primary care, used the 'emrAdapter' tool programmed with a set of quality checks to query large samples of primary care encounter records extracted in accord with the CER Hub common data framework. The tool, deployed to each study site, generated error reports indicating data problems to be fixed locally and aggregate data sharable with the central site for quality review. Across the CER Hub network of six health systems, data completeness and correctness issues were prevalent in the first iteration and were considerably improved after three iterations of the QA process. A common issue encountered was incomplete mapping of local EHR data values to those defined by the common data framework. A highly automated and distributed QA process helped to ensure the correctness and completeness of patient care data extracted from EHRs for a multi-institution CER study in smoking cessation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. AIP study of multi-institutional collaborations: Phase 1, high-energy physics

    International Nuclear Information System (INIS)

    Warnow-Blewett, J.; Weart, S.R.

    1992-01-01

    Although the multi-institutional collaboration is increasingly the organizational framework for scientific research, it has received only incidental attention from scholars. Without a dedicated effort to understand the process of collaborative research, even the records necessary for efficient administration, for historical and: studies, and for posterity, will be largely scattered or destroyed. The Center for History of Physics of the American Institute of Physics (AIP) is working to redress this situation with a multi-stage investigation. The aim is to identify patterns of collaborations, define the scope of the documentation problems, field test possible solutions, and recommend future actions. The first phase of the study addressed high-energy physics. The two-year study of high-energy physics research focused on experiments approved between 1973 and 1984 at five of the world's major accelerator laboratories. A broad-scale picture of changes in the structure of collaborations was obtained by using databases on high energy physics experiments and publications, At a more detailed level, the project conducted interviews on 24 selected experimental collaborations. Still more detailed ''probes'' of some highly significant collaborations featured historical research as well as many additional interviews and work to preserve records. Some 300 interviews were analyzed to identify patterns of collaborative research and records creation, retention, and location. Meanwhile project staff surveyed the records-keeping practices of key physicists and made numerous site visits to accelerator facilities and university archives to discuss archival issues and records policies

  19. Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series.

    Science.gov (United States)

    Kretschmer, Alexander; Hüsch, Tanja; Thomsen, Frauke; Kronlachner, Dominik; Obaje, Alice; Anding, Ralf; Pottek, Tobias; Rose, Achim; Olianas, Roberto; Friedl, Alexander; Hübner, Wilhelm; Homberg, Roland; Pfitzenmaier, Jesco; Grein, Ulrich; Queissert, Fabian; Naumann, Carsten Maik; Schweiger, Josef; Wotzka, Carola; Nyarangi-Dix, Joanne N; Hofmann, Torben; Seiler, Roland; Haferkamp, Axel; Bauer, Ricarda M

    2016-01-01

    Background/Aims/Objectives: To analyze perioperative complication and short-term explantation rates after perineal or penoscrotal single-cuff and double-cuff artificial urinary sphincter (AUS) implantation in a large middle European multi-institutional patient cohort. 467 male patients with stress urinary incontinence underwent implantation of a perineal single-cuff (n = 152), penoscrotal single-cuff (n = 99), or perineal double-cuff (n = 216) AUS between 2010 and 2012. Postoperative complications and 6-month explantation rates were assessed. For statistical analysis, Fisher's exact test and Kruskal-Wallis rank sum test, and a multiple logistic regression model were used (p AUS, penoscrotal single-cuff implantation led to significantly increased short-term explantation rates (8.6% (perineal) vs. 19.2% (penoscrotal), p = 0.019). The postoperative infection rate was significantly higher after double-cuff compared to single-cuff implantation (6.0% (single-cuff) vs. 13.9% (double-cuff), p = 0.019). The short-term explantation rate after primary double-cuff placement was 6.5% (p = 0.543 vs. perineal single-cuff). In multivariate analysis, the penoscrotal approach (p = 0.004), intraoperative complications (p = 0.005), postoperative bleeding (p = 0.011), and perioperative infection (p < 0.001) were independent risk factors for short-term explantation. Providing data from a large contemporary multi-institutional patient cohort from high-volume and low-volume institutions, our results reflect the current standard of care in middle Europe. We indicate that the penoscrotal approach is an independent risk factor for increased short-term explantation rates. © 2016 S. Karger AG, Basel.

  20. A quasi-experimental cross-disciplinary evaluation of the impacts of education outside the classroom on pupils' physical activity, well-being and learning

    DEFF Research Database (Denmark)

    Nielsen, Glen; Mygind, Erik; Bølling, Mads

    2016-01-01

    in their parallel non-EOTC classes. Furthermore, the interdependencies between PA, social relations, well-being, motivation, and learning are explored using path analysis. To help describe and understand the processes that have led to the quantitative outcomes, qualitative case observations of children's practices...... and interactions in EOTC as well as classroom teaching were carried out and combined with qualitative interviews about children's perceptions of these practices. DISCUSSION: The TEACHOUT study represents a holistic multidisciplinary approach to educational and school health-promotion research through its study......BACKGROUND: Education Outside the Classroom (EOTC) is a teaching method that aims to promote schoolchildren's learning, physical activity (PA), social relations, motivation, and well-being. EOTC activities are characterized by teachers using the local environment in their teaching, and involve...

  1. Prospective, multi-institutional pain assessment of 150 women undergoing diagnostic cystoscopy.

    Science.gov (United States)

    Seklehner, Stephan; Saratlija-Novakovic, Zana; Skopek, Matthias; Fajkovic, Harun; Remzi, Mesut; Duvnjak, Mario; Resch, Irene; Hruby, Stephan; lmHÜBNER, Wilhelm; Librenjak, Davor; Breinl, Eckart; Riedl, Claus; Engelhardt, Paul F

    2016-10-01

    The aim of this study was to prospectively assess women's pain during rigid and flexible diagnostic cystoscopy and afterwards during a one-week follow-up. Prospective, multi-institutional trial analyzing numeric rating scales (NRS) of women undergoing diagnostic cystoscopy. Pain categories: no (0 points), mild (1-3), moderate (4-6) and severe pain (7-10). Assessing of pain before, during cystoscopy, and at day 1, 4 and 7 of follow-up. A total of 150 women undergoing rigid (N.=85) or flexible (N.=65) diagnostic cystoscopy were analyzed. Women undergoing flexible cystoscopy were more frequently pain-free (64.6% vs. 40%, P=0.003) and experienced mild pain less frequently (27.7% vs. 52.9% vs. P=0.002). No significant differences were noted among moderate (6.2% vs. 5.9%, P=0.95) and severe pain (1.5% vs. 1.2%, P=0.85). Patients undergoing their first (P=0.14) and repeat cystoscopy (P=0.08) had similar pain perception. In multivariate logistic regression analyses, women undergoing flexible cystoscopy had a 2.6 increased chance of being pain-free (OR=2.6, CI: 1.28-5.11, P=0.08) and their odds of experiencing mild pain were significantly lower (OR=0.34, CI: 0.17-0.71, P=0.004). The likelihood of experiencing moderate (OR=1.1, CI: 0.28- 4.4, P=0.83) or severe pain (OR=2.42, CI: 0.11-51.79, P=0.57) differed insignificantly. Rigid and flexible cystoscopies were well-tolerated by most women. However, flexible cystoscopy was associated with a higher likelihood of being pain-free and lower chances of experiencing mild pain. Patients' previous experience with cystoscopy did not influence pain perception.

  2. OSiRIS: a distributed Ceph deployment using software defined networking for multi-institutional research

    Science.gov (United States)

    McKee, Shawn; Kissel, Ezra; Meekhof, Benjeman; Swany, Martin; Miller, Charles; Gregorowicz, Michael

    2017-10-01

    We report on the first year of the OSiRIS project (NSF Award #1541335, UM, IU, MSU and WSU) which is targeting the creation of a distributed Ceph storage infrastructure coupled together with software-defined networking to provide high-performance access for well-connected locations on any participating campus. The projects goal is to provide a single scalable, distributed storage infrastructure that allows researchers at each campus to read, write, manage and share data directly from their own computing locations. The NSF CC*DNI DIBBS program which funded OSiRIS is seeking solutions to the challenges of multi-institutional collaborations involving large amounts of data and we are exploring the creative use of Ceph and networking to address those challenges. While OSiRIS will eventually be serving a broad range of science domains, its first adopter will be the LHC ATLAS detector project via the ATLAS Great Lakes Tier-2 (AGLT2) jointly located at the University of Michigan and Michigan State University. Part of our presentation will cover how ATLAS is using the OSiRIS infrastructure and our experiences integrating our first user community. The presentation will also review the motivations for and goals of the project, the technical details of the OSiRIS infrastructure, the challenges in providing such an infrastructure, and the technical choices made to address those challenges. We will conclude with our plans for the remaining 4 years of the project and our vision for what we hope to deliver by the projects end.

  3. Tamsulosin and the spontaneous passage of ureteral stones in children: A multi-institutional cohort study

    Science.gov (United States)

    Tasian, Gregory E.; Cost, Nicholas G.; Granberg, Candace F.; Pulido, Jose E.; Rivera, Marcelino; Schwen, Zeyad; Schulte, Marion; Fox, Janelle A.

    2014-01-01

    Purpose Tamsulosin is associated with increased passage of ureteral stones in adults, but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. Methods We performed a multi-institutional retrospective cohort study of children ≤ 18 years who presented between 2007 and 2012 with a ureteral stone ≤ 10 mm and were managed with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Results Of 449 children with ureteral stones, 334 were eligible for inclusion, and complete data were available for 274 children from 4 institutions (99 tamsulosin; 175 analgesics alone). Following case matching, there were no differences in patient age, gender, weight, height, stone size, or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity-score matched subjects prescribed analgesics alone. In the tamsulosin cohort, 55% of ureteral stones passed versus 44% in the analgesics alone cohort (p = 0.03). In multivariate analysis adjusting for stone size and location, tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31; 95% CI 1.49–7.34). Conclusions The odds of spontaneous passage of ureteral stones were higher in children prescribed tamsulosin versus analgesics alone. PMID:24518765

  4. Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study.

    Science.gov (United States)

    Tasian, Gregory E; Cost, Nicholas G; Granberg, Candace F; Pulido, Jose E; Rivera, Marcelino; Schwen, Zeyad; Schulte, Marion; Fox, Janelle A

    2014-08-01

    Tamsulosin is associated with increased passage of ureteral stones in adults but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. We performed a multi-institutional retrospective cohort study of patients 18 years or younger who presented between 2007 and 2012 with ureteral stones up to 10 mm and who were treated with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage, defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone, using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Of 449 children with ureteral stones 334 were eligible for inclusion, and complete data were available for 274 patients from 4 institutions (99 receiving tamsulosin, 175 receiving analgesics alone). Following case matching, there were no differences in age, gender, weight, height, stone size or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity score matched subjects prescribed analgesics alone. In the tamsulosin cohort 55% of ureteral stones passed, compared to 44% in the analgesics alone cohort (p=0.03). In multivariate analysis adjusting for stone size and location tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31, 95% CI 1.49-7.34). The odds of spontaneous passage of ureteral stones were greater in children prescribed tamsulosin vs analgesics alone. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study

    Directory of Open Access Journals (Sweden)

    Dae Keun Kim

    2018-01-01

    Full Text Available Emerging evidence has suggested that cytoreductive prostatectomy (CRP allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa. Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001 and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001 compared to the control group. However, both overall (8.82% vs 5.85% and major complication rates (4.41% vs 2.17% were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001. Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02-1.37; P = 0.025 and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01-1.36; P = 0.034. In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.

  6. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration.

    Science.gov (United States)

    Chade, Daher C; Shariat, Shahrokh F; Cronin, Angel M; Savage, Caroline J; Karnes, R Jeffrey; Blute, Michael L; Briganti, Alberto; Montorsi, Francesco; van der Poel, Henk G; Van Poppel, Hendrik; Joniau, Steven; Godoy, Guilherme; Hurtado-Coll, Antonio; Gleave, Martin E; Dall'Oglio, Marcos; Srougi, Miguel; Scardino, Peter T; Eastham, James A

    2011-08-01

    Oncologic outcomes in men with radiation-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) are poorly defined. To identify predictors of biochemical recurrence (BCR), metastasis, and death following SRP to help select patients who may benefit from SRP. This is a retrospective, international, multi-institutional cohort analysis. There was a median follow-up of 4.4 yr following SRP performed on 404 men with radiation-recurrent PCa from 1985 to 2009 in tertiary centers. Open SRP. BCR after SRP was defined as a serum prostate-specific antigen (PSA) ≥ 0.1 or ≥ 0.2 ng/ml (depending on the institution). Secondary end points included progression to metastasis and cancer-specific death. Median age at SRP was 65 yr of age, and median pre-SRP PSA was 4.5 ng/ml. Following SRP, 195 patients experienced BCR, 64 developed metastases, and 40 died from PCa. At 10 yr after SRP, BCR-free survival, metastasis-free survival, and cancer-specific survival (CSS) probabilities were 37% (95% confidence interval [CI], 31-43), 77% (95% CI, 71-82), and 83% (95% CI, 76-88), respectively. On preoperative multivariable analysis, pre-SRP PSA and Gleason score at postradiation prostate biopsy predicted BCR (p = 0.022; global p 75% of patients 10 yr after surgery. Patients with lower pre-SRP PSA levels and lower postradiation prostate biopsy Gleason score have the highest probability of cure from SRP. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Cross-disciplinary links in environmental systems science: Current state and claimed needs identified in a meta-review of process models.

    Science.gov (United States)

    Ayllón, Daniel; Grimm, Volker; Attinger, Sabine; Hauhs, Michael; Simmer, Clemens; Vereecken, Harry; Lischeid, Gunnar

    2018-05-01

    to open up new interdisciplinary pathways. No clear pattern across disciplines exists with respect to suggested future research efforts. There is no evidence that environmental research would clearly converge towards more integrated approaches or towards an overarching environmental systems theory. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. How does leadership education shape students’ definitions of leadership? Insights from the Multi-institutional Study of Leadership

    OpenAIRE

    Kaufman, EK; Thornton, J; Coartney, J

    2017-01-01

    The Multi-institutional Study of Leadership (MSL) is an international research program focused on understanding the influences of higher education in shaping socially responsible leadership capacity and other related student outcomes. While there have been numerous reports on the quantitative findings from the MSL, the published research tends to ignore data from the qualitative prompt: “Please provide a brief definition of what the term leadership means to you.” By coding and categorizing th...

  9. Enhancing Comparative Effectiveness Research With Automated Pediatric Pneumonia Detection in a Multi-Institutional Clinical Repository: A PHIS+ Pilot Study.

    Science.gov (United States)

    Meystre, Stephane; Gouripeddi, Ramkiran; Tieder, Joel; Simmons, Jeffrey; Srivastava, Rajendu; Shah, Samir

    2017-05-15

    Community-acquired pneumonia is a leading cause of pediatric morbidity. Administrative data are often used to conduct comparative effectiveness research (CER) with sufficient sample sizes to enhance detection of important outcomes. However, such studies are prone to misclassification errors because of the variable accuracy of discharge diagnosis codes. The aim of this study was to develop an automated, scalable, and accurate method to determine the presence or absence of pneumonia in children using chest imaging reports. The multi-institutional PHIS+ clinical repository was developed to support pediatric CER by expanding an administrative database of children's hospitals with detailed clinical data. To develop a scalable approach to find patients with bacterial pneumonia more accurately, we developed a Natural Language Processing (NLP) application to extract relevant information from chest diagnostic imaging reports. Domain experts established a reference standard by manually annotating 282 reports to train and then test the NLP application. Findings of pleural effusion, pulmonary infiltrate, and pneumonia were automatically extracted from the reports and then used to automatically classify whether a report was consistent with bacterial pneumonia. Compared with the annotated diagnostic imaging reports reference standard, the most accurate implementation of machine learning algorithms in our NLP application allowed extracting relevant findings with a sensitivity of .939 and a positive predictive value of .925. It allowed classifying reports with a sensitivity of .71, a positive predictive value of .86, and a specificity of .962. When compared with each of the domain experts manually annotating these reports, the NLP application allowed for significantly higher sensitivity (.71 vs .527) and similar positive predictive value and specificity . NLP-based pneumonia information extraction of pediatric diagnostic imaging reports performed better than domain experts in this

  10. Multi-institutional MicroCT image comparison of image-guided small animal irradiators

    Science.gov (United States)

    Johnstone, Chris D.; Lindsay, Patricia; E Graves, Edward; Wong, Eugene; Perez, Jessica R.; Poirier, Yannick; Ben-Bouchta, Youssef; Kanesalingam, Thilakshan; Chen, Haijian; E Rubinstein, Ashley; Sheng, Ke; Bazalova-Carter, Magdalena

    2017-07-01

    To recommend imaging protocols and establish tolerance levels for microCT image quality assurance (QA) performed on conformal image-guided small animal irradiators. A fully automated QA software SAPA (small animal phantom analyzer) for image analysis of the commercial Shelley micro-CT MCTP 610 phantom was developed, in which quantitative analyses of CT number linearity, signal-to-noise ratio (SNR), uniformity and noise, geometric accuracy, spatial resolution by means of modulation transfer function (MTF), and CT contrast were performed. Phantom microCT scans from eleven institutions acquired with four image-guided small animal irradiator units (including the commercial PXi X-RAD SmART and Xstrahl SARRP systems) with varying parameters used for routine small animal imaging were analyzed. Multi-institutional data sets were compared using SAPA, based on which tolerance levels for each QA test were established and imaging protocols for QA were recommended. By analyzing microCT data from 11 institutions, we established image QA tolerance levels for all image quality tests. CT number linearity set to R 2  >  0.990 was acceptable in microCT data acquired at all but three institutions. Acceptable SNR  >  36 and noise levels  1.5 lp mm-1 for MTF  =  0.2) was obtained at all but four institutions due to their large image voxel size used (>0.275 mm). Ten of the eleven institutions passed the set QA tolerance for geometric accuracy (2000 HU for 30 mgI ml-1). We recommend performing imaging QA with 70 kVp, 1.5 mA, 120 s imaging time, 0.20 mm voxel size, and a frame rate of 5 fps for the PXi X-RAD SmART. For the Xstrahl SARRP, we recommend using 60 kVp, 1.0 mA, 240 s imaging time, 0.20 mm voxel size, and 6 fps. These imaging protocols should result in high quality images that pass the set tolerance levels on all systems. Average SAPA computation time for complete QA analysis for a 0.20 mm voxel, 400 slice Shelley phantom microCT data set

  11. ECORS Truc Vert'08: a Multi-Institutional International Nearshore Field Experiment

    Science.gov (United States)

    Senechal, N.; Ardhuin, F.

    2008-12-01

    A large multi-institutional international field experiment (ECORS Truc Vert'08) was conducted Feb-April 2008 on the southern part of the French Atlantic coastline. More than 120 scientists, students and technicians participated to this effort coming from 3 continents and 6 countries : Australia (University of New South Wales), France (SHOM, University Bordeaux I, University Pau et Pays de l'Adour, University Sud-Toulon Var, University Joseph Fourier, University Perpignan, BRGM, University Lyon 1), Great Britain (Plymouth University), New Zealand (NIWA), The Netherlands (Delft University of Technology, University of Utrecht) and USA (Naval Postgraduate School, University of Miami, Franklin and Marshall College). Truc Vert beach is a high-energy, dynamic, macrotidal, double-barred beach representative of most of the beaches on this 250 km long coastline. The inner bar can go through all the states within the intermediate classification and usually exhibits a transverse bar and rip morphology (380 m alongshore wavelength). The outer bar is changeable from linear to crescentic (720 m alongshore wavelength). The goals were to measure the hydrodynamic processes, sedimentary processes and morphologic responses on a macrotidal beach during energetic wave conditions and covering a large spectrum of spatial and temporal scales. This dataset will facilitate the validation of surf zone wave, hydrodynamic and morphodynamic models, it will lend insight into the morphodynamic evolution of three dimensional beaches and it will fill the gaps in previous nearshore data sets. A wide range of unique instrumentation was used including continuously sampled 2Hz high-resolution surfzone video cameras, daily topographic surveys, bathymetric surveys from the French naval vessels and personal watercrafts, high frequency velocity and pressure sensors, acoustic Doppler current profilers, sediment transport devices, sand porosity and grain size devices, and position-tracking drifters

  12. Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Simone, Charles B. [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Allen, Pamela K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gajjar, Sameer R. [Baylor College of Medicine, Houston, Texas (United States); Shah, Chirag [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Zhen, Weining [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Harkenrider, Matthew M. [Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois (United States); Hallemeier, Christopher L. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Jabbour, Salma K. [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey (United States); Matthiesen, Chance L. [Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma (United States); Braunstein, Steve E. [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, California (United States); Lee, Percy [Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California (United States); Dilling, Thomas J. [Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida (United States); Allen, Bryan G. [Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (United States); Nichols, Elizabeth M. [Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States); and others

    2017-02-01

    Purpose: For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. Methods and Materials: The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. Results: From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and “elsewhere lung” (20.8%). The median time to each was 5 to 7 months. Conclusions: From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50

  13. Cross-Disciplinary Scientific Foundation for Sustainability

    DEFF Research Database (Denmark)

    Fast, Alf Michael; Clark, Woodrow

    2017-01-01

    , they are adamantly opposed to a Lifeworld view of economics. The objectivist's paradigm in a pre–mass production globalized world provides little guidance in terms of uneven economic growth and clearly substantive problems with understanding the needs of developing nations. Instead, it argues that “market forces...

  14. Cross-disciplinary, authentic student research projects

    NARCIS (Netherlands)

    Heck, A.; Uylings, P.; Kędzierska, E.; Ellermeijer, T.

    2010-01-01

    In the Dutch secondary education system, students must carry out at the end of their school career a rather large research or design project to demonstrate their ability to apply acquired knowledge and skills while pursuing a research question or design goal in some depth. They are encouraged to

  15. A multi-institutional study to assess adherence to lung stereotactic body radiotherapy planning goals

    Energy Technology Data Exchange (ETDEWEB)

    Woerner, Andrew; Roeske, John C.; Harkenrider, Matthew M.; Campana, Maria; Surucu, Murat, E-mail: msurucu@lumc.edu [Loyola University Medical Center, Maywood, Illinois 60153 (United States); Fan, John [Edward Cancer Center, Naperville, Illinois 60540 (United States); Aydogan, Bulent; Koshy, Matthew [Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois 60612 (United States); Laureckas, Robert; Vali, Faisal [Advocate Christ Medical Center, Oak Lawn, Illinois 60453 (United States)

    2015-08-15

    Purpose: A multi-institutional planning study was performed to evaluate the frequency that current guidelines established by Radiation Therapy Oncology Group (RTOG) protocols and other literature for lung stereotactic body radiotherapy (SBRT) treatments are followed. Methods: A total of 300 patients receiving lung SBRT treatments in four different institutions were retrospectively reviewed. The treatments were delivered using Linac based SBRT (160 patients) or image guided robotic radiosurgery (140). Most tumors were located peripherally (250/300). Median fractional doses and ranges were 18 Gy (8–20 Gy), 12 Gy (6–15 Gy), and 10 Gy (5–12 Gy) for three, four, and five fraction treatments, respectively. The following planning criteria derived from RTOG trials and the literature were used to evaluate the treatment plans: planning target volumes, PTV{sub V} {sub 100} ≥ 95% and PTV{sub V} {sub 95} ≥ 99%; conformality indices, CI{sub 100%} < 1.2 and CI{sub 50%} range of 2.9–5.9 dependent on PTV; total lung-ITV: V{sub 20Gy} < 10%, V{sub 12.5Gy} < 15%, and V{sub 5Gy} < 37%; contralateral lung V{sub 5Gy} < 26%; and maximum doses for spinal cord, esophagus, trachea/bronchus, and heart and great vessels. Populations were grouped by number of fractions, and dosimetric criteria satisfaction rates (CSRs) were reported. Results: Five fraction regimens were the most common lung SBRT fractionation (46%). The median PTV was 27.2 cm{sup 3} (range: 3.8–419.5 cm{sup 3}). For all plans: mean PTV{sub V} {sub 100} was 94.5% (±5.6%, planning CSR: 69.8%), mean PTV{sub V} {sub 95} was 98.1% (±4.1%, CSR: 69.5%), mean CI{sub 100%} was 1.14 (±0.21, CSR: 79.1%, and 16.5% within minor deviation), and mean CI{sub 50%} was 5.63 (±2.8, CSR: 33.0%, and 28.0% within minor deviation). When comparing plans based on location, peripherally located tumors displayed higher PTV{sub V} {sub 100} and PTV{sub V} {sub 95} CSR (71.5% and 71.9%, respectively) than centrally located tumors (61

  16. A multi-institutional study to assess adherence to lung stereotactic body radiotherapy planning goals

    International Nuclear Information System (INIS)

    Woerner, Andrew; Roeske, John C.; Harkenrider, Matthew M.; Campana, Maria; Surucu, Murat; Fan, John; Aydogan, Bulent; Koshy, Matthew; Laureckas, Robert; Vali, Faisal

    2015-01-01

    Purpose: A multi-institutional planning study was performed to evaluate the frequency that current guidelines established by Radiation Therapy Oncology Group (RTOG) protocols and other literature for lung stereotactic body radiotherapy (SBRT) treatments are followed. Methods: A total of 300 patients receiving lung SBRT treatments in four different institutions were retrospectively reviewed. The treatments were delivered using Linac based SBRT (160 patients) or image guided robotic radiosurgery (140). Most tumors were located peripherally (250/300). Median fractional doses and ranges were 18 Gy (8–20 Gy), 12 Gy (6–15 Gy), and 10 Gy (5–12 Gy) for three, four, and five fraction treatments, respectively. The following planning criteria derived from RTOG trials and the literature were used to evaluate the treatment plans: planning target volumes, PTV_V _1_0_0 ≥ 95% and PTV_V _9_5 ≥ 99%; conformality indices, CI_1_0_0_% < 1.2 and CI_5_0_% range of 2.9–5.9 dependent on PTV; total lung-ITV: V_2_0_G_y < 10%, V_1_2_._5_G_y < 15%, and V_5_G_y < 37%; contralateral lung V_5_G_y < 26%; and maximum doses for spinal cord, esophagus, trachea/bronchus, and heart and great vessels. Populations were grouped by number of fractions, and dosimetric criteria satisfaction rates (CSRs) were reported. Results: Five fraction regimens were the most common lung SBRT fractionation (46%). The median PTV was 27.2 cm"3 (range: 3.8–419.5 cm"3). For all plans: mean PTV_V _1_0_0 was 94.5% (±5.6%, planning CSR: 69.8%), mean PTV_V _9_5 was 98.1% (±4.1%, CSR: 69.5%), mean CI_1_0_0_% was 1.14 (±0.21, CSR: 79.1%, and 16.5% within minor deviation), and mean CI_5_0_% was 5.63 (±2.8, CSR: 33.0%, and 28.0% within minor deviation). When comparing plans based on location, peripherally located tumors displayed higher PTV_V _1_0_0 and PTV_V _9_5 CSR (71.5% and 71.9%, respectively) than centrally located tumors (61.2% and 57.1%, respectively). Overall, the planning criteria were met for all the

  17. SU-F-P-13: NRG Oncology Medical Physics Manpower Survey Quantifying Support Demands for Multi Institutional Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Monroe, J [St. Anthony’s Cancer Center, St. Louis, MO (United States); Case Western Reserve University (United States); Boparai, K [ACR, Reston, VA (United States); Xiao, Y [University of Pennsylvania, Philadelphia, PA (United States); Followill, D [UT MD Anderson Cancer Center, Houston, TX (United States); Galvin, J [Thomas Jefferson University Hospital, Newtown, PA (United States); Sohn, J [Case Western University, Cleveland, OH (United States)

    2016-06-15

    Purpose: A survey was taken by NRG Oncology to assess Full Time Equivalent (FTE) contributions to multi institutional clinical trials by medical physicists.No current quantification of physicists’ efforts in FTE units associated with clinical trials is available. The complexity of multi-institutional trials increases with new technologies and techniques. Proper staffing may directly impact the quality of trial data and outcomes. The demands on physics time supporting clinical trials needs to be assessed. Methods: The NRG Oncology Medical Physicist Subcommittee created a sixteen question survey to obtain this FTE data. IROC Houston distributed the survey to their list of 1802 contact physicists. Results: After three weeks, 363 responded (20.1% response). 187 (51.5%) institutions reporting external beam participation were processed. There was a wide range in number of protocols active and supported at each institution. Of the 187 clinics, 134 (71.7%) participate in 0 to 10 trials, 28 (15%) in 11 to 20 trials, 10 (5.3%) in 21 to 30 trials, 9 (4.8%) had 40 to 75 trials. On average, physicist spent 2.7 hours (SD: 6.0) per week supervising or interacting with clinical trial staff. 1.25 hours (SD: 3.37), 1.83 hours (SD: 4.13), and 0.64 hours(SD: 1.13) per week were spent on patient simulation, reviewing treatment plans, and maintaining a DICOM server, respectively. For all protocol credentialing activities, physicist spent an average of 37.05 hours (SD: 96.94) yearly. To support dosimetrists, clinicians, and therapists, physicist spend on average 2.07 hours (SD: 3.52) per week just reading protocols. Physicist attended clinical trial meetings for on average 1.13 hours (SD: 1.85) per month. Conclusion: Responding physicists spend a nontrivial amount of time: 8.8 hours per week (0.22 FTE) supporting, on average, 9 active multi-institutional clinical trials.

  18. What Impact Does Behavior of Doctors and Patients on Service Integration of Multi-institutional Readmission cross Township—county Hospitals in Rural China

    OpenAIRE

    Zhang, Yan; Tang, Wenxi; Zhang, Liang

    2017-01-01

    Background: With the change of rural residents’ disease spectrum and patients with chronic diseases boom, multi-institutional health service utilization of rural residents and the continuous service demands are growing sharply in rural China.Objective: Evaluate the service integration of multi-institutional readmission cross township—county hospitals (MRCTCH) in rural China, and figure out determines of service integration.Methods: This study featured 7 sample counties in rural China. Based o...

  19. The study of multi-institutional collaborations in high-energy physics. Progress report, January 1989--March 1991

    Energy Technology Data Exchange (ETDEWEB)

    1991-12-31

    Since World War II, the organizational framework for scientific research is increasingly the multi-institutional collaboration, especially in high-energy physics. A broad preliminary survey, into the functioning of research collaborations involving three or more institutions is described. The study is designed to identify patterns of collaborations, define the scope of the documentation problems, field-test possible solutions, recommend future actions, and build an archives of oral history interviews and other resources for scholarly use. Once the study is completed, its findings will be used to promote systems to document significant collaborative research.

  20. Benefits of mock oral examinations in a multi-institutional consortium for board certification in general surgery training.

    Science.gov (United States)

    Subhas, Gokulakkrishna; Yoo, Stephen; Chang, Yeon-Jeen; Peiper, David; Frikker, Mark J; Bouwman, David L; Silbergleit, Allen; Lloyd, Larry R; Mittal, Vijay K

    2009-09-01

    The Southeast Michigan Center for Medical Education (SEMCME) is a consortium of teaching hospitals in the Greater Detroit metropolitan area. SEMCME pools its resources for several educational means, including mock oral board examinations. The educational and cost benefits to mock oral examinations on a multi-institutional basis in preparation for the American Board of Surgery (ABS) certifying examination were analyzed. Ten-year multi-institution data from the mock oral examinations were correlated with ABS certifying examination pass rates. Mock oral examination scores were available for 107 of 147 graduates, which included 12 candidates who failed their certifying examination on the first attempt (pass rate = 89%). Four of 31 examinees who had a low score (4.9 or less) in their mock oral exams failed their certifying examination in their first attempt. The cost of running the mock examination was low (approximately $35/resident for 50 residents). When graduates from the last 10 years were surveyed, the majority of respondents believed that the mock oral examination helped in their success and with their preparation for the certifying examination. Thus, the many benefits of administering the examination with the resources of a consortium of hospitals result in the accurate reproduction of real-life testing conditions with reasonable overall costs per resident.

  1. Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis.

    Science.gov (United States)

    Ost, Piet; Jereczek-Fossa, Barbara Alicja; As, Nicholas Van; Zilli, Thomas; Muacevic, Alexander; Olivier, Kenneth; Henderson, Daniel; Casamassima, Franco; Orecchia, Roberto; Surgo, Alessia; Brown, Lindsay; Tree, Alison; Miralbell, Raymond; De Meerleer, Gert

    2016-01-01

    The literature on metastasis-directed therapy for oligometastatic prostate cancer (PCa) recurrence consists of small heterogeneous studies. This study aimed to reduce the heterogeneity by pooling individual patient data from different institutions treating oligometastatic PCa recurrence with stereotactic body radiotherapy (SBRT). We focussed on patients who were treatment naive, with the aim of determining if SBRT could delay disease progression. We included patients with three or fewer metastases. The Kaplan-Meier method was used to estimate distant progression-free survival (DPFS) and local progression-free survival (LPFS). Toxicity was scored using the Common Terminology Criteria for Adverse Events. In total, 163 metastases were treated in 119 patients. The median DPFS was 21 mo (95% confidence interval, 15-26 mo). A lower radiotherapy dose predicted a higher local recurrence rate with a 3-yr LPFS of 79% for patients treated with a biologically effective dose ≤100Gy versus 99% for patients treated with >100Gy (p=0.01). Seventeen patients (14%) developed toxicity classified as grade 1, and three patients (3%) developed grade 2 toxicity. No grade ≥3 toxicity occurred. These results should serve as a benchmark for future prospective trials. This multi-institutional study pools all of the available data on the use of stereotactic body radiotherapy for limited prostate cancer metastases. We concluded that this approach is safe and associated with a prolonged treatment progression-free survival. Copyright © 2015. Published by Elsevier B.V.

  2. Reliability of diffusion-weighted imaging in acute ischemic stroke. A multi-institutional multivendor validation study

    International Nuclear Information System (INIS)

    Sasaki, Makoto; Yamada, Kei; Watanabe, Yoshiyuki; Matsui, Mieko; Ida, Masahiro

    2006-01-01

    Diffusion-weighted imaging (DWI) is widely applied for evaluating patients with acute ischemic stroke. However, its display conditions are different among institutions, and reliability of the apparent diffusion coefficient (ADC) has not been validated enough. Recently, we proposed an easy-to-use technique to standardize display conditions, in which window width and level are normalized by the signal intensity of brain tissue on b0 images. We carried out a multi-institutional multivendor study, and revealed that the technique successfully minimized difference in the display condition among institutions and vendors. On the other hand, we found that the ADC value is significantly different among vendors and static magnetic fields, suggesting that the ADC should be evaluated semiquantitatively. Standardization and technical advancement are considered to be necessary to improve reliability of DWI in acute stroke managements. (author)

  3. CT and MR imaging features of mucinous tubular and spindle cell carcinoma of the kidneys. A multi-institutional review

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F.; Grenier, N. [Pellegrin Hospital, Department of Radiology, Bordeaux (France); Ambrosetti, D. [Pasteur Hospital, Department of Pathology, Nice (France); Rocher, L. [Kremlin-Bicetre Hospital, Department of Radiology, Paris (France); Derchi, L.E. [University of Genoa, IRCCS AOU Ospedale, San Martino IST, Department of Health Sciences (DISSAL), Genoa (Italy); Renard, B.; Puech, P. [Claude Huriez Hospital, Department of Radiology, Lille (France); Claudon, M. [Brabois Hospital, Department of Radiology, Vandoeuvre-les-Nancy (France); Rouviere, O. [E. Herriot Hospital, Department of Radiology, Lyon (France); Ferlicot, S. [Kremlin-Bicetre Hospital, Department of Pathology, Paris (France); Roy, C. [Civil Hospital, Department of Radiology, Strasbourg (France); Yacoub, M. [Pellegrin Hospital, Department of Pathology, Bordeaux (France); Bernhard, J.C. [Pellegrin Hospital, Department of Urologic Surgery, Bordeaux (France)

    2017-03-15

    Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney is a recently identified renal malignancy. Diagnosis of this rare subtype of renal tumour can be challenging for pathologists, and as such, any additional data would be helpful to improve diagnostic reliability. As imaging features of this new and rare sub-type have not yet been clearly described, the purpose of this study was to describe the main radiologic features on computed tomography (CT) and magnetic resonance imaging (MRI), based jointly on the literature and findings from a multi-institutional retrospective review of pathology and imaging databases. Using a combination of CT/MRI features, diagnosis of MTSCC could be suggested in many cases. A combination of slow enhancement with plateau on dynamic contrast-enhanced CT/MRI, intermediate to high T2 signal intensity contrasting with low apparent diffusion coefficient values on MRI appeared evocative of this diagnosis. (orig.)

  4. CER Hub: An informatics platform for conducting comparative effectiveness research using multi-institutional, heterogeneous, electronic clinical data.

    Science.gov (United States)

    Hazlehurst, Brian L; Kurtz, Stephen E; Masica, Andrew; Stevens, Victor J; McBurnie, Mary Ann; Puro, Jon E; Vijayadeva, Vinutha; Au, David H; Brannon, Elissa D; Sittig, Dean F

    2015-10-01

    Comparative effectiveness research (CER) requires the capture and analysis of data from disparate sources, often from a variety of institutions with diverse electronic health record (EHR) implementations. In this paper we describe the CER Hub, a web-based informatics platform for developing and conducting research studies that combine comprehensive electronic clinical data from multiple health care organizations. The CER Hub platform implements a data processing pipeline that employs informatics standards for data representation and web-based tools for developing study-specific data processing applications, providing standardized access to the patient-centric electronic health record (EHR) across organizations. The CER Hub is being used to conduct two CER studies utilizing data from six geographically distributed and demographically diverse health systems. These foundational studies address the effectiveness of medications for controlling asthma and the effectiveness of smoking cessation services delivered in primary care. The CER Hub includes four key capabilities: the ability to process and analyze both free-text and coded clinical data in the EHR; a data processing environment supported by distributed data and study governance processes; a clinical data-interchange format for facilitating standardized extraction of clinical data from EHRs; and a library of shareable clinical data processing applications. CER requires coordinated and scalable methods for extracting, aggregating, and analyzing complex, multi-institutional clinical data. By offering a range of informatics tools integrated into a framework for conducting studies using EHR data, the CER Hub provides a solution to the challenges of multi-institutional research using electronic medical record data. Copyright © 2015. Published by Elsevier Ireland Ltd.

  5. A Multi-Institutional Project to Develop Discipline-Specific Data Literacy Instruction for Graduate Students

    Science.gov (United States)

    Wright, S. J.; Fosmire, M.; Jeffryes, J.; Stowell Bracke, M.; Westra, B.

    2012-12-01

    some of the educational and support practices undertaken by the teams. The authors' approaches ranged from offering a one-credit special topics class, "Managing data to facilitate your research," to closely integrating resources and training with research projects and practices. A range of strategies will likely need to be employed to educate future scientists in the fundamentals of data stewardship; our strategies are intended to give attendees a starting point for how they can approach the issue at their own institution.

  6. Issues in assessing multi-institutional performance of BI-RADS-based CAD systems

    Science.gov (United States)

    Markey, Mia K.; Lo, Joseph Y.

    2005-04-01

    The purpose of this study was to investigate factors that impact the generalization of breast cancer computer-aided diagnosis (CAD) systems that utilize the Breast Imaging Reporting and Data System (BI-RADS). Data sets from four institutions were analyzed: Duke University Medical Center, University of Pennsylvania Medical Center, Massachusetts General Hospital, and Wake Forest University. The latter two data sets are subsets of the Digital Database for Screening Mammography. Each data set consisted of descriptions of mammographic lesions according to the BI-RADS lexicon, patient age, and pathology status (benign/malignant). Models were developed to predict pathology status from the BI-RADS descriptors and the patient age. Comparisons between the models built on data from the different institutions were made in terms of empirical (non-parametric) receiver operating characteristic (ROC) curves. Results suggest that BI-RADS-based CAD systems focused on specific classes of lesions may be more generally applicable than models that cover several lesion types. However, better generalization was seen in terms of the area under the ROC curve than in the partial area index (>90% sensitivity). Previous studies have illustrated the challenges in translating a BI-RADS-based CAD system from one institution to another. This study provides new insights into possible approaches to improve the generalization of BI-RADS-based CAD systems.

  7. Audiovisual biofeedback breathing guidance for lung cancer patients receiving radiotherapy: a multi-institutional phase II randomised clinical trial.

    Science.gov (United States)

    Pollock, Sean; O'Brien, Ricky; Makhija, Kuldeep; Hegi-Johnson, Fiona; Ludbrook, Jane; Rezo, Angela; Tse, Regina; Eade, Thomas; Yeghiaian-Alvandi, Roland; Gebski, Val; Keall, Paul J

    2015-07-18

    There is a clear link between irregular breathing and errors in medical imaging and radiation treatment. The audiovisual biofeedback system is an advanced form of respiratory guidance that has previously demonstrated to facilitate regular patient breathing. The clinical benefits of audiovisual biofeedback will be investigated in an upcoming multi-institutional, randomised, and stratified clinical trial recruiting a total of 75 lung cancer patients undergoing radiation therapy. To comprehensively perform a clinical evaluation of the audiovisual biofeedback system, a multi-institutional study will be performed. Our methodological framework will be based on the widely used Technology Acceptance Model, which gives qualitative scales for two specific variables, perceived usefulness and perceived ease of use, which are fundamental determinants for user acceptance. A total of 75 lung cancer patients will be recruited across seven radiation oncology departments across Australia. Patients will be randomised in a 2:1 ratio, with 2/3 of the patients being recruited into the intervention arm and 1/3 in the control arm. 2:1 randomisation is appropriate as within the interventional arm there is a screening procedure where only patients whose breathing is more regular with audiovisual biofeedback will continue to use this system for their imaging and treatment procedures. Patients within the intervention arm whose free breathing is more regular than audiovisual biofeedback in the screen procedure will remain in the intervention arm of the study but their imaging and treatment procedures will be performed without audiovisual biofeedback. Patients will also be stratified by treating institution and for treatment intent (palliative vs. radical) to ensure similar balance in the arms across the sites. Patients and hospital staff operating the audiovisual biofeedback system will complete questionnaires to assess their experience with audiovisual biofeedback. The objectives of this

  8. Audiovisual biofeedback breathing guidance for lung cancer patients receiving radiotherapy: a multi-institutional phase II randomised clinical trial

    International Nuclear Information System (INIS)

    Pollock, Sean; O’Brien, Ricky; Makhija, Kuldeep; Hegi-Johnson, Fiona; Ludbrook, Jane; Rezo, Angela; Tse, Regina; Eade, Thomas; Yeghiaian-Alvandi, Roland; Gebski, Val; Keall, Paul J

    2015-01-01

    There is a clear link between irregular breathing and errors in medical imaging and radiation treatment. The audiovisual biofeedback system is an advanced form of respiratory guidance that has previously demonstrated to facilitate regular patient breathing. The clinical benefits of audiovisual biofeedback will be investigated in an upcoming multi-institutional, randomised, and stratified clinical trial recruiting a total of 75 lung cancer patients undergoing radiation therapy. To comprehensively perform a clinical evaluation of the audiovisual biofeedback system, a multi-institutional study will be performed. Our methodological framework will be based on the widely used Technology Acceptance Model, which gives qualitative scales for two specific variables, perceived usefulness and perceived ease of use, which are fundamental determinants for user acceptance. A total of 75 lung cancer patients will be recruited across seven radiation oncology departments across Australia. Patients will be randomised in a 2:1 ratio, with 2/3 of the patients being recruited into the intervention arm and 1/3 in the control arm. 2:1 randomisation is appropriate as within the interventional arm there is a screening procedure where only patients whose breathing is more regular with audiovisual biofeedback will continue to use this system for their imaging and treatment procedures. Patients within the intervention arm whose free breathing is more regular than audiovisual biofeedback in the screen procedure will remain in the intervention arm of the study but their imaging and treatment procedures will be performed without audiovisual biofeedback. Patients will also be stratified by treating institution and for treatment intent (palliative vs. radical) to ensure similar balance in the arms across the sites. Patients and hospital staff operating the audiovisual biofeedback system will complete questionnaires to assess their experience with audiovisual biofeedback. The objectives of this

  9. Radiotherapy for Adrenal Metastasis from Hepatocellular Carcinoma: A Multi-Institutional Retrospective Study (KROG 13-05.

    Directory of Open Access Journals (Sweden)

    Jinhong Jung

    Full Text Available Although the adrenal glands are not common sites of metastasis from hepatocellular carcinoma (HCC, this metastasis can be met in patients with advanced HCC in some clinical settings. However, the effectiveness of radiotherapy against such metastases is unclear. Therefore, we performed the present multi-institutional study to investigate tumor response, overall survival (OS, treatment-related toxicity, and prognostic factors after radiotherapy. We retrospectively reviewed 134 patients who completed a planned radiotherapy for their adrenal metastases. Complete response was noted in 6 (4.3%, partial response in 48 (34.0%, and stable disease in 78 patients (55.3%. The median OS was 12.8 months, and the 1-, 2-, and 5-year OS rates were 53.1%, 23.9%, and 9.3%, respectively. Grade 3 anorexia occurred in 2 patients, grade 3 diarrhea in 1, and grade 3 fatigue in 1. Multivariate analyses revealed that the following factors had significant effects on OS: controlled intrahepatic tumor; controlled extrahepatic metastasis; and Child-Pugh class A. Although patients with adrenal metastasis from HCC had poor OS, radiotherapy provided an objective response rate of 38.3% and disease stability of 93.6%, with minimal adverse events. Therefore, radiotherapy for these patients could represent a good treatment modality, especially for patients with controlled intrahepatic tumors, controlled extrahepatic metastasis, and good hepatic function.

  10. A survey of informatics platforms that enable distributed comparative effectiveness research using multi-institutional heterogeneous clinical data

    Science.gov (United States)

    Sittig, Dean F.; Hazlehurst, Brian L.; Brown, Jeffrey; Murphy, Shawn; Rosenman, Marc; Tarczy-Hornoch, Peter; Wilcox, Adam B.

    2012-01-01

    Comparative Effectiveness Research (CER) has the potential to transform the current healthcare delivery system by identifying the most effective medical and surgical treatments, diagnostic tests, disease prevention methods and ways to deliver care for specific clinical conditions. To be successful, such research requires the identification, capture, aggregation, integration, and analysis of disparate data sources held by different institutions with diverse representations of the relevant clinical events. In an effort to address these diverse demands, there have been multiple new designs and implementations of informatics platforms that provide access to electronic clinical data and the governance infrastructure required for inter-institutional CER. The goal of this manuscript is to help investigators understand why these informatics platforms are required and to compare and contrast six, large-scale, recently funded, CER-focused informatics platform development efforts. We utilized an 8-dimension, socio-technical model of health information technology use to help guide our work. We identified six generic steps that are necessary in any distributed, multi-institutional CER project: data identification, extraction, modeling, aggregation, analysis, and dissemination. We expect that over the next several years these projects will provide answers to many important, and heretofore unanswerable, clinical research questions. PMID:22692259

  11. A survey of informatics platforms that enable distributed comparative effectiveness research using multi-institutional heterogenous clinical data.

    Science.gov (United States)

    Sittig, Dean F; Hazlehurst, Brian L; Brown, Jeffrey; Murphy, Shawn; Rosenman, Marc; Tarczy-Hornoch, Peter; Wilcox, Adam B

    2012-07-01

    Comparative effectiveness research (CER) has the potential to transform the current health care delivery system by identifying the most effective medical and surgical treatments, diagnostic tests, disease prevention methods, and ways to deliver care for specific clinical conditions. To be successful, such research requires the identification, capture, aggregation, integration, and analysis of disparate data sources held by different institutions with diverse representations of the relevant clinical events. In an effort to address these diverse demands, there have been multiple new designs and implementations of informatics platforms that provide access to electronic clinical data and the governance infrastructure required for interinstitutional CER. The goal of this manuscript is to help investigators understand why these informatics platforms are required and to compare and contrast 6 large-scale, recently funded, CER-focused informatics platform development efforts. We utilized an 8-dimension, sociotechnical model of health information technology to help guide our work. We identified 6 generic steps that are necessary in any distributed, multi-institutional CER project: data identification, extraction, modeling, aggregation, analysis, and dissemination. We expect that over the next several years these projects will provide answers to many important, and heretofore unanswerable, clinical research questions.

  12. Connecting the Dots: A Comparative Global Multi-Institutional Study of Prohibitive Factors Affecting Cancer Pain Management.

    Science.gov (United States)

    Amoatey Odonkor, Charles; Addison, William; Smith, Sean; Osei-Bonsu, Ernest; Tang, Teresa; Erdek, Michael

    2017-02-01

    The goal of this study was to elucidate the attitudes, beliefs, and barriers interfering with cancer pain management, the degree of barrier interference with trainees’ care of patients, and the relationships among prohibitive factors to pain management for physicians in a low–middle-income countries (LMICs) vs high-income countries (HICs). A multi-institutional cross-sectional survey of physicians in specialties with a focus in pain management training was performed. All surveys were completed anonymously from July 1, 2015, to November 30, 2015. One hundred and twenty physicians participated in the survey. Surveys were based on prior questionnaires published in the literature. Descriptive statistics were calculated, and chi-square (ℵ2) analysis, Fisher’s exact test, and Spearman rank correlation analyses were performed. Compared with their peers in HICs, physicians in LMICs reported less experience with cancer pain management despite seeing more cancer patients with advanced disease (41% vs 15.2%, p pain (84% vs 76%) and lack of training and expertise (87% vs 78%) were significantly more prohibitive for physicians in LMICs than those in HICs; p pain management among trainee physicians in low- vs high-resource environments. Understanding these differences may spur further collaboration in the design of contextually relevant solutions, which could potentially help improve the adequacy of cancer pain management

  13. Peptide receptor radionuclide therapy for neuroendocrine tumors in Germany: first results of a multi-institutional cancer registry.

    Science.gov (United States)

    Hörsch, Dieter; Ezziddin, Samer; Haug, Alexander; Gratz, Klaus Friedrich; Dunkelmann, Simone; Krause, Bernd Joachim; Schümichen, Carl; Bengel, Frank M; Knapp, Wolfram H; Bartenstein, Peter; Biersack, Hans-Jürgen; Plöckinger, Ursula; Schwartz-Fuchs, Sabine; Baum, R P

    2013-01-01

    Peptide receptor radionuclide therapy is an effective treatment option for patients with well-differentiated somatostatin receptor-expressing neuroendocrine tumors. However, published data result mainly from retrospective monocentric studies. We initiated a multi-institutional, prospective, board-reviewed registry for patients treated with peptide receptor radionuclide therapy in Germany in 2009. In five centers, 297 patients were registered. Primary tumors were mainly derived from pancreas (117/297) and small intestine (80/297), whereas 56 were of unknown primary. Most tumors were well differentiated with median Ki67 proliferation rate of 5% (range 0.9-70%). Peptide receptor radionuclide therapy was performed using mainly yttrium-90 and/or lutetium-177 as radionuclides in 1-8 cycles. Mean overall survival was estimated at 213 months with follow-up between 1 and 230 months after initial diagnosis, and 87 months with follow-up between 1 and 92 months after start of peptide receptor radionuclide therapy. Median overall survival was not yet reached. Subgroup analysis demonstrated that best results were obtained in neuroendocrine tumors with proliferation rate below 20%. Our results indicate that peptide receptor radionuclide therapy is an effective treatment for well- and moderately differentiated neuroendocrine tumors irrespective of previous therapies and should be regarded as one of the primary treatment options for patients with somatostatin receptor-expressing neuroendocrine tumors.

  14. SU-E-T-544: A Radiation Oncology-Specific Multi-Institutional Federated Database: Initial Implementation

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickson, K; Phillips, M; Fishburn, M; Evans, K; Banerian, S; Mayr, N [University of Washington, Seattle, WA (United States); Wong, J; McNutt, T; Moore, J; Robertson, S [Johns Hopkins University, Baltimore, MD (United States)

    2014-06-01

    Purpose: To implement a common database structure and user-friendly web-browser based data collection tools across several medical institutions to better support evidence-based clinical decision making and comparative effectiveness research through shared outcomes data. Methods: A consortium of four academic medical centers agreed to implement a federated database, known as Oncospace. Initial implementation has addressed issues of differences between institutions in workflow and types and breadth of structured information captured. This requires coordination of data collection from departmental oncology information systems (OIS), treatment planning systems, and hospital electronic medical records in order to include as much as possible the multi-disciplinary clinical data associated with a patients care. Results: The original database schema was well-designed and required only minor changes to meet institution-specific data requirements. Mobile browser interfaces for data entry and review for both the OIS and the Oncospace database were tailored for the workflow of individual institutions. Federation of database queries--the ultimate goal of the project--was tested using artificial patient data. The tests serve as proof-of-principle that the system as a whole--from data collection and entry to providing responses to research queries of the federated database--was viable. The resolution of inter-institutional use of patient data for research is still not completed. Conclusions: The migration from unstructured data mainly in the form of notes and documents to searchable, structured data is difficult. Making the transition requires cooperation of many groups within the department and can be greatly facilitated by using the structured data to improve clinical processes and workflow. The original database schema design is critical to providing enough flexibility for multi-institutional use to improve each institution s ability to study outcomes, determine best practices

  15. SU-E-T-544: A Radiation Oncology-Specific Multi-Institutional Federated Database: Initial Implementation

    International Nuclear Information System (INIS)

    Hendrickson, K; Phillips, M; Fishburn, M; Evans, K; Banerian, S; Mayr, N; Wong, J; McNutt, T; Moore, J; Robertson, S

    2014-01-01

    Purpose: To implement a common database structure and user-friendly web-browser based data collection tools across several medical institutions to better support evidence-based clinical decision making and comparative effectiveness research through shared outcomes data. Methods: A consortium of four academic medical centers agreed to implement a federated database, known as Oncospace. Initial implementation has addressed issues of differences between institutions in workflow and types and breadth of structured information captured. This requires coordination of data collection from departmental oncology information systems (OIS), treatment planning systems, and hospital electronic medical records in order to include as much as possible the multi-disciplinary clinical data associated with a patients care. Results: The original database schema was well-designed and required only minor changes to meet institution-specific data requirements. Mobile browser interfaces for data entry and review for both the OIS and the Oncospace database were tailored for the workflow of individual institutions. Federation of database queries--the ultimate goal of the project--was tested using artificial patient data. The tests serve as proof-of-principle that the system as a whole--from data collection and entry to providing responses to research queries of the federated database--was viable. The resolution of inter-institutional use of patient data for research is still not completed. Conclusions: The migration from unstructured data mainly in the form of notes and documents to searchable, structured data is difficult. Making the transition requires cooperation of many groups within the department and can be greatly facilitated by using the structured data to improve clinical processes and workflow. The original database schema design is critical to providing enough flexibility for multi-institutional use to improve each institution s ability to study outcomes, determine best practices

  16. SU-E-T-50: A Multi-Institutional Study of Independent Dose Verification Software Program for Lung SBRT

    International Nuclear Information System (INIS)

    Kawai, D; Takahashi, R; Kamima, T; Baba, H; Yamamoto, T; Kubo, Y; Ishibashi, S; Higuchi, Y; Takahashi, H; Tachibana, H

    2015-01-01

    Purpose: The accuracy of dose distribution depends on treatment planning system especially in heterogeneity-region. The tolerance level (TL) of the secondary check using the independent dose verification may be variable in lung SBRT plans. We conducted a multi-institutional study to evaluate the tolerance level of lung SBRT plans shown in the AAPM TG114. Methods: Five institutes in Japan participated in this study. All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. Analytical Anisotropic Algorithm (AAA), Pencil Beam Convolution with modified Batho-method (PBC-B) and Adaptive Convolve (AC) were used for lung SBRT planning. A measurement using an ion-chamber was performed in a heterogeneous phantom to compare doses from the three different algorithms and the SMU to the measured dose. In addition to it, a retrospective analysis using clinical lung SBRT plans (547 beams from 77 patients) was conducted to evaluate the confidence limit (CL, Average±2SD) in dose between the three algorithms and the SMU. Results: Compared to the measurement, the AAA showed the larger systematic dose error of 2.9±3.2% than PBC-B and AC. The Clarkson-based SMU showed larger error of 5.8±3.8%. The CLs for clinical plans were 7.7±6.0 % (AAA), 5.3±3.3 % (AC), 5.7±3.4 % (PBC -B), respectively. Conclusion: The TLs from the CLs were evaluated. A Clarkson-based system shows a large systematic variation because of inhomogeneous correction. The AAA showed a significant variation. Thus, we must consider the difference of inhomogeneous correction as well as the dependence of dose calculation engine

  17. SU-E-T-48: A Multi-Institutional Study of Independent Dose Verification for Conventional, SRS and SBRT

    International Nuclear Information System (INIS)

    Takahashi, R; Kamima, T; Tachibana, H; Baba, H; Itano, M; Yamazaki, T; Ishibashi, S; Higuchi, Y; Shimizu, H; Yamamoto, T; Yamashita, M; Sugawara, Y; Sato, A; Nishiyama, S; Kawai, D; Miyaoka, S

    2015-01-01

    Purpose: To show the results of a multi-institutional study of the independent dose verification for conventional, Stereotactic radiosurgery and body radiotherapy (SRS and SBRT) plans based on the action level of AAPM TG-114. Methods: This study was performed at 12 institutions in Japan. To eliminate the bias of independent dose verification program (Indp), all of the institutions used the same CT-based independent dose verification software (Simple MU Analysis, Triangle Products, JP) with the Clarkson-based algorithm. Eclipse (AAA, PBC), Pinnacle 3 (Adaptive Convolve) and Xio (Superposition) were used as treatment planning system (TPS). The confidence limits (CL, Mean±2SD) for 18 sites (head, breast, lung, pelvis, etc.) were evaluated in comparison in dose between the TPS and the Indp. Results: A retrospective analysis of 6352 treatment fields was conducted. The CLs for conventional, SRS and SBRT were 1.0±3.7 %, 2.0±2.5 % and 6.2±4.4 %, respectively. In conventional plans, most of the sites showed within 5 % of TG-114 action level. However, there were the systematic difference (4.0±4.0 % and 2.5±5.8 % for breast and lung, respectively). In SRS plans, our results showed good agreement compared to the action level. In SBRT plans, the discrepancy between the Indp was variable depending on dose calculation algorithms of TPS. Conclusion: The impact of dose calculation algorithms for the TPS and the Indp affects the action level. It is effective to set the site-specific tolerances, especially for the site where inhomogeneous correction can affect dose distribution strongly

  18. Interobserver variability of clinical target volume delineation in supra-diaphragmatic Hodgkin's disease. A multi-institutional experience

    International Nuclear Information System (INIS)

    Genovesi, Domenico; Cefaro, Giampiero Ausili; Vinciguerra, Annamaria

    2011-01-01

    To determine interobserver variability in clinical target volume (CTV) of supra-diaphragmatic Hodgkin's lymphoma. At the 2008 AIRO (Italian Society of Radiation Oncology) Meeting, the Radiation Oncology Department of Chieti proposed a multi-institutional contouring dummy-run of two cases of early stage supra-diaphragmatic Hodgkin's lymphoma after chemotherapy. Clinical history, diagnostics, and planning CT imaging were available on Chieti's radiotherapy website (www.radioterapia.unich.it). Participating centers were requested to delineate the CTV and submit it to the coordinating center. To quantify interobserver variability of CTV delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated. A total of 18 institutions for case A and 15 institutions for case B submitted the targets. Case A presented significant variability in total volume (range: 74.1-1,157.1 cc), craniocaudal (range: 6.5-22.5 cm; median: 16.25 cm), anteroposterior (range: 5.04-14.82 cm; median: 10.28 cm), and laterolateral diameters (range: 8.23-22.88 cm; median: 15.5 cm). Mean CTV was 464.8 cc (standard deviation: 280.5 cc). Case B presented significant variability in total volume (range: 341.8-1,662 cc), cranio-caudal (range: 8.0-28.5 cm; median: 23 cm), anteroposterior (range: 7.9-1.8 cm; median: 11.1 cm), and laterolateral diameters (range: 12.9-24.0 cm; median: 18.8 cm). Mean CTV was 926.0 cc (standard deviation: 445.7 cc). This significant variability confirms the need to apply specific guidelines to improve contouring uniformity in Hodgkin's lymphoma. (orig.)

  19. Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study.

    Science.gov (United States)

    Williams, Michael D; Watts, Dorraine; Fakhry, Samir

    2003-11-01

    Blunt injury to the colon is rare. Few studies of adequate size and design exist to allow clinically useful conclusions. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) Study presents a unique opportunity to definitively study these injuries. Patients with blunt HVI were identified from the registries of 95 trauma centers over 2 years (1998-1999). Patients with colon injuries (cases) were compared with blunt trauma patient undergoing a negative laparotomy (controls). Data were abstracted by chart review. Of the 227,972 patients represented, 2,632 (1.0%) had an HVI and 798 had a colonic/rectal injury (0.3%). Of patients diagnosed with HVI, 30.2% had a colon injury. No physical findings or imaging modalities were able to discriminate colonic injury. Logistic regression modeling yielded no clinically useful combination of findings that would reliably predict colonic injury. In patients undergoing laparotomy, presence of colon injury was associated with a higher risk of some complications but not mortality. Colon injury was associated with increased hospital (17.4 vs. 13.1, p colon patients (92.0%) underwent laparotomy within 24 hours of injury. Colonic injury after blunt trauma is rare and difficult to diagnose. No diagnostic test or combination of findings reliably excluded blunt colonic injury. Despite the inadequacy of current diagnostic tests, almost all patients with colonic injury were taken to the operating room within 24 hours. Even with relatively prompt surgery, patients with colon injury were at significantly higher risk for serious complications and increased length of stay. In contrast to small bowel perforation, delay in operative intervention appears to be less common but is still associated with serious morbidity.

  20. Gaps in Radiation Therapy Awareness: Results From an Educational Multi-institutional Survey of US Internal Medicine Residents.

    Science.gov (United States)

    Shaverdian, Narek; Yoo, Sun Mi; Cook, Ryan; Chang, Eric M; Jiang, Naomi; Yuan, Ye; Sandler, Kiri; Steinberg, Michael; Lee, Percy

    2017-08-01

    Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings

  1. Medical School Applicant Characteristics Associated With Performance in Multiple Mini-Interviews Versus Traditional Interviews: A Multi-Institutional Study.

    Science.gov (United States)

    Henderson, Mark C; Kelly, Carolyn J; Griffin, Erin; Hall, Theodore R; Jerant, Anthony; Peterson, Ellena M; Rainwater, Julie A; Sousa, Francis J; Wofsy, David; Franks, Peter

    2017-10-31

    To examine applicant characteristics associated with multi mini-interview (MMI) or traditional interview (TI) performance at five California public medical schools. Of the five California Longitudinal Evaluation of Admissions Practices (CA-LEAP) consortium schools, three used TIs and two used MMIs. Schools provided the following retrospective data on all 2011-2013 admissions cycle interviewees: age, gender, race/ethnicity (under-represented in medicine [UIM] or not), self-identified disadvantaged (DA) status, undergraduate GPA, Medical College Admission Test (MCAT) score, and interview score (standardized as z-score, mean = 0, SD = 1). Adjusted linear regression analyses, stratified by interview type, examined associations with interview performance. The 4,993 applicants who completed 7,516 interviews included 931 (18.6%) UIM and 962 (19.3%) DA individuals; 3,226 (64.6%) had one interview. Mean age was 24.4 (SD = 2.7); mean GPA and MCAT score were 3.72 (SD = 0.22) and 33.6 (SD = 3.7), respectively. Older age, female gender, and number of prior interviews were associated with better performance on both MMIs and TIs. Higher GPA was associated with lower MMI scores (z-score, per unit GPA = -0.26, 95% CI [-0.45, -0.06]), but unrelated to TI scores. DA applicants had higher TI scores (z-score = 0.17, 95% CI [0.07, 0.28]), but lower MMI scores (z-score = -0.18, 95% CI [-0.28, -.08]) than non-DA applicants. Neither UIM status nor MCAT score were associated with interview performance. These findings have potentially important workforce implications, particularly regarding DA applicants, and illustrate the need for other multi-institutional studies of medical school admissions processes.

  2. Residency characteristics that matter most to plastic surgery applicants: a multi-institutional analysis and review of the literature.

    Science.gov (United States)

    Sinno, Sammy; Mehta, Karan; Squitieri, Lee; Ranganathan, Kavitha; Koeckert, Michael S; Patel, Ashit; Saadeh, Pierre B; Thanik, Vishal

    2015-06-01

    The National Residency Matching Program Match is a very unique process in which applicants and programs are coupled to each other based on a ranking system. Although several studies have assessed features plastic surgery programs look for in applicants, no study in the present plastic surgery literature identifies which residency characteristics are most important to plastic surgery applicants. Therefore, we sought to perform a multi-institutional assessment as to which factors plastic surgery residency applicants consider most important when applying for residency. A validated and anonymous questionnaire containing 37 items regarding various program characteristics was e-mailed to 226 applicants to New York University, Albany, University of Michigan, and University of Southern California plastic surgery residency programs. Applicants were asked to rate each feature on a scale from 1 to 10, with 10 being the most important. The 37 variables were ranked by the sum of the responses. The median rating and interquartile range as well as the mean for each factor was then calculated. A Wilcoxon signed rank test was used to compare medians in rank order. A total of 137 completed questionnaires were returned, yielding a 61% response rate. The characteristics candidates considered most important were impressions during the interview, experiences during away rotations, importance placed on resident training/support/mentoring by faculty, personal experiences with residents, and the amount of time spent in general surgery. The characteristics candidates considered least important were second-look experiences, compensation/benefits, program reputation from Internet forums, accessibility of program coordinator, opportunity for laboratory research, and fellowship positions available at the program. Applicants value personal contact and time spent in general surgery when selecting residency programs. As the number of integrated programs continues to grow, programs will benefit

  3. Multi-institutional Nomogram Predicting Survival Free From Salvage Whole Brain Radiation After Radiosurgery in Patients With Brain Metastases

    International Nuclear Information System (INIS)

    Gorovets, Daniel; Ayala-Peacock, Diandra; Tybor, David J.; Rava, Paul; Ebner, Daniel; Cielo, Deus; Norén, Georg; Wazer, David E.; Chan, Michael; Hepel, Jaroslaw T.

    2017-01-01

    Purpose: Optimal patient selection for stereotactic radiosurgery (SRS) as the initial treatment for brain metastases is complicated and controversial. This study aimed to develop a nomogram that predicts survival without salvage whole brain radiation therapy (WBRT) after upfront SRS. Methods and Materials: Multi-institutional data were analyzed from 895 patients with 2095 lesions treated with SRS without prior or planned WBRT. Cox proportional hazards regression model was used to identify independent pre-SRS predictors of WBRT-free survival, which were integrated to build a nomogram that was subjected to bootstrap validation. Results: Median WBRT-free survival was 8 months (range, 0.1-139 months). Significant independent predictors for inferior WBRT-free survival were age (hazard ratio [HR] 1.1 for each 10-year increase), HER2(−) breast cancer (HR 1.6 relative to other histologic features), colorectal cancer (HR 1.4 relative to other histologic features), increasing number of brain metastases (HR 1.09, 1.32, 1.37, and 1.87 for 2, 3, 4, and 5+ lesions, respectively), presence of neurologic symptoms (HR 1.26), progressive systemic disease (HR 1.35), and increasing extracranial disease burden (HR 1.31 for oligometastatic and HR 1.56 for widespread). Additionally, HER2(+) breast cancer (HR 0.81) and melanoma (HR 1.11) trended toward significance. The independently weighted hazard ratios were used to create a nomogram to display estimated probabilities of 6-month and 12-month WBRT-free survival with a corrected Harrell's C concordance statistic of 0.62. Conclusions: Our nomogram can be used at initial evaluation to help select patients best suited for upfront SRS for brain metastases while reducing expense and morbidity in patients who derive minimal or no benefit.

  4. SU-E-T-50: A Multi-Institutional Study of Independent Dose Verification Software Program for Lung SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Kawai, D [Kanagawa Cancer Center, Yokohama, Kanagawa-prefecture (Japan); Takahashi, R; Kamima, T [The Cancer Institute Hospital of JFCR, Koutou-ku, Tokyo (Japan); Baba, H [The National Cancer Center Hospital East, Kashiwa-city, Chiba prefecture (Japan); Yamamoto, T; Kubo, Y [Otemae Hospital, Chuou-ku, Osaka-city (Japan); Ishibashi, S; Higuchi, Y [Sasebo City General Hospital, Sasebo, Nagasaki (Japan); Takahashi, H [St Lukes International Hospital, Chuou-ku, Tokyo (Japan); Tachibana, H [National Cancer Center Hospital East, Kashiwa, Chiba (Japan)

    2015-06-15

    Purpose: The accuracy of dose distribution depends on treatment planning system especially in heterogeneity-region. The tolerance level (TL) of the secondary check using the independent dose verification may be variable in lung SBRT plans. We conducted a multi-institutional study to evaluate the tolerance level of lung SBRT plans shown in the AAPM TG114. Methods: Five institutes in Japan participated in this study. All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. Analytical Anisotropic Algorithm (AAA), Pencil Beam Convolution with modified Batho-method (PBC-B) and Adaptive Convolve (AC) were used for lung SBRT planning. A measurement using an ion-chamber was performed in a heterogeneous phantom to compare doses from the three different algorithms and the SMU to the measured dose. In addition to it, a retrospective analysis using clinical lung SBRT plans (547 beams from 77 patients) was conducted to evaluate the confidence limit (CL, Average±2SD) in dose between the three algorithms and the SMU. Results: Compared to the measurement, the AAA showed the larger systematic dose error of 2.9±3.2% than PBC-B and AC. The Clarkson-based SMU showed larger error of 5.8±3.8%. The CLs for clinical plans were 7.7±6.0 % (AAA), 5.3±3.3 % (AC), 5.7±3.4 % (PBC -B), respectively. Conclusion: The TLs from the CLs were evaluated. A Clarkson-based system shows a large systematic variation because of inhomogeneous correction. The AAA showed a significant variation. Thus, we must consider the difference of inhomogeneous correction as well as the dependence of dose calculation engine.

  5. SU-E-T-48: A Multi-Institutional Study of Independent Dose Verification for Conventional, SRS and SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, R; Kamima, T [The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo (Japan); Tachibana, H; Baba, H [National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Itano, M; Yamazaki, T [Inagi Municipal Hospital, Inagi, Tokyo (Japan); Ishibashi, S; Higuchi, Y [Sasebo City General Hospital, Sasebo, Nagasaki (Japan); Shimizu, H [Kitasato University Medical Center, Kitamoto, Saitama (Japan); Yamamoto, T [Otemae Hospital, Chuou-ku, Osaka-city (Japan); Yamashita, M [Kobe City Medical Center General Hospital, Kobe, Hyogo (Japan); Sugawara, Y [The National Center for Global Health and Medicine, Shinjuku-ku, Tokyo (Japan); Sato, A [Itabashi Central General Hospital, Itabashi-ku, Tokyo (Japan); Nishiyama, S [Kuki General Hospital, Kuki, Saitama (Japan); Kawai, D [Kanagawa Cancer Center, Yokohama, Kanagawa-prefecture (Japan); Miyaoka, S [Kamitsuga General Hospital, Kanuma, Tochigi (Japan)

    2015-06-15

    Purpose: To show the results of a multi-institutional study of the independent dose verification for conventional, Stereotactic radiosurgery and body radiotherapy (SRS and SBRT) plans based on the action level of AAPM TG-114. Methods: This study was performed at 12 institutions in Japan. To eliminate the bias of independent dose verification program (Indp), all of the institutions used the same CT-based independent dose verification software (Simple MU Analysis, Triangle Products, JP) with the Clarkson-based algorithm. Eclipse (AAA, PBC), Pinnacle{sup 3} (Adaptive Convolve) and Xio (Superposition) were used as treatment planning system (TPS). The confidence limits (CL, Mean±2SD) for 18 sites (head, breast, lung, pelvis, etc.) were evaluated in comparison in dose between the TPS and the Indp. Results: A retrospective analysis of 6352 treatment fields was conducted. The CLs for conventional, SRS and SBRT were 1.0±3.7 %, 2.0±2.5 % and 6.2±4.4 %, respectively. In conventional plans, most of the sites showed within 5 % of TG-114 action level. However, there were the systematic difference (4.0±4.0 % and 2.5±5.8 % for breast and lung, respectively). In SRS plans, our results showed good agreement compared to the action level. In SBRT plans, the discrepancy between the Indp was variable depending on dose calculation algorithms of TPS. Conclusion: The impact of dose calculation algorithms for the TPS and the Indp affects the action level. It is effective to set the site-specific tolerances, especially for the site where inhomogeneous correction can affect dose distribution strongly.

  6. Multi-institutional Nomogram Predicting Survival Free From Salvage Whole Brain Radiation After Radiosurgery in Patients With Brain Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Gorovets, Daniel [Department of Radiation Oncology, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island (United States); Department of Radiation Oncology, Perlmutter Cancer Center, NYU School of Medicine, New York, New York (United States); Ayala-Peacock, Diandra [Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (United States); Tybor, David J. [Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts (United States); Rava, Paul [Department of Radiation Oncology, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island (United States); Department of Radiation Oncology, UMass Memorial Medical Center, University of Massachusetts School of Medicine, Worcester, Massachusetts (United States); Ebner, Daniel [Department of Radiation Oncology, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island (United States); Cielo, Deus; Norén, Georg [Department of Neurosurgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island (United States); Wazer, David E. [Department of Radiation Oncology, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island (United States); Chan, Michael [Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Hepel, Jaroslaw T., E-mail: jhepel@lifespan.org [Department of Radiation Oncology, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island (United States)

    2017-02-01

    Purpose: Optimal patient selection for stereotactic radiosurgery (SRS) as the initial treatment for brain metastases is complicated and controversial. This study aimed to develop a nomogram that predicts survival without salvage whole brain radiation therapy (WBRT) after upfront SRS. Methods and Materials: Multi-institutional data were analyzed from 895 patients with 2095 lesions treated with SRS without prior or planned WBRT. Cox proportional hazards regression model was used to identify independent pre-SRS predictors of WBRT-free survival, which were integrated to build a nomogram that was subjected to bootstrap validation. Results: Median WBRT-free survival was 8 months (range, 0.1-139 months). Significant independent predictors for inferior WBRT-free survival were age (hazard ratio [HR] 1.1 for each 10-year increase), HER2(−) breast cancer (HR 1.6 relative to other histologic features), colorectal cancer (HR 1.4 relative to other histologic features), increasing number of brain metastases (HR 1.09, 1.32, 1.37, and 1.87 for 2, 3, 4, and 5+ lesions, respectively), presence of neurologic symptoms (HR 1.26), progressive systemic disease (HR 1.35), and increasing extracranial disease burden (HR 1.31 for oligometastatic and HR 1.56 for widespread). Additionally, HER2(+) breast cancer (HR 0.81) and melanoma (HR 1.11) trended toward significance. The independently weighted hazard ratios were used to create a nomogram to display estimated probabilities of 6-month and 12-month WBRT-free survival with a corrected Harrell's C concordance statistic of 0.62. Conclusions: Our nomogram can be used at initial evaluation to help select patients best suited for upfront SRS for brain metastases while reducing expense and morbidity in patients who derive minimal or no benefit.

  7. Estrogen receptor and progesterone receptor status of breast cancer patients of eastern India: A multi-institutional study.

    Science.gov (United States)

    Chatterjee, Koushik; Bhaumik, Gautam; Chattopadhyay, Bhargab

    2018-01-01

    There is a paucity of any significant data on the estrogen receptor (ER) and progesterone receptor (PR) status of breast cancer patients from the eastern part of India. This study aims to document the ER and PR status of breast cancer patients in the eastern Indian population, as catered by two premier tertiary care hospitals in Kolkata. All breast cancer patients registered between January 1, 2013 and December 31, 2015, in the Departments of Oncology, of IPGMER and SSKM Hospitals and R. G. Kar Medical College and Hospital, Kolkata, who had at least undergone a core biopsy or surgery, were analyzed retrospectively for documentation of their ER and PR status, using the 2010 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) interpretation guidelines. Over a period of 3 years, a total of 927 patients were included for the study. A total of 825 (89%) patients had their ER and PR data available for evaluation. ER and PR positive was seen in 312 (37.82%) patients, ER and PR negative in 399 (48.36%) patients, ER positive and PR negative in 71 (8.6%) patients, and ER negative and PR positive results was found in 43 (5.21%) patients. This is the first multi-institutional documentation of ER and PR status from eastern India, having a modest number of patients and one of the earliest documentations using the latest ASCO/CAP interpretation guidelines. These findings resemble the data from the south and also reiterate the fact that majority of the Indian breast cancer patients are still ER and PR negative in spite of the changes in the interpretation guidelines.

  8. MUC1 Expression by Immunohistochemistry Is Associated with Adverse Pathologic Features in Prostate Cancer: A Multi-Institutional Study.

    Directory of Open Access Journals (Sweden)

    Okyaz Eminaga

    Full Text Available The uncertainties inherent in clinical measures of prostate cancer (CaP aggressiveness endorse the investigation of clinically validated tissue biomarkers. MUC1 expression has been previously reported to independently predict aggressive localized prostate cancer. We used a large cohort to validate whether MUC1 protein levels measured by immunohistochemistry (IHC predict aggressive cancer, recurrence and survival outcomes after radical prostatectomy independent of clinical and pathological parameters.MUC1 IHC was performed on a multi-institutional tissue microarray (TMA resource including 1,326 men with a median follow-up of 5 years. Associations with clinical and pathological parameters were tested by the Chi-square test and the Wilcoxon rank sum test. Relationships with outcome were assessed with univariable and multivariable Cox proportional hazard models and the Log-rank test.The presence of MUC1 expression was significantly associated with extracapsular extension and higher Gleason score, but not with seminal vesicle invasion, age, positive surgical margins or pre-operative serum PSA levels. In univariable analyses, positive MUC1 staining was significantly associated with a worse recurrence free survival (RFS (HR: 1.24, CI 1.03-1.49, P = 0.02, although not with disease specific survival (DSS, P>0.5. On multivariable analyses, the presence of positive surgical margins, extracapsular extension, seminal vesicle invasion, as well as higher pre-operative PSA and increasing Gleason score were independently associated with RFS, while MUC1 expression was not. Positive MUC1 expression was not independently associated with disease specific survival (DSS, but was weakly associated with overall survival (OS.In our large, rigorously designed validation cohort, MUC1 protein expression was associated with adverse pathological features, although it was not an independent predictor of outcome after radical prostatectomy.

  9. Multi-institutional evaluation of end-to-end protocol for IMRT/VMAT treatment chains utilizing conventional linacs.

    Science.gov (United States)

    Loughery, Brian; Knill, Cory; Silverstein, Evan; Zakjevskii, Viatcheslav; Masi, Kathryn; Covington, Elizabeth; Snyder, Karen; Song, Kwang; Snyder, Michael

    2018-03-20

    We conducted a multi-institutional assessment of a recently developed end-to-end monthly quality assurance (QA) protocol for external beam radiation therapy treatment chains. This protocol validates the entire treatment chain against a baseline to detect the presence of complex errors not easily found in standard component-based QA methods. Participating physicists from 3 institutions ran the end-to-end protocol on treatment chains that include Imaging and Radiation Oncology Core (IROC)-credentialed linacs. Results were analyzed in the form of American Association of Physicists in Medicine (AAPM) Task Group (TG)-119 so that they may be referenced by future test participants. Optically stimulated luminescent dosimeter (OSLD), EBT3 radiochromic film, and A1SL ion chamber readings were accumulated across 10 test runs. Confidence limits were calculated to determine where 95% of measurements should fall. From calculated confidence limits, 95% of measurements should be within 5% error for OSLDs, 4% error for ionization chambers, and 4% error for (96% relative gamma pass rate) radiochromic film at 3% agreement/3 mm distance to agreement. Data were separated by institution, model of linac, and treatment protocol (intensity-modulated radiation therapy [IMRT] vs volumetric modulated arc therapy [VMAT]). A total of 97% of OSLDs, 98% of ion chambers, and 93% of films were within the confidence limits; measurements were found outside these limits by a maximum of 4%, consistent despite institutional differences in OSLD reading equipment and radiochromic film calibration techniques. Results from this test may be used by clinics for data comparison. Areas of improvement were identified in the end-to-end protocol that can be implemented in an updated version. The consistency of our data demonstrates the reproducibility and ease-of-use of such tests and suggests a potential role for their use in broad end-to-end QA initiatives. Copyright © 2018 American Association of Medical

  10. Prediction of new brain metastases after radiosurgery: validation and analysis of performance of a multi-institutional nomogram.

    Science.gov (United States)

    Ayala-Peacock, Diandra N; Attia, Albert; Braunstein, Steve E; Ahluwalia, Manmeet S; Hepel, Jaroslaw; Chung, Caroline; Contessa, Joseph; McTyre, Emory; Peiffer, Ann M; Lucas, John T; Isom, Scott; Pajewski, Nicholas M; Kotecha, Rupesh; Stavas, Mark J; Page, Brandi R; Kleinberg, Lawrence; Shen, Colette; Taylor, Robert B; Onyeuku, Nasarachi E; Hyde, Andrew T; Gorovets, Daniel; Chao, Samuel T; Corso, Christopher; Ruiz, Jimmy; Watabe, Kounosuke; Tatter, Stephen B; Zadeh, Gelareh; Chiang, Veronica L S; Fiveash, John B; Chan, Michael D

    2017-11-01

    Stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) for brain metastases can avoid WBRT toxicities, but with risk of subsequent distant brain failure (DBF). Sole use of number of metastases to triage patients may be an unrefined method. Data on 1354 patients treated with SRS monotherapy from 2000 to 2013 for new brain metastases was collected across eight academic centers. The cohort was divided into training and validation datasets and a prognostic model was developed for time to DBF. We then evaluated the discrimination and calibration of the model within the validation dataset, and confirmed its performance with an independent contemporary cohort. Number of metastases (≥8, HR 3.53 p = 0.0001), minimum margin dose (HR 1.07 p = 0.0033), and melanoma histology (HR 1.45, p = 0.0187) were associated with DBF. A prognostic index derived from the training dataset exhibited ability to discriminate patients' DBF risk within the validation dataset (c-index = 0.631) and Heller's explained relative risk (HERR) = 0.173 (SE = 0.048). Absolute number of metastases was evaluated for its ability to predict DBF in the derivation and validation datasets, and was inferior to the nomogram. A nomogram high-risk threshold yielding a 2.1-fold increased need for early WBRT was identified. Nomogram values also correlated to number of brain metastases at time of failure (r = 0.38, p < 0.0001). We present a multi-institutionally validated prognostic model and nomogram to predict risk of DBF and guide risk-stratification of patients who are appropriate candidates for radiosurgery versus upfront WBRT.

  11. Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis

    International Nuclear Information System (INIS)

    Guckenberger, Matthias; Mantel, Frederick; Gerszten, Peter C; Flickinger, John C; Sahgal, Arjun; Létourneau, Daniel; Grills, Inga S; Jawad, Maha; Fahim, Daniel K; Shin, John H; Winey, Brian; Sheehan, Jason; Kersh, Ron

    2014-01-01

    To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases. Eight centers from the United States (n = 5), Canada (n = 2) and Germany (n = 1) participated in the retrospective study and analyzed 301 patients with 387 vertebral metastases. No patient had been exposed to prior radiation at the treatment site. All patients were treated with linac-based SBRT using cone-beam CT image-guidance and online correction of set-up errors in six degrees of freedom. 387 spinal metastases were treated and the median follow-up was 11.8 months. The median number of consecutive vertebrae treated in a single volume was one (range, 1-6), and the median total dose was 24 Gy (range 8-60 Gy) in 3 fractions (range 1-20). The median EQD2 10 was 38 Gy (range 12-81 Gy). Median overall survival (OS) was 19.5 months and local tumor control (LC) at two years was 83.9%. On multivariate analysis for OS, male sex (p < 0.001; HR = 0.44), performance status <90 (p < 0.001; HR = 0.46), presence of visceral metastases (p = 0.007; HR = 0.50), uncontrolled systemic disease (p = 0.007; HR = 0.45), >1 vertebra treated with SBRT (p = 0.04; HR = 0.62) were correlated with worse outcomes. For LC, an interval between primary diagnosis of cancer and SBRT of ≤30 months (p = 0.01; HR = 0.27) and histology of primary disease (NSCLC, renal cell cancer, melanoma, other) (p = 0.01; HR = 0.21) were correlated with worse LC. Vertebral compression fractures progressed and developed de novo in 4.1% and 3.6%, respectively. Other adverse events were rare and no radiation induced myelopathy reported. This multi-institutional cohort study reports high rates of efficacy with spine SBRT. At this time the optimal fractionation within high dose practice is unknown

  12. Multi institutional quantitative phantom study of yttrium-90 PET in PET/MRI: the MR-QUEST study.

    Science.gov (United States)

    Maughan, Nichole M; Eldib, Mootaz; Faul, David; Conti, Maurizio; Elschot, Mattijs; Knešaurek, Karin; Leek, Francesca; Townsend, David; DiFilippo, Frank P; Jackson, Kimberly; Nekolla, Stephan G; Lukas, Mathias; Tapner, Michael; Parikh, Parag J; Laforest, Richard

    2018-04-04

    Yttrium-90 ( 90 Y) radioembolization involves the intra-arterial delivery of radioactive microspheres to treat hepatic malignancies. Though this therapy involves careful pre-treatment planning and imaging, little is known about the precise location of the microspheres once they are administered. Recently, there has been growing interest post-radioembolization imaging using positron-emission tomography (PET) for quantitative dosimetry and identifying lesions that may benefit from additional salvage therapy. In this study, we aim to measure the inter-center variability of 90 Y PET measurements as measured on PET/MRI in preparation for a multi-institutional prospective phase I/II clinical trial. Eight institutions participated in this study and followed a standardized phantom filling and imaging protocol. The NEMA NU2-2012 body phantom was filled with 3 GBq of 90 Y chloride solution. The phantom was imaged for 30 min in listmode on a Siemens Biograph mMR non-TOF PET/MRI scanner at five time points across 10 days (0.3-3.0 GBq). Raw PET data were sent to a central site for image reconstruction and data analysis. Images were reconstructed with optimal parameters determined from a previous study. Volumes of interest (VOIs) matching the known sphere diameters were drawn on the vendor-provided attenuation map and propagated to the PET images. Recovery coefficients (RCs) and coefficient of variation of the RCs (COV) were calculated from these VOIs for each sphere size and activity level. Mean RCs ranged from 14.5 to 75.4%, with the lowest mean RC coming from the smallest sphere (10 mm) on the last day of imaging (0.16 MBq/ml) and the highest mean RC coming from the largest sphere (37 mm) on the first day of imaging (2.16 MBq/ml). The smaller spheres tended to exhibit higher COVs. In contrast, the larger spheres tended to exhibit lower COVs. COVs from the 37 mm sphere were  25%. Post-radioembolization dosimetry of lesions or other VOIs ≥ 22 mm in diameter can

  13. Proton Beam Reirradiation for Recurrent Head and Neck Cancer: Multi-institutional Report on Feasibility and Early Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Romesser, Paul B. [Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, New York (United States); Cahlon, Oren [Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, New York (United States); ProCure Proton Therapy Center, Somerset, New Jersey (United States); Scher, Eli D. [Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, New York (United States); Hug, Eugen B.; Sine, Kevin [ProCure Proton Therapy Center, Somerset, New Jersey (United States); DeSelm, Carl [Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, New York (United States); Fox, Jana L. [Montefiore Medical Center, Radiation Oncology, Bronx, New York (United States); Mah, Dennis [ProCure Proton Therapy Center, Somerset, New Jersey (United States); Garg, Madhur K. [Montefiore Medical Center, Radiation Oncology, Bronx, New York (United States); Han-Chih Chang, John [Northwestern Medicine Chicago Proton Center, Warrenville, Illinois (United States); Lee, Nancy Y., E-mail: leen2@mskcc.org [Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, New York (United States)

    2016-05-01

    Purpose: Reirradiation therapy (re-RT) is the only potentially curative treatment option for patients with locally recurrent head and neck cancer (HNC). Given the significant morbidity with head and neck re-RT, interest in proton beam radiation therapy (PBRT) has increased. We report the first multi-institutional clinical experience using curative-intent PBRT for re-RT in recurrent HNC. Methods and Materials: A retrospective analysis of ongoing prospective data registries from 2 hybrid community practice and academic proton centers was conducted. Patients with recurrent HNC who underwent at least 1 prior course of definitive-intent external beam radiation therapy (RT) were included. Acute and late toxicities were assessed with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 and the Radiation Therapy Oncology Group late radiation morbidity scoring system, respectively. The cumulative incidence of locoregional failure was calculated with death as a competing risk. The actuarial 12-month freedom–from–distant metastasis and overall survival rates were calculated with the Kaplan-Meier method. Results: Ninety-two consecutive patients were treated with curative-intent re-RT with PBRT between 2011 and 2014. Median follow-up among surviving patients was 13.3 months and among all patients was 10.4 months. The median time between last RT and PBRT was 34.4 months. There were 76 patients with 1 prior RT course and 16 with 2 or more courses. The median PBRT dose was 60.6 Gy (relative biological effectiveness, [RBE]). Eighty-five percent of patients underwent prior HNC RT for an oropharynx primary, and 39% underwent salvage surgery before re-RT. The cumulative incidence of locoregional failure at 12 months, with death as a competing risk, was 25.1%. The actuarial 12-month freedom–from–distant metastasis and overall survival rates were 84.0% and 65.2%, respectively. Acute toxicities of grade 3 or greater included mucositis (9

  14. Proton Beam Reirradiation for Recurrent Head and Neck Cancer: Multi-institutional Report on Feasibility and Early Outcomes

    International Nuclear Information System (INIS)

    Romesser, Paul B.; Cahlon, Oren; Scher, Eli D.; Hug, Eugen B.; Sine, Kevin; DeSelm, Carl; Fox, Jana L.; Mah, Dennis; Garg, Madhur K.; Han-Chih Chang, John; Lee, Nancy Y.

    2016-01-01

    Purpose: Reirradiation therapy (re-RT) is the only potentially curative treatment option for patients with locally recurrent head and neck cancer (HNC). Given the significant morbidity with head and neck re-RT, interest in proton beam radiation therapy (PBRT) has increased. We report the first multi-institutional clinical experience using curative-intent PBRT for re-RT in recurrent HNC. Methods and Materials: A retrospective analysis of ongoing prospective data registries from 2 hybrid community practice and academic proton centers was conducted. Patients with recurrent HNC who underwent at least 1 prior course of definitive-intent external beam radiation therapy (RT) were included. Acute and late toxicities were assessed with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 and the Radiation Therapy Oncology Group late radiation morbidity scoring system, respectively. The cumulative incidence of locoregional failure was calculated with death as a competing risk. The actuarial 12-month freedom–from–distant metastasis and overall survival rates were calculated with the Kaplan-Meier method. Results: Ninety-two consecutive patients were treated with curative-intent re-RT with PBRT between 2011 and 2014. Median follow-up among surviving patients was 13.3 months and among all patients was 10.4 months. The median time between last RT and PBRT was 34.4 months. There were 76 patients with 1 prior RT course and 16 with 2 or more courses. The median PBRT dose was 60.6 Gy (relative biological effectiveness, [RBE]). Eighty-five percent of patients underwent prior HNC RT for an oropharynx primary, and 39% underwent salvage surgery before re-RT. The cumulative incidence of locoregional failure at 12 months, with death as a competing risk, was 25.1%. The actuarial 12-month freedom–from–distant metastasis and overall survival rates were 84.0% and 65.2%, respectively. Acute toxicities of grade 3 or greater included mucositis (9

  15. Prognostic Significance of Nodal Location and Ratio in Stage IIIC Endometrial Carcinoma Among a Multi-Institutional Academic Collaboration.

    Science.gov (United States)

    Mayadev, Jyoti; Elshaikh, Mohamed A; Christie, Alana; Nagel, Christa; Kennedy, Vanessa; Khan, Nadia; Lea, Jayanthi; Ghanem, Ahmad; Miller, David; Xie, Xian-Jin; Folkert, Michael; Albuquerque, Kevin

    2018-04-20

    Stage IIIC endometrial carcinoma (EC) represents pathologically heterogenous patients with single/multiple pelvic (stage IIIC1) or paraaortic (stage IIIC2) lymph nodes (LNs). There is an increasing trend to offer adjuvant chemotherapy (CT) +/- radiation (RT) uniformly to these patients, regardless of substage. We investigate the prognostic significance of positive LN (pLN) number, ratio (%pLN), location (IIC1 vs. IIC2), and adjuvant treatment on patterns of failure and survival in a large collaborative multi-institutional series. Clinical data for stage III EC patients such as patient characteristics, surgery/pathologic details, adjuvant therapies (including CT, RT, and chemotherapy and radiation), and outcomes (including pelvic control [PC], disease-free survival [DFS], distant DFS, and overall survival [OS]) were collected from 3 academic institutions. Log-rank analyses, Cox regression univariate and multivariate analyses were performed. Of the 264 patients queried for stage III disease, 237 (73%) had pLN, and complete LN sampling for analysis. The mean number of pLN in the combined data were 3.9, with 26.1% of all LN sampled positive; 121 patients (51%) staged IIIC1, and 116 patients (49%) staged IIIC2. There was a significant difference in number of pLN (P=0.0006) and total LN sampled by institution (range, 13 to 35; P=0.0004), without a difference in %pLN (P=0.35). Ninety-seven of 220 (44.1%) have ≥20% pLN. While controlling for substage and institution, a decrease in DFS (hazard ratio [HR], 1.1; P=0.007), and OS (HR, 1.1; P=0.01) was observed with every increase of 10% in the pLN ratio. There was a significant difference in DFS (HR, 1.8; P=0.003), PC (HR, 1.9; P=0.004), and distant DFS (HR, 1.6; P=0.03), as well as a trend for decreased OS (HR, 1.6; P=0.08) for substage IIIC2 versus IIIC1 disease; 5 years DFS 40% versus 45%, OS 50% versus 57%. Patients received no adjuvant therapy (10%), CT alone (27%), RT alone (16%), or chemotherapy and radiation (47

  16. A multi-institutional outcome and prognostic factor analysis of radiosurgery (RS) for resectable single brain metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Auchter, RM; Lamond, JP; Alexander, E; Buatti, JM; Chappell, RJ; Friedman, W; Kinsella, TJ; Levin, AB; Noyes, WR; Schultz, C; Loeffler, JS; Mehta, MP

    1995-07-01

    PURPOSE: Recent randomized trials comparing resection of single brain metastasis (BM) in selected patients (pts) followed by whole brain radiotherapy (WBRT) to WBRT alone demonstrated statistically significant survival advantage for surgery (Patchell, 1990 and Noordijk, 1994). This multi-institutional retrospective study was performed in similar pts who were treated with RS and WBRT to provide a baseline for comparison for a future randomized trial. MATERIALS AND METHODS: The RS databases of four institutions were reviewed to identify all pts who met the following criteria: single BM; age > 18; surgically resectable lesion; independently functional (KPS {>=} 70); non-radiosensitive histology (small cell, lymphoma, myeloma, germ cell excluded); no prior cranial surgery or WBRT. 122 of 533 pts with BM treated with RS met these criteria. Pts were categorized by: (a) status of the primary: 'absent' = complete resection, 26 pts; 'controlled' locally controlled with radiotherapy or chemotherapy, 70 pts; 'under treatment' = undergoing radiotherapy, 15 pts; 'active' = no definitive or successful treatment of the primary, 11 pts; (b) status of non-CNS metastasis: present=64 pts, absent=58 pts; (c) age: median=61, range 23-83; (d) KPS : KPS 70/80/90/100=20/26/44/32 pts; (e) histology: lung=58, melanoma=16, breast=13, renal=12,colon=9, other=10, unknown primary=4; (f) time from primary to BM: median=12 months, range=1-252 months; (g) gender: male=64, female=58; (h) tumor volume: median=2.68 cc, range=0.13-27.2 cc. RS was performed with a linear accelerator based technique (peripheral dose 10-27 Gy, median 17 Gy). WBRT was performed in all but 5 pts who refused it (range 25 - 40 Gy, median 37.5 Gy). RESULTS: The potential median follow-up for all pts is 123 weeks (wks). The overall local response rate is 59% (complete response = 25%, partial response = 34%). In field progression occurred in 17 patients (14%), with overall local control of 86%. Local control was highest for

  17. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    Science.gov (United States)

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  18. MO-G-201-01: A Multi-Institutional Study Investigating the Performance of a Knowledge-Based Planning System Against Pinnacle Auto-Planning Engine in SIB-IMRT for the Head-And-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wu, B; Pang, D [Georgetown University Hospital, Washington, DC (United States); Kusters, M; Kunze-busch, M; Dijkema, T [Radboud University Medical Center, Nijmegen (Netherlands); McNutt, T [Johns Hopkins University, Baltimore, MD (United States); Sanguineti, G [Istituto Nazionale Tumori Regina Elena, Roma (Italy)

    2016-06-15

    Purpose: Knowledge-based Planning (KBP) founded on prior planning experience and Auto-Planning Engine (APE; commercialized in Pinnacle v9.10 TPS) based on progressive optimization algorithm both aim to eliminate the trial-and-error process in radiotherapy inverse planning. This study investigates the performance of the approaches in a multi-institutional setting to evaluate their functionalities in oropharyngeal cancer and offers suggestions how they can be implemented in the clinic. Methods: Radboud University Medical Center (RUMC) provided 35 oropharyngeal cancer patients (SIB-IMRT with two-dose-level prescription: 68 Gy to PTV68 and 50.3 Gy to PTV50.3) with corresponding comparative APE plans. Johns Hopkins University (JHU) contributed to a three-dose-level (70 Gy 63 Gy and 58.1 Gy) plan library for RUMC’s patient KBP generation. MedStar Georgetown University Hospital (MGUH) contributed to a KBP approach employing overlap-volume histogram (OVH-KBP) for generating RUMC’s patient KBP plans using JHU’s plan library. Since both approaches need their own user-defined parameters as initial inputs the first 10 patients were set aside as training set to finalize them. Meanwhile cross-institutional comparisons and adjustments were implemented for investigating institutions’ protocol discrepancies and the approaches’ user-defined parameters were updated accordingly. The finalized parameters were then applied to the remaining 25 patients for OVH-KBP and APE generation. A Wilcoxon rank-sum test was used for statistical comparison with significance level of p<0.05. Results: On average PTV68’s V95 was 96.5% in APE plans vs. 97% in OVH-KBP plans (p=0.36); PTV50.3’s V95 in APE plans was 97.8% vs.97.6% in OVH-KBP plans (p=0.6); cord’s D0.1 cc was 38.6 Gy in OVH-KBP plans vs. 43.7 Gy in APE plans (p=0.0001); mean doses to larynxes oral cavities parotids and submandibular glands were similar with p>0.2. Conclusions: The study demonstrates that KBP and APE can

  19. A quasi-experimental cross-disciplinary evaluation of the impacts of education outside the classroom on pupils’ physical activity, well-being and learning: the TEACHOUT study protocol

    DEFF Research Database (Denmark)

    Nielsen, Glen; Mygind, Erik; Bølling, Mads

    2016-01-01

    Background: Education Outside the Classroom (EOTC) is a teaching method that aims to promote schoolchildren’s learning, physical activity (PA), social relations, motivation, and well-being. EOTC activities are characterized by teachers using the local environment in their teaching, and involve...... innovative teaching methods, child-led approaches to problem-solving, experimentation, cooperation, PA, and play. EOTC has become common practice for many teachers in Scandinavia; however, only case studies have evaluated its impacts. The TEACHOUT study aims to evaluate the impacts of EOTC on Danish...... in both EOTC and nonEOTC classes were monitored day-to-day throughout the school year, using an online teacher survey platform. The effects of EOTC are mainly analysed by comparing EOTC pupils to non-EOTC (i.e. control) pupils based on their scores on the outcome variables (i.e. school performance, well...

  20. Multi-institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion-weighted MRI.

    Science.gov (United States)

    Brown, Anna M; Nagala, Sidhartha; McLean, Mary A; Lu, Yonggang; Scoffings, Daniel; Apte, Aditya; Gonen, Mithat; Stambuk, Hilda E; Shaha, Ashok R; Tuttle, R Michael; Deasy, Joseph O; Priest, Andrew N; Jani, Piyush; Shukla-Dave, Amita; Griffiths, John

    2016-04-01

    Ultrasound-guided fine needle aspirate cytology fails to diagnose many malignant thyroid nodules; consequently, patients may undergo diagnostic lobectomy. This study assessed whether textural analysis (TA) could noninvasively stratify thyroid nodules accurately using diffusion-weighted MRI (DW-MRI). This multi-institutional study examined 3T DW-MRI images obtained with spin echo echo planar imaging sequences. The training data set included 26 patients from Cambridge, United Kingdom, and the test data set included 18 thyroid cancer patients from Memorial Sloan Kettering Cancer Center (New York, New York, USA). Apparent diffusion coefficients (ADCs) were compared over regions of interest (ROIs) defined on thyroid nodules. TA, linear discriminant analysis (LDA), and feature reduction were performed using the 21 MaZda-generated texture parameters that best distinguished benign and malignant ROIs. Training data set mean ADC values were significantly different for benign and malignant nodules (P = 0.02) with a sensitivity and specificity of 70% and 63%, respectively, and a receiver operator characteristic (ROC) area under the curve (AUC) of 0.73. The LDA model of the top 21 textural features correctly classified 89/94 DW-MRI ROIs with 92% sensitivity, 96% specificity, and an AUC of 0.97. This algorithm correctly classified 16/18 (89%) patients in the independently obtained test set of thyroid DW-MRI scans. TA classifies thyroid nodules with high sensitivity and specificity on multi-institutional DW-MRI data sets. This method requires further validation in a larger prospective study. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

  1. Matched-pair analysis of a multi-institutional cohort reveals that epidermal growth factor receptor mutation is not a risk factor for postoperative recurrence of lung adenocarcinoma.

    Science.gov (United States)

    Matsumura, Yuki; Suzuki, Hiroyuki; Ohira, Tetsuya; Shiono, Satoshi; Abe, Jiro; Sagawa, Motoyasu; Sakurada, Akira; Katahira, Masato; Machida, Yuichiro; Takahashi, Satomi; Okada, Yoshinori

    2017-12-01

    It is unclear whether epidermal growth factor receptor (EGFR) mutation status is a risk factor for postoperative recurrence of surgically resected lung adenocarcinoma (ADC). Therefore, we conducted a multi-institutional study employing matched-pair analysis to compare recurrence-free survival (RFS) and overall survival (OS) of patients with lung ADC according to EGFR mutation status. We collected the records of 909 patients who underwent surgical resection for lung ADC between 2005 and 2012 at five participating institutions and were also examined their EGFR mutation status. For each patient with an EGFR mutation, we selected one with the wild-type EGFR sequence and matched them according to institution, age, gender, smoking history, pathological stage (pStage), and adjuvant treatment. We compared RFS and OS of the matched cohort. The patients were allocated into groups (n=181 each) with mutated or wild-type EGFR sequences. Both cohorts had identical characteristics as follows: institution, median age (68 years), men (85, 47%), ever smokers (77, 43%), and pStage (IA, 108, 60%; IB, 48, 27%; II, 14, 8%; III, 11, 6%). The 3- and 5-year RFS rates of patients with mutated or wild-type EGFR sequence were 79%, 68% and 77%, 68%, respectively (p=0.557). The respective OS rates were 92%, 81%, and 89%, 79% (p=0.574). Matched-pair and multi-institutional analysis reveals that an EGFR mutation was not a significant risk factor for recurrence of patients with surgically resected lung adenocarcinoma. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. A Multi-institutional Comparison of Adrenal Venous Sampling in Patients with Primary Aldosteronism: Caution Advised if Successful Bilateral Adrenal Vein Sampling is Not Achieved.

    Science.gov (United States)

    Wang, Tracy S; Kline, Greg; Yen, Tina W; Yin, Ziyan; Liu, Ying; Rilling, William; So, Benny; Findling, James W; Evans, Douglas B; Pasieka, Janice L

    2018-02-01

    In patients with primary aldosteronism (PA), adrenal venous sampling (AVS) is recommended to differentiate between unilateral (UNI) or bilateral (BIL) adrenal disease. A recent study suggested that lateralization could be predicted, based on the ratio of aldosterone/cortisol levels (A/C) between the left adrenal vein (LAV) and inferior vena cava (IVC), with a 100% positive predictive value (PPV). This study aimed to validate those findings utilizing a larger, multi-institutional cohort. A retrospective review was performed of patients with PA who underwent AVS from 2 tertiary-care institutions. Laterality was predicted by an A/C ratio of >3:1 between the dominant and non-dominant adrenal. AVS results were compared to LAV/IVC ratios utilizing the published criteria (Lt ≥ 5.5; Rt ≤ 0.5). Of 222 patients, 124 (57%) had UNI and 98 (43%) had BIL disease based on AVS. AVS and LAV/IVC findings were concordant for laterality in 141 (64%) patients (69 UNI, 72 BIL). Using only the LAV/IVC ratio, 54 (24%) patients with UNI disease on AVS who underwent successful surgery would have been assumed to have BAH unless AVS was repeated, and 24 (11%) patients with BIL disease on AVS may have been incorrectly offered surgery (PPV 70%). Based on median LAV/IVC ratios (left 5.26; right 0.31; BIL 2.84), no LAV/IVC ratio accurately predicted laterality. This multi-institutional study of patients with both UNI and BIL PA failed to validate the previously reported PPV of LAV/IVC ratio for lateralization. Caution should be used in interpreting incomplete AVS data to differentiate between UNI versus BIL disease and strong consideration given to repeat AVS prior to adrenalectomy.

  3. Defining Extreme Events: A Cross-Disciplinary Review

    Science.gov (United States)

    McPhillips, Lauren E.; Chang, Heejun; Chester, Mikhail V.; Depietri, Yaella; Friedman, Erin; Grimm, Nancy B.; Kominoski, John S.; McPhearson, Timon; Méndez-Lázaro, Pablo; Rosi, Emma J.; Shafiei Shiva, Javad

    2018-03-01

    Extreme events are of interest worldwide given their potential for substantial impacts on social, ecological, and technical systems. Many climate-related extreme events are increasing in frequency and/or magnitude due to anthropogenic climate change, and there is increased potential for impacts due to the location of urbanization and the expansion of urban centers and infrastructures. Many disciplines are engaged in research and management of these events. However, a lack of coherence exists in what constitutes and defines an extreme event across these fields, which impedes our ability to holistically understand and manage these events. Here, we review 10 years of academic literature and use text analysis to elucidate how six major disciplines—climatology, earth sciences, ecology, engineering, hydrology, and social sciences—define and communicate extreme events. Our results highlight critical disciplinary differences in the language used to communicate extreme events. Additionally, we found a wide range in definitions and thresholds, with more than half of examined papers not providing an explicit definition, and disagreement over whether impacts are included in the definition. We urge distinction between extreme events and their impacts, so that we can better assess when responses to extreme events have actually enhanced resilience. Additionally, we suggest that all researchers and managers of extreme events be more explicit in their definition of such events as well as be more cognizant of how they are communicating extreme events. We believe clearer and more consistent definitions and communication can support transdisciplinary understanding and management of extreme events.

  4. How University Teachers Design Assessments: A Cross-Disciplinary Study

    Science.gov (United States)

    Bearman, Margaret; Dawson, Phillip; Bennett, Sue; Hall, Matt; Molloy, Elizabeth; Boud, David; Joughin, Gordon

    2017-01-01

    There are dissonances between educators' aspirations for assessment design and actual assessment implementation in higher education. Understanding how assessment is designed "on the ground" can assist in resolving this tension. Thirty-three Australian university educators from a mix of disciplines and institutions were interviewed. A…

  5. A Cross-Disciplinary Examination of Print Resources on Abortion

    Science.gov (United States)

    Johnson, Wendell G.

    2011-01-01

    Abortion is a highly-charged, emotional topic which often appears in the news, particularly during the confirmation process for a Supreme Court nominee. Community College students continue to ask reference librarians for print resources dealing with this controversial issue. Often we turn to the reliable series "Current Controversies," "At Issue,"…

  6. Ten simple rules for a successful cross-disciplinary collaboration

    DEFF Research Database (Denmark)

    Knapp, Bernhartd; Bardenet, Rémi; Bernabeu, Miguel O

    2015-01-01

    by regulators and policy-makers, as it is reflected in the 80 billion Euro "Horizon 2020" EU Framework Programme for Research and Innovation. This programme puts special emphasis at breaking down barriers between fields to create a path breaking environment for knowledge, research and innovation. However...

  7. Solving cross-disciplinary problems by mathematical modelling

    Science.gov (United States)

    Panfilov, D. A.; Romanchikov, V. V.; Krupin, K. N.

    2018-03-01

    The article deals with the creation of a human tibia 3D model by means of “Autodesk Revit-2016” PC based on tomogram data. The model was imported into “Lira- SAPR2013 R4” software system. To assess the possibility of education and the nature of bone fracture (and their visualization), the Finite Element Analysis (FEA) method was used. The geometric parameters of the BBK model corresponded to the physical parameters of the individual. The compact plate different thickness is modeled by rigidity properties of the finite elements in accordance with the parameters on the roentgenogram. The BBK model included parameters of the outer compact plate and the spongy substance having a more developed structure of the epiphysic region. In the “Lira-SAPR2013 R4” software system, mathematical modeling of the traumatic effect was carried out and the analysis of the stress-strain state of the finite element model of the tibia was made to assess fracture conditions.

  8. Comparison of observed and modeled seasonal crustal vertical displacements derived from multi-institution GPS and GRACE solutions

    Science.gov (United States)

    Gu, Yanchao; Fan, Dongming; You, Wei

    2017-07-01

    Eleven GPS crustal vertical displacement (CVD) solutions for 110 IGS08/IGS14 core stations provided by the International Global Navigation Satellite Systems Service Analysis Centers are compared with seven Gravity Recovery and Climate Experiment (GRACE)-modeled CVD solutions. The results of the internal comparison of the GPS solutions from multiple institutions imply large uncertainty in the GPS postprocessing. There is also evidence that GRACE solutions from both different institutions and different processing approaches (mascon and traditional spherical harmonic coefficients) show similar results, suggesting that GRACE can provide CVD results of good internal consistency. When the uncertainty of the GPS data is accounted for, the GRACE data can explain as much as 50% of the actual signals and more than 80% of the GPS annual signals. Our study strongly indicates that GRACE data have great potential to correct the nontidal loading in GPS time series.

  9. Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases.

    Science.gov (United States)

    Dulabon, Lori M; Kaouk, Jihad H; Haber, Georges-Pascal; Berkman, Douglas S; Rogers, Craig G; Petros, Firas; Bhayani, Sam B; Stifelman, Michael D

    2011-03-01

    Minimally invasive approaches to partial nephrectomy have been rapidly gaining popularity but require advanced laparoscopic surgical skills. Renal hilar tumors, due to their anatomic location, pose additional technical challenges to the operating surgeon. We compared the outcomes of robot-assisted partial nephrectomy (RPN) for hilar and nonhilar tumors in our large multicenter contemporary series of patients. We retrospectively reviewed prospectively collected data on 446 consecutive patients who underwent RPN by renal surgeons experienced in minimally invasive techniques at four academic institutions from June 2006 to March 2010. Patients were stratified into two groups: those with hilar lesions and those with nonhilar lesions. Patient demographics, operative outcomes, and postoperative outcomes, including oncologic outcomes, were recorded. Forty-one patients (9%) had hilar renal masses; 405 patients (91%) had nonhilar masses. There was no statistical differences in patient demographics except for larger median tumor size in the hilar cohort (3.2 cm vs 2.6 cm; p=0.001). The only significant difference in operative outcomes was an increase in warm ischemia times for the hilar group versus the nonhilar group (26.3±7.4 min vs 19.6±10.0 min; p=<0.0001). There were no differences in postoperative outcomes; however, there was a trend for increased risk of malignancy and higher stage tumors in the hilar lesion group. Final pathologic margin status was similar in both groups. Only one patient in the nonhilar group had evidence of recurrence at 21 mo. The study was limited by the lack of standard anatomic classification of renal tumors and the potential influence of the surgeons' prior robotic experience. The data represent the largest series of its kind and strongly suggest that RPN is a safe, effective, and feasible option for the minimally invasive approach to renal hilar tumors with no increased risk of adverse outcomes compared with nonhilar tumors in the hands of

  10. "A good career choice for women": female medical students' mentoring experiences: a multi-institutional qualitative study.

    Science.gov (United States)

    Levine, Rachel B; Mechaber, Hilit F; Reddy, Shalini T; Cayea, Danelle; Harrison, Rebecca A

    2013-04-01

    The career decisions, practice patterns, and approach to patient care of current female students, who make up close to 50% of medical school classes, will have a profound impact on the profession. This study explores the role gender plays in the mentoring experiences of female medical students. In 2011, the authors conducted focus groups with 48 third- and fourth-year female medical students at four U.S. medical schools. Using a template organizing style, they derived themes in an iterative process to explore female medical students' mentoring relationships and the impact of gender on those relationships. The authors identified four major themes: (1) Optimal mentoring relationships are highly relational. Students emphasized shared values, trust, and a personal connection in describing ideal mentoring relationships. (2) Relational mentoring is more important than gender concordance. Students identified a desire for access to female mentors but stated that when a mentor and mentee developed a personal connection, the gender of the mentor was less important. (3) Gender-based assumptions and stereotypes affect mentoring relationships. Students described gender-based assumptions and expectations for themselves and their mentors. (4) Gender-based power dynamics influence students' thinking about mentoring. Students stated that they were concerned about how their mentors might perceive their professional decisions because of their gender, which influenced what they disclosed to male mentors and mentors in positions of power. Gender appears to play a role in female medical students' expectations and experience with mentoring relationships and may influence their decision making around career planning.

  11. Value added or misattributed? A multi-institution study on the educational benefit of labs for reinforcing physics content

    Science.gov (United States)

    Holmes, N. G.; Olsen, Jack; Thomas, James L.; Wieman, Carl E.

    2017-06-01

    Instructional labs are widely seen as a unique, albeit expensive, way to teach scientific content. We measured the effectiveness of introductory lab courses at achieving this educational goal across nine different lab courses at three very different institutions. These institutions and courses encompassed a broad range of student populations and instructional styles. The nine courses studied had two key things in common: the labs aimed to reinforce the content presented in lectures, and the labs were optional. By comparing the performance of students who did and did not take the labs (with careful normalization for selection effects), we found universally and precisely no added value to learning course content from taking the labs as measured by course exam performance. This work should motivate institutions and departments to reexamine the goals and conduct of their lab courses, given their resource-intensive nature. We show why these results make sense when looking at the comparative mental processes of students involved in research and instructional labs, and offer alternative goals and instructional approaches that would make lab courses more educationally valuable.

  12. MO-FG-202-09: Virtual IMRT QA Using Machine Learning: A Multi-Institutional Validation

    Energy Technology Data Exchange (ETDEWEB)

    Valdes, G; Scheuermann, R; Solberg, T [University of Pennsylvania, Philadelphia, PA (United States); Chan, M; Deasy, J [Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2016-06-15

    Purpose: To validate a machine learning approach to Virtual IMRT QA for accurately predicting gamma passing rates using different QA devices at different institutions. Methods: A Virtual IMRT QA was constructed using a machine learning algorithm based on 416 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3mm with 10% threshold. An independent set of 139 IMRT measurements from a different institution, with QA data based on portal dosimetry using the same gamma index and 10% threshold, was used to further test the algorithm. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. Results: In addition to predicting passing rates with 3% accuracy for all composite plans using diode-array detectors, passing rates for portal dosimetry on per-beam basis were predicted with an error <3.5% for 120 IMRT measurements. The remaining measurements (19) had large areas of low CU, where portal dosimetry has larger disagreement with the calculated dose and, as such, large errors were expected. These beams need to be further modeled to correct the under-response in low dose regions. Important features selected by Lasso to predict gamma passing rates were: complete irradiated area outline (CIAO) area, jaw position, fraction of MLC leafs with gaps smaller than 20 mm or 5mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted Average Irregularity Factor, duty cycle among others. Conclusion: We have demonstrated that the Virtual IMRT QA can predict passing rates using different QA devices and across multiple institutions. Prediction of QA passing rates could have profound implications on the current IMRT process.

  13. MO-FG-202-09: Virtual IMRT QA Using Machine Learning: A Multi-Institutional Validation

    International Nuclear Information System (INIS)

    Valdes, G; Scheuermann, R; Solberg, T; Chan, M; Deasy, J

    2016-01-01

    Purpose: To validate a machine learning approach to Virtual IMRT QA for accurately predicting gamma passing rates using different QA devices at different institutions. Methods: A Virtual IMRT QA was constructed using a machine learning algorithm based on 416 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3mm with 10% threshold. An independent set of 139 IMRT measurements from a different institution, with QA data based on portal dosimetry using the same gamma index and 10% threshold, was used to further test the algorithm. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. Results: In addition to predicting passing rates with 3% accuracy for all composite plans using diode-array detectors, passing rates for portal dosimetry on per-beam basis were predicted with an error <3.5% for 120 IMRT measurements. The remaining measurements (19) had large areas of low CU, where portal dosimetry has larger disagreement with the calculated dose and, as such, large errors were expected. These beams need to be further modeled to correct the under-response in low dose regions. Important features selected by Lasso to predict gamma passing rates were: complete irradiated area outline (CIAO) area, jaw position, fraction of MLC leafs with gaps smaller than 20 mm or 5mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted Average Irregularity Factor, duty cycle among others. Conclusion: We have demonstrated that the Virtual IMRT QA can predict passing rates using different QA devices and across multiple institutions. Prediction of QA passing rates could have profound implications on the current IMRT process.

  14. Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study.

    Science.gov (United States)

    Gulack, Brian C; Kirkwood, Katherine A; Shi, Wei; Smith, Peter K; Alexander, John H; Burks, Sandra G; Gelijns, Annetine C; Thourani, Vinod H; Bell, Daniel; Greenberg, Ann; Goldfarb, Seth D; Mayer, Mary Lou; Bowdish, Michael E

    2018-04-01

    To analyze patient risk factors and processes of care associated with secondary surgical-site infection (SSI) after coronary artery bypass grafting (CABG). Data were collected prospectively between February and October 2010 for consenting adult patients undergoing CABG with saphenous vein graft (SVG) conduits. Patients who developed a deep or superficial SSI of the leg or groin within 65 days of CABG were compared with those who did not develop a secondary SSI. Among 2174 patients identified, 65 (3.0%) developed a secondary SSI. Median time to diagnosis was 16 days (interquartile range 11-29) with the majority (86%) diagnosed after discharge. Gram-positive bacteria were most common. Readmission was more common in patients with a secondary SSI (34% vs 17%, P < .01). After adjustment, an open SVG harvest approach was associated with an increased risk of secondary SSI (adjusted hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.28-3.48). Increased body mass index (adjusted HR, 1.08, 95% CI, 1.04-1.12) and packed red blood cell transfusions (adjusted HR, 1.13; 95% CI, 1.05-1.22) were associated with a greater risk of secondary SSI. Antibiotic type, antibiotic duration, and postoperative hyperglycemia were not associated with risk of secondary SSI. Secondary SSI after CABG continues to be an important source of morbidity. This serious complication often occurs after discharge and is associated with open SVG harvesting, larger body mass, and blood transfusions. Patients with a secondary SSI have longer lengths of stay and are readmitted more frequently. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  15. Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study.

    Science.gov (United States)

    Steuber, T; Jilg, C; Tennstedt, P; De Bruycker, A; Tilki, D; Decaestecker, K; Zilli, T; Jereczek-Fossa, B A; Wetterauer, U; Grosu, A L; Schultze-Seemann, W; Heinzer, H; Graefen, M; Morlacco, A; Karnes, R J; Ost, P

    2018-03-10

    Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. The SOC cohort (n=1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n=263) received either salvage lymph node dissection (n=166) or stereotactic body radiotherapy (n=97) at PSA progression to a positron emission tomography-detected nodal recurrence. The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p=0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p=0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at

  16. Sequential Participation in a Multi-Institutional Mock Oral Examination Is Associated With Improved American Board of Surgery Certifying Examination First-Time Pass Rate.

    Science.gov (United States)

    Fingeret, Abbey L; Arnell, Tracey; McNelis, John; Statter, Mindy; Dresner, Lisa; Widmann, Warren

    We sought to determine whether sequential participation in a multi-institutional mock oral examination affected the likelihood of passing the American Board of Surgery Certifying Examination (ABSCE) in first attempt. Residents from 3 academic medical centers were able to participate in a regional mock oral examination in the fall and spring of their fourth and fifth postgraduate year from 2011 to 2014. Candidate׳s highest composite score of all mock orals attempts was classified as risk for failure, intermediate, or likely to pass. Factors including United States Medical Licensing Examination steps 1, 2, and 3, number of cases logged, American Board of Surgery In-Training Examination performance, American Board of Surgery Qualifying Examination (ABSQE) performance, number of attempts, and performance in the mock orals were assessed to determine factors predictive of passing the ABSCE. A total of 128 mock oral examinations were administered to 88 (71%) of 124 eligible residents. The overall first-time pass rate for the ABSCE was 82%. There was no difference in pass rates between participants and nonparticipants. Of them, 16 (18%) residents were classified as at risk, 47 (53%) as intermediate, and 25 (29%) as likely to pass. ABSCE pass rate for each group was as follows: 36% for at risk, 84% for intermediate, and 96% for likely pass. The following 4 factors were associated with first-time passing of ABSCE on bivariate analysis: mock orals participation in postgraduate year 4 (p = 0.05), sequential participation in mock orals (p = 0.03), ABSQE performance (p = 0.01), and best performance on mock orals (p = 0.001). In multivariable logistic regression, the following 3 factors remained associated with ABSCE passing: ABSQE performance, odds ratio (OR) = 2.9 (95% CI: 1.3-6.1); mock orals best performance, OR = 1.7 (1.2-2.4); and participation in multiple mock oral examinations, OR = 1.4 (1.1-2.7). Performance on a multi-institutional mock oral examination can identify

  17. Security and privacy requirements for a multi-institutional cancer research data grid: an interview-based study.

    Science.gov (United States)

    Manion, Frank J; Robbins, Robert J; Weems, William A; Crowley, Rebecca S

    2009-06-15

    security officers and university legal counsel. Nineteen total interviews were conducted over a period of 16 weeks. Respondents provided answers for all four scenarios (a total of 87 questions). Results were grouped by broad themes, including among others: governance, legal and financial issues, partnership agreements, de-identification, institutional technical infrastructure for security and privacy protection, training, risk management, auditing, IRB issues, and patient/subject consent. The findings suggest that with additional work, large scale federated sharing of data within a regulated environment is possible. A key challenge is developing suitable models for authentication and authorization practices within a federated environment. Authentication--the recognition and validation of a person's identity--is in fact a global property of such systems, while authorization - the permission to access data or resources--mimics data sharing agreements in being best served at a local level. Nine specific recommendations result from the work and are discussed in detail. These include: (1) the necessity to construct separate legal or corporate entities for governance of federated sharing initiatives on this scale; (2) consensus on the treatment of foreign and commercial partnerships; (3) the development of risk models and risk management processes; (4) development of technical infrastructure to support the credentialing process associated with research including human subjects; (5) exploring the feasibility of developing large-scale, federated honest broker approaches; (6) the development of suitable, federated identity provisioning processes to support federated authentication and authorization; (7) community development of requisite HIPAA and research ethics training modules by federation members; (8) the recognition of the need for central auditing requirements and authority, and; (9) use of two-protocol data exchange models where possible in the federation.

  18. Security and privacy requirements for a multi-institutional cancer research data grid: an interview-based study

    Directory of Open Access Journals (Sweden)

    Weems William A

    2009-06-01

    security officers, directors of offices of research, information security officers and university legal counsel. Nineteen total interviews were conducted over a period of 16 weeks. Respondents provided answers for all four scenarios (a total of 87 questions. Results were grouped by broad themes, including among others: governance, legal and financial issues, partnership agreements, de-identification, institutional technical infrastructure for security and privacy protection, training, risk management, auditing, IRB issues, and patient/subject consent. Conclusion The findings suggest that with additional work, large scale federated sharing of data within a regulated environment is possible. A key challenge is developing suitable models for authentication and authorization practices within a federated environment. Authentication – the recognition and validation of a person's identity – is in fact a global property of such systems, while authorization – the permission to access data or resources – mimics data sharing agreements in being best served at a local level. Nine specific recommendations result from the work and are discussed in detail. These include: (1 the necessity to construct separate legal or corporate entities for governance of federated sharing initiatives on this scale; (2 consensus on the treatment of foreign and commercial partnerships; (3 the development of risk models and risk management processes; (4 development of technical infrastructure to support the credentialing process associated with research including human subjects; (5 exploring the feasibility of developing large-scale, federated honest broker approaches; (6 the development of suitable, federated identity provisioning processes to support federated authentication and authorization; (7 community development of requisite HIPAA and research ethics training modules by federation members; (8 the recognition of the need for central auditing requirements and authority, and; (9 use of two

  19. Security and privacy requirements for a multi-institutional cancer research data grid: an interview-based study

    Science.gov (United States)

    2009-01-01

    offices of research, information security officers and university legal counsel. Nineteen total interviews were conducted over a period of 16 weeks. Respondents provided answers for all four scenarios (a total of 87 questions). Results were grouped by broad themes, including among others: governance, legal and financial issues, partnership agreements, de-identification, institutional technical infrastructure for security and privacy protection, training, risk management, auditing, IRB issues, and patient/subject consent. Conclusion The findings suggest that with additional work, large scale federated sharing of data within a regulated environment is possible. A key challenge is developing suitable models for authentication and authorization practices within a federated environment. Authentication – the recognition and validation of a person's identity – is in fact a global property of such systems, while authorization – the permission to access data or resources – mimics data sharing agreements in being best served at a local level. Nine specific recommendations result from the work and are discussed in detail. These include: (1) the necessity to construct separate legal or corporate entities for governance of federated sharing initiatives on this scale; (2) consensus on the treatment of foreign and commercial partnerships; (3) the development of risk models and risk management processes; (4) development of technical infrastructure to support the credentialing process associated with research including human subjects; (5) exploring the feasibility of developing large-scale, federated honest broker approaches; (6) the development of suitable, federated identity provisioning processes to support federated authentication and authorization; (7) community development of requisite HIPAA and research ethics training modules by federation members; (8) the recognition of the need for central auditing requirements and authority, and; (9) use of two-protocol data exchange

  20. Novel approach to utilizing electronic health records for dermatologic research: developing a multi-institutional federated data network for clinical and translational research in psoriasis and psoriatic arthritis.

    Science.gov (United States)

    Armstrong, April W; Reddy, Shalini B; Garg, Amit

    2012-05-15

    The implementation of Electronic Health Records (EHR) in the United States has created new opportunities for research using automated data extraction methods. A large amount of information from the EHR can be utilized for clinical and translational research. To date, a number of institutions have the capability of extracting clinical data from EHR to create local repositories of de-identified data amenable to research queries through the Informatics for Integrated Biology and the Bedside (i2b2) platform. Collaborations among institutions sharing a common i2b2 platform hold exciting opportunities for research in psoriasis and psoriatic arthritis. With the automated extraction of patient-level data from multiple institutions, this novel informatics network has the ability to address high-priority research questions. With commitment to high-quality data through applied algorithms for cohort identification and validation of outcomes, the creation of Psoriasis and Psoriatic Arthritis Integrated Research Data Network (PIONEER) will make a significant contribution to psoriasis and psoriatic arthritis research.

  1. Distributed health data networks: a practical and preferred approach to multi-institutional evaluations of comparative effectiveness, safety, and quality of care.

    Science.gov (United States)

    Brown, Jeffrey S; Holmes, John H; Shah, Kiran; Hall, Ken; Lazarus, Ross; Platt, Richard

    2010-06-01

    Comparative effectiveness research, medical product safety evaluation, and quality measurement will require the ability to use electronic health data held by multiple organizations. There is no consensus about whether to create regional or national combined (eg, "all payer") databases for these purposes, or distributed data networks that leave most Protected Health Information and proprietary data in the possession of the original data holders. Demonstrate functions of a distributed research network that supports research needs and also address data holders concerns about participation. Key design functions included strong local control of data uses and a centralized web-based querying interface. We implemented a pilot distributed research network and evaluated the design considerations, utility for research, and the acceptability to data holders of methods for menu-driven querying. We developed and tested a central, web-based interface with supporting network software. Specific functions assessed include query formation and distribution, query execution and review, and aggregation of results. This pilot successfully evaluated temporal trends in medication use and diagnoses at 5 separate sites, demonstrating some of the possibilities of using a distributed research network. The pilot demonstrated the potential utility of the design, which addressed the major concerns of both users and data holders. No serious obstacles were identified that would prevent development of a fully functional, scalable network. Distributed networks are capable of addressing nearly all anticipated uses of routinely collected electronic healthcare data. Distributed networks would obviate the need for centralized databases, thus avoiding numerous obstacles.

  2. Impact of smoking on the age at diagnosis of upper tract urothelial carcinoma: Subanalysis of the Japanese Urological Association multi-institutional national database.

    Science.gov (United States)

    Miyazaki, Jun; Nishiyama, Hiroyuki; Fujimoto, Hiroyuki; Ohyama, Chikara; Koie, Takuya; Hinotsu, Shiro; Kikuchi, Eiji; Sakura, Mizuaki; Inokuchi, Junichi; Hara, Tomohiko

    2015-11-01

    To examine the influence of smoking history on the diagnosis and other tumor characteristics of upper tract urothelial carcinoma in Japan. A total of 1509 patients with upper tract urothelial carcinoma who were diagnosed in 2005 from 348 Japanese institutions were registered using the multi-institutional national database of the Japanese Urological Association and included in this analysis. Clinical data of the patients were collected in 2011. The associations between the patients' self-reported smoking history and their age at the diagnosis of upper tract urothelial carcinoma, sex, pathological T stage and tumor grade were analyzed. The mean age at the diagnosis of upper tract urothelial carcinoma was approximately 5 years earlier for the 238 current smokers than for the 618 current non-smokers (P smokers, the age at diagnosis for the smoking ≥ 20 cigarettes per day group was 6.5 years lower than that of the perspective of both healthcare and medical economies. © 2015 The Japanese Urological Association.

  3. Clinicopathological features and prognosis of mucin-producing bile duct tumor and mucinous cystic tumor of the liver: a multi-institutional study by the Japan Biliary Association.

    Science.gov (United States)

    Kubota, Keiichi; Nakanuma, Yasuni; Kondo, Fukuo; Hachiya, Hiroyuki; Miyazaki, Masaru; Nagino, Masato; Yamamoto, Masakazu; Isayama, Hiroyuki; Tabata, Masami; Kinoshita, Hisafumi; Kamisawa, Terumi; Inui, Kazuo

    2014-03-01

    The aim of this study was to determine the clinicopathological features and surgical outcomes of mucinous cystic neoplasm of the liver (MCN) and mucin-producing intraductal papillary neoplasm of the intrahepatic bile duct (M-IPNB). We performed a multi-institutional, retrospective study of patients with MCN or M-IPNB pathologically defined by the presence or absence of an ovarian-like stroma. The M-IPNB and MCN were diagnosed in 119 and nine patients, respectively. MCN was observed in female patients, while M-IPNB produced symptoms of cholangitis. M-IPNBs were classed as low or intermediate grade in 53 cases, high grade in 23 and invasive carcinoma in 43. Fifty-one of the M-IPNBs were the pancreatobiliary type (PT), 33 were the intestinal type (IT), 23 were the oncocytic type (OT), and 12 were the gastric type (GT). The 1-, 5- and 10-year survival rates for the 105 patients with M-IPNB were 96%, 84% and 81%, respectively, while the 5-year survival rate for patients with MCN was 100%. OT and GT M-IPNB had better 10-year survival rates than PT and IT M-IPNB. Although MCN has different features from M-IPNB, both diseases have a good prognosis after resection. The cellular type of M-IPNB appears to predict outcome. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  4. Migrating a professional field of study in a multi-institutional partnership: facilitators’ experience in the competence-based curriculum development process

    Directory of Open Access Journals (Sweden)

    Proscovia Namubiru Ssentamu

    2014-07-01

    Full Text Available With the urge to Africanise the curriculum following colonisation, many African countries are still wary of the educational initiatives from the developed countries. However, with the clear curriculum design and development guidelines provided by various national Quality Assurance bodies, African countries need not fear migrating curricula from developed countries. Drawing from the workshop experiences, authors of this paper illustrate the steps involved in migrating, contextualising and adapting a professional field of study in a multi-institutional partnership, with particular focus on the competence-based curriculum design and development process. The process of migrating higher education (HE Administration, Leadership and Management curriculum taught at the University of Tampere (Finland to a Postgraduate Diploma in Higher Education Leadership and Management (PGDHELM curriculum at Uganda Management Institute (UMI in partnership with the Makerere University and the University of Helsinki involved undertaking a needs assessment, training of trainers and adapting the programme to the UMI context. The training of trainers provided opportunity for the trainees to reflect and generate information on the status of HE leadership and management in Uganda. The curriculum was institutionalised by aligning it to the vision, mission and profile of UMI in the context of the existing internal and external Quality Assurance frameworks. This paper underscores the importance of involving stakeholders, taking into account national and institutional requirements in all the steps when migrating an academic curriculum.

  5. Frequency, outcome and prognostic factors of carotid blowout syndrome after hypofractionated re-irradiation of head and neck cancer using CyberKnife: A multi-institutional study

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Ogita, Mikio; Kodani, Naohiro; Nakamura, Satoakai; Inoue, Hiroshi; Himei, Kengo; Kotsuma, Tadayuki; Yoshida, Ken; Yoshioka, Yasuo; Yamashita, Koichi; Udono, Hiroki

    2013-01-01

    Purpose: Re-irradiation has attracted attention as a potential therapy for recurrent head and neck tumors. However, carotid blowout syndrome (CBS) has become a serious complication of re-irradiation because of the associated life-threatening toxicity. Determining of the characteristics of CBS is important. We conducted a multi-institutional study. Methods and patients: Head and neck carcinoma patients (n = 381) were treated with 484 re-irradiation sessions at 7 Japanese CyberKnife institutions between 2000 and 2010. Results: Of these, 32 (8.4%) developed CBS, which proved fatal that median survival time after CBS onset was 0.1 month, and the 1-year survival rate was 37.5%. The median duration between re-irradiation and CBS onset was 5 months (range, 0–69 months). Elder age, skin invasion, and necrosis/infection were identified as statistically significant risk factors after CBS by univariate analysis. The presence of skin invasion at the time of treatment found only in postoperative case, is identified as only statistically significant prognostic factor after CBS in multivariate analysis. The 1-year survival rate for the group without skin invasion was 42%, whereas no patient with skin invasion survived more than 4 months (0% at 1 year, p = 0.0049). Conclusions: Careful attention should be paid to the occurrence of CBS if the tumor is located adjacent to the carotid artery. The presence of skin invasion at CBS onset is ominous sign of lethal consequences

  6. Multi-Institutional External Validation of Seminal Vesicle Invasion Nomograms: Head-to-Head Comparison of Gallina Nomogram Versus 2007 Partin Tables

    International Nuclear Information System (INIS)

    Zorn, Kevin C.; Capitanio, Umberto; Jeldres, Claudio; Arjane, Philippe; Perrotte, Paul; Shariat, Shahrokh F.; Lee, David I.; Shalhav, Arieh L.; Zagaja, Gregory P.; Shikanov, Sergey A.; Gofrit, Ofer N.; Thong, Alan E.; Albala, David M.; Sun, Leon; Karakiewicz, Pierre I.

    2009-01-01

    Purpose: The Partin tables represent one of the most widely used prostate cancer staging tools for seminal vesicle invasion (SVI) prediction. Recently, Gallina et al. reported a novel staging tool for the prediction of SVI that further incorporated the use of the percentage of positive biopsy cores. We performed an external validation of the Gallina et al. nomogram and the 2007 Partin tables in a large, multi-institutional North American cohort of men treated with robotic-assisted radical prostatectomy. Methods and Materials: Clinical and pathologic data were prospectively gathered from 2,606 patients treated with robotic-assisted radical prostatectomy at one of four North American robotic referral centers between 2002 and 2007. Discrimination was quantified with the area under the receiver operating characteristics curve. The calibration compared the predicted and observed SVI rates throughout the entire range of predictions. Results: At robotic-assisted radical prostatectomy, SVI was recorded in 4.2% of patients. The discriminant properties of the Gallina et al. nomogram resulted in 81% accuracy compared with 78% for the 2007 Partin tables. The Gallina et al. nomogram overestimated the true rate of SVI. Conversely, the Partin tables underestimated the true rate of SVI. Conclusion: The Gallina et al. nomogram offers greater accuracy (81%) than the 2007 Partin tables (78%). However, both tools are associated with calibration limitations that need to be acknowledged and considered before their implementation into clinical practice.

  7. Development of a virtual private database for a multi-institutional internet-based radiation oncology database overcoming differences in protocols

    International Nuclear Information System (INIS)

    Harauchi, Hajime; Kondo, Takashi; Kumasaki, Yu

    2002-01-01

    A multi-institutional Radiation Oncology Greater Area Database (ROGAD) was started in 1991 under the direction of the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). Use of ROGAD was intended to allow reflection of results of data analysis into treatment strategy and treatment planning for individual cases, to provide quality assurance, to maximize the efficacy of radiotherapy, to allow assessment of new technologies or new modalities, and to optimize medical decision making. ROGAD collected 13,448 radiotherapy treatment cases from 325 facilities during the period from 1992 to 2001. In 2000, questionnaires were sent to 725 radiotherapy facilities throughout Japan, to further obtain the situation of the radiation oncology database. Workers at 179 facilities replied that ''the protocol of my facility is different from ROGAD protocol and I must send data according to the ROGAD protocol''. So, we developed the Virtual Private Database System (VPDS) which is operated as if an oncologist had a database solely owned by his own facility, in spite of actually operating ROGAD. VPDS realizes integration of different plural databases, regardless of differences in entry methods, protocols, definitions and interpretations of contents of clinical data elements between facilities. (author)

  8. Safety of open ventral hernia repair in high-risk patients with metabolic syndrome: a multi-institutional analysis of 39,118 cases.

    Science.gov (United States)

    Zavlin, Dmitry; Jubbal, Kevin T; Van Eps, Jeffrey L; Bass, Barbara L; Ellsworth, Warren A; Echo, Anthony; Friedman, Jeffrey D; Dunkin, Brian J

    2018-02-01

    Metabolic syndrome (MetS) entails the simultaneous presence of a constellation of dangerous risk factors including obesity, diabetes, hypertension, and dyslipidemia. The prevalence of MetS in Western society continues to rise and implies an elevated risk for surgical complications and/or poor surgical outcomes within the affected population. To assess the risks and outcomes of multi-morbid patients with MetS undergoing open ventral hernia repair. Multi-institutional case-control study in the United States. The American College of Surgeons National Surgical Quality Improvement Program database was sampled for patients undergoing initial open ventral hernia repair from 2012 through 2014 and then stratified into 2 cohorts based on the presence or absence of MetS. Statistical analyses were performed to evaluate preoperative co-morbidities, intraoperative details, and postoperative morbidity and mortality to identify risk factors for adverse outcomes. Mean age (61.0 versus 56.0 yr, Phigh operative risk in a population that is generally prone to obesity and its associated diseases. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Regional hyperthermia combined with radiotherapy for locally advanced non-small cell lung cancers. A multi-institutional prospective randomized trial of the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    Mitsumori, Michihide; Hiraoka, Masahiro; Zeng Zhifan; Oliynychenko, P.; Park, Jeong-Ho; Choi, Ihl-Bohng; Tatsuzaki, Hideo; Tanaka, Yoshiaki

    2007-01-01

    An International Atomic Energy Agency (IAEA)-sponsored, multi-institutional prospective randomized trial was conducted to clarify whether the combination of hyperthermia and radiotherapy improves the local response rate of locally advanced non-small cell lung cancer (NSCLC) compared with that obtained by radiotherapy alone. Between October 1998 and April 2002, 80 patients with locally advanced NSCLC were randomized to receive either standard radiation therapy alone (RT) or radiation therapy combined with hyperthermia (RT+HT). The primary endpoint was the local response rate. The secondary endpoints were local progression-free survival and overall survival. The median follow-up period was 204 days for all patients and 450 days for surviving patients. There were no significant differences between the two arms with regard to local response rate (P=0.49) or overall survival rate (P=0.868). However, local progression-free survival was significantly better in the RT+HT arm (P=0.036). Toxicity was generally mild and no grade 3 late toxicity was observed in either arm. Although improvement of local progression-free survival was observed in the RT+HT arm, this prospective randomized study failed to show any substantial benefit from the addition of hyperthermia to radiotherapy in the treatment of locally advanced NSCLC. (author)

  10. Inverse correlation between coffee consumption and prevalence of metabolic syndrome: baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study in Tokushima, Japan.

    Science.gov (United States)

    Takami, Hidenobu; Nakamoto, Mariko; Uemura, Hirokazu; Katsuura, Sakurako; Yamaguchi, Miwa; Hiyoshi, Mineyoshi; Sawachika, Fusakazu; Juta, Tomoya; Arisawa, Kokichi

    2013-01-01

    It is unclear whether consumption of coffee and green tea is associated with metabolic syndrome. This cross-sectional study enrolled 554 adults who had participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study in Tokushima Prefecture, Japan. Consumption of coffee and green tea was assessed using a questionnaire. Metabolic syndrome was diagnosed using the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the Japan Society for the Study of Obesity (JASSO). Logistic regression analysis was used to examine the association between consumption of coffee and green tea and prevalence of metabolic syndrome and its components. After adjustment for sex, age, and other potential confounders, greater coffee consumption was associated with a significantly lower prevalence of metabolic syndrome, as defined by NCEP ATP III criteria (P for trend = 0.03). Participants who drank more coffee had a lower odds ratio (OR) for high serum triglycerides (P for trend = 0.02), but not for increased waist circumference or high blood pressure. Using JASSO criteria, moderate coffee consumption (1.5 to inversely correlated with metabolic syndrome diagnosed using NCEP ATP III criteria, mainly because it was associated with lower serum triglyceride levels. This association highlights the need for further prospective studies of the causality of these relationships.

  11. A Comparison of Secondary Polycythemia in Hypogonadal Men Treated with Clomiphene Citrate versus Testosterone Replacement: A Multi-Institutional Study.

    Science.gov (United States)

    Wheeler, Karen M; Smith, Ryan P; Kumar, Raj A; Setia, Shaan; Costabile, Raymond A; Kavoussi, Parviz K

    2017-04-01

    We evaluated the relative prevalence of secondary polycythemia in hypogonadal men treated with clomiphene citrate or testosterone replacement therapy. In this retrospective, multi-institutional study, we included 188 men who received clomiphene citrate and 175 who received testosterone replacement therapy with symptomatic hypogonadism. The overall prevalence and ORs of secondary polycythemia for clomiphene citrate treatment vs testosterone replacement were primarily measured, as were baseline characteristics. Subset analysis included polycythemia rates for different types of testosterone replacement therapy. Overall, men on testosterone replacement therapy were older than clomiphene citrate treated men (age 51.5 vs 38 years). Men on testosterone replacement had longer treatment duration than clomiphene citrate treated men (19.6 vs 9.2 months). For testosterone replacement therapy and clomiphene citrate the mean change in hematocrit was 3.0% and 0.6%, and the mean change in serum testosterone was 333.1 and 367.6 ng/dl, respectively. The prevalence of polycythemia in men on testosterone replacement was 11.2% vs 1.7% in men on clomiphene citrate (p = 0.0003). This significance remained on logistic regression after correcting for age, site, smoking history and pretreatment hematocrit. The prevalence of polycythemia in men treated with clomiphene citrate was markedly lower than that in men on testosterone replacement therapy. The improvement in absolute serum testosterone levels was similar to that in men on testosterone replacement. There is no significant risk of polycythemia in men treated with clomiphene citrate for hypogonadism. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. Radiogenomics of High-Grade Serous Ovarian Cancer: Multireader Multi-Institutional Study from the Cancer Genome Atlas Ovarian Cancer Imaging Research Group.

    Science.gov (United States)

    Vargas, Hebert Alberto; Huang, Erich P; Lakhman, Yulia; Ippolito, Joseph E; Bhosale, Priya; Mellnick, Vincent; Shinagare, Atul B; Anello, Maria; Kirby, Justin; Fevrier-Sullivan, Brenda; Freymann, John; Jaffe, C Carl; Sala, Evis

    2017-11-01

    Purpose To evaluate interradiologist agreement on assessments of computed tomography (CT) imaging features of high-grade serous ovarian cancer (HGSOC), to assess their associations with time-to-disease progression (TTP) and HGSOC transcriptomic profiles (Classification of Ovarian Cancer [CLOVAR]), and to develop an imaging-based risk score system to predict TTP and CLOVAR profiles. Materials and Methods This study was a multireader, multi-institutional, institutional review board-approved, HIPAA-compliant retrospective analysis of 92 patients with HGSOC (median age, 61 years) with abdominopelvic CT before primary cytoreductive surgery available through the Cancer Imaging Archive. Eight radiologists from the Cancer Genome Atlas Ovarian Cancer Imaging Research Group developed and independently recorded the following CT features: characteristics of primary ovarian mass(es), presence of definable mesenteric implants and infiltration, presence of other implants, presence and distribution of peritoneal spread, presence and size of pleural effusions and ascites, lymphadenopathy, and distant metastases. Interobserver agreement for CT features was assessed, as were univariate and multivariate associations with TTP and CLOVAR mesenchymal profile (worst prognosis). Results Interobserver agreement for some features was strong (eg, α = .78 for pleural effusion and ascites) but was lower for others (eg, α = .08 for intraparenchymal splenic metastases). Presence of peritoneal disease in the right upper quadrant (P = .0003), supradiaphragmatic lymphadenopathy (P = .0004), more peritoneal disease sites (P = .0006), and nonvisualization of a discrete ovarian mass (P = .0037) were associated with shorter TTP. More peritoneal disease sites (P = .0025) and presence of pouch of Douglas implants (P = .0045) were associated with CLOVAR mesenchymal profile. Combinations of imaging features contained predictive signal for TTP (concordance index = 0.658; P = .0006) and CLOVAR profile (mean

  13. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Nelson, Carl; Bai, Harrison; Neboori, Hanmanth; Takita, Cristiane; Motwani, Sabin; Wright, Jean L.; Hobeika, Georges; Haffty, Bruce G.; Jones, Tiffanie; Goyal, Sharad; Moran, Meena S.

    2012-01-01

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  14. Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules.

    Science.gov (United States)

    Dobbins, James T; McAdams, H Page; Sabol, John M; Chakraborty, Dev P; Kazerooni, Ella A; Reddy, Gautham P; Vikgren, Jenny; Båth, Magnus

    2017-01-01

    Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P chest radiography for all nodules (1.49-fold, P chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest

  15. Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative.

    Science.gov (United States)

    Subbe, Christian P; Kellett, John; Barach, Paul; Chaloner, Catriona; Cleaver, Hayley; Cooksley, Tim; Korsten, Erik; Croke, Eilish; Davis, Elinor; De Bie, Ashley Jr; Durham, Lesley; Hancock, Chris; Hartin, Jilian; Savijn, Tracy; Welch, John

    2017-05-08

    'Failure to rescue' of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology. A scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use. Safety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. 'Check In'), a list of prompts regarding common omissions (i.e. 'Stop & Think'), and, a list of items required for the safe "handover" of patients that remain on the general ward (i.e. 'Check Out'). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients. Emergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are

  16. Dose-Painted Intensity-Modulated Radiation Therapy for Anal Cancer: A Multi-Institutional Report of Acute Toxicity and Response to Therapy

    International Nuclear Information System (INIS)

    Kachnic, Lisa A.; Tsai, Henry K.; Coen, John J.; Blaszkowsky, Lawrence S.; Hartshorn, Kevan; Kwak, Eunice L.; Willins, John D.; Ryan, David P.; Hong, Theodore S.

    2012-01-01

    Purpose: Chemoradiation for anal cancer yields effective tumor control, but is associated with significant acute toxicity. We report our multi-institutional experience using dose-painted IMRT (DP-IMRT). Patients and Methods: Between August 2005 and May 2009, 43 patients were treated with DP-IMRT and concurrent chemotherapy for biopsy-proven, squamous cell carcinoma of the anal canal at two academic medical centers. DP-IMRT was prescribed as follows: T2N0: 42 Gy, 1.5 Gy/fraction (fx) to elective nodal planning target volume (PTV) and 50.4 Gy, 1.8 Gy/fx to anal tumor PTV; T3-4N0-3: 45 Gy, 1.5 Gy/fx to elective nodal PTV, and 54 Gy, 1.8 Gy/fx to the anal tumor and metastatic nodal PTV >3 cm with 50.4 Gy, 1.68 Gy/fx to nodal PTVs ≤3 cm in size. Acute and late toxicity was reported by the treating physician. Actuarial analysis was performed using the Kaplan-Meier method. Results: Median age was 58 years; 67% female; 16% Stage I, 37% II; 42% III; 5% IV. Fourteen patients were immunocompromised: 21% HIV-positive and 12% on chronic immunosuppression. Median follow-up was 24 months (range, 0.6–43.5 months). Sixty percent completed chemoradiation without treatment interruption; median duration of treatment interruption was 2 days (range, 2–24 days). Acute Grade 3+ toxicity included: hematologic 51%, dermatologic 10%, gastrointestinal 7%, and genitourinary 7%. Two-year local control, overall survival, colostomy-free survival, and metastasis-free survival were 95%, 94%, 90%, and 92%, respectively. Conclusions: Dose-painted IMRT appears effective and well-tolerated as part of a chemoradiation therapy regimen for the treatment of anal canal cancer.

  17. Dose-Painted Intensity-Modulated Radiation Therapy for Anal Cancer: A Multi-Institutional Report of Acute Toxicity and Response to Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kachnic, Lisa A., E-mail: lisa.kachnic@bmc.org [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Tsai, Henry K. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Coen, John J. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hartshorn, Kevan [Department of Medicine, Boston Medical Center, Boston, MA (United States); Kwak, Eunice L. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Willins, John D. [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hong, Theodore S. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

    2012-01-01

    Purpose: Chemoradiation for anal cancer yields effective tumor control, but is associated with significant acute toxicity. We report our multi-institutional experience using dose-painted IMRT (DP-IMRT). Patients and Methods: Between August 2005 and May 2009, 43 patients were treated with DP-IMRT and concurrent chemotherapy for biopsy-proven, squamous cell carcinoma of the anal canal at two academic medical centers. DP-IMRT was prescribed as follows: T2N0: 42 Gy, 1.5 Gy/fraction (fx) to elective nodal planning target volume (PTV) and 50.4 Gy, 1.8 Gy/fx to anal tumor PTV; T3-4N0-3: 45 Gy, 1.5 Gy/fx to elective nodal PTV, and 54 Gy, 1.8 Gy/fx to the anal tumor and metastatic nodal PTV >3 cm with 50.4 Gy, 1.68 Gy/fx to nodal PTVs {<=}3 cm in size. Acute and late toxicity was reported by the treating physician. Actuarial analysis was performed using the Kaplan-Meier method. Results: Median age was 58 years; 67% female; 16% Stage I, 37% II; 42% III; 5% IV. Fourteen patients were immunocompromised: 21% HIV-positive and 12% on chronic immunosuppression. Median follow-up was 24 months (range, 0.6-43.5 months). Sixty percent completed chemoradiation without treatment interruption; median duration of treatment interruption was 2 days (range, 2-24 days). Acute Grade 3+ toxicity included: hematologic 51%, dermatologic 10%, gastrointestinal 7%, and genitourinary 7%. Two-year local control, overall survival, colostomy-free survival, and metastasis-free survival were 95%, 94%, 90%, and 92%, respectively. Conclusions: Dose-painted IMRT appears effective and well-tolerated as part of a chemoradiation therapy regimen for the treatment of anal canal cancer.

  18. Radiomic features for prostate cancer detection on MRI differ between the transition and peripheral zones: Preliminary findings from a multi-institutional study.

    Science.gov (United States)

    Ginsburg, Shoshana B; Algohary, Ahmad; Pahwa, Shivani; Gulani, Vikas; Ponsky, Lee; Aronen, Hannu J; Boström, Peter J; Böhm, Maret; Haynes, Anne-Maree; Brenner, Phillip; Delprado, Warick; Thompson, James; Pulbrock, Marley; Taimen, Pekka; Villani, Robert; Stricker, Phillip; Rastinehad, Ardeshir R; Jambor, Ivan; Madabhushi, Anant

    2017-07-01

    To evaluate in a multi-institutional study whether radiomic features useful for prostate cancer (PCa) detection from 3 Tesla (T) multi-parametric MRI (mpMRI) in the transition zone (TZ) differ from those in the peripheral zone (PZ). 3T mpMRI, including T2-weighted (T2w), apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced MRI (DCE-MRI), were retrospectively obtained from 80 patients at three institutions. This study was approved by the institutional review board of each participating institution. First-order statistical, co-occurrence, and wavelet features were extracted from T2w MRI and ADC maps, and contrast kinetic features were extracted from DCE-MRI. Feature selection was performed to identify 10 features for PCa detection in the TZ and PZ, respectively. Two logistic regression classifiers used these features to detect PCa and were evaluated by area under the receiver-operating characteristic curve (AUC). Classifier performance was compared with a zone-ignorant classifier. Radiomic features that were identified as useful for PCa detection differed between TZ and PZ. When classification was performed on a per-voxel basis, a PZ-specific classifier detected PZ tumors on an independent test set with significantly higher accuracy (AUC = 0.61-0.71) than a zone-ignorant classifier trained to detect cancer throughout the entire prostate (P  0.14) were obtained for all institutions. A zone-aware classifier significantly improves the accuracy of cancer detection in the PZ. 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:184-193. © 2016 International Society for Magnetic Resonance in Medicine.

  19. Urology Residents' Experience and Attitude Toward Surgical Simulation: Presenting our 4-Year Experience With a Multi-institutional, Multi-modality Simulation Model.

    Science.gov (United States)

    Chow, Alexander K; Sherer, Benjamin A; Yura, Emily; Kielb, Stephanie; Kocjancic, Ervin; Eggener, Scott; Turk, Thomas; Park, Sangtae; Psutka, Sarah; Abern, Michael; Latchamsetty, Kalyan C; Coogan, Christopher L

    2017-11-01

    To evaluate the Urological resident's attitude and experience with surgical simulation in residency education using a multi-institutional, multi-modality model. Residents from 6 area urology training programs rotated through simulation stations in 4 consecutive sessions from 2014 to 2017. Workshops included GreenLight photovaporization of the prostate, ureteroscopic stone extraction, laparoscopic peg transfer, 3-dimensional laparoscopy rope pass, transobturator sling placement, intravesical injection, high definition video system trainer, vasectomy, and Urolift. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a nonvalidated questionnaire evaluating utility of the workshop and soliciting suggestions for improvement. Sixty-three of 75 participants (84%) (postgraduate years 1-6) completed the exit questionnaire. Median rating of exercise usefulness on a scale of 1-10 ranged from 7.5 to 9. On a scale of 0-10, cumulative median scores of the course remained high over 4 years: time limit per station (9; interquartile range [IQR] 2), faculty instruction (9, IQR 2), ease of use (9, IQR 2), face validity (8, IQR 3), and overall course (9, IQR 2). On multivariate analysis, there was no difference in rating of domains between postgraduate years. Sixty-seven percent (42/63) believe that simulation training should be a requirement of Urology residency. Ninety-seven percent (63/65) viewed the laboratory as beneficial to their education. This workshop model is a valuable training experience for residents. Most participants believe that surgical simulation is beneficial and should be a requirement for Urology residency. High ratings of usefulness for each exercise demonstrated excellent face validity provided by the course. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: treatment planning and quality assurance

    International Nuclear Information System (INIS)

    Otani, Yuki; Nose, Takayuki; Dokiya, Takushi; Saeki, Toshiaki; Kumazaki, Yu

    2015-01-01

    In Japan, breast-conserving surgery with closed cavity has generally been performed for breast cancer patients, and accelerated partial breast irradiation (APBI) is considered difficult because Asian females generally have smaller breast sizes than Western females. Therefore, common identification of target and treatment plan method in APBI is required. A prospective multicenter study was conducted in Japan to determine institutional compliance with APBI using high-dose-rate interstitial brachytherapy (ISBT) designed for Japanese female patients. For this study, 46 patients were recruited at eight institutions from January 2009 to December 2011. The reproducibility of the ISBT–APBI plan was evaluated using three criteria: (1) minimum clinical target volume dose with a clip dose ≥ 6 Gy/fraction, (2) irradiated volume constraint of 40-150 cm 3 , and (3) uniformity of dose distribution, expressed as the dose non-uniformity ratio (DNR, V150/V100) < 0.35. The ISBT–APBI plan for each patient was considered reproducible when all three criteria were met. When the number of non-reproducible patients was ≤ 4 at study completion, APBI at this institution was considered statistically reproducible. Half of the patients (52 %) had a small bra size (A/B cup). The mean values of the dose-constrained parameters were as follows: Vref, 117 cm 3 (range, 40-282), DNR, 0.30 (range, 0.22-0.51), and clip dose, 784 cGy (range, 469-3146). A total of 43/46 treatment plans were judged to be compliant and ISBT–APBI was concluded to be reproducible. This study showed that multi-institutional ISBT–APBI treatment plan was reproducible for small breast patient with closed cavity

  1. Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

    Science.gov (United States)

    Grignol, Valerie P; Grannan, Kevin; Sabra, John; Cromer, Robert M; Jarman, Benjamin; Dent, Daniel; Sticca, Robert P; Nelson, Timothy M; Kukora, John S; Daley, Brian J; Treat, Robert W; Termuhlen, Paula M

    2013-01-01

    Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear. We sought to verify these results in a multi-institutional study. A scenario-based survey describing potentially unethical activities related to the American Board of Surgery In-training Examination (ABSITE) was administered. Participants were asked about their knowledge of or participation in the activities and whether the activity was unethical. Program directors were surveyed about the use of ABSITE results for resident evaluation and promotion. Ten programs participated in the study. The resident response rate was 67% (186/277). Of the respondents, 43% felt that memorizing questions to study for future examinations was unethical and 50% felt that using questions another resident memorized was unethical. Most felt that buying (86%) or selling (79%) questions was unethical. Significantly more senior than junior residents have memorized (30% vs 16%; p = 0.04) or used questions others memorized (33% vs 12%; p = 0.002) to study for future ABSITE examinations and know of other residents who have done so (42% vs 20%; p = 0.004). Most programs used results of the ABSITE in promotion (80%) and set minimum score expectations and consequences (70%). Similar to our single-institution study, residents had not participated in activities they felt to be unethical; however the definition of what constitutes cheating remains unclear. Differences were identified between senior and junior residents with regard to memorizing questions for study. Cheating and unethical behavior is not always clear to the learner and represents an area for further education. © 2013 Association of Program Directors in Surgery

  2. SU-F-P-35: A Multi-Institutional Plan Quality Checking Tool Built On Oncospace: A Shared Radiation Oncology Database System

    International Nuclear Information System (INIS)

    Bowers, M; Robertson, S; Moore, J; Wong, J; Phillips, M; Hendrickson, K; Evans, K; McNutt, T

    2016-01-01

    Purpose: Late toxicity from radiation to critical structures limits the possible dose in Radiation Therapy. Perfectly conformal treatment of a target is not realizable, so the clinician must accept a certain level of collateral radiation to nearby OARs. But how much? General guidelines exist for healthy tissue sparing which guide RT treatment planning, but are these guidelines good enough to create the optimal plan given the individualized patient anatomy? We propose a means to evaluate the planned dose level to an OAR using a multi-institutional data-store of previously treated patients, so a clinician might reconsider planning objectives. Methods: The tool is built on Oncospace, a federated data-store system, which consists of planning data import, web based analysis tools, and a database containing:1) DVHs: dose by percent volume delivered to each ROI for each patient previously treated and included in the database.2) Overlap Volume Histograms (OVHs): Anatomical measure defined as the percent volume of an ROI within a given distance to target structures.Clinicians know what OARs are important to spare. For any ROI, Oncospace knows for which patients’ anatomy that ROI was harder to plan in the past (the OVH is less). The planned dose should be close to the least dose of previous patients. The tool displays the dose those OARs were subjected to, and the clinician can make a determination about the planning objectives used.Multiple institutions contribute to the Oncospace Consortium, and their DVH and OVH data are combined and color coded in the output. Results: The Oncospace website provides a plan quality display tool which identifies harder to treat patients, and graphically displays the dose delivered to them for comparison with the proposed plan. Conclusion: The Oncospace Consortium manages a data-store of previously treated patients which can be used for quality checking new plans. Grant funding by Elekta.

  3. SU-F-P-35: A Multi-Institutional Plan Quality Checking Tool Built On Oncospace: A Shared Radiation Oncology Database System

    Energy Technology Data Exchange (ETDEWEB)

    Bowers, M; Robertson, S; Moore, J; Wong, J [Johns Hopkins University, Baltimore, MD (United States); Phillips, M [University Washington, Seattle, WA (United States); Hendrickson, K; Evans, K [University of Washington, Seattle, WA (United States); McNutt, T [Johns Hopkins University, Severna Park, MD (United States)

    2016-06-15

    Purpose: Late toxicity from radiation to critical structures limits the possible dose in Radiation Therapy. Perfectly conformal treatment of a target is not realizable, so the clinician must accept a certain level of collateral radiation to nearby OARs. But how much? General guidelines exist for healthy tissue sparing which guide RT treatment planning, but are these guidelines good enough to create the optimal plan given the individualized patient anatomy? We propose a means to evaluate the planned dose level to an OAR using a multi-institutional data-store of previously treated patients, so a clinician might reconsider planning objectives. Methods: The tool is built on Oncospace, a federated data-store system, which consists of planning data import, web based analysis tools, and a database containing:1) DVHs: dose by percent volume delivered to each ROI for each patient previously treated and included in the database.2) Overlap Volume Histograms (OVHs): Anatomical measure defined as the percent volume of an ROI within a given distance to target structures.Clinicians know what OARs are important to spare. For any ROI, Oncospace knows for which patients’ anatomy that ROI was harder to plan in the past (the OVH is less). The planned dose should be close to the least dose of previous patients. The tool displays the dose those OARs were subjected to, and the clinician can make a determination about the planning objectives used.Multiple institutions contribute to the Oncospace Consortium, and their DVH and OVH data are combined and color coded in the output. Results: The Oncospace website provides a plan quality display tool which identifies harder to treat patients, and graphically displays the dose delivered to them for comparison with the proposed plan. Conclusion: The Oncospace Consortium manages a data-store of previously treated patients which can be used for quality checking new plans. Grant funding by Elekta.

  4. Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study.

    Science.gov (United States)

    Brown, Carlos V R; Teixeira, Pedro G; Furay, Elisa; Sharpe, John P; Musonza, Tashinga; Holcomb, John; Bui, Eric; Bruns, Brandon; Hopper, H Andrew; Truitt, Michael S; Burlew, Clay C; Schellenberg, Morgan; Sava, Jack; VanHorn, John; Eastridge, Pa-C Brian; Cross, Alicia M; Vasak, Richard; Vercruysse, Gary; Curtis, Eleanor E; Haan, James; Coimbra, Raul; Bohan, Phillip; Gale, Stephen; Bendix, Peter G

    2018-02-01

    Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three

  5. Evaluation of ERG and SPINK1 by Immunohistochemical Staining and Clinicopathological Outcomes in a Multi-Institutional Radical Prostatectomy Cohort of 1067 Patients.

    Directory of Open Access Journals (Sweden)

    James D Brooks

    Full Text Available Distinguishing between patients with early stage, screen detected prostate cancer who must be treated from those that can be safely watched has become a major issue in prostate cancer care. Identification of molecular subtypes of prostate cancer has opened the opportunity for testing whether biomarkers that characterize these subtypes can be used as biomarkers of prognosis. Two established molecular subtypes are identified by high expression of the ERG oncoprotein, due to structural DNA alterations that encode for fusion transcripts in approximately ½ of prostate cancers, and over-expression of SPINK1, which is purportedly found only in ERG-negative tumors. We used a multi-institutional prostate cancer tissue microarray constructed from radical prostatectomy samples with associated detailed clinical data and with rigorous selection of recurrent and non-recurrent cases to test the prognostic value of immunohistochemistry staining results for the ERG and SPINK1 proteins. In univariate analysis, ERG positive cases (419/1067; 39% were associated with lower patient age, pre-operative serum PSA levels, lower Gleason scores (≤ 3+4=7 and improved recurrence free survival (RFS. On multivariate analysis, ERG status was not correlated with RFS, disease specific survival (DSS or overall survival (OS. High-level SPINK1 protein expression (33/1067 cases; 3% was associated with improved RFS on univariate and multivariate Cox regression analysis. Over-expression of either protein was not associated with clinical outcome. While expression of ERG and SPINK1 proteins was inversely correlated, it was not mutually exclusive since 3 (0.28% cases showed high expression of both. While ERG and SPINK1 appear to identify discrete molecular subtypes of prostate cancer, only high expression of SPINK1 was associated with improved clinical outcome. However, by themselves, neither ERG nor SPINK1 appear to be useful biomarkers for prognostication of early stage prostate

  6. Evaluation of ERG and SPINK1 by Immunohistochemical Staining and Clinicopathological Outcomes in a Multi-Institutional Radical Prostatectomy Cohort of 1067 Patients.

    Science.gov (United States)

    Brooks, James D; Wei, Wei; Hawley, Sarah; Auman, Heidi; Newcomb, Lisa; Boyer, Hilary; Fazli, Ladan; Simko, Jeff; Hurtado-Coll, Antonio; Troyer, Dean A; Carroll, Peter R; Gleave, Martin; Lance, Raymond; Lin, Daniel W; Nelson, Peter S; Thompson, Ian M; True, Lawrence D; Feng, Ziding; McKenney, Jesse K

    2015-01-01

    Distinguishing between patients with early stage, screen detected prostate cancer who must be treated from those that can be safely watched has become a major issue in prostate cancer care. Identification of molecular subtypes of prostate cancer has opened the opportunity for testing whether biomarkers that characterize these subtypes can be used as biomarkers of prognosis. Two established molecular subtypes are identified by high expression of the ERG oncoprotein, due to structural DNA alterations that encode for fusion transcripts in approximately ½ of prostate cancers, and over-expression of SPINK1, which is purportedly found only in ERG-negative tumors. We used a multi-institutional prostate cancer tissue microarray constructed from radical prostatectomy samples with associated detailed clinical data and with rigorous selection of recurrent and non-recurrent cases to test the prognostic value of immunohistochemistry staining results for the ERG and SPINK1 proteins. In univariate analysis, ERG positive cases (419/1067; 39%) were associated with lower patient age, pre-operative serum PSA levels, lower Gleason scores (≤ 3+4=7) and improved recurrence free survival (RFS). On multivariate analysis, ERG status was not correlated with RFS, disease specific survival (DSS) or overall survival (OS). High-level SPINK1 protein expression (33/1067 cases; 3%) was associated with improved RFS on univariate and multivariate Cox regression analysis. Over-expression of either protein was not associated with clinical outcome. While expression of ERG and SPINK1 proteins was inversely correlated, it was not mutually exclusive since 3 (0.28%) cases showed high expression of both. While ERG and SPINK1 appear to identify discrete molecular subtypes of prostate cancer, only high expression of SPINK1 was associated with improved clinical outcome. However, by themselves, neither ERG nor SPINK1 appear to be useful biomarkers for prognostication of early stage prostate cancer.

  7. Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk cT3b/4 PCa: a multi-institutional outcome study of 266 patients.

    Science.gov (United States)

    Moltzahn, F; Karnes, J; Gontero, P; Kneitz, B; Tombal, B; Bader, P; Briganti, A; Montorsi, F; Van Poppel, H; Joniau, S; Spahn, M

    2015-03-01

    The value of radical prostatectomy (RP) as an approach for very high-risk prostate cancer (PCa) patients is controversial. To examine the risk of 10-year cancer-specific mortality (CSM) and other-cause mortality (OCM) according to clinical and pathological characteristics of very high-risk cT3b/4 PCa patients treated with RP as the primary treatment option. In a multi-institutional cohort, 266 patients with very high-risk cT3b/4 PCa treated with RP were identified. All patients underwent RP and pelvic lymph-node dissection. Competing-risk analyses assessed 10-year CSM and OCM before and after stratification for age and Charlson comorbidity index (CCI). Overall, 34 (13%) patients died from PCa and 73 (28%) from OCM. Ten-year CSM and OCM rates ranged from 5.6% to 12.9% and from 10% to 38%, respectively. OCM was the leading cause of death in all subgroups. Age and comorbidities were the main determinants of OCM. In healthy men, CSM rate did not differ among age groups (10-year CSM rate for ⩽64, 65-69 and ⩾70 years: 16.2%, 11.5% and 17.1%, respectively). Men with a CCI ⩾1 showed a very low risk of CSM irrespective of age (10-year CSM: 5.6-6.1%), whereas the 10-year OCM rates increased with age up to 38% in men ⩾70 years. Very high-risk cT3b/4 PCa represents a heterogeneous group. We revealed overall low CSM rates despite the highly unfavorable clinical disease. For healthy men, CSM was independent of age, supporting RP even for older men. Conversely, less healthy patients had the highest risk of dying from OCM while sharing very low risk of CSM, indicating that this group might not benefit from an aggressive surgical treatment. Outcome after RP as the primary treatment option in cT3b/4 PCa patients is related to age and comorbidity status.

  8. Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: a multi-institutional study of the AAST.

    Science.gov (United States)

    Michetti, Christopher P; Fakhry, Samir M; Ferguson, Pamela L; Cook, Alan; Moore, Forrest O; Gross, Ronald

    2012-05-01

    Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers. VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics. At 47 participating Level I and II centers, the pooled mean VAP rate was 17.2 versus 8.1 for NHSN (2006-2008). Hospitals' rates were highly variable (range, 1.8-57.6), with 72.3% being above NHSN's mean. Rates differed based on who determined the rate (trauma service, 27.5; infection control or quality or epidemiology, 11.9; or collaborative effort, 19.9) and the frequency with which VAP was excluded based on aspiration or diagnosis before hospital day 5. In 2008 and 2009, blunt trauma patients had higher VAP rates (17.3 and 17.6, respectively) than penetrating patients (11.0 and 10.9, respectively). More centers used a clinical diagnostic strategy (57%) than a bacteriologic strategy (43%). Patients with VAP had a mean Injury Severity Score of 28.7, mean Intensive Care Unit length of stay of 20.8 days, and a 12.2% mortality rate. 50.5% of VAP patients had a traumatic brain injury. VAP rates at major trauma centers are markedly higher than those reported by NHSN and vary significantly among centers. Available data are insufficient to set benchmarks, because it is questionable whether any one data set is truly representative of most trauma centers. Application of a single benchmark to all centers may be inappropriate, and reliable diagnostic and reporting standards are needed. Prospective analysis of a larger data set is warranted, with attention to injury severity, risk factors specific to trauma patients, diagnostic method used, VAP definitions

  9. A multi-institutional phase II study of hyperfractionated accelerated radiation therapy for unresectable non-small cell lung cancer: initial report of ECOG 4593

    International Nuclear Information System (INIS)

    Tannehill, Scott P.; Froseth, Carrie; Wagner, Henry; Petereit, Dan P.; Mehta, Minesh P.

    1996-01-01

    keeping with the previously published CALGB report, NEJM 323:940, 1990) results in a 1-yr actuarial survival of 71%. Conclusion: This multi-institution pilot trial has demonstrated the feasibility and tolerance of a t.i.d. thoracic radiation therapy regimen compatible with radiotherapy practices in North America, providing the basis for a larger trial to assess the response and survival of NSCLC pts treated with such a regimen

  10. Multi-Institutional Phase II Study of High-Dose Hypofractionated Proton Beam Therapy in Patients With Localized, Unresectable Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma.

    Science.gov (United States)

    Hong, Theodore S; Wo, Jennifer Y; Yeap, Beow Y; Ben-Josef, Edgar; McDonnell, Erin I; Blaszkowsky, Lawrence S; Kwak, Eunice L; Allen, Jill N; Clark, Jeffrey W; Goyal, Lipika; Murphy, Janet E; Javle, Milind M; Wolfgang, John A; Drapek, Lorraine C; Arellano, Ronald S; Mamon, Harvey J; Mullen, John T; Yoon, Sam S; Tanabe, Kenneth K; Ferrone, Cristina R; Ryan, David P; DeLaney, Thomas F; Crane, Christopher H; Zhu, Andrew X

    2016-02-10

    To evaluate the efficacy and safety of high-dose, hypofractionated proton beam therapy for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). In this single-arm, phase II, multi-institutional study, 92 patients with biopsy-confirmed HCC or ICC, determined to be unresectable by multidisciplinary review, with a Child-Turcotte-Pugh score (CTP) of A or B, ECOG performance status of 0 to 2, no extrahepatic disease, and no prior radiation received 15 fractions of proton therapy to a maximum total dose of 67.5 Gy equivalent. Sample size was calculated to demonstrate > 80% local control (LC) defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 criteria at 2 years for HCC patients, with the parallel goal of obtaining acceptable precision for estimating outcomes for ICC. Eighty-three patients were evaluable: 44 with HCC, 37 with ICC, and two with mixed HCC/ICC. The CTP score was A for 79.5% of patients and B for 15.7%; 4.8% of patients had no cirrhosis. Prior treatment had been given to 31.8% of HCC patients and 61.5% of ICC patients. The median maximum dimension was 5.0 cm (range, 1.9 to 12.0 cm) for HCC patients and 6.0 cm (range, 2.2 to 10.9 cm) for ICC patients. Multiple tumors were present in 27.3% of HCC patients and in 12.8% of ICC patients. Tumor vascular thrombosis was present in 29.5% of HCC patients and in 28.2% of ICC patients. The median dose delivered to both HCC and ICC patients was 58.0 Gy. With a median follow-up among survivors of 19.5 months, the LC rate at 2 years was 94.8% for HCC and 94.1% for ICC. The overall survival rate at 2 years was 63.2% for HCC and 46.5% ICC. High-dose hypofractionated proton therapy demonstrated high LC rates for HCC and ICC safely, supporting ongoing phase III trials of radiation in HCC and ICC. © 2015 by American Society of Clinical Oncology.

  11. Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Ohashi, Toshio, E-mail: ohashi@rad.med.keio.ac.jp [Keio University School of Medicine, Tokyo (Japan); Yorozu, Atsunori; Saito, Shiro [National Hospital Organization Tokyo Medical Center, Tokyo (Japan); Tanaka, Nobumichi [Nara Medical University School of Medicine, Nara (Japan); Katayama, Norihisa [Okayama University School of Medicine, Okayama (Japan); Kojima, Shinsuke; Maruo, Shinichiro; Kikuchi, Takashi [Translational Research Informatics Center, Hyogo (Japan); Dokiya, Takushi [Kyoundo Hospital, Tokyo (Japan); Fukushima, Masanori [Translational Research Informatics Center, Hyogo (Japan); Yamanaka, Hidetoshi [Institutes of Preventive Medicine, Kurosawa Hospital, Gunma (Japan)

    2015-09-01

    Purpose: To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT). Methods and Materials: Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiation therapy. Results: Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P<.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P<.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment. Conclusions: The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other

  12. Outcomes in a Multi-institutional Cohort of Patients Treated With Intraoperative Radiation Therapy for Advanced or Recurrent Renal Cell Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Paly, Jonathan J. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Hallemeier, Christopher L. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Biggs, Peter J.; Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Roeder, Falk [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Martínez-Monge, Rafael [Radiation Oncology Division, University of Navarre, Pamplona (Spain); Whitson, Jared [Department of Urology, University of California San Francisco, San Francisco, California (United States); Calvo, Felipe A. [Departamento de Oncología, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Fastner, Gerd; Sedlmayer, Felix [Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Clinics, Salzburg (Austria); Wong, William W. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States); Ellis, Rodney J. [Department of Radiation Oncology, Seidman Cancer Center University Hospitals Case Medical Center, Cleveland, Ohio (United States); Haddock, Michael G.; Choo, Richard [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Shipley, William U.; Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Efstathiou, Jason A., E-mail: jefstathiou@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-03-01

    Purpose/Objective(s): This study aimed to analyze outcomes in a multi-institutional cohort of patients with advanced or recurrent renal cell carcinoma (RCC) who were treated with intraoperative radiation therapy (IORT). Methods and Materials: Between 1985 and 2010, 98 patients received IORT for advanced or locally recurrent RCC at 9 institutions. The median follow-up time for surviving patients was 3.5 years. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were estimated with the Kaplan-Meier method. Chained imputation accounted for missing data, and multivariate Cox hazards regression tested significance. Results: IORT was delivered during nephrectomy for advanced disease (28%) or during resection of locally recurrent RCC in the renal fossa (72%). Sixty-nine percent of the patients were male, and the median age was 58 years. At the time of primary resection, the T stages were as follows: 17% T1, 12% T2, 55% T3, and 16% T4. Eighty-seven percent of the patients had a visibly complete resection of tumor. Preoperative or postoperative external beam radiation therapy was administered to 27% and 35% of patients, respectively. The 5-year OS was 37% for advanced disease and 55% for locally recurrent disease. The respective 5-year DSS was 41% and 60%. The respective 5-year DFS was 39% and 52%. Initial nodal involvement (hazard ratio [HR] 2.9-3.6, P<.01), presence of sarcomatoid features (HR 3.7-6.9, P<.05), and higher IORT dose (HR 1.3, P<.001) were statistically significantly associated with decreased survival. Adjuvant systemic therapy was associated with decreased DSS (HR 2.4, P=.03). For locally recurrent tumors, positive margin status (HR 2.6, P=.01) was associated with decreased OS. Conclusions: We report the largest known cohort of patients with RCC managed by IORT and have identified several factors associated with survival. The outcomes for patients receiving IORT in the setting of local recurrence compare favorably to

  13. Effectiveness and side-effects of peptide receptor radionuclide therapy for neuroendocrine neoplasms in Germany: A multi-institutional registry study with prospective follow-up.

    Science.gov (United States)

    Hörsch, Dieter; Ezziddin, Samer; Haug, Alexander; Gratz, Klaus Friedrich; Dunkelmann, Simone; Miederer, Matthias; Schreckenberger, Mathias; Krause, Bernd Joachim; Bengel, Frank M; Bartenstein, Peter; Biersack, Hans-Jürgen; Pöpperl, Gabriele; Baum, R P

    2016-05-01

    Monocentric and retrospective studies indicate effectiveness of peptide receptor radionuclide therapy targeting somatostatin receptors of neuroendocrine neoplasms. We assessed overall and progression-free survival and adverse events of peptide receptor radionuclide therapy by a multi-institutional, board certified registry with prospective follow-up in five centres in Germany. A total of 450 patients were included and followed for a mean of 24.4 months. Most patients had progressive low- or intermediate grade neuroendocrine neoplasms and 73% were pretreated with at least one therapy. Primary neuroendocrine neoplasms were mainly derived of pancreas (38%), small bowel (30%), unknown primary (19%) or bronchial system (4%). Patients were treated with Lutetium-177 in 54%, with Yttrium-90 in 17% and with both radionuclides in 29%. Overall and progression-free survival was determined with Kaplan-Meier curves and uni-variate log rank test Cox models. Median overall survival of all patients was 59 (95% confidence interval [CI] 49-68.9) months. Overall survival was significantly inferior in the patients treated with Yttrium-90 solely (hazard ratio, 3.22; 95% CI, 1.83-5.64) compared to any peptide receptor radionuclide therapy with Lutetium-177. Grade II (hazard ratio, 2.06; 95% CI, 0.79-5.32) and grade III (hazard ratio, 4.22; 95% CI, 1.41-12.06) neuroendocrine neoplasms had significantly worse overall survival than grade I neuroendocrine neoplasms. Patients with small neuroendocrine neoplasms of small bowel had significantly increased survival (hazard ratio, 0.39; 95% CI, 0.18-0.87) compared to neuroendocrine neoplasms of other locations. Median progression-free survival was 41 (35.9-46.1) months and significantly inferior in patients treated with Yttrium solely (hazard ratio, 2.7; 95% CI, 1.71-4.55). Complete remission was observed in 5.6% of patients, 22.4% had a partial remission, 47.3% were stable and 4% were progressive as best response. Adverse events of bone marrow

  14. Measuring Electrospun Nanofibre Diameter: a Novel Approach

    International Nuclear Information System (INIS)

    Ziabari, M.; Mottaghitalab, V.; Haghi, A. K.; McGovern, S. T.

    2008-01-01

    A new method based on image analysis for electrospun nanofibre diameter measurement is presented. First, the SEM micrograph of the nanofibre web obtained by electrospinning process is converted to binary image using local thresholding method. In the next step, skeleton and distance transformed image are generated. Then, the intersection points which bring about untrue measurements are identified and removed from the skeleton. Finally, the resulting skeleton and distance transformed image are used to determine fibre diameter. The method is evaluated by a simulated image with known characteristics generated by ?-randomness procedure. The results indicate that this approach is successful in making fast, accurate automated measurements of electrospun fibre diameters. (cross-disciplinary physics and related areas of science and technology)

  15. Is Intermediate Radiation Dose Escalation With Concurrent Chemotherapy for Stage III Non–Small-Cell Lung Cancer Beneficial? A Multi-Institutional Propensity Score Matched Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, George, E-mail: george.rodrigues@lhsc.on.ca [London Health Sciences Centre, London, Ontario (Canada); Oberije, Cary [MAASTRO Clinic, Maastricht (Netherlands); Senan, Suresh [VU University Medical Center, Amsterdam (Netherlands); Tsujino, Kayoko [Hyogo Cancer Center, Akashi (Japan); Wiersma, Terry [MAASTRO Clinic, Maastricht (Netherlands); Moreno-Jimenez, Marta [Universidad de Navarra, Pamplona (Spain); Kim, Tae Hyun [National Cancer Center, Goyang-si, Gy eonggi (Korea, Republic of); Marks, Lawrence B. [University of North Carolina, Chapel Hill, North Carolina (United States); Rengan, Ramesh [University of Washington, Seattle, Washington (United States); De Petris, Luigi [Karolinska University Hospital, Stockholm (Sweden); Ramella, Sara [Campus Bio-Medico University, Rome (Italy); DeRuyck, Kim [Ghent University, Ghent (Belgium); De Dios, Núria Rodriguez [Universidad Pompeu Fabra, Barcelona (Spain); Warner, Andrew [London Health Sciences Centre, London, Ontario (Canada); Bradley, Jeffrey D. [Washington University School of Medicine, St. Louis, Missouri (United States); Palma, David A. [London Health Sciences Centre, London, Ontario (Canada)

    2015-01-01

    Purpose: The clinical benefits and risks of dose escalation (DE) for stage III non–small-cell lung cancer (NSCLC) remain uncertain despite the results from Radiation Therapy Oncology Group (RTOG) protocol 0617. There is significant heterogeneity of practice, with many clinicians prescribing intermediate dose levels between the 0617 study arms of 60 and 74 Gy. This study investigated whether this strategy is associated with any survival benefits/risks by analyzing a large multi-institutional database. Methods and Materials: An individual patient database of stage III NSCLC patients treated with radical intent concurrent chemoradiation therapy was created (13 institutions, n=1274 patients). Patients were divided into 2 groups based on tumor Biological Effective Dose at 10 Gy (BED 10): those receiving standard dose (SD; n=552), consisting of 72Gy ≤ BED 10 ≤ 76.8 Gy (eg 60-64 Gy/30-32 fractions [fr]), and those receiving intermediate dose (ID; n=497), consisting of 76.8Gy < BED 10 < 100.8 Gy (eg >64 Gy/32 fr and <74 Gy/37 fr), with lower-dose patients (n=225) excluded from consideration. Patients were then matched using propensity scores, leading to 2 matched groups of 196 patients. Outcomes were compared using various statistics including interquartile range (IQR), Kaplan-Meier curves, and adjusted Cox regression analysis. Results: Matched groups were found to be balanced except for N stage (more N3 disease in SD), median treatment year (SD in 2003; ID in 2007), platinum and taxane chemotherapy (SD in 28%; ID in 39%), and median follow-up (SD were 89 months; ID were 40 months). Median dose fractionation was 60 Gy/30 fr in SD (BED 10 IQR: 72.0-75.5 Gy) and 66 Gy/33 fr (BED 10 IQR: 78.6-79.2 Gy) in ID. Survival curves for SD and ID matched cohorts were statistically similar (P=.27); however, a nonstatistically significant trend toward better survival for ID was observed after 15 months (median survival SD: 19.3 months; ID: 21.0

  16. Approach of Complex Networks for the Determination of Brain Death

    International Nuclear Information System (INIS)

    Sun Wei-Gang; Cao Jian-Ting; Wang Ru-Bin

    2011-01-01

    In clinical practice, brain death is the irreversible end of all brain activity. Compared to current statistical methods for the determination of brain death, we focus on the approach of complex networks for real-world electroencephalography in its determination. Brain functional networks constructed by correlation analysis are derived, and statistical network quantities used for distinguishing the patients in coma or brain death state, such as average strength, clustering coefficient and average path length, are calculated. Numerical results show that the values of network quantities of patients in coma state are larger than those of patients in brain death state. Our findings might provide valuable insights on the determination of brain death. (cross-disciplinary physics and related areas of science and technology)

  17. Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer: A Multi-institutional Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Shostrom, Valerie K. [Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (United States); Zhen, Weining; Zhang, Mutian [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Braunstein, Steve E. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Holland, John [Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon (United States); Hallemeier, Christopher L. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Harkenrider, Matthew M. [Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois (United States); Iskhanian, Adrian [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida (United States); Jabbour, Salma K. [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey (United States); Attia, Albert [Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (United States); Lee, Percy [Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California (United States); Wang, Kyle [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina (United States); Decker, Roy H. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); McGarry, Ronald C. [Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky (United States); Simone, Charles B., E-mail: charlessimone@umm.edu [Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States)

    2017-03-15

    Purpose: To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. Methods: Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. Results: Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05). Conclusions: From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.

  18. Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer: A Multi-institutional Analysis.

    Science.gov (United States)

    Verma, Vivek; Shostrom, Valerie K; Zhen, Weining; Zhang, Mutian; Braunstein, Steve E; Holland, John; Hallemeier, Christopher L; Harkenrider, Matthew M; Iskhanian, Adrian; Jabbour, Salma K; Attia, Albert; Lee, Percy; Wang, Kyle; Decker, Roy H; McGarry, Ronald C; Simone, Charles B

    2017-03-15

    To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, Plocation (P>.05). From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Multi-institutional Feasibility Study of a Fast Patient Localization Method in Total Marrow Irradiation With Helical Tomotherapy: A Global Health Initiative by the International Consortium of Total Marrow Irradiation

    International Nuclear Information System (INIS)

    Takahashi, Yutaka; Vagge, Stefano; Agostinelli, Stefano; Han, Eunyoung; Matulewicz, Lukasz; Schubert, Kai; Chityala, Ravishankar; Ratanatharathorn, Vaneerat; Tournel, Koen; Penagaricano, Jose A.; Florian, Sterzing; Mahe, Marc-Andre; Verneris, Michael R.; Weisdorf, Daniel J.

    2015-01-01

    Purpose: To develop, characterize, and implement a fast patient localization method for total marrow irradiation. Methods and Materials: Topographic images were acquired using megavoltage computed tomography (MVCT) detector data by delivering static orthogonal beams while the couch traversed through the gantry. Geometric and detector response corrections were performed to generate a megavoltage topogram (MVtopo). We also generated kilovoltage topograms (kVtopo) from the projection data of 3-dimensional CT images to reproduce the same geometry as helical tomotherapy. The MVtopo imaging dose and the optimal image acquisition parameters were investigated. A multi-institutional phantom study was performed to verify the image registration uncertainty. Forty-five MVtopo images were acquired and analyzed with in-house image registration software. Results: The smallest jaw size (front and backup jaws of 0) provided the best image contrast and longitudinal resolution. Couch velocity did not affect the image quality or geometric accuracy. The MVtopo dose was less than the MVCT dose. The image registration uncertainty from the multi-institutional study was within 2.8 mm. In patient localization, the differences in calculated couch shift between the registration with MVtopo-kVtopo and MVCT-kVCT images in lateral, cranial–caudal, and vertical directions were 2.2 ± 1.7 mm, 2.6 ± 1.4 mm, and 2.7 ± 1.1 mm, respectively. The imaging time in MVtopo acquisition at the couch speed of 3 cm/s was <1 minute, compared with ≥15 minutes in MVCT for all patients. Conclusion: Whole-body MVtopo imaging could be an effective alternative to time-consuming MVCT for total marrow irradiation patient localization

  20. Reproducibility and predictive value of scoring stromal tumour infiltrating lymphocytes in triple-negative breast cancer: a multi-institutional study.

    Science.gov (United States)

    O'Loughlin, Mark; Andreu, Xavier; Bianchi, Simonetta; Chemielik, Ewa; Cordoba, Alicia; Cserni, Gábor; Figueiredo, Paulo; Floris, Giuseppe; Foschini, Maria P; Heikkilä, Päivi; Kulka, Janina; Liepniece-Karele, Inta; Regitnig, Peter; Reiner, Angelika; Ryska, Ales; Sapino, Anna; Shalaby, Aliaa; Stovgaard, Elisabeth Specht; Quinn, Cecily; Walsh, Elaine M; Zolota, Vicky; Glynn, Sharon A; Callagy, Grace

    2018-05-17

    Several studies have demonstrated a prognostic role for stromal tumour infiltrating lymphocytes (sTILs) in triple-negative breast cancer (TNBC). The reproducibility of scoring sTILs is variable with potentially excellent concordance being achievable using a software tool. We examined agreement between breast pathologists across Europe scoring sTILs on H&E-stained sections without software, an approach that is easily applied in clinical practice. The association between sTILs and response to anthracycline-taxane NACT was also examined. Pathologists from the European Working Group for Breast Screening Pathology scored sTILs in 84 slides from 75 TNBCs using the immune-oncology biomarker working group guidance in two circulations. There were 16 participants in the first and 19 in the second circulation. Moderate agreement was achieved for absolute sTILs scores (intraclass correlation coefficient (ICC) = 0.683, 95% CI 0.601-0.767, p-value value value values (Spearman ρ = 0.727); fair for sTILs ≥ 25% (κ = 0.53) and for LPBC (κ = 0.49), but poor for sTILs as 10% increments (κ = 0.24). Increasing sTILs was significantly associated with an increased likelihood of a pathological complete response (pCR) on multivariable analysis. Increasing sTILs in TNBCs improves the likelihood of a pCR. However, inter-observer agreement is such that H&E-based assessment is not sufficiently reproducible for clinical application. Other methodologies should be explored, but may be at the cost of ease of application.

  1. Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease. A multi-institutional treatment recommendation

    International Nuclear Information System (INIS)

    Nieder, Carsten; Ruysscher, Dirk de; Gaspar, Laurie E.; Guckenberger, Matthias; Mehta, Minesh P.; Cheung, Patrick; Sahgal, Arjun

    2017-01-01

    Practice guidelines have been developed for early-stage and locally advanced non-small cell lung cancer (NSCLC). However, many common clinical scenarios still require individualized decision making. This is true for locoregional relapse after initial stereotactic radiotherapy (stereotactic body radiation therapy or stereotactic ablative radiotherapy; SBRT or SABR), an increasingly utilized curative treatment option for stage I NSCLC. A consortium of expert radiation oncologists was established with the aim of providing treatment recommendations. In this scenario, a case was distributed to six radiation oncologists who provided their institutions' treatment recommendations. In this case, a patient developed local and mediastinal relapse after SABR (45 Gy, 3 fractions), comparable to the tumor burden in de novo stage IIIA NSCLC. Treatment recommendations were tabulated and a consensus conclusion was developed. Three institutions recommended evaluation for surgery. If the patient was not a surgical candidate, and/or refused surgery, definitive chemoradiation was recommended, including retreating the primary to full dose. European participants were more in favor of a non-surgical approach. None of the participants were reluctant to prescribe reirradiation, but two institutions prescribed doses lower than 60 Gy. Platinum-based doublets together with intensity-modulated radiotherapy were preferred. The institutional recommendations reflect the questions and uncertainties discussed in current stage III guidelines. All institutions agreed that previous SABR is not a contraindication for salvage chemoradiation. In the absence of high-quality prospective trials for recurrent NSCLC, all treatment options recommended in current guidelines for stage III disease can be considered in clinical scenarios such as this. (orig.) [de

  2. The Feasibility of Real-Time Intraoperative Performance Assessment With SIMPL (System for Improving and Measuring Procedural Learning): Early Experience From a Multi-institutional Trial.

    Science.gov (United States)

    Bohnen, Jordan D; George, Brian C; Williams, Reed G; Schuller, Mary C; DaRosa, Debra A; Torbeck, Laura; Mullen, John T; Meyerson, Shari L; Auyang, Edward D; Chipman, Jeffrey G; Choi, Jennifer N; Choti, Michael A; Endean, Eric D; Foley, Eugene F; Mandell, Samuel P; Meier, Andreas H; Smink, Douglas S; Terhune, Kyla P; Wise, Paul E; Soper, Nathaniel J; Zwischenberger, Joseph B; Lillemoe, Keith D; Dunnington, Gary L; Fryer, Jonathan P

    Intraoperative performance assessment of residents is of growing interest to trainees, faculty, and accreditors. Current approaches to collect such assessments are limited by low participation rates and long delays between procedure and evaluation. We deployed an innovative, smartphone-based tool, SIMPL (System for Improving and Measuring Procedural Learning), to make real-time intraoperative performance assessment feasible for every case in which surgical trainees participate, and hypothesized that SIMPL could be feasibly integrated into surgical training programs. Between September 1, 2015 and February 29, 2016, 15 U.S. general surgery residency programs were enrolled in an institutional review board-approved trial. SIMPL was made available after 70% of faculty and residents completed a 1-hour training session. Descriptive and univariate statistics analyzed multiple dimensions of feasibility, including training rates, volume of assessments, response rates/times, and dictation rates. The 20 most active residents and attendings were evaluated in greater detail. A total of 90% of eligible users (1267/1412) completed training. Further, 13/15 programs began using SIMPL. Totally, 6024 assessments were completed by 254 categorical general surgery residents (n = 3555 assessments) and 259 attendings (n = 2469 assessments), and 3762 unique operations were assessed. There was significant heterogeneity in participation within and between programs. Mean percentage (range) of users who completed ≥1, 5, and 20 assessments were 62% (21%-96%), 34% (5%-75%), and 10% (0%-32%) across all programs, and 96%, 75%, and 32% in the most active program. Overall, response rate was 70%, dictation rate was 24%, and mean response time was 12 hours. Assessments increased from 357 (September 2015) to 1146 (February 2016). The 20 most active residents each received mean 46 assessments by 10 attendings for 20 different procedures. SIMPL can be feasibly integrated into surgical training programs

  3. A phase II multi-institutional study assessing simultaneous in-field boost helical tomotherapy for 1-3 brain metastases

    International Nuclear Information System (INIS)

    Rodrigues, George; Yartsev, Slav; Tay, Keng Yeow; Pond, Gregory R; Lagerwaard, Frank; Bauman, Glenn

    2012-01-01

    Our research group has previously published a dosimetric planning study that demonstrated that a 60 Gy/10 fractions intralesional boost with whole-brain radiotherapy (WBRT) to 30 Gy/10 fractions was biologically equivalent with a stereotactic radiosurgery (SRS) boost of 18 Gy/1 fraction with 30 Gy/10 fractions WBRT. Helical tomotherapy (HT) was found to be dosimetrically equivalent to SRS in terms of target coverage and superior to SRS in terms of normal tissue tolerance. A phase I trial has been now completed at our institution with a total of 60 enrolled patients and 48 evaluable patients. The phase II dose has been determined to be the final phase I cohort dose of 60 Gy/10 fractions. The objective of this clinical trial is to subject the final phase I cohort dose to a phase II assessment of the endpoints of overall survival, intracranial control (ICC) and intralesional control (ILC). We hypothesize HT would be considered unsuitable for further study if the median OS for patients treated with the HT SIB technique is degraded by 2 months, or the intracranial progression-free rates (ICC and ILC) are inferior by 10% or greater compared to the expected results with treatment by whole brain plus SRS as defined by the RTOG randomized trial. A sample size of 93 patients was calculated based on these parameters as well as the statistical assumptions of alpha = 0.025 and beta = 0.1 due to multiple statistical testing. Secondary assessments of toxicity, health-related quality-of-life, cognitive changes, and tumor response are also integrated into this research protocol. To summarize, the purpose of this phase II trial is to assess this non-invasive alternative to SRS in terms of central nervous system (CNS) control when compared to SRS historical controls. A follow-up phase III trial may be required depending on the results of this trial in order to definitively assess non-inferiority/superiority of this approach. Ultimately, the purpose of this line of research is to

  4. Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease. A multi-institutional treatment recommendation

    Energy Technology Data Exchange (ETDEWEB)

    Nieder, Carsten [Nordland Hospital, Department of Oncology and Palliative Medicine, Bodoe (Norway); University of Tromsoe, Institute of Clinical Medicine, Faculty of Health Sciences, Tromsoe (Norway); Ruysscher, Dirk de [MAASTRO Clinic, Department of Radiation Oncology, Maastricht (Netherlands); Gaspar, Laurie E. [University of Colorado School of Medicine, Department of Radiation Oncology, Aurora, CO (United States); Guckenberger, Matthias [University Hospital Zurich, Department of Radiation Oncology, Zurich (Switzerland); Mehta, Minesh P. [Miami Cancer Institute, Department of Radiation Oncology, Miami, FL (United States); Cheung, Patrick; Sahgal, Arjun [Sunnybrook Health Sciences Centre and University of Toronto, Department of Radiation Oncology, Toronto (Canada)

    2017-07-15

    Practice guidelines have been developed for early-stage and locally advanced non-small cell lung cancer (NSCLC). However, many common clinical scenarios still require individualized decision making. This is true for locoregional relapse after initial stereotactic radiotherapy (stereotactic body radiation therapy or stereotactic ablative radiotherapy; SBRT or SABR), an increasingly utilized curative treatment option for stage I NSCLC. A consortium of expert radiation oncologists was established with the aim of providing treatment recommendations. In this scenario, a case was distributed to six radiation oncologists who provided their institutions' treatment recommendations. In this case, a patient developed local and mediastinal relapse after SABR (45 Gy, 3 fractions), comparable to the tumor burden in de novo stage IIIA NSCLC. Treatment recommendations were tabulated and a consensus conclusion was developed. Three institutions recommended evaluation for surgery. If the patient was not a surgical candidate, and/or refused surgery, definitive chemoradiation was recommended, including retreating the primary to full dose. European participants were more in favor of a non-surgical approach. None of the participants were reluctant to prescribe reirradiation, but two institutions prescribed doses lower than 60 Gy. Platinum-based doublets together with intensity-modulated radiotherapy were preferred. The institutional recommendations reflect the questions and uncertainties discussed in current stage III guidelines. All institutions agreed that previous SABR is not a contraindication for salvage chemoradiation. In the absence of high-quality prospective trials for recurrent NSCLC, all treatment options recommended in current guidelines for stage III disease can be considered in clinical scenarios such as this. (orig.) [German] Fuer fruehe und lokal fortgeschrittene Stadien des nicht-kleinzelligen Bronchialkarzinoms (NSCLC) wurden Behandlungsleitlinien publiziert

  5. Analysis of 2000 cases treated with gamma knife surgery: validating eligibility criteria for a prospective multi-institutional study of stereotactic radiosurgery alone for treatment of patients with 1-10 brain metastases (JLGK0901) in Japan

    Science.gov (United States)

    Higuchi, Yoshinori; Nagano, Osamu; Sato, Yasunori; Yamamoto, Masaaki; Ono, Junichi; Saeki, Naokatsu; Miyakawa, Akifumi; Hirai, Tatsuo

    2012-01-01

    Objective The Japan Leksell Gamma Knife (JLGK) Society has conducted a prospective multi-institute study (JLGK0901, UNIN000001812) for selected patients in order to prove the effectiveness of stereotactic radiosurgery (SRS) alone using the gamma knife (GK) for 1-10 brain lesions. Herein, we verify the validity of 5 major patient selection criteria for the JLGK0901 trial. Materials and Methods Between 1998 and 2010, 2246 consecutive cases with 10352 brain metastases treated with GK were analyzed to determine the validity of the following 5 major JLGK0901 criteria; 1) 1-10 brain lesions, 2) less than 10 cm3 volume of the largest tumor, 3) no more than 15 cm3 total tumor volume, 4) no cerebrospinal fluid (CSF) dissemination, 5) Karnofsky performance status (KPS) score ≥70. Results For cases with >10 brain metastases, salvage treatments for new lesions were needed more frequently. The tumor control rate for lesions larger than 10 cm3 was significantly lower than that of tumors 15 cm3 total tumor volume or positive magnetic resonance imaging findings of CSF were significantly poorer. Outcomes in cases with KPS <70 were significantly poorer in terms of OS. Conclusion Our retrospective results of 2246 GK-treated cases verified the validity of the 5 major JLGK0901 criteria. The inclusion criteria for the JLGK0901 study are appearently good indications for SRS. PMID:29296339

  6. Long-term Follow-up Results of a Multi-institutional Phase 2 Study of Concurrent Chemoradiation Therapy for Locally Advanced Cervical Cancer in East and Southeast Asia

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Shingo, E-mail: s_kato@saitama-med.ac.jp [Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama (Japan); National Institute of Radiological Sciences of Japan, Chiba (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Gunma University, Gunma (Japan); Thephamongkhol, Kullathorn; Chansilpa, Yaowalak [Division of Radiation Oncology, Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok (Thailand); Cao, Jianping [School of Radiation Medicine and Public Health, Soochow University, Soochow (China); Xu, Xiaoting [Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow (China); Devi, C. R. Beena; Swee, Tang Tieng [Department of Radiotherapy and Oncology, Hospital Umum Sarawak, Kuching (Malaysia); Calaguas, Miriam J.C. [Department of Radiation Oncology, St. Luke' s Medical Center, Quezon City, the Philippines (Philippines); Reyes, Rey H. de los [Department of Obstetrics and Gynecology, Dr Jose R. Reyes Memorial Medical Center, Manila, the Philippines (Philippines); Cho, Chul-Koo [Department of Radiation Oncology, Korea Cancer Center Hospital, Seoul (Korea, Republic of); Dung, To Anh [Department of Breast and Gynecology Radiotherapy, National Cancer Institute, Hanoi (Viet Nam); Supriana, Nana [Department of Radiation Therapy, Faculty of Medicine, University of Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta (Indonesia); Erawati, Dyah [Division of Radiotherapy, Dr Soetomo General Hospital, Surabaya (Indonesia); Mizuno, Hideyuki [National Institute of Radiological Sciences of Japan, Chiba (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma (Japan); Tsujii, Hirohiko [National Institute of Radiological Sciences of Japan, Chiba (Japan)

    2013-09-01

    Purpose: To report the long-term survival and toxicity of a multi-institutional phase 2 study of concurrent chemoradiation therapy (CCRT) for locally advanced cervical cancer in east and southeast Asia. Methods and Materials: Ten institutions from 8 Asian countries participated in the study. Between April 2003 and March 2006, 120 patients (60 with bulky stage IIB and 60 with stage IIIB) were treated with CCRT. Radiation therapy consisted of pelvic external beam radiation therapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m{sup 2}) were administered during the course of radiation therapy. Treatment results were evaluated by the rates of local control, overall survival, and late toxicities. Results: Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year local control and overall survival rates for all patients were 76.8% and 55.1%, respectively. The 5-year rates of major late toxicities of the rectum and bladder were 7.9% and 0%, respectively. Conclusions: The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in east and southeast Asia. However, further efforts are needed to improve overall survival.

  7. Multi-Institutional Collaborative Astronomy Education Research

    Science.gov (United States)

    Slater, T. F.; Slater, S. J.

    2011-09-01

    ASP, AAS, APS, and AAPT advocate that scientists should be engaged and acknowledged for successfully engaging in astronomy and physics education research and the scholarship of teaching because these efforts serve to improve pedagogical techniques and the evaluation of teaching. However, scientists have had the opportunity to pursue formal training in how to meaningfully engage in astronomy education research as an important scholarly endeavor. This special interest session for college and university physics and astronomy faculty, post-docs, and graduate students provided a forum to discuss the motivations, strategies, methodology, and publication routes for improving astronomy education through conducting rigorous science education research. Topics for discussion targeted the value of various education research questions, strengths and weaknesses of several different research design methodologies, strategies to successfully obtain Institutional Review Board approval to conduct education research on human subjects, and become more aware of how education research articles are created for publication in journals such as the Astronomy Education Review.

  8. Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma

    International Nuclear Information System (INIS)

    Merchant, Thomas E.; Kun, Larry E.; Krasin, Matthew J.; Wallace, Dana; Chintagumpala, Murali M.; Woo, Shiao Y.; Ashley, David M.; Sexton, Maree; Kellie, Stewart J.; Ahern, Verity M.B.B.S.; Gajjar, Amar

    2008-01-01

    Purpose: Limiting the neurocognitive sequelae of radiotherapy (RT) has been an objective in the treatment of medulloblastoma. Conformal RT to less than the entire posterior fossa (PF) after craniospinal irradiation might reduce neurocognitive sequelae and requires evaluation. Methods and Materials: Between October 1996 and August 2003, 86 patients, 3-21 years of age, with newly diagnosed, average-risk medulloblastoma were treated in a prospective, institutional review board-approved, multi-institution trial of risk-adapted RT and dose-intensive chemotherapy. RT began within 28 days of definitive surgery and consisted of craniospinal irradiation (23.4 Gy), conformal PF RT (36.0 Gy), and primary site RT (55.8 Gy). The planning target volume for the primary site included the postoperative tumor bed surrounded by an anatomically confined margin of 2 cm that was then expanded with a geometric margin of 0.3-0.5 cm. Chemotherapy was initiated 6 weeks after RT and included four cycles of high-dose cyclophosphamide, cisplatin, and vincristine. Results: At a median follow-up of 61.2 months (range, 5.2-115.0 months), the estimated 5-year event-free survival and cumulative incidence of PF failure rate was 83.0% ± 5.3% and 4.9% ± 2.4% (± standard error), respectively. The targeting guidelines used in this study resulted in a mean reduction of 13% in the volume of the PF receiving doses >55 Gy compared with conventionally planned RT. The reductions in the dose to the temporal lobes, cochleae, and hypothalamus were statistically significant. Conclusion: This prospective trial has demonstrated that irradiation of less than the entire PF after 23.4 Gy craniospinal irradiation for average-risk medulloblastoma results in disease control comparable to that after treatment of the entire PF

  9. Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In-situ in Patients with Lobular Neoplasia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 020).

    Science.gov (United States)

    Nakhlis, Faina; Gilmore, Lauren; Gelman, Rebecca; Bedrosian, Isabelle; Ludwig, Kandice; Hwang, E Shelley; Willey, Shawna; Hudis, Clifford; Iglehart, J Dirk; Lawler, Elizabeth; Ryabin, Nicole Y; Golshan, Mehra; Schnitt, Stuart J; King, Tari A

    2016-03-01

    Lobular neoplasia (LN) represents a spectrum of atypical proliferative lesions, including atypical lobular hyperplasia and lobular carcinoma-in-situ. The need for excision for LN found on core biopsy (CB) is controversial. We conducted a prospective multi-institutional trial (TBCRC 20) to determine the rate of upgrade to cancer after excision for pure LN on CB. Patients with a CB diagnosis of pure LN were prospectively identified and consented to excision. Cases with discordant imaging and those with additional lesions requiring excision were excluded. Upgrade rates to cancer were quantified on the basis of local and central pathology review. Confidence intervals and sample size were based on exact binomial calculations. A total of 77 of 79 registered patients underwent excision (median age 51 years, range 27-82 years). Two cases (3%; 95% confidence interval 0.3-9) were upgraded to cancer (one tubular carcinoma, one ductal carcinoma-in-situ) at excision per local pathology. Central pathology review of 76 cases confirmed pure LN in the CB in all but two cases. In one case, the tubular carcinoma identified at excision was also found in the CB specimen, and in the other, LN was not identified, yielding an upgrade rate of one case (1%; 95% CI 0.01-7) by central pathology review. In this prospective study of 77 patients with pure LN on CB, the upgrade rate was 3% by local pathology and 1% by central pathology review, demonstrating that routine excision is not indicated for patients with pure LN on CB and concordant imaging findings.

  10. A nationwide multi-institutional retrospective study to identify prognostic factors and develop a graded prognostic assessment system for patients with brain metastases from uterine corpus and cervical cancer.

    Science.gov (United States)

    Hayashi, Nakamasa; Takahashi, Hideaki; Hasegawa, Yuzo; Higuchi, Fumi; Takahashi, Masamichi; Makino, Keishi; Takagaki, Masatoshi; Akimoto, Jiro; Okuda, Takeshi; Okita, Yoshiko; Mitsuya, Koichi; Hirashima, Yasuyuki; Narita, Yoshitaka; Nakasu, Yoko

    2017-06-02

    The prevalence of brain metastases (BM) from uterine cancer has recently increased because of the improvement of overall survival (OS) of patients with uterine cancer due to its early detection and improved local control as a result of new effective treatments. However, little information is available regarding their clinical characteristics and prognosis, because oncologists have encountered BM from uterine cancer on rare occasions. Records from 81 patients with uterine BM were collected from 10 institutes in Japan. These were used in a multi-institutional study to identify prognostic factors and develop a graded prognostic assessment (GPA) for patients with BM from uterine cancer. Median OS after the development of BM was 7 months (95% confidence interval, 4 to 10 months). Multivariate analysis revealed that there were survival differences according to the existence of extracranial metastases and number of BM. In the present uterine-GPA, a score of 0 was assigned to those patients with ≥5 BM and extracranial metastasis, a score of 2 was assigned to those patients with one to four BM or without extracranial metastasis, and a score of 4 was assigned to those patients with one to four BM and without extracranial metastasis. The median OS for patients with a uterine-GPA scores of 0, 2, and 4 was 3, 7, and 22 months, respectively. A survival analysis confirmed the presence of statistically significant differences between these groups (p Brain Tumor Registry of Japan. Uterine GPA incorporates two simple clinical parameters of high prognostic significance and can be used to predict the expected survival times in patients with BM from uterine cancer. Its use may help in determining an appropriate treatment for individual patients with BM.

  11. BCNU wafer placement with temozolomide (TMZ) in the immediate postoperative period after tumor resection followed by radiation therapy with TMZ in patients with newly diagnosed high grade glioma: final results of a prospective, multi-institutional, phase II trial.

    Science.gov (United States)

    Burri, Stuart H; Prabhu, Roshan S; Sumrall, Ashley L; Brick, Wendy; Blaker, Brian D; Heideman, Brent E; Boltes, Peggy; Kelly, Renee; Symanowski, James T; Wiggins, Walter F; Ashby, Lynn; Norton, H James; Judy, Kevin; Asher, Anthony L

    2015-06-01

    Temozolomide (TMZ) and BCNU have demonstrated anti-glioma synergism in preclinical models. We report final data from a prospective, multi-institutional study of BCNU wafers and early TMZ followed by radiation therapy with TMZ in patients with newly diagnosed malignant glioma. 65 patients were consented in 4 institutions, and 46 patients (43 GBM, 3 AA) were eligible for analysis. After resection and BCNU wafer placement, TMZ began on day four postoperatively. Radiation and TMZ (RT/TMZ) were then administered, followed by monthly TMZ at 200 mg/m2 for the first 26 patients, which was reduced to 150 mg/m2 for the remaining 20 patients. Non-hematologic toxicities were minimal. Nine of 27 patients (33 %) who received 200 mg/m2 TMZ, but only 1 of 20 (5 %) who received 150 mg/m2, experienced grade 3/4 thrombocytopenia. Median progression free survival (PFS) and overall survival (OS) period was 8.5 and 18 months, respectively. The 1-year OS rate was 76 %, which is a significant improvement compared with the historical control 1-year OS rate of 59 % (p = 0.023). However, there was no difference in 1-year OS compared with standard RT/TMZ (p = 0.12) or BCNU wafer followed by RT/TMZ (p = 0.87) in post hoc analyses. Early post-operative TMZ can be safely administered with BCNU wafers following resection of malignant glioma at the 150 mg/m2 dose level. Although there was an OS benefit compared to historical control, there was no indication of benefit for BCNU wafers and early TMZ in addition to standard RT/TMZ or early TMZ in addition to regimens of BCNU wafers followed by RT/TMZ.

  12. Distinguishing benign and malignant breast tumors: preliminary comparison of kinetic modeling approaches using multi-institutional dynamic contrast-enhanced MRI data from the International Breast MR Consortium 6883 trial.

    Science.gov (United States)

    Sorace, Anna G; Partridge, Savannah C; Li, Xia; Virostko, Jack; Barnes, Stephanie L; Hippe, Daniel S; Huang, Wei; Yankeelov, Thomas E

    2018-01-01

    Comparative preliminary analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data collected in the International Breast MR Consortium 6883 multicenter trial was performed to distinguish benign and malignant breast tumors. Prebiopsy DCE-MRI data from 45 patients with suspicious breast lesions were obtained. Semiquantitative mean signal-enhancement ratio ([Formula: see text]) was calculated for all lesions, and quantitative pharmacokinetic, parameters [Formula: see text], [Formula: see text], and [Formula: see text], were calculated for the subset with available [Formula: see text] maps ([Formula: see text]). Diagnostic performance was estimated for DCE-MRI parameters and compared to standard clinical MRI assessment. Quantitative and semiquantitative metrics discriminated benign and malignant lesions, with receiver operating characteristic area under the curve (AUC) values of 0.71, 0.70, and 0.82 for [Formula: see text], [Formula: see text], and [Formula: see text], respectively ([Formula: see text]). At equal 94% sensitivity, the specificity and positive predictive value of [Formula: see text] (53% and 63%, respectively) and K trans (42% and 58%) were higher than clinical MRI assessment (32% and 54%). A multivariable model combining [Formula: see text] and clinical MRI assessment had an AUC value of 0.87. Quantitative pharmacokinetic and semiquantitative analyses of DCE-MRI improves discrimination of benign and malignant breast tumors, with our findings suggesting higher diagnostic accuracy using [Formula: see text]. [Formula: see text] has potential to help reduce unnecessary biopsies resulting from routine breast imaging.

  13. A Cross-Disciplinary Literature Review: Examining Trust on Virtual Teams

    Science.gov (United States)

    Berry, Gregory R.

    2011-01-01

    Effective and efficient teams communicate, collaborate, and perform, even if these teams are not co-located. Although much is known about enabling effectiveness on face-to-face teams, considerably less is known about similarly enabling effectiveness on virtual teams. Yet the use of virtual teams is common and will likely become more commonplace as…

  14. Appropriate Ventilation Solutions For The Iconographic Buildings From The Fifties - A Cross Disciplinary Investigation

    DEFF Research Database (Denmark)

    Vestergaard, Inge; Blyt, Henrik Jean

    2016-01-01

    In Denmark we currently have an increased focus on preserving the most valuable domestic building examples from the period 1945 - 60. New literature deals with these architectural heritage matters. The authors of this paper argue, that due to question of preservation the buildings physiology is n...

  15. Academic Globalization: Universality of Cross-Cultural And Cross-Disciplinary LMR Perspectives

    Directory of Open Access Journals (Sweden)

    Marta Szabo White

    2010-10-01

    Full Text Available The contribution of this paper suggests that previous research underscoring cross-cultural differences may be misleading, when in fact it is cross-professional rather than cross-cultural differences that should be emphasized. Employing the LMR framework, this paper concludes that business or non-business predisposition has a more direct impact on one's individual cultural profile than does nationality. Regardless of culture, persons involved in business are characterized primarily by linear-active modes of communication, and persons not involved in business typically employ less linear and more multi-active/hybrid modes of communication. The linkages among individual characteristics, communication styles, work behaviors, and the extent to which the LMR constructs can facilitate and predict leadership, negotiating styles, individual behaviors, etc. are central to academic globalization and preparing global business leaders.

  16. A cross-disciplinary introduction to quantum annealing-based algorithms

    Science.gov (United States)

    Venegas-Andraca, Salvador E.; Cruz-Santos, William; McGeoch, Catherine; Lanzagorta, Marco

    2018-04-01

    A central goal in quantum computing is the development of quantum hardware and quantum algorithms in order to analyse challenging scientific and engineering problems. Research in quantum computation involves contributions from both physics and computer science; hence this article presents a concise introduction to basic concepts from both fields that are used in annealing-based quantum computation, an alternative to the more familiar quantum gate model. We introduce some concepts from computer science required to define difficult computational problems and to realise the potential relevance of quantum algorithms to find novel solutions to those problems. We introduce the structure of quantum annealing-based algorithms as well as two examples of this kind of algorithms for solving instances of the max-SAT and Minimum Multicut problems. An overview of the quantum annealing systems manufactured by D-Wave Systems is also presented.

  17. RHETORICAL PATTERNS, VERB TENSE, AND VOICE IN CROSS DISCIPLINARY RESEARCH ARTICLE ABSTRACT

    Directory of Open Access Journals (Sweden)

    Sharifah Hanidar

    2016-05-01

    Full Text Available This article investigates research article abstracts in terms of their rhetorical patterns and the use of verb tenses and voice. A total of 40 abstracts were selected from four international journals in the fields of Biology, Mechanical Engineering, Linguistics, and Medicine. A four move model was adopted from Hardjanto (1997 to analyze the structure of the abstracts. The results show that all the abstracts have Move 1, creating a research space; 70% have Move 2, describing research procedure; 85% have Move 3, summarizing principal results; and 85% have Move 4, evaluating results. All the abstracts in medicine have Moves 1, 2, 3 and 4, whereas the most common pattern in Biology is Moves 1, 3 and 4, in Mechanical Engineering Moves 1, 2 and 3, and in Linguistics Moves 1, 2 and 4. This seems to suggest that there is a disciplinary variation in the structuring of RA abstracts in the four disciplines under investigation. With regard to the use of verb tense and voice in each move, the present tense and past tense in the active voice and the past tense in the passive voice were the most frequently used tenses. The present tense in the active voice was frequently used in Moves 1 and 4, while the past tense in the active voice was commonly used in Move 3 and the past tense in the passive voice was frequently found in Move 2. Furthermore, it was found that the present tense in the active voice was frequently used in Biology, Mechanical Engineering and Linguistics, whereas the past tense in the active voice occurred more frequently in Medicine, and the past tense in the passive voice was more frequently found in Mechanical Engineering than in other disciplines.

  18. Cross-disciplinary management of polytrauma patients: radiological screening and comparison

    International Nuclear Information System (INIS)

    Messmer, P.; Loew, R.; Jacob, A.L.

    2001-01-01

    The comprehensive survey addresses the various modalities available today for trauma screening and presents a comparative assessment of their value in respect of type of trauma and evidence provided. (orig./CB) [de

  19. A Multi- and Cross-Disciplinary Capstone Experience in Engineering Art: Animatronic Polar Bear

    Science.gov (United States)

    Sirinterlikci, Arif; Toukonen, Kayne; Mason, Steve; Madison, Russel

    2005-01-01

    An animatronic robot was designed and constructed for the 2003 Annual Student Robotic Technology and Engineering Challenge organized by the Robotics International (RI) association of the Society of Manufacturing Engineers (SME). It was also the senior capstone design project for two of the design team members. After a thorough study of body and…

  20. A staffing decision support methodology using a quality loss function : a cross-disciplinary quantitative study

    NARCIS (Netherlands)

    Mincsovics, G.Z.

    2009-01-01

    Background Understanding the quality loss implications of short staffing is essential in maintaining service quality on a limited budget. Objectives For elaborate financial control on staffing decisions, it is necessary to quantify the cost of the incidental quality loss that a given workload and

  1. A Vodcasted, Cross-Disciplinary, Behavioral Neuroscience Laboratory Exercise Investigating the Effects of Methamphetamine on Aggression

    Science.gov (United States)

    Shanks, Ryan A.; Southard, E. Megan; Tarnowski, Laura; Bruster, Matthew; Wingate, Stacia W.; Dalman, Nancy; Lloyd, Steven A.

    2011-01-01

    This article describes a laboratory experience utilizing videos to engage students in hypothesis-driven experimentation in behavioral neuroscience. It provides students with an opportunity to investigate the effects of chronic methamphetamine exposure on aggression in adult mice using a resident-intruder paradigm. Instructors and students only…

  2. The Social Regulation of Emotion: An Integrative, Cross-Disciplinary Model.

    Science.gov (United States)

    Reeck, Crystal; Ames, Daniel R; Ochsner, Kevin N

    2016-01-01

    Research in emotion regulation has largely focused on how people manage their own emotions, but there is a growing recognition that the ways in which we regulate the emotions of others also are important. Drawing on work from diverse disciplines, we propose an integrative model of the psychological and neural processes supporting the social regulation of emotion. This organizing framework, the 'social regulatory cycle', specifies at multiple levels of description the act of regulating another person's emotions as well as the experience of being a target of regulation. The cycle describes the processing stages that lead regulators to attempt to change the emotions of a target person, the impact of regulation on the processes that generate emotions in the target, and the underlying neural systems. Copyright © 2015. Published by Elsevier Ltd.

  3. Nurturing Opportunity Identification for Business Sophistication in a Cross-disciplinary Study Environment

    OpenAIRE

    Karine Oganisjana; Tatjana Koke

    2012-01-01

    Opportunity identification is the key element of the entrepreneurial process; therefore the issue of developing this skill in students is a crucial task in contemporary European education which has recognized entrepreneurship as one of the lifelong learning key competences. The earlier opportunity identification becomes a habitual way of thinking and behavior across a broad range of contexts, the more likely that entrepreneurial disposition will steadily reside in students. In order to nurtur...

  4. Workshop: Preventing Air Pollution-related Cardiopulmonary Illnesses: Innovative, Cross-disciplinary Solutions

    Science.gov (United States)

    On Sept. 28-29, 2016 in Washington, DC, EPA’s held its first workshop to share multi-stakeholder perspectives on how to improve cardiopulmonary health outcomes through the integration of environmental health, public health, health care services, data.

  5. Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning.

    Science.gov (United States)

    El-Sherief, Ahmed H; Lau, Charles T; Obuchowski, Nancy A; Mehta, Atul C; Rice, Thomas W; Blackstone, Eugene H

    2017-04-01

    Accurate and consistent regional lymph node classification is an important element in the staging and multidisciplinary management of lung cancer. Regional lymph node definition sets-lymph node maps-have been created to standardize regional lymph node classification. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a lymph node map to supersede all preexisting lymph node maps. Our aim was to study if and how lung cancer specialists apply the IASLC lymph node map when classifying thoracic lymph nodes encountered on CT scans during lung cancer staging. From April 2013 through July 2013, invitations were distributed to all members of the Fleischner Society, Society of Thoracic Radiology, General Thoracic Surgical Club, and the American Association of Bronchology and Interventional Pulmonology to participate in an anonymous online image-based and text-based 20-question survey regarding lymph node classification for lung cancer staging on CT imaging. Three hundred thirty-seven people responded (approximately 25% participation). Respondents consisted of self-reported thoracic radiologists (n = 158), thoracic surgeons (n = 102), and pulmonologists who perform endobronchial ultrasonography (n = 77). Half of the respondents (50%; 95% CI, 44%-55%) reported using the IASLC lymph node map in daily practice, with no significant differences between subspecialties. A disparity was observed between the IASLC definition sets and their interpretation and application on CT scans, in particular for lymph nodes near the thoracic inlet, anterior to the trachea, anterior to the tracheal bifurcation, near the ligamentum arteriosum, between the bronchus intermedius and esophagus, in the internal mammary space, and adjacent to the heart. Use of older lymph node maps and inconsistencies in interpretation and application of definitions in the IASLC lymph node map may potentially lead to misclassification of stage and suboptimal management of lung cancer in some patients. Published by Elsevier Inc.

  6. Feminist Scholarship: Cross-Disciplinary Connections for Cultivating a Critical Perspective in Kinesiology

    Science.gov (United States)

    Reifsteck, Erin J.

    2014-01-01

    Kinesiology has not been a particularly inviting space for feminist critical analysis. In this article, as a graduate student in the field, I argue that feminist scholarship from women and gender studies can be applied to kinesiology issues to promote a critical perspective that is often missing in kinesiology. I draw connections between feminist…

  7. Achieving generic competences through a cross-disciplinary research based course in Arctic Technology

    DEFF Research Database (Denmark)

    Kirkelund, Gunvor Marie; Hansen, Claus Thorp; Jensen, Pernille Erland

    2014-01-01

    In a research based course in Arctic Technology, different teaching activities were used to support learning of both technical and generic competences. The active learning was based around a 3-weeks field work period in Greenland in combination with lectures, assignments, project and peer group...... support the process of developing generic competences and are preparing the students to become professional engineers. For the future teaching of the course we have some suggestions for improvements: • Include peer-work as a learning objective and specify rubrics of how to give feedback to make it more...... work prior to and after the field work. The students represent a heterogeneous group of nationalities, previous experiences and scientific subjects. It was clearly seen by the learning outcome and assessment that students who used the offered feedback options during the course actively were more...

  8. Capitalizing on Cultural difference: A Cross-Disciplinary Outlook from Social Psychology to International Business

    OpenAIRE

    Katiuscia Vaccarini; Barbara Pojaghi

    2015-01-01

    Drawing upon social psychology and international business literature the aim of this paper is to raise international managers and entrepreneurs’ awareness on the opportunity to capitalize on cultural differences and diversity in international business settings. Following our quantitative and qualitative data collection based on managers’ perceptions on cultural differences, we propose and illustrate the sociocognitive value of a group cultural laboratory as a potential “structured business pr...

  9. Outcomes of a Cross-Disciplinary Concussion Prevention and Diagnosis Workshop Series

    Directory of Open Access Journals (Sweden)

    Patrick Drane

    2018-02-01

    Full Text Available This paper reports the outcomes of a series of two Concussion Research Workshops held in Lowell, MA, USA. The workshop examined the state-of-the-art in concussion research, research challenges and the future directions of research within the following three core topic areas: (A Concussion Prevention Techniques & Technology, (B Concussion Diagnosis, and (C Treatment of Concussions. Concussions are a form of traumatic brain injury caused by an impact and are a growing concern among athletes and those who are involved with sports. Recent years have led to increasing awareness and research related to concussions with limited definitive understanding of the specific mechanism and pathology. Technology is beginning to take on an important role in the prevention, diagnosis and treatment of concussions. Currently, sensors provide data about the impact and the athlete. However, sensors and better protective equipment can enable an effective monitoring and thus protection of athletes. Only when a more definitive understanding of the injury mechanism is achieved, can sensors and protective equipment design contribute to effective monitoring and protection of athletes.

  10. Modals in the construction of research articles: A cross-disciplinary perspective

    Directory of Open Access Journals (Sweden)

    Matthew Peacock

    2014-03-01

    Full Text Available This paper describes a corpus-based analysis of variation in the distribution and function of modals and their role in the expression of “stance” in a corpus of 600 research articles (RAs across twelve disciplines. Stance is an expression of attitudes, judgments, or assessments towards the truth of propositions (Biber et al., 1999, and part of the important function of claiming and confirming membership of discourse communities and therefore in constructing identity. Three functional categories of modals perform a valuable role in the construction of stance: Possibility/Ability, Obligation/Necessity, and Prediction (Biber et al., 1999. However, very little research seems to have investigated variation across disciplines or their use in the RA. The corpus was analysed using WordSmith Tools (Scott, 2004, followed by manual checking of the function of every occurrence. Inter- and intra-rater agreement was also checked. Many statistically significant disciplinary differences were found, along with numerous marked differences with individual modals. Further examination of the corpus revealed considerable disciplinary variation in the patterns and verbs associated with the target modals, and a number of sub-functions of the topics covered by the modals. Conclusions are that modals perform an important role in the construction of stance.

  11. Understanding Neurophobia: Reasons behind Impaired Understanding and Learning of Neuroanatomy in Cross-Disciplinary Healthcare Students

    Science.gov (United States)

    Javaid, Muhammad Asim; Chakraborty, Shelly; Cryan, John F.; Schellekens, Harriët; Toulouse, André

    2018-01-01

    Recent studies have highlighted a fear or difficulty with the study and understanding of neuroanatomy among medical and healthcare students. This has been linked with a diminished confidence of clinical practitioners and students to manage patients with neurological conditions. The underlying reasons for this difficulty have been queried among a…

  12. Beyond Deficit-filling and Developmental Stakes: Cross-disciplinary Perspectives on Parental Heritage.

    Science.gov (United States)

    Moss, Nancy E.; Abramowitz, Stephen I.

    1982-01-01

    Proposes an interdisciplinary conceptual foundation for studying parental heritage. Defines parental heritage as the intentional transmission of valued psychological and material assets from parent to child. Suggests advances in the realm of parental heritage are dependent on clarification of the complex interactions among such sociohistorical,…

  13. A first approach to filament dynamics

    International Nuclear Information System (INIS)

    Silva, P E S; De Abreu, F Vistulo; Dias, R G; Simoes, R

    2010-01-01

    Modelling elastic filament dynamics is a topic of high interest due to the wide range of applications. However, it has reached a high level of complexity in the literature, making it unaccessible to a beginner. In this paper we explain the main steps involved in the computational modelling of the dynamics of an elastic filament. We first derive equations governing the dynamics of an elastic lament suitable for a computer simulation implementation. The derivation starts from the relation between forces and potential energy in conservative systems in order to derive the equation of motion of any bead in the filament. Only two-dimensional movements are considered, but extensions to three dimensions can follow similar lines. Suggestions for computer implementations are provided in Matlab as well as an example of application related to the generation of musical sounds. This example allows a critical analysis of the numerical results obtained using a cross-disciplinary perspective. Since derivations start from basic physics equations, use simple calculus and computational implementations are straightforward, this paper proposes a different approach to introduce simple molecular dynamics simulations or animations of real systems in undergraduate elasticity or computer modelling courses.

  14. Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

    Energy Technology Data Exchange (ETDEWEB)

    Tokumaru, Sunao, E-mail: tokumaru@cc.saga-u.ac.jp [Department of Heavy Particle Therapy and Radiation Oncology, Saga University, Saga (Japan); Toita, Takafumi [Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa (Japan); Oguchi, Masahiko [Radiation Oncology Department, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kato, Shingo [Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Matsuyama (Japan); Shikama, Naoto [Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tuskuba (Japan); Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita (Japan); Kagami, Yoshikazu [Department of Radiology, Showa University School of Medicine, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); and others

    2012-10-01

    Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria for Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.

  15. Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

    Energy Technology Data Exchange (ETDEWEB)

    Toita, Takafumi, E-mail: b983255@med.u-ryukyu.ac.jp [Department of Radiology, Graduate School of Medical Science, University of Ryukyus, Okinawa (Japan); Kato, Shingo [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Ehime (Japan); Shikama, Naoto [Department of Radiation Oncology, Saku Central Hospital, Saku (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Tokumaru, Sunao [Department of Radiology, Saga University, Saga (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tsukuba (Japan); Numasaki, Hodaka; Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital, Tokyo (Japan); Kagami, Yoshikazu [Radiation Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-01-01

    Purpose: To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials: Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size <40 mm in diameter (assessed by T2-weighted magnetic resonance imaging), and no pelvic/para-aortic lymphadenopathy. The treatment protocol consisted of whole-pelvis external beam radiotherapy (EBRT) of 20 Gy/10 fractions, pelvic EBRT with midline block of 30 Gy/15 fractions, and HDR-ICBT of 24 Gy/4 fractions (at point A). The cumulative biologically effective dose (BED) was 62 Gy{sub 10} ({alpha}/{beta} = 10) at point A. The primary endpoint was the 2-year pelvic disease progression-free (PDPF) rate. All patients received a radiotherapy quality assurance review. Results: Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6-39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7-72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%-100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%-98%) and 95% (95% CI, 89%-100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade {>=}1) were 18% (95% CI, 8%-28%) for large intestine/rectum, 4% (95% CI, 0%-8%) for small intestine, and 0% for bladder. No Grade {>=}3 cases were

  16. EDUCATIONAL OPPORTUNITIES OF COLLAGE AS A DIDACTIC MEANS: INTERDISCIPLINARY APPROACH

    Directory of Open Access Journals (Sweden)

    I. B. Ryzhkina

    2014-01-01

    Full Text Available The research aim is to examine the functions and educational opportunities of collage as a didactic means.The methodology and methods involve the multilateral theoretical data analysis and generalization; activity approach to pupils’ perception analysis; communicative approach to finding the interrelation between the perception and speech act; lingua-cultural approach to collage consideration as a sign, information vehicle and communication subject; and developmental teaching approach.The author undertakes the cross-disciplinary analysis, including the scientific works on philosophy, psychology, semiotics and culture studies, and proves the collage adequacy to the cognitive specificity of modern pupils’perception and foreign-language teaching. The concept of collage is specified, its semiotic characteristics and unique features as a didactic means discussed.The research novelty involves developing a new frame of reference to collage as a didactic tool and cultural phenomenon with educational and developmental opportunities.The research findings, including the methodology basis for content structuring and selecting a collage type, can be used for educational problem solving.

  17. Mainstreaming Multi-Risk Approaches into Policy

    Directory of Open Access Journals (Sweden)

    Anna Scolobig

    2017-12-01

    Full Text Available Multi-risk environments are characterized by domino effects that often amplify the overall risk. Those include chains of hazardous events and increasing vulnerability, among other types of correlations within the risk process. The recently developed methods for multi-hazard and risk assessment integrate interactions between different risks by using harmonized procedures based on common metrics. While the products of these assessments, such as multi-hazard and -risk indexes, maps, cascade scenarios, or warning systems provide innovative and effective information, they also pose specific challenges to policy makers and practitioners due to their novel cross-disciplinary aspects. In this paper we discuss the institutional barriers to the adoption of multi-risk approaches, summarizing the results of the fieldwork conducted in Italy and Guadeloupe and of workshops with disaster risk reduction practitioners from eleven European countries. Results show the need for a clear identification of responsibilities for the implementation of multi-risk approaches, as institutional frameworks for risk reduction remain to this day primarily single-risk centered. Authorities are rarely officially responsible for the management of domino effects between e.g., tsunamis and industrial accidents, earthquake and landslides, floods and electricity network failures. Other barriers for the implementation of multi-risk approaches include the limited measures to reduce exposure at the household level, inadequate financial capacities at the local level and limited public-private partnerships, especially in case of interactions between natural and industrial risks. Adapting the scale of institutions to that of multi-risk environments remains a major challenge to better mainstream multi-risk approaches into policy. To address it, we propose a multi-risk governance framework, which includes the phases of observation, social and institutional context analysis, generation of

  18. An interdisciplinary approach to study Pre-Earthquake processes

    Science.gov (United States)

    Ouzounov, D.; Pulinets, S. A.; Hattori, K.; Taylor, P. T.

    2017-12-01

    We will summarize a multi-year research effort on wide-ranging observations of pre-earthquake processes. Based on space and ground data we present some new results relevant to the existence of pre-earthquake signals. Over the past 15-20 years there has been a major revival of interest in pre-earthquake studies in Japan, Russia, China, EU, Taiwan and elsewhere. Recent large magnitude earthquakes in Asia and Europe have shown the importance of these various studies in the search for earthquake precursors either for forecasting or predictions. Some new results were obtained from modeling of the atmosphere-ionosphere connection and analyses of seismic records (foreshocks /aftershocks), geochemical, electromagnetic, and thermodynamic processes related to stress changes in the lithosphere, along with their statistical and physical validation. This cross - disciplinary approach could make an impact on our further understanding of the physics of earthquakes and the phenomena that precedes their energy release. We also present the potential impact of these interdisciplinary studies to earthquake predictability. A detail summary of our approach and that of several international researchers will be part of this session and will be subsequently published in a new AGU/Wiley volume. This book is part of the Geophysical Monograph series and is intended to show the variety of parameters seismic, atmospheric, geochemical and historical involved is this important field of research and will bring this knowledge and awareness to a broader geosciences community.

  19. STEAM-y Partnerships: A Case of Interdisciplinary Professional Development and Collaboration

    Science.gov (United States)

    Kelton, Molly L.; Saraniero, Patti

    2018-01-01

    Museum partnerships can involve significant tensions, especially when these collaborations reach across institutions to blend disciplines such as art and mathematics. Rather than simply being obstacles to overcome, we suggest that tensions arising in multi-institutional, cross-disciplinary collaborations can be highly generative for collaborators,…

  20. A salutogenic approach to prevention of metabolic syndrome: a mixed methods population study.

    Science.gov (United States)

    Miettola, Juhani; Viljanen, Anna Maria

    2014-12-01

    To find a salutogenic approach for prevention of metabolic syndrome in primary care practice. An explanatory sequential mixed-methods procedure was used to find salutogenic approaches for lifestyle change by assessing individual need, potential, and personal motivation. Data from a population health survey and interviews that focused on a sense of coherence were analysed. Altogether 480 Finnish subjects participated in a population health survey, and 43 of them were interviewed. The 43 interviewees' data were included in the final analysis. With the health survey participants' liability for MetS was assessed, and the objective need for lifestyle intervention was determined. Through the focused interviews potential and personal motivation for lifestyle modification were explored. Finally the data of the 43 interviewed subjects were merged. Four possible lifestyle intervention approaches were identified for specific intervention. First, subjects with a strong sense of coherence only need encouragement to maintain a healthy lifestyle; second, professional support was found important for subjects with gaps in health awareness to improve health understanding; third, strengthening of social support for lifestyle change is necessary for subjects with various practical constraints in their everyday life; and fourth, strengthening of stress adaptation is important for subjects with redundant concerns about their health. Salutogenic client-centred lifestyle modification approaches should be part of primary care practice. Further, a cross-disciplinary approach is needed in primary care research and practice to combat the exploding lifestyle illnesses.

  1. Designing medical technology for resilience: integrating health economics and human factors approaches.

    Science.gov (United States)

    Borsci, Simone; Uchegbu, Ijeoma; Buckle, Peter; Ni, Zhifang; Walne, Simon; Hanna, George B

    2018-01-01

    The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of the existing healthcare system and a failure to recognise the need to generate resilient products. Areas covered: Recognising a cross-disciplinary need to enhance evidence generation early in a technology's life cycle, the present paper proposes a new approach that integrates human factors and health economic evaluation as part of a wider systems approach to the design of technology. This approach (Human and Economic Resilience Design for Medical Technology or HERD MedTech) supports early stages of product development and is based on the recent experiences of the National Institute for Health Research London Diagnostic Evidence Co-operative in the UK. Expert commentary: HERD MedTech i) proposes a shift from design for usability to design for resilience, ii) aspires to reduce the need for service adaptation to technological constraints iii) ensures value of innovation at the time of product development, and iv) aims to stimulate discussion around the integration of pre- and post-market methods of assessment of medical technology.

  2. A unified approach to validation, reliability, and education study design for surgical technical skills training.

    Science.gov (United States)

    Sweet, Robert M; Hananel, David; Lawrenz, Frances

    2010-02-01

    To present modern educational psychology theory and apply these concepts to validity and reliability of surgical skills training and assessment. In a series of cross-disciplinary meetings, we applied a unified approach of behavioral science principles and theory to medical technical skills education given the recent advances in the theories in the field of behavioral psychology and statistics. While validation of the individual simulation tools is important, it is only one piece of a multimodal curriculum that in and of itself deserves examination and study. We propose concurrent validation throughout the design of simulation-based curriculum rather than once it is complete. We embrace the concept that validity and curriculum development are interdependent, ongoing processes that are never truly complete. Individual predictive, construct, content, and face validity aspects should not be considered separately but as interdependent and complementary toward an end application. Such an approach could help guide our acceptance and appropriate application of these exciting new training and assessment tools for technical skills training in medicine.

  3. The Use of Central Pathology Review With Digital Slide Scanning in Advanced-stage Mycosis Fungoides and Sézary Syndrome: A Multi-institutional and International Pathology Study.

    Science.gov (United States)

    Gru, Alejandro A; Kim, Jinah; Pulitzer, Melissa; Guitart, Joan; Battistella, Maxime; Wood, Gary S; Cerroni, Lorenzo; Kempf, Werner; Willemze, Rein; Pawade, Joya; Querfeld, Christiane; Schaffer, Andras; Pincus, Laura; Tetzlaff, Michael; Duvic, Madeleine; Scarisbrick, Julia; Porcu, Pierluigi; Mangold, Aaron R; DiCaudo, David J; Shinohara, Michi; Hong, Eric K; Horton, Bethany; Kim, Youn H

    2018-06-01

    for a methodical approach to perform central pathology review in the context of a large clinical prospective study.

  4. Variations in Textualization: A Cross-Generic and Cross-Disciplinary Study, Implications for Readability of the Academic Discourse

    Science.gov (United States)

    Bonabi, Mina Abbasi; Lotfipour-Saedi, Kazem; Hemmati, Fatemeh; Jafarigohar, Manoochehr

    2018-01-01

    According to discoursal views on language, variations in textualization strategies are always sociocontextually motivated and never happen at random. The textual forms employed in a text, along with many other discoursal and contextual factors, could certainly affect the readability of the text, making it more or less processable for the same…

  5. A cross-disciplinary assessment of student loans debt, financial support for study and career preferences upon graduation.

    Science.gov (United States)

    Webster, Craig S; Ling, Christopher; Barrow, Mark; Poole, Phillippa; Henning, Marcus

    2017-07-21

    To explore relationships between student loans debt, financial support and career preferences upon graduation for all healthcare disciplines offered at the Faculty of Medical and Health Sciences, University of Auckland. The Faculty Tracking Project is a longitudinal study which invites students to complete a questionnaire at the beginning and end of their educational programmes, including questions on debt, financial support and career preference. Our analysis comprised three phases: (1) a descriptive analysis of data related to debt and financial support; (2) a principal component analysis in order to find related categories of career choice; and (3) logistic regression models to determine how career preference categories could be explained by either levels of student loans debt or financial support. Data from 2,405 participating students were included. Students in health sciences, nursing and pharmacy typically accrue levels of student loans debt of around $15,000 to $29,999, while optometry students accrue debt around $15,000 higher. Medical students show debt distributed around modes of $0 and $90,000 or more. All students typically access three sources of financial support during study. Career preferences at graduation reduced to four categories for all health disciplines. We found five significant effects, involving students in health sciences, medicine and pharmacy, relating the number of sources of financial support to the four categories of career preference. No significant effects were found related to level of student loans debt. Our results suggest that financial support is a more strongly determining factor in career choices than the level of student loans debt. The four-category framework for student career preferences appears to be a useful model for further research.

  6. Lowering the Barrier to Cross-Disciplinary Scientific Data Access via a Brokering Service Built Around a Unified Data Model

    Science.gov (United States)

    Lindholm, D. M.; Wilson, A.

    2012-12-01

    The steps many scientific data users go through to use data (after discovering it) can be rather tedious, even when dealing with datasets within their own discipline. Accessing data across domains often seems intractable. We present here, LaTiS, an Open Source brokering solution that bridges the gap between the source data and the user's code by defining a unified data model plus a plugin framework for "adapters" to read data from their native source, "filters" to perform server side data processing, and "writers" to output any number of desired formats or streaming protocols. A great deal of work is being done in the informatics community to promote multi-disciplinary science with a focus on search and discovery based on metadata - information about the data. The goal of LaTiS is to go that last step to provide a uniform interface to read the dataset into computer programs and other applications once it has been identified. The LaTiS solution for integrating a wide variety of data models is to return to mathematical fundamentals. The LaTiS data model emphasizes functional relationships between variables. For example, a time series of temperature measurements can be thought of as a function that maps a time to a temperature. With just three constructs: "Scalar" for a single variable, "Tuple" for a collection of variables, and "Function" to represent a set of independent and dependent variables, the LaTiS data model can represent most scientific datasets at a low level that enables uniform data access. Higher level abstractions can be built on top of the basic model to add more meaningful semantics for specific user communities. LaTiS defines its data model in terms of the Unified Modeling Language (UML). It also defines a very thin Java Interface that can be implemented by numerous existing data interfaces (e.g. NetCDF-Java) such that client code can access any dataset via the Java API, independent of the underlying data access mechanism. LaTiS also provides a reference implementation of the data model and server framework (with a RESTful service interface) in the Scala programming language. Scala can be thought of as the next generation of Java. It runs on the Java Virtual Machine and can directly use Java code. Scala improves upon Java's object-oriented capabilities and adds support for functional programming paradigms which are particularly well suited for scientific data analysis. The Scala implementation of LaTiS can be thought of as a Domain Specific Language (DSL) which presents an API that better matches the semantics of the problems scientific data users are trying to solve. Instead of working with bytes, ints, or arrays, the data user can directly work with data as "time series" or "spectra". LaTiS provides many layers of abstraction with which users can interact to support a wide variety of data access and analysis needs.

  7. Cross-disciplinary management of polytrauma patients: radiological screening and comparison; Interdisziplinaeres Management von polytraumatisierten Patienten: Beitrag der Radiologie

    Energy Technology Data Exchange (ETDEWEB)

    Messmer, P. [Universitaetskliniken Basel, Dept. Chirurgie, Allgemeinchirurgische Klinik, Abt. Traumatologie (Switzerland); Loew, R.; Jacob, A.L. [Universitaetskliniken Basel, Dept. Medizinische Radiologie, Abt. Diagnostische Radiologie (Switzerland)

    2001-09-01

    The comprehensive survey addresses the various modalities available today for trauma screening and presents a comparative assessment of their value in respect of type of trauma and evidence provided. (orig./CB) [German] Die Versorgung polytraumatischer Patienten stellt hoechste Anforderungen an das Koennen des Radiologen. Neben einer schnellen und schonenden Durchfuehrung der notwendigen Diagnostik darf keine potenziell lebensbedrohende Verletzung uebersehen werden. Die Kriterien fuer eine rationelle Diagnostik wurden im ATLS-Kurs (Advanced Trauma Life Support) zusammengefasst. Es gilt, die sog. 'golden hour' moeglichst effektiv fuer die Primaerdiagnostik und -therapie zu nutzen. Haeufige Verletzungsformen beim Polytrauma sind das Schaedel-Hirn-Trauma, Thoraxverletzungen, Milzverletzungen, Leberverletzungen und Frakturen von Becken, Wirbelsaeule und Extremitaeten. Die Primaere und Sekundaere Radiologische Diagnostik ist abhaengig von der Ausstattung der Klinik und besteht aus einer abdominellen Sonographie, Thorax ap, Beckenuebersicht ap, Halswirbelsaeule seitlich sowie falls vorhanden aus CT und Angiographie. Ein definitiver Schritt zur Verkuerzung der Zeit bis zur Behandlung waeren sterile OP-Einheiten mit integrierter Roentgendiagnostik (moeglichst nativ und CT), die ein staendiges Umlagern und Transportieren des Patienten verhindern koennten. (orig.)

  8. Cross-Disciplinary Perceptions of Structured Interprofessional Rounds in Promoting Teamwork Within an Academic Tertiary Care Obstetric Unit.

    Science.gov (United States)

    Chau, Anthony; Vijjeswarapu, Mary A; Hickey, Margaret; Acker, David; Huang, Chuan-Chin; Tsen, Lawrence C

    2017-06-01

    In 2005, physician and nursing leaders at Brigham and Women's Hospital initiated structured interprofessional rounds (SIPRs) on the labor and delivery (L&D) suite to improve team communication. We performed a cross-sectional analysis of providers' perceptions of SIPRs and their effectiveness in improving teamwork. We hypothesized that on average, providers would perceive SIPRs as being effective in promoting teamwork, but ratings would differ among professional groups. After a factor analysis and internal consistency assessment, a 19-item paper-based questionnaire was used to evaluate providers' perceptions using a 5-point Likert scale. Respondents included L&D nurses, midwives, obstetricians, and anesthesiologists who participate in SIPRs. The primary aim was to evaluate the providers' perceptions of SIPRs and their association with professional roles. The outcome was total response score for each provider, ranging from 19 to 95; perception of SIPRs as being effective in promoting teamwork was defined as having a total response score of >66.5 (mean score, >3.5 per question). A univariable linear regression model was performed, followed by a multivariable analysis adjusting for predictors that modified the outcome; predictors included years of professional practice, years of experience on the L&D suite, number of clinical work hours worked weekly, and principal shift assignment among nurses. The associations between these predictors and providers' perceptions were assessed as a secondary aim. A total of 234 practitioners responded (100% response rate). The mean total response score (SD) for all providers was 73.3 (9.5). After multivariable adjustment, the mean total response scores were significantly higher for obstetric providers than for anesthesia (Δ mean, 6.5, 95% CI, 0.3, 12.7 P = .036) and midwifery (Δ mean, 12.5, 95% CI, 2.0, 23.0, P = .009) providers. Providers scored significantly lower if they worked >60 clinical hours per week compared with ≤20 (Δ mean, -13.7, 95% CI, -25.3, -2.1, P = .009), 21-40 (Δ mean, -8.0, 95% CI, -15.8, -0.09, P = .049), or 41-60 hours (Δ mean, -8.1, 95% CI, -14.5, -1.7, P = .004). Duration of practice in professional role and experience on the L&D suite were not predictive of SIPRs ratings. On average, providers on the L&D suite perceive SIPRs as being effective in promoting teamwork. Perception ratings were significantly influenced by professional role and number of clinical hours worked weekly, suggesting that these factors should be explored in future research to minimize perception gaps and support a dynamic culture of interprofessional collaboration.

  9. SEARCH: Study of Environmental Arctic Change—A System-scale, Cross-disciplinary Arctic Research Program

    Science.gov (United States)

    Wiggins, H. V.; Eicken, H.; Fox, S. E.

    2012-12-01

    SEARCH is an interdisciplinary and interagency program that works with academic and government agency scientists to plan, conduct, and synthesize studies of arctic change. The vision of SEARCH is to provide scientific understanding of arctic environmental change to help society understand and respond to a rapidly changing Arctic. Towards this end, SEARCH: 1. Generates and synthesizes research findings and promotes arctic science and scientific discovery across disciplines and among agencies. 2. Identifies emerging issues in arctic environmental change. 3. Provides information resources to arctic stakeholders, policy-makers, and the public to help them respond to arctic environmental change. 4. Coordinates with national arctic science programs integral to SEARCH goals. 5. Facilitates research activities across local-to-global scales with stakeholder concerns incorporated from the start of the planning process. 6. Represents the U.S. arctic environmental change science community in international and global change research initiatives. Specific current activities include: Arctic Observing Network (AON) - coordinating a system of atmospheric, land- and ocean-based environmental monitoring capabilities that will significantly advance our observations of arctic environmental conditions. Arctic Sea Ice Outlook ¬- an international effort that provides monthly summer reports synthesizing community estimates of the expected sea ice minimum. Sea Ice for Walrus Outlook - a resource for Alaska Native subsistence hunters, coastal communities, and others that provides weekly reports with information on sea ice conditions relevant to walrus in Alaska waters. In April, the SEARCH Science Steering Committee (SSC) released a set of draft 5-year goals and objectives for review by the broader arctic science community. The goals and objectives will direct the SEARCH program in the next five years. The draft SEARCH goals focus on four areas: ice-diminished Arctic Ocean, warming permafrost, land ice and sea level, and societal and policy implications. Together, the goals will provide significant insight into arctic system change as a whole. The SEARCH SSC will release the goals in their revised form and then work closely with agency representatives to implement the goals through research opportunities and community activities. SEARCH is guided by a Science Steering Committee and several panels and working groups, with broad representation of the research community. SEARCH is sponsored by eight U.S. agencies, including: the National Science Foundation (NSF), the National Oceanic and Atmospheric Administration (NOAA), the National Aeronautics and Space Administration (NASA), the Department of Defense (DOD), the Department of Energy (DOE), the Department of the Interior (DOI), the Smithsonian Institution, and the U.S. Department of Agriculture (USDA). The U.S. Arctic Research Commission participates as an agency observer. For further information, please visit the website: http://www.arcus.org/search or contact: Helen V. Wiggins: helen@arcus.org, SEARCH Project Office, Arctic Research Consortium of the U.S. (ARCUS).

  10. Informing Food Protection Education: A Project to Define and Classify Resources for a Cross-Disciplinary Expert Community

    Science.gov (United States)

    Schenck-Hamlin, Donna; Pierquet, Jennifer; McClellan, Chuck

    2011-01-01

    In the wake of the September 2001 attacks, the U.S. government founded the Department of Homeland Security (DHS) with responsibility to develop a National Infrastructure Protection Plan for securing critical infrastructures and key resources. DHS established interdisciplinary networks of academic expertise administered through Centers of…

  11. Towards the understanding of the requirements of a communication language to support process interoperation in cross-disciplinary supply chains

    OpenAIRE

    DAS , BISHNU PADA; Young , R I M; Case , K; Rahimifard , S; Anumba , C; Bouchlaghem , N; Cutting Decelle , Anne-Francoise

    2007-01-01

    Abstract Many manufacturing organisations while doing business either directly or indirectly with other industrial sectors often encounter interoperability problems amongst software systems. This increases the business cost and reduces the efficiency. Research communities are exploring ways to reduce this cost. Incompatibility amongst the syntaxes and the semantics of the languages of application systems is the most common cause to this problem. The Process Specification Language (...

  12. From galaxy to universe? A cross-disciplinary review and analysis of public values publications from 1969 to 2012

    NARCIS (Netherlands)

    van der Wal, Z.; Nabatchi, T.; de Graaf, G.

    2015-01-01

    The study of public values (PVs) is generating growing interest in public administration and public management, yet many challenges and unanswered questions remain. For the study of PVs to progress, we need to go beyond the traditional boundaries of public administration and management, to explore

  13. CROSS-DISCIPLINARY PHYSICS AND RELATED AREAS OF SCIENCE AND TECHNOLOGY: Diffusion-Based Recommendation in Collaborative Tagging Systems

    Science.gov (United States)

    Shang, Ming-Sheng; Zhang, Zi-Ke

    2009-11-01

    Recently, collaborative tagging systems have attracted more and more attention and have been widely applied in web systems. Tags provide highly abstracted information about personal preferences and item content, and therefore have the potential to help in improving better personalized recommendations. We propose a diffusion-based recommendation algorithm considering the personal vocabulary and evaluate it in a real-world dataset: Del.icio.us. Experimental results demonstrate that the usage of tag information can significantly improve the accuracy of personalized recommendations.

  14. Adopting Open-Source Software Applications in U. S. Higher Education: A Cross-Disciplinary Review of the Literature

    Science.gov (United States)

    van Rooij, Shahron Williams

    2009-01-01

    Higher Education institutions in the United States are considering Open Source software applications such as the Moodle and Sakai course management systems and the Kuali financial system to build integrated learning environments that serve both academic and administrative needs. Open Source is presumed to be more flexible and less costly than…

  15. CROSS-DISCIPLINARY PHYSICS AND RELATED AREAS OF SCIENCE AND TECHNOLOGY: Fatigue life of metal treated by magnetic field

    Science.gov (United States)

    Liu, Zhao-Long; Hu, Hai-Yun; Fan, Tian-You; Xing, Xiu-San

    2009-03-01

    This paper investigates theoretically the influence of magnetization on fatigue life by using non-equilibrium statistical theory of fatigue fracture for metals. The fatigue microcrack growth rate is obtained from the dynamic equation of microcrack growth, where the influence of magnetization is described by an additional term in the potential energy of microcrack. The statistical value of fatigue life of metal under magnetic field is derived, which is expressed in terms of magnetic field and macrophysical as well as microphysical quantities. The fatigue life of AISI 4140 steel in static magnetic field from this theory is basically consistent with the experimental data.

  16. The Merapi Interactive Project: Offering a Fancy Cross-Disciplinary Scientific Understanding of Merapi Volcano to a Wide Audience.

    Science.gov (United States)

    Morin, J.; Kerlow, I.

    2015-12-01

    The Merapi volcano is of great interest to a wide audience as it is one of the most dangerous volcanoes worldwide and a beautiful touristic spot. The scientific literature available on that volcano both in Earth and Social sciences is rich but mostly inaccessible to the public because of the scientific jargon and the restricted database access. Merapi Interactive aims at developing clear information and attractive content about Merapi for a wide audience. The project is being produced by the Art and Media Group at the Earth Observatory of Singapore, and it takes the shape of an e-book. It offers a consistent, comprehensive, and jargon-filtered synthesis of the main volcanic-risk related topics about Merapi: volcanic mechanisms, eruptive history, associated hazards and risks, the way inhabitants and scientists deal with it, and what daily life at Merapi looks like. The project provides a background to better understand volcanoes, and it points out some interactions between scientists and society. We propose two levels of interpretation: one that is understandable by 10-year old kids and above and an expert level with deeper presentations of specific topics. Thus, the Merapi Interactive project intends to provide an engaging and comprehensive interactive book that should interest kids, adults, as well as Earth Sciences undergraduates and academics. Merapi Interactive is scheduled for delivery in mid-2016.

  17. Teaching a Cross-Disciplinary Environmental Science, Policy, and Culture Course on Costa Rica's Ecotourism to Business Students

    Science.gov (United States)

    Lester, Toni; Rodgers, Vikki L.

    2012-01-01

    Within the business world, there is growing evidence and increasing acceptance that sustainability and environmental practices are the main drivers for current innovation and success. We developed an interdisciplinary, offshore course where undergraduate business students could truly investigate and experience the benefits of environmentally and…

  18. MDO and Cross-Disciplinary Practice in R&D: A Portrait of Principles and Current Practice

    Science.gov (United States)

    Rivas McGowan, Anna-Maria; Papalambros, Panos Y.; Baker, Wayne E.

    2014-01-01

    For several decades, Multidisciplinary Design Optimization (MDO) has served an important role in aerospace engineering by incorporating physics based disciplinary models into integrated system or sub-system models for use in research, development, (R&D) and design. This paper examines MDO's role in facilitating the integration of the researchers from different single disciplines during R&D and early design of large-scale complex engineered systems (LaCES) such as aerospace systems. The findings in this paper are summarized from a larger study on interdisciplinary practices and perspectives that included considerable empirical data from surveys, interviews, and ethnography. The synthesized findings were derived by integrating the data with theories from organization science and engineering. The over-arching finding is that issues related to cognition, organization, and social interrelations mostly dominate interactions across disciplines. Engineering issues, such as the integration of hardware or physics-based models, are not as significant. Correspondingly, the data showed that MDO is not the primary integrator of researchers working across disciplines during R&D and early design of LaCES. Cognitive focus such as analysis versus design, organizational challenges such as incentives, and social opportunities such as personal networks often drove the human interactive practices among researchers from different disciplines. Facilitation of the inherent confusion, argument, and learning in crossdisciplinary research was identified as one of several needed elements of enabling successful research across disciplines.

  19. Learning and Sharing Technology in Informal Contexts. A Multiagent-Based Ontological Approach

    Directory of Open Access Journals (Sweden)

    Dino Borri

    2014-05-01

    Full Text Available An increasing debate is growing today, in both academic and research-in-action contexts, about the roles of new and traditional technologies in raising knowledge of agents involved, as well as in boosting an effective development of communities. The last century has been largely dominated by capital-intensive technologies, impacting large and populated areas. From the late 1990s up to the present days, due to social, financial, environmental concerns, new low-impact, local-born, little to medium-scale experiences have been challenging large technologies, with interesting results. The importance of such experiences seems to lay on the abilities and knowledge of local populations, which are quite difficult to emerge as formal methodologies and attain recognizable levels of generalization and sharing. Yet the effectiveness of local-based technologies is being increasingly documented, often succeeding in cases where more formal technologies had previously failed. The EU-funded ANTINOMOS project has largely dealt with local-community knowledge enhancing and managing in the water sector management, aiming at creating a real learning environment for the sharing and the active generation of knowledge through mutual synergies. In this paper, the above subject is discussed and carried out with a cross-disciplinary, cross-scale, multi-agent approach, considering the different forms of local knowledge and language involved.

  20. Art and architecture as experience: an alternative approach to bridging art history and the neurosciences.

    Science.gov (United States)

    Zschocke, Nina

    2012-08-01

    In 1972, Michael Baxandal characterizes the processes responsible for the cultural relativism of art experience as highly complex and unknown in their physiological detail. While art history still shows considerable interest in the brain sciences forty years later, most cross-disciplinary studies today are referring to the neurosciences in an attempt to seek scientific legitimization of variations of a generalized and largely deterministic model of perception, reducing interaction between a work of art and its observers to a set of biological automatisms. I will challenge such an approach and take up art theory's interest in the historico-cultural and situational dimensions of art experience. Looking at two examples of large-scale installation and sculptural post-war American art, I will explore instable perceptions of depth and changing experiences of space that indicate complex interactions between perceptual and higher cognitive processes. The argument will draw on recent theories describing neuronal processes underlying multistable phenomena, eye movement, visual attention and decision-making. As I will show a large number of neuroscientific studies provide theoretical models that help us analyse not the anthropological constants but the influence of cultural, individual and situational variables on aesthetic experience.

  1. Predicting introductory programming performance: A multi-institutional multivariate study

    Science.gov (United States)

    Bergin, Susan; Reilly, Ronan

    2006-12-01

    A model for predicting student performance on introductory programming modules is presented. The model uses attributes identified in a study carried out at four third-level institutions in the Republic of Ireland. Four instruments were used to collect the data and over 25 attributes were examined. A data reduction technique was applied and a logistic regression model using 10-fold stratified cross validation was developed. The model used three attributes: Leaving Certificate Mathematics result (final mathematics examination at second level), number of hours playing computer games while taking the module and programming self-esteem. Prediction success was significant with 80% of students correctly classified. The model also works well on a per-institution level. A discussion on the implications of the model is provided and future work is outlined.

  2. The nitrogen footprint tool network: a multi-institution program ...

    Science.gov (United States)

    Anthropogenic sources of reactive nitrogen have local and global impacts on air and water quality and detrimental effects on human and ecosystem health. This paper uses the nitrogen footprint tool (NFT) to determine the amount of nitrogen (N) released as a result of institutional consumption. The sectors accounted for include food (consumption and the upstream production), energy, transportation, fertilizer, research animals, and agricultural research. The NFT is then used for scenario analysis to manage and track reductions to institution N footprints, which are driven by the consumption behaviors of both the institution itself and its constituent individuals. In this paper, the first seven institution N footprint results are presented. The institution NFT network aims to develop footprints for many institutions to encourage widespread upper-level management strategies that will create significant reductions in reactive N released to the environment. Energy use and food purchases are the two largest contributors to institution N footprints. Ongoing efforts by institutions to reduce greenhouse gas emissions also help to reduce the N footprint, but the impact of food production on N pollution has not been directly addressed by the higher-ed sustainability community. The NFT Network found that institutions could reduce their N footprints by optimizing food purchasing to reduce consumption of animal products and minimize food waste, as well as reducing dependence o

  3. Spinal cord gliomas: A multi-institutional retrospective analysis

    International Nuclear Information System (INIS)

    Abdel-Wahab, May; Etuk, Blessing; Palermo, James; Shirato, Hiroki; Kresl, John; Yapicier, Ozlem; Walker, Gail; Scheithauer, Bernd W.; Shaw, Edward; Lee, Charles; Curran, Walter; Thomas, Terry; Markoe, Arnold

    2006-01-01

    Purpose: To determine the impact of postoperative radiation therapy (POXRT) on outcome in spinal cord gliomas. Patients and Methods: Data from 242 patients were collected retrospectively from six institutions using a standardized data sheet. Pathology specimens, when available, were centrally reviewed. Results: A total of 183 patients were analyzed: 82 received surgery alone as initial treatment, whereas 101 had surgery and POXRT. Demographic, diagnostic, and treatment factors were analyzed for impact on progression-free (PFS) and overall survival (OS). PFS in ependymoma patients was 74%, 60%, and 35% at 5, 10, 15 years, respectively, and was significantly influenced by treatment type, race, age, tumor grade, and type of surgery on univariate analysis, with age being the only significant factor on multivariate analysis (MVA) (p = 0.01). OS of ependymoma patients was 91%, 84%, and 75% at 5, 10, and 15 years, respectively, and was significantly influenced by both complete resection (p = 0.04) and age (p = 0.03) on MVA. In astrocytomas, PFS was 42%, 29%, and 15% at 5, 10, and 15 years, and was significantly influenced by POXRT in low- and intermediate-grade tumors on MVA (p = 0.02). OS at 5, 10, and 15 years was 59%, 53%, and 32%, respectively, and was significantly influenced by grade on MVA (p < 0.01). Conclusion: Postoperative radiation therapy reduced disease progression in low- and moderate-grade astrocytomas. In ependymomas, complete resection significantly influenced OS

  4. Radiosurgery for hemangioblastoma: results of a multi-institutional experience

    Energy Technology Data Exchange (ETDEWEB)

    Patrice, Stephen J; Sneed, Penny K; Flickinger, John C; Alexander, Eben; Larson, David A; Shrieve, Dennis C; Pollock, Bruce E; Kondziolka, Douglas S; Gutin, Philip H; Wara, William M; McDermott, Michael W; Lunsford, L Dade; Loeffler, Jay S

    1995-07-01

    Purpose/Objective: Hemangioblastoma is a primary solid or cystic vascular tumor of the central nervous system that occurs most frequently in the cerebellum, brain stem and spinal cord. Between June 1988 and June 1994, 38 hemangioblastomas were treated with stereotactic radiosurgery (SR) at 3 active SR centers in order to evaluate the efficacy and potential toxicity of this therapeutic modality as an adjuvant or alternative treatment to surgical resection. Materials and Methods: SR was performed using either a 201-cobalt source Gamma Knife unit or a dedicated SR linear accelerator. Of the 18 primary tumors treated, 16 had no prior history of surgical resection and were treated definitively with SR and 2 primary lesions were subtotally resected and subsequently treated with SR. Twenty lesions were treated with SR after prior surgical failure (17 tumors) or failure after prior surgery and conventional radiotherapy (3 tumors). Eight patients were treated with SR for multifocal disease (total, 24 known tumors). SR tumor volumes measured 0.05 to 12 cc (median, 0.97 cc). Minimum tumor doses ranged from 12 to 20 Gy (median, 15.5 Gy). Results: Median follow-up from the time of SR was 24.5 months (range, 6 to 77 months). The 2-year actuarial overall survival was 88% +/- 15% (95% confidence interval). To date, 4 of the 22 patients in the study have died. Of these 4 patients, 2 who received SR for salvage of surgical failure died of progressive intracranial tumor, 1 died of metastatic breast carcinoma, and 1 died of renal failure as a result of systemic complications of von Hippel-Lindau Syndrome (VHL). Three-year actuarial freedom from progression was 86% +/- 12% (95% confidence interval). Thirty-one of the 36 evaluable tumors (86%) were controlled locally. None of the 18 primary tumors that were treated with SR as definitive therapy have failed to date. All 5 lesions that ultimately failed to be controlled by SR were recurrent tumors that had been treated with SR for salvage of initial surgical failure. Thirteen of the 18 evaluable recurrent tumors (72%) were therefore controlled as of last follow-up. The median tumor volume of the lesions that failed to be controlled by SR was 7.85 cc (range, 3.20 to 10.53 cc) compared to 0.67 cc (range, 0.05 to 12 cc) for controlled lesions (p = 0.0023). The lesions that failed to be controlled by SR received a median minimum tumor dose of 14 Gy (range, 13 to 17 Gy) compared to 16 Gy (range, 12 to 20 Gy) for controlled lesions (p = 0.0239). Seventy-eight percent of the surviving patients remained neurologically stable or clinically improved. There were no significant permanent complications directly attributable to SR. Conclusion: This report documents the largest experience in the literature of the use of SR in the treatment of hemangioblastoma. We conclude that SR: 1) controls the majority of primary and recurrent hemangioblastomas; 2) offers the ability to treat multiple lesions in a single treatment session which is particularly important for patients with VHL; and that 3) better control rates are associated with higher doses and smaller tumor volumes. We believe that SR will play an increasingly important role as a non-invasive alternative therapeutic modality for hemangioblastoma and recommend its use in the following clinical situations: 1) surgically unresectable disease; 2) as adjuvant treatment for subtotally resected disease; 3) as definitive treatment of multifocal disease; and 4) as salvage therapy for radiographically discrete recurrences after surgical failure.

  5. Planning a multi-institutional information for development study centre

    CSIR Research Space (South Africa)

    Moreno, A

    2010-05-01

    Full Text Available . The I4D Study Centre tasks are to increase both the research expertise pool available for Meraka and the partner university, and the joint development of study programs with universities that will prepare students for a researcher career with an ICT4D...

  6. Multi-institutional collaborating study on CT scan of schizophrenia

    International Nuclear Information System (INIS)

    Takahashi, Ryo; Sato, Tokijiro; Okuma, Teruo

    1984-01-01

    More abnormal CT findings were observed in nuclear schizophrenic patients (55%) than in the matchable controls with a statistically significant difference. According to the site of the brain, these were marked in the whole ventricle (especially the third ventricle) and in the cortex including the longitudinal fissure, frontal lobe, temporal lobe, and sylvian fissure (especially of the left hemisphere). There was no correlation between the cerebral ventricular enlargement and the patient's age, the duration of illness or drug dosage, suggesting that the enlargement may exist from the onset of the disease. Aging or taking drug(s) were also not responsible for the cortical atrophy. CT findings were associated mainly with negative symptoms. In particular, the association between abnormalities of the left hemisphere and psychiatric symptoms was marked. Direct measurements of CT images revealed significantly higher incidences only in the third ventricular enlargement in schizophrenic patients. These results suggest the possibility that subtypes of schizophrenia can be classified. (Namekawa, K.)

  7. Spinal Cord Subependymoma Surgery : A Multi-Institutional Experience.

    Science.gov (United States)

    Yuh, Woon Tak; Chung, Chun Kee; Park, Sung-Hye; Kim, Ki-Jeong; Lee, Sun-Ho; Kim, Kyoung-Tae

    2018-03-01

    A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.

  8. Quality assurance in clinical trials : a multi-disciplinary approach

    International Nuclear Information System (INIS)

    Cornes, D.

    2001-01-01

    Full text: Multi-disciplinary groups, such as medical physicists and radiation therapists, which work effectively together, can ensure continued improvements in radiation therapy quality. The same is also true for clinical trials, which have the added complication of requiring multi-institutional participation to collate sufficient data to effectively assess treatment benefits. It can be difficult to manage quality across all aspects of a multi-disciplinary and multi-institutional trial. A planned system of quality assurance is necessary to provide support for participating centres and facilitate a collaborative approach. To ensure protocol compliance a good relationship between the clinical trial group and treatment centre is idea with definition of mutual goals and objectives before and during the trial, and ongoing consultation and feedback throughout the trial process. To ensure good quality data and maximise the validity of results the study protocol must be strictly adhered to. Because of the need for meticulous attention to detail, both in treatment delivery and standards of documentation, clinical trials are often seen to further complicate the process of delivery of radiation therapy treatment. The Declaration of Helsinki and Good Clinical Practise Guidelines (adopted in May 1996, ICH) provide 'international ethical and scientific standards for designing, conducting, recording and reporting clinical research' and multi-disciplinary groups in each participating centre should also adhere to these guidelines. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  9. SINGLE MOLECULE APPROACHES TO BIOLOGY, 2010 GORDON RESEARCH CONFERENCE, JUNE 27-JULY 2, 2010, ITALY

    Energy Technology Data Exchange (ETDEWEB)

    Professor William Moerner

    2010-07-09

    Tuscany, provides an avenue for scientists from different disciplines to interact and brainstorm and promotes cross-disciplinary collaborations directed toward compelling biological problems.

  10. Powerful qPCR assays for the early detection of latent invaders: interdisciplinary approaches in clinical cancer research and plant pathology.

    Science.gov (United States)

    Luchi, Nicola; Capretti, Paolo; Pazzagli, Mario; Pinzani, Pamela

    2016-06-01

    Latent invaders represent the first step of disease before symptoms occur in the host. Based on recent findings, tumors are considered to be ecosystems in which cancer cells act as invasive species that interact with the native host cell species. Analogously, in plants latent fungal pathogens coevolve within symptomless host tissues. For these reasons, similar detection approaches can be used for an early diagnosis of the invasion process in both plants and humans to prevent or reduce the spread of the disease. Molecular tools based on the evaluation of nucleic acids have been developed for the specific, rapid, and early detection of human diseases. During the last decades, these techniques to assess and quantify the proliferation of latent invaders in host cells have been transferred from the medical field to different areas of scientific research, such as plant pathology. An improvement in molecular biology protocols (especially referring to qPCR assays) specifically designed and optimized for detection in host plants is therefore advisable. This work is a cross-disciplinary review discussing the use of a methodological approach that is employed within both medical and plant sciences. It provides an overview of the principal qPCR tools for the detection of latent invaders, focusing on comparisons between clinical cancer research and plant pathology, and recent advances in the early detection of latent invaders to improve prevention and control strategies.

  11. Interlaboratory Collaborations in the Undergraduate Setting

    Science.gov (United States)

    Megehee, Elise G.; Hyslop, Alison G.; Rosso, Richard J.

    2005-01-01

    A novel approach to cross-disciplinary and group learning, known as interlaboratory collaborations, was developed. The method mimics an industrial or research setting, fosters teamwork, and emphasizes the importance of good communication skills in the sciences.

  12. Students as Producers: An "X" Disciplinary Client-Based Approach to Collaborative Art, Design and Media Pedagogy

    Science.gov (United States)

    Cocchiarella, Fabrizio; Booth, Paul

    2015-01-01

    This article presents the findings of a cross-disciplinary project between BA (Hons) Interior Design, Creative Multimedia and Film and Media Studies at a large Metropolitan University in the North of England. The collaboration was part of Unit X, a faculty-wide credit-bearing initiative to enable better collaboration across art and design courses.…

  13. A Continuation of the Paradigm Wars? Prevalence Rates of Methodological Approaches across the Social/Behavioral Sciences

    Science.gov (United States)

    Alise, Mark A.; Teddlie, Charles

    2010-01-01

    A new line of research has emerged that examines the prevalence rates of mixed methods within disciplines in the social/behavioral sciences. Research presented in this article is unique in that it examines prevalence rates across multiple disciplines using an established cross-disciplinary classification scheme. Results indicate that there are…

  14. The neurovestibular challenges of astronauts and balance patients: some past countermeasures and two alternative approaches to elicitation, assessment and mitigation

    Directory of Open Access Journals (Sweden)

    Ben Lawson

    2016-11-01

    Full Text Available Astronauts and vestibular patients face analogous challenges to orientation function due to adaptive exogenous (weightlessness-induced or endogenous (pathology-induced alterations in the processing of acceleration stimuli. Given some neurovestibular similarities between these challenges, both affected groups may benefit from shared research approaches and adaptation measurement/improvement strategies. This paper reviews various past strategies and introduces two plausible ground-based approaches, the first of which is a method for eliciting and assessing vestibular adaptation-induced imbalance. Second, we review a strategy for mitigating imbalance associated with vestibular pathology and fostering readaptation. In discussing the first strategy (for imbalance assessment, we review a pilot study wherein imbalance was elicited (among healthy subjects via an adaptive challenge that caused a temporary/reversible disruption. The surrogate vestibular deficit was caused by a brief period of movement-induced adaptation to an altered (rotating gravitoinertial frame of reference. This elicited adaptation and caused imbalance when head movements were made after reentry into the normal (non-rotating frame of reference. We also review a strategy for fall mitigation, viz., a prototype tactile sway feedback device for aiding balance/recovery after disruptions caused by vestibular pathology. We introduce the device and review a preliminary exploration of its effectiveness in aiding clinical balance rehabilitation (discussing the implications for healthy astronauts. Both strategies reviewed in this paper represent cross-disciplinary research spin-offs: the ground-based vestibular challenge and tactile cueing display were derived from aeromedical research to benefit military aviators suffering from flight simulator-relevant aftereffects or inflight spatial disorientation, respectively. These strategies merit further evaluation using clinical and astronaut

  15. E-learning and blended learning in textile engineering education: a closed feedback loop approach

    Science.gov (United States)

    Charitopoulos, A.; Vassiliadis, S.; Rangoussi, M.; Koulouriotis, D.

    2017-10-01

    E-learning has gained a significant role in typical education and in professional training, thanks to the flexibility it offers to the time and location parameters of the education event framework. Purely e-learning scenarios are mostly limited either to Open University-type higher education institutions or to graduate level or professional degrees; blended learning scenarios are progressively becoming popular thanks to their balanced approach. The aim of the present work is to propose approaches that exploit the e-learning and the blended-learning scenarios for Textile Engineering education programmes, especially for multi-institutional ones. The “E-Team” European MSc degree programme organized by AUTEX is used as a case study. The proposed solution is based on (i) a free and open-source e-learning platform (moodle) and (ii) blended learning educational scenarios. Educational challenges addressed include student engagement, student error / failure handling, as well as collaborative learning promotion and support.

  16. Extensive cross-disciplinary analysis of biological and chemical control of Calanus finmarchicus reproduction during an aldehyde forming diatom bloom in mesocosms

    DEFF Research Database (Denmark)

    Jonasdottir, Sigrun; Dutz, Jörg; Koski, Marja

    2011-01-01

    Egg and faecal pellet production and egg hatching success of the calanoid copepod Calanus finmarchicus were monitored over a period of 14 days (14-28 April, 2008) while fed water from 4 differently treated mesocosms and ambient water. Two of the mesocosms used were inoculated with the polyunsatur...

  17. Changing the Paradigm: Implementation of Combined Law Enforcement, Fire, and Emergency Medical Service (EMS) Cross-Disciplinary Response to Hostile Events

    Science.gov (United States)

    2014-12-01

    Levels of organizational commitment, job satisfaction, employee stress , and mental well-being were analyzed at various points throughout the merger or... Acculturation Model to describe the process of contact, conflict, and adaption when two or more cultures come together. Acculturation reflects the...integrated.194 Acculturation occurs through four different modes depending on the member’s views

  18. Surface characteristics, copper release, and toxicity of nano- and micrometer-sized copper and copper(II) oxide particles: a cross-disciplinary study.

    OpenAIRE

    Midander, Klara; Cronholm, Pontus; Karlsson, Hanna L.; Elihn, Karine; Moller, Lennart; Leygraf, Christofer; Wallinder, Inger Odnevall

    2009-01-01

    An interdisciplinary and multianalytical research effort is undertaken to assess the toxic aspects of thoroughly characterized nano- and micrometer-sized particles of oxidized metallic copper and copper(II) oxide in contact with cultivated lung cells, as well as copper release in relevant media. All particles, except micrometer-sized Cu, release more copper in serum-containing cell medium (supplemented Dulbecco's minimal essential medium) compared to identical exposures in phosphate-buffered ...

  19. Building Better Scientists through Cross-Disciplinary Collaboration in Synthetic Biology: A Report from the Genome Consortium for Active Teaching Workshop 2010

    Science.gov (United States)

    Wolyniak, Michael J.; Alvarez, Consuelo J.; Chandrasekaran, Vidya; Grana, Theresa M.; Holgado, Andrea; Jones, Christopher J.; Morris, Robert W.; Pereira, Anil L.; Stamm, Joyce; Washington, Talitha M.; Yang, Yixin

    2010-01-01

    Synthetic biology is the application of engineering and mathematical principles to develop novel biological devices and circuits. What separates synthetic biology from traditional molecular biology is the development of standardized interchangeable DNA "parts," just as advances in engineering in the nineteenth century brought about standardized…

  20. Fitness and health benefits of team handball training for young untrained women - A cross-disciplinary RCT on physiological adaptations and motivational aspects

    DEFF Research Database (Denmark)

    Hornstrup, Therese; Wikman, Johan Michael; Fristrup, Bjørn

    2018-01-01

    was equal to 85% ± 6% HRmax. Between-group intervention effects were observed in favor of HG for muscle mass (2.1%, p = 0.024), proximal femur bone mineral density (0.8%, p = 0.041), Yo-Yo IE1 intermittent endurance test level 1 (IE1) performance (35%, p ...Purpose: The present study evaluated the effects of regular participation in small-sided team handball training on body composition, osteogenic response, physical performance, and cardiovascular risk factors, as well as well-being and motivation, in young untrained women. Methods: Twenty...

  1. Determining the Scope of Collection Development and Research Assistance for Cross-Disciplinary Areas: A Case Study of Two Contrasting Areas, Nanotechnology and Transportation Engineering

    Science.gov (United States)

    Williamson, Jeanine M.; Han, Lee D.; Colon-Aguirre, Monica

    2009-01-01

    The study examined the extent of cross-disciplinarity in nanotechnology and transportation engineering research. Researchers in these two fields were determined from the web sites of the U.S. News and World Report top 100 schools in civil engineering and materials science. Web of Science searches for 2006 and 2007 articles were obtained and the…

  2. Incorporation of Cross-Disciplinary Teaching and a Wiki Research Project to Engage Undergraduate Students' to Develop Information Literacy, Critical Thinking, and Communication Skills

    Science.gov (United States)

    Crist, Courtney A.; Duncan, Susan E.; Bianchi, Laurie M.

    2017-01-01

    A Wiki research project was created in the Functional Foods for Health (FST/HNFE 2544) as an instructional tool and assignment for improving undergraduate students' proficiency in evaluating appropriate information sources for rapidly evolving science and research. The project design targeted improving students' information literacy skills…

  3. Asymmetry in scientific method and limits to cross-disciplinary dialogue: toward a shared language and science policy in pharmacogenomics and human disease genetics.

    Science.gov (United States)

    Ozdemir, Vural; Williams-Jones, Bryn; Graham, Janice E; Preskorn, Sheldon H; Gripeos, Dimitrios; Glatt, Stephen J; Friis, Robert H; Reist, Christopher; Szabo, Sandor; Lohr, James B; Someya, Toshiyuki

    2007-04-01

    Pharmacogenomics is a hybrid field of experimental science at the intersection of human disease genetics and clinical pharmacology sharing applications of the new genomic technologies. But this hybrid field is not yet stable or fully integrated, nor is science policy in pharmacogenomics fully equipped to resolve the challenges of this emerging hybrid field. The disciplines of human disease genetics and clinical pharmacology contain significant differences in their scientific practices. Whereas clinical pharmacology originates as an experimental science, human disease genetics is primarily observational in nature. The result is a significant asymmetry in scientific method that can differentially impact the degree to which gene-environment interactions are discerned and, by extension, the study sample size required in each discipline. Because the number of subjects enrolled in observational genetic studies of diseases is characteristically viewed as an important criterion of scientific validity and reliability, failure to recognize discipline-specific requirements for sample size may lead to inappropriate dismissal or silencing of meritorious, although smaller-scale, craft-based pharmacogenomic investigations using an experimental study design. Importantly, the recognition that pharmacogenomics is an experimental science creates an avenue for systematic policy response to the ethical imperative to prospectively pursue genetically customized therapies before regulatory approval of pharmaceuticals. To this end, we discuss the critical role of interdisciplinary engagement between medical sciences, policy, and social science. We emphasize the need for development of shared standards across scientific, methodologic, and socioethical epistemologic divides in the hybrid field of pharmacogenomics to best serve the interests of public health.

  4. Fitness and health benefits of team handball training for young untrained women—A cross-disciplinary RCT on physiological adaptations and motivational aspects

    Directory of Open Access Journals (Sweden)

    Therese Hornstrup

    2018-04-01

    Full Text Available Purpose: The present study evaluated the effects of regular participation in small-sided team handball training on body composition, osteogenic response, physical performance, and cardiovascular risk factors, as well as well-being and motivation, in young untrained women. Methods: Twenty-eight untrained 20- to 30-year-old women were randomized to a handball training group (HG; n = 14, height 170 ± 5 cm, weight 73 ± 11 kg, VO2peak 37.7 ± 4.1 mL/min/kg that trained 1.7 ± 0.3 times per week over 12 weeks (70 min 4 v 4 handball sessions or an inactive control group (CG; n = 14, 169 ± 5 cm, 71 ± 12 kg, 38.1 ± 3.7 mL/min/kg. Physiological and psychological and motivational training adaptations were assessed pre- and post-intervention by dual-energy X-ray Absorptiometry (DXA scans, blood sampling, physical tests, and questionnaires. Results: The average heart rate (HR over all training sessions was equal to 85% ± 6% HRmax. Between-group intervention effects were observed in favor of HG for muscle mass (2.1%, p = 0.024, proximal femur bone mineral density (0.8%, p = 0.041, Yo-Yo IE1 intermittent endurance test level 1 (IE1 performance (35%, p < 0.001, and incremental treadmill test performance (11.5%, p = 0.003, but not total fat mass (p = 0.176, mean arterial blood pressure (p = 0.328, resting HR (p = 0.219, or blood lipids (p = 0.298–0.854. In CG, no changes were observed in any of the measured physiological variables after the training period. Compared to CG, HG had an increase in intrinsic motivation (p < 0.001 and in the well-being subscale “energy” (p = 0.010. Conclusion: Participation in regular recreational team handball training organized as small-sided games has marked beneficial effects on physical performance, musculoskeletal fitness, well-being, and motivation in untrained young women. Keywords: Bone mineral density (BMD, Intensity, Intermittent, Motivation, Muscle mass, Physical performance, Recreational handball, Well-being

  5. PROCEEDINGS OF THE 2008 Computers in Music Modeling and Retrieval and Network for Cross-Disciplinary Studies of Music and Meaning Conference

    DEFF Research Database (Denmark)

    and encouraged studies that linked sound modeling by analysis-synthesis to perception and cognition. CMMR 2008 seeks to enlarge upon the Sense of Sounds-concept by taking into account the musical structure as a whole. More precisely, the workshop will have as its theme Genesis of Meaning in Sound and Music......The field of computer music is interdisciplinary by nature and closely related to a number of areas in computer science and engineering. The first CMMR  gatherings mainly focused on information retrieval, programming, digital libraries, hypermedia, artificial intelligence, acoustics and signal...... processing. In 2005 CMMR started moving towards a more interdisciplinary view of the field by putting increased emphasis on the investigation of the role of human interaction at all levels of musical practice. CMMR 2007 focused on the Sense of Sounds from the synthesis and retrieval point of view...

  6. Fitness and health benefits of team handball training for young untrained women - A cross-disciplinary RCT on physiological adaptations and motivational aspects

    DEFF Research Database (Denmark)

    Hornstrup, Therese; Wikman, Johan Michael; Fristrup, Bjørn

    2018-01-01

    , 38.1 ± 3.7 mL/min/kg). Physiological and psychological and motivational training adaptations were assessed pre- and post-intervention by Dual-Energy X-ray Absorptiometry (DXA) scans, blood sampling, physical tests, and questionnaires.  Results: The average heart rate (HR) over all training sessions...... an increase in intrinsic motivation (p fitness, well...

  7. EAP course design within a context of institutional change and cross-disciplinary collaboration: Factors shaping the creating of ‘writing for commerce’

    Directory of Open Access Journals (Sweden)

    Jackson, Fiona

    2009-12-01

    Full Text Available Many reports of needs analysis and curriculum design of EAP courses focus largely on the immediate pedagogic context and ensuing decision making and materials design processes of the course designers. This paper explores the process of curriculum design from the perspectives of both debates and developments within the field of language and literacy education, and the impact of international, national and institutional shifts in higher education on one course design process within one South African university. The paper explores the realities of institutional and disciplinary histories and changes that impacted on the design of an EAP course for a linguistically, culturally and racially diverse group of first-year commerce students. The intricacies of creating such a course as an inter-disciplinary school, rather than departmental, project are explored and briefly evaluated. The key principles underpinning the course design are explained. The paper concludes with consideration of why the collaborative inter-disciplinary project has faded, although the course has continued successfully.

  8. NIMROD: A Customer Focused, Team Driven Approach for Fusion Code Development

    Science.gov (United States)

    Karandikar, H. M.; Schnack, D. D.

    1996-11-01

    NIMROD is a new code that will be used for the analysis of existing fusion experiments, prediction of operational limits, and design of future devices. An approach called Integrated Product Development (IPD) is being used for the development of NIMROD. It is a dramatic departure from existing practice in the fusion program. Code development is being done by a self-directed, multi-disciplinary, multi-institutional team that consists of experts in plasma theory, experiment, computational physics, and computer science. Customer representatives (ITER, US experiments) are an integral part of the team. The team is using techniques such as Quality Function Deployment (QFD), Pugh Concept Selection, Rapid Prototyping, and Risk Management, during the design phase of NIMROD. Extensive use is made of communication and internet technology to support collaborative work. Our experience with using these team techniques for such a complex software development project will be reported.

  9. Exploring complex dynamics in multi agent-based intelligent systems: Theoretical and experimental approaches using the Multi Agent-based Behavioral Economic Landscape (MABEL) model

    Science.gov (United States)

    Alexandridis, Konstantinos T.

    This dissertation adopts a holistic and detailed approach to modeling spatially explicit agent-based artificial intelligent systems, using the Multi Agent-based Behavioral Economic Landscape (MABEL) model. The research questions that addresses stem from the need to understand and analyze the real-world patterns and dynamics of land use change from a coupled human-environmental systems perspective. Describes the systemic, mathematical, statistical, socio-economic and spatial dynamics of the MABEL modeling framework, and provides a wide array of cross-disciplinary modeling applications within the research, decision-making and policy domains. Establishes the symbolic properties of the MABEL model as a Markov decision process, analyzes the decision-theoretic utility and optimization attributes of agents towards comprising statistically and spatially optimal policies and actions, and explores the probabilogic character of the agents' decision-making and inference mechanisms via the use of Bayesian belief and decision networks. Develops and describes a Monte Carlo methodology for experimental replications of agent's decisions regarding complex spatial parcel acquisition and learning. Recognizes the gap on spatially-explicit accuracy assessment techniques for complex spatial models, and proposes an ensemble of statistical tools designed to address this problem. Advanced information assessment techniques such as the Receiver-Operator Characteristic curve, the impurity entropy and Gini functions, and the Bayesian classification functions are proposed. The theoretical foundation for modular Bayesian inference in spatially-explicit multi-agent artificial intelligent systems, and the ensembles of cognitive and scenario assessment modular tools build for the MABEL model are provided. Emphasizes the modularity and robustness as valuable qualitative modeling attributes, and examines the role of robust intelligent modeling as a tool for improving policy-decisions related to land

  10. QBCov: A Linked Data interface for Discrete Global Grid Systems, a new approach to delivering coverage data on the web

    Science.gov (United States)

    Zhang, Z.; Toyer, S.; Brizhinev, D.; Ledger, M.; Taylor, K.; Purss, M. B. J.

    2016-12-01

    We are witnessing a rapid proliferation of geoscientific and geospatial data from an increasing variety of sensors and sensor networks. This data presents great opportunities to resolve cross-disciplinary problems. However, working with it often requires an understanding of file formats and protocols seldom used outside of scientific computing, potentially limiting the data's value to other disciplines. In this paper, we present a new approach to serving satellite coverage data on the web, which improves ease-of-access using the principles of linked data. Linked data adapts the concepts and protocols of the human-readable web to machine-readable data; the number of developers familiar with web technologies makes linked data a natural choice for bringing coverages to a wider audience. Our approach to using linked data also makes it possible to efficiently service high-level SPARQL queries: for example, "Retrieve all Landsat ETM+ observations of San Francisco between July and August 2016" can easily be encoded in a single query. We validate the new approach, which we call QBCov, with a reference implementation of the entire stack, including a simple web-based client for interacting with Landsat observations. In addition to demonstrating the utility of linked data for publishing coverages, we investigate the heretofore unexplored relationship between Discrete Global Grid Systems (DGGS) and linked data. Our conclusions are informed by the aforementioned reference implementation of QBCov, which is backed by a hierarchical file format designed around the rHEALPix DGGS. Not only does the choice of a DGGS-based representation provide an efficient mechanism for accessing large coverages at multiple scales, but the ability of DGGS to produce persistent, unique identifiers for spatial regions is especially valuable in a linked data context. This suggests that DGGS has an important role to play in creating sustainable and scalable linked data infrastructures. QBCov is being

  11. Organising to Enable Innovation

    DEFF Research Database (Denmark)

    Brink, Tove

    2016-01-01

    The purpose of this conceptual paper is to reveal how organising can enable innovation across organisational layers and organisational units. This approach calls for a cross-disciplinary literature review. The aim is to provide an integrated understanding of innovation in an organisational approach....... The findings reveal a continous organising process between individual/ team creativity and organisational structures/control to enable innovation at firm level. Organising provides a dynamic approach and contains the integrated reconstruction of creativity, structures and boundaries for enhanced balance...... of explorative and exploitative learning in uncertain environments. Shedding light on the cross-disciplinary theories to organise innovation provides a contribution at the firm level to enable innovation....

  12. Professional Use of Social Media Among Surgeons: Results of a Multi-Institutional Study.

    Science.gov (United States)

    Wagner, Justin P; Cochran, Amalia L; Jones, Christian; Gusani, Niraj J; Varghese, Thomas K; Attai, Deanna J

    2017-09-27

    Among surgeons, professional use of social media (SM) is varied, and attitudes are ambiguous. We sought to characterize surgeons' professional use and perceptions of SM. Surgical faculty and trainees received institutional review board-approved e-mail surveys assessing SM usage and attitudes. Regression analyses identified predictors of SM attitudes and preference for professional contact. Surveys were administered to surgical faculty, fellows, and residents at 4 academic medical centers between January and April 2016. Of 1037 surgeons, clinical fellows, and residents e-mailed, 208 (20%) responded, including 132 faculty and 76 trainees. Among 208 respondents, 46 (22%) indicated they preferred some form of SM as their preferred networking and communication modality. A total of 145 (70%) indicated they believe SM benefits professional development. The position of clinical resident predicted preference to maintain professional contact via SM (p = 0.03). Age professional purposes. Perceived barriers include lack of value, time constraints, and personal and patient privacy concerns. Generational differences in surgeon attitudes suggest usage of SM among surgeons will expand over time. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study.

    Science.gov (United States)

    El-Yahchouchi, Christine A; Plastaras, Christopher T; Maus, Timothy P; Carr, Carrie M; McCormick, Zachary L; Geske, Jennifer R; Smuck, Matthew; Pingree, Matthew J; Kennedy, David J

    2016-02-01

    Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety. To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines. Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events. There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2% of procedures, more frequently (P = 0.004) in TFESI (1.3%) than ILESI (0.5%). Dural punctures occurred in 0.06% of procedures, more commonly after ILESI (0.2% vs 0.04%, P = 0.006). Delayed follow up on PM&R patients (92.5% and 78.5, next business day) and radiology patients (63.1%, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6% of both TFESI and ILESI patients. 2.1% of TFESI and 1.8% of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event. Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.

  14. Motivation Filtering on a Multi-Institution Assessment of General College Outcomes

    Science.gov (United States)

    Steedle, Jeffrey T.

    2014-01-01

    Possible lack of motivation is a perpetual concern when tests have no stakes attached to performance. Specifically, the validity of test score interpretations may be compromised when examinees are unmotivated to exert their best efforts. Motivation filtering, a procedure that filters out apparently unmotivated examinees, was applied to the…

  15. Prehospital care training in a rapidly developing economy: a multi-institutional study.

    Science.gov (United States)

    Vyas, Dinesh; Hollis, Michael; Abraham, Rohit; Rustagi, Neeti; Chandra, Siddharth; Malhotra, Ajai; Rajpurohit, Vikas; Purohit, Harshada; Pal, Ranabir

    2016-06-01

    The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality. An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels. Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise. Published by Elsevier Inc.

  16. Quality Assurance Issues in Conducting Multi-Institutional Advanced Technology Clinical Trials

    International Nuclear Information System (INIS)

    Purdy, James A.

    2008-01-01

    The National Cancer Institute-sponsored Advanced Technology Quality Assurance (QA) Consortium, which consisted of the Image-Guided Therapy QA Center, Radiation Therapy Oncology Group, Radiological Physics Center, Quality Assurance Review Center, and Resource Center for Emerging Technologies, has pioneered the development of an infrastructure and QA method for advanced technology clinical trials that requires volumetric digital data submission of a protocol patient's treatment plan and verification data. In particular, the Image-Guided Therapy QA Center has nearly 15 years experience in facilitating QA review for Radiation Therapy Oncology Group advanced technology clinical trials. This QA process includes (1) a data integrity review for completeness of protocol required elements, the format of data, and possible data corruption, and recalculation of dose-volume histograms; (2) a review of compliance with target volume and organ-at-risk contours by study chairs; and (3) a review of dose prescription and dose heterogeneity compliance by the Radiation Therapy Oncology Group Headquarters Dosimetry Group or the Radiological Physics Center dosimetrists (for brachytherapy protocols). This report reviews the lessons learned and the QA challenges presented by the use of advanced treatment modalities in clinical trials requiring volumetric digital data submission

  17. The Hazard of Graduation: Analysis of Three Multivariate Statistics Used to Study Multi-Institutional Attendance

    Science.gov (United States)

    Muehlberg, Jessica Marie

    2013-01-01

    Adelman (2006) observed that a large quantity of research on retention is "institution-specific or use institutional characteristics as independent variables" (p. 81). However, he observed that over 60% of the students he studied attended multiple institutions making the calculation of institutional effects highly problematic. He argued…

  18. SU-E-T-49: A Multi-Institutional Study of Independent Dose Verification for IMRT

    International Nuclear Information System (INIS)

    Baba, H; Tachibana, H; Kamima, T; Takahashi, R; Kawai, D; Sugawara, Y; Yamamoto, T; Sato, A; Yamashita, M

    2015-01-01

    Purpose: AAPM TG114 does not cover the independent verification for IMRT. We conducted a study of independent dose verification for IMRT in seven institutes to show the feasibility. Methods: 384 IMRT plans in the sites of prostate and head and neck (HN) were collected from the institutes, where the planning was performed using Eclipse and Pinnacle3 with the two techniques of step and shoot (S&S) and sliding window (SW). All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. An ion-chamber measurement in a water-equivalent slab phantom was performed to compare the doses computed using the TPS and an independent dose verification program. Additionally, the agreement in dose computed in patient CT images between using the TPS and using the SMU was assessed. The dose of the composite beams in the plan was evaluated. Results: The agreement between the measurement and the SMU were −2.3±1.9 % and −5.6±3.6 % for prostate and HN sites, respectively. The agreement between the TPSs and the SMU were −2.1±1.9 % and −3.0±3.7 for prostate and HN sites, respectively. There was a negative systematic difference with similar standard deviation and the difference was larger in the HN site. The S&S technique showed a statistically significant difference between the SW. Because the Clarkson-based method in the independent program underestimated (cannot consider) the dose under the MLC. Conclusion: The accuracy would be improved when the Clarkson-based algorithm should be modified for IMRT and the tolerance level would be within 5%

  19. Using generalizability analysis to estimate parameters for anatomy assessments: A multi-institutional study.

    Science.gov (United States)

    Byram, Jessica N; Seifert, Mark F; Brooks, William S; Fraser-Cotlin, Laura; Thorp, Laura E; Williams, James M; Wilson, Adam B

    2017-03-01

    With integrated curricula and multidisciplinary assessments becoming more prevalent in medical education, there is a continued need for educational research to explore the advantages, consequences, and challenges of integration practices. This retrospective analysis investigated the number of items needed to reliably assess anatomical knowledge in the context of gross anatomy and histology. A generalizability analysis was conducted on gross anatomy and histology written and practical examination items that were administered in a discipline-based format at Indiana University School of Medicine and in an integrated fashion at the University of Alabama School of Medicine and Rush University Medical College. Examination items were analyzed using a partially nested design s×(i:o) in which items were nested within occasions (i:o) and crossed with students (s). A reliability standard of 0.80 was used to determine the minimum number of items needed across examinations (occasions) to make reliable and informed decisions about students' competence in anatomical knowledge. Decision study plots are presented to demonstrate how the number of items per examination influences the reliability of each administered assessment. Using the example of a curriculum that assesses gross anatomy knowledge over five summative written and practical examinations, the results of the decision study estimated that 30 and 25 items would be needed on each written and practical examination to reach a reliability of 0.80, respectively. This study is particularly relevant to educators who may question whether the amount of anatomy content assessed in multidisciplinary evaluations is sufficient for making judgments about the anatomical aptitude of students. Anat Sci Educ 10: 109-119. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

  20. Expectation-Based Efficiency and Quality Improvements in Research Administration: Multi-Institutional Case Studies

    Science.gov (United States)

    Saha, Dhanonjoy C.; Ahmed, Abrar; Hanumandla, Shailaja

    2011-01-01

    Conventional wisdom may support the presumed notion that higher expectations increase efficiency and improve quality. However, this claim may only be validated when workers are equipped with appropriate tools, training, and a conducive work environment. This study implements various interventions, observes outcomes, and analyzes data collected in…

  1. Multi-institutional analysis of early squamous cell carcinoma of the hypopharynx treated with radical radiotherapy

    International Nuclear Information System (INIS)

    Nakamura, Katsumasa; Shioyama, Yoshiyuki; Kawashima, Mitsuhiko; Saito, Yoshihiro; Nakamura, Naoki; Nakata, Kensei; Hareyama, Masato; Takada, Takahiro; Karasawa, Kumiko; Watanabe, Toshiichi; Yorozu, Atsunori; Tachibana, Hiroyuki; Suzuki, Gen; Hayabuchi, Naofumi; Toba, Takashi; Yamada, Shogo

    2006-01-01

    Purpose: To analyze the outcomes of patients with early hypopharyngeal cancer treated with radical radiotherapy (RT). Methods and Materials: Ten institutions combined the data from 115 patients with Stage I-II hypopharyngeal squamous cell carcinoma treated with definitive RT between 1990 and 2001. The median patient age was 67 years; 99 patients were men and 16 were women. Of the 115 patients, 39 had Stage I and 76 had Stage II disease. Conventional fractionation was used in 98 patients and twice-daily RT in 17 patients; chemotherapy was combined with RT in 57 patients. The median follow-up period was 47 months. Results: The overall and disease-specific 5-year survival rate for 95 patients without synchronous malignancies was 66.0% and 77.4%, respectively. The 5-year disease-specific survival rate by T stage was 95.8% for patients with T1 disease and 70.1% for patients with T2 disease (p = 0.02). Of the 115 patients, local control with laryngeal voice preservation was achieved in 34 of 39 patients with T1 lesions, including 7 patients successfully salvaged, and in 56 of 76 patients with T2 lesions. Sixty-five patients (56.5%) had synchronous or metachronous cancers. Of the 115 patients, 19 died of hypopharyngeal cancer, 10 died of second primary cancers, and 14 died of other causes during the study and follow-up periods. Conclusions: Patients with early hypopharyngeal cancer tended to have a good prognosis after RT. However, second malignancies had an adverse effect on the overall outcomes of patients with early hypopharyngeal cancer

  2. A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery

    International Nuclear Information System (INIS)

    Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade; Pollock, Bruce E.; Yamamoto, Masaaki; Gorman, Deborah A.; Schomberg, Paula J.; Sneed, Patricia; Larson, David; Smith, Vernon; McDermott, Michael W.; Miyawaki, Lloyd; Chilton, Jonathan; Morantz, Robert A.; Young, Byron; Jokura, Hidefumi; Liscak, Roman

    1999-01-01

    Purpose: To better understand radiation complications of arteriovenous malformation (AVM) radiosurgery and factors affecting their resolution. Methods and Materials: AVM patients (102/1255) who developed neurological sequelae after radiosurgery were studied. The median AVM marginal dose (D min ) was 19 Gy (range: 10-35). The median volume was 5.7 cc (range: 0.26-143). Median follow-up was 34 months (range: 9-140). Results: Complications consisted of 80/102 patients with evidence of radiation injury to the brain parenchyma (7 also with cranial nerve deficits, 12 also with seizures, 5 with cyst formation), 12/102 patients with isolated cranial neuropathies, and 10/102 patients with only new or worsened seizures. Severity was classified as minimal in 39 patients, mild in 40, disabling in 21, and fatal in 2 patients. Symptoms resolved completely in 42 patients for an actuarial resolution rate of 54% ± 7% at 3 years post-onset. Multivariate analysis identified significantly greater symptom resolution in patients with no prior history of hemorrhage (p = 0.01, 66% vs. 41%), and in patients with symptoms of minimal severity: headache or seizure as the only sequelae of radiosurgery (p < 0.0001, 88% vs. 34%). Conclusion: Late sequelae of radiosurgery manifest in varied ways. Further long-term studies of these problems are needed that take into account symptom severity and prior hemorrhage history

  3. Development and Evaluation of a Multi-Institutional Case Studies-Based Course in Food Safety

    Science.gov (United States)

    Pleitner, Aaron M.; Chapin, Travis K.; Hammons, Susan R.; Stelten, Anna Van; Nightingale, Kendra K.; Wiedmann, Martin; Johnston, Lynette M.; Oliver, Haley F.

    2015-01-01

    Developing novel, engaging courses in food safety is necessary to train professionals in this discipline. Courses that are interactive and case-based encourage development of critical thinking skills necessary for identifying and preventing foodborne disease outbreaks. The purpose of this study was to assess the efficacy of a case study…

  4. Multi-institutional Outcomes of Endoscopic Management of Stricture Recurrence after Bulbar Urethroplasty.

    Science.gov (United States)

    Sukumar, Shyam; Elliott, Sean P; Myers, Jeremy B; Voelzke, Bryan B; Smith, Thomas G; Carolan, Alexandra Mc; Maidaa, Michael; Vanni, Alex J; Breyer, Benjamin N; Erickson, Bradley A

    2018-05-03

    Approximately 10-20% of patients will have a recurrence after urethroplasty. Initial management of these recurrences is often with urethral dilation (UD) or direct vision internal urethrotomy (DVIU). In the current study, we describe outcomes of endoscopic management of stricture recurrence after bulbar urethroplasty. We retrospectively reviewed bulbar urethroplasty data from 5 surgeons from the Trauma and Urologic Reconstruction Network of Surgeons. Men who underwent UD or DVIU for urethroplasty recurrence were identified. Recurrence was defined as inability to pass a 17Fr cystoscope through the area of reconstruction. The primary outcome was the success rate of recurrence management. Comparisons were made between UD and DVIU and then between endoscopic management of recurrences after excision and primary anastomosis urethroplasty (EPA) versus substitutional repairs using time-to-event statistics. There were 53 men with recurrence that were initially managed endoscopically. Median time to urethral stricture recurrence after urethroplasty was noted to be 5 months. At a median follow-up of 5 months, overall success was 42%. Success after UD (n=1/10, 10%) was significantly lower than after DVIU (n=21/43, 49%; p urethroplasty. DVIU is more successful for patients with a recurrence after a substitution urethroplasty compared to after EPA, perhaps indicating a different mechanism of recurrence for EPA (ischemic) versus substitution urethroplasty (non-ischemic). Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

    Science.gov (United States)

    2015-10-01

    biomarkers; prediction models; PCA3; TMPRSS2: ERG ; kallikreins; 4KScore; OncotypeDX; 5 3. ACCOMPLISHMENTS What were the major goals and...urine, alone or in combination with TMPRSS2: ERG mRNA. (Lead site: FHCRC) Milestone 10. Urine specimens identified for analysis. Due 12/30/2014...COMPLETED Milestone 11. PCA3 and TMPRSS2: ERG validation complete in PASS cohort. Due 12/30/2015 Milestone 12. Manuscript submission of PCA3 and TMPRSS2: ERG

  6. Factors Influencing Readmission After Pancreaticoduodenectomy: A Multi-Institutional Study of 1302 Patients.

    NARCIS (Netherlands)

    Ahmad, S.A.; Edwards, M.J.R.; Sutton, J.M.; Grewal, S.S.; Hanseman, D.J.; Maithel, S.K.; Patel, S.H.; Bentram, D.J.; Weber, S.M.; Cho, C.S.; Winslow, E.R.; Scoggins, C.R.; Martin, R.C.; Kim, H.J.; Baker, J.J.; Merchant, N.B.; Parikh, A.A.; Kooby, D.A.

    2012-01-01

    OBJECTIVE AND BACKGROUND:: Morbidity, mortality, and length of hospital stay after pancreaticoduodenectomy (PD) have significantly decreased over recent decades. Despite this progress, early readmission rates after PD have been reported as high as 50%. Few reports have delineated factors associated

  7. A Multi-Institutional Investigation of Students' Preinstructional Ideas about Cosmology

    Science.gov (United States)

    Bailey, Janelle M.; Sanchez, Roxanne; Coble, Kim; Larrieu, Donna; Cochran, Geraldine; Cominsky, Lynn R.

    2012-01-01

    In order to improve instruction in introductory astronomy, we are investigating students' preinstructional ideas about a number of cosmology topics. This article describes one aspect of this large research study in which 1270 students responded to a subset of three questions each from a larger set of questions about the following areas: definition…

  8. Biomarkers for Early Detection of Clinically Relevant Prostate Cancer. A Multi-Institutional Validation Trial

    Science.gov (United States)

    2016-10-01

    aim 2: Evaluate a panel of four-kallikrein plasma-based markers to determine the presence of or progression to clinically relevant prostate cancer...and sent to Genomic Health, Inc. for processing. Task 3: Analysis of scientific Aim 2: Evaluate a panel of four-kallikrein plasma-based markers to...site: FHCRC) PCA3 and the TMPRSS2:ERG fusion are prostate cancer-specific biomarkers that hold promise for stratifying risk in the setting of AS

  9. Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

    Science.gov (United States)

    2015-10-01

    provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently ...biomarker platforms in our multi-center, prospectively accrued prostate cancer active surveillance cohort – the Canary Prostate Active Surveillance...prostate cancers currently diagnosed are low risk tumors for which there is substantial evidence that the cancer will not cause harm if left untreated

  10. Data management, documentation and analysis systems in radiation oncology: a multi-institutional survey

    International Nuclear Information System (INIS)

    Kessel, Kerstin A.; Combs, Stephanie E.

    2015-01-01

    Recently, information availability has become more elaborate and widespread, and treatment decisions are based on a multitude of factors. Gathering relevant data, also referred to as Big Data, is therefore critical for reaching the best patient care, and enhancing interdisciplinary and clinical research. Combining patient data from all involved systems is essential to prepare unstructured data for analyses. This demands special coordination in data management. Our study aims to characterize current developments in German-speaking hospital departments and practices. We successfully conducted the survey with the members of the Deutsche Gesellschaft für Radioonkologie (DEGRO). A questionnaire was developed consisting of 17 questions related to data management, documentation and clinical trial analyses, reflecting the clinical topics such as basic patient information, imaging, follow-up information as well as connection of documentation tools with radiooncological treatment planning machines. A total of 44 institutions completed the online survey (University hospitals n = 17, hospitals n = 13, practices/institutes n = 14). University hospitals, community hospitals and private practices are equally equipped concerning IT infrastructure for clinical use. However, private practices have a low interest in research work. All respondents stated the biggest obstacles about introducing a documentation system into their unit lie in funding and support of the central IT departments. Only 27 % (12/44) of responsible persons are specialists for documentation and data management. Our study gives an understanding of the challenges and solutions we need to be looking at for medical data storage. In the future, inter-departmental cross-links will enable the radiation oncology community to generate large-scale analyses. The online version of this article (doi:10.1186/s13014-015-0543-0) contains supplementary material, which is available to authorized users

  11. The Role of Multi-Institutional Partnerships in Supply Chain Management Course Design and Improvement

    Science.gov (United States)

    Long, Suzanna; Moos, J. Chris; Radic, Anne Bartel

    2012-01-01

    The authors examined the skills achieved through a multicultural, virtual student project environment among 3 supply chain management courses. The partnership included 2 universities in the United States and 1 in France and created virtual teams of students across university lines and is presented as a case study. The case includes detailed…

  12. Post-hemispherectomy hydrocephalus: results of a comprehensive, multi-institutional review

    Science.gov (United States)

    Lew, Sean M.; Matthews, Anne E.; Hartman, Adam L.; Haranhalli, Neil

    2012-01-01

    SUMMARY Purpose Hemispherectomy surgery for medically intractable epilepsy is known to cause hydrocephalus in a subset of patients. Existing data regarding the incidence of, and risk factors for developing, post-hemispherectomy hydrocephalus has been limited by the relatively small number of cases performed by any single center. Our goal was to better understand this phenomenon and to identify risk factors that may predispose patients to developing hydrocephalus after hemispherectomy surgery. Methods Fifteen pediatric epilepsy centers participated in this study. A retrospective chart review was performed on all available patients who had hemispherectomy surgery. Data collected included surgical techniques, etiology of seizures, prior brain surgery, symptoms and signs of hydrocephalus, timing of shunt placement and basic demographics. Key findings Data were collected from 736 patients who underwent hemispherectomy surgery between 1986 and 2011. Forty-six patients had pre-existing shunted hydrocephalus and were excluded from analysis, yielding 690 patients for this study. One hundred sixty-two patients (23%) required hydrocephalus treatment. The timing of hydrocephalus ranged from the immediate post-operative period to 8.5 years after surgery, with 43 patients (27%) receiving shunts more than 90 days after surgery. Multivariate regression analysis revealed anatomic hemispherectomies (OR 4.1, phydrocephalus. There was a trend towards significance for the use of hemostatic agents (O.R. 2.2, p=0.07) and the involvement of basal ganglia or thalamus in the resection (O.R. 2.2, p=0.08) as risk factors. Significance Hydrocephalus is a common sequela of hemispherectomy surgery. Surgical technique and prior brain surgery influence the occurrence of post-hemispherectomy hydrocephalus. A significant portion of patients develop hydrocephalus on a delayed basis, indicating the need for long-term surveillance. PMID:23106378

  13. Comparing predictive models of glioblastoma multiforme built using multi-institutional and local data sources.

    Science.gov (United States)

    Singleton, Kyle W; Hsu, William; Bui, Alex A T

    2012-01-01

    The growing amount of electronic data collected from patient care and clinical trials is motivating the creation of national repositories where multiple institutions share data about their patient cohorts. Such efforts aim to provide sufficient sample sizes for data mining and predictive modeling, ultimately improving treatment recommendations and patient outcome prediction. While these repositories offer the potential to improve our understanding of a disease, potential issues need to be addressed to ensure that multi-site data and resultant predictive models are useful to non-contributing institutions. In this paper we examine the challenges of utilizing National Cancer Institute datasets for modeling glioblastoma multiforme. We created several types of prognostic models and compared their results against models generated using data solely from our institution. While overall model performance between the data sources was similar, different variables were selected during model generation, suggesting that mapping data resources between models is not a straightforward issue.

  14. Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multi-institutional trial.

    Science.gov (United States)

    Giguère, Chantal M; Bauman, Nancy M; Sato, Yutaka; Burke, Diane K; Greinwald, John H; Pransky, Seth; Kelley, Peggy; Georgeson, Keith; Smith, Richard J H

    2002-10-01

    To describe and to determine the robustness of our study evaluating the efficacy of OK-432 (Picibanil) as a therapeutic modality for lymphangiomas. Prospective, randomized trial and parallel-case series at 13 US tertiary care referral centers. Thirty patients diagnosed as having lymphangioma. Ages in 25 ranged from 6 months to 18 years. Twenty-nine had lesions located in the head-and-neck area. Every patient received a 4-dose injection series of OK-432 scheduled 6 to 8 weeks apart unless a contraindication existed or a complete response was observed before completion of all injections. A control group was observed for 6 months. Successful outcome of therapy was defined as a complete or a substantial (>60%) reduction in lymphangioma size as determined by calculated lesion volumes on computed tomographic or magnetic resonance imaging scans. Overall, 19 (86%) of the 22 patients with predominantly macrocystic lymphangiomas had a successful outcome. OK-432 should be efficacious in the treatment of lymphangiomas. Our study design is well structured to clearly define the role of this treatment agent.

  15. Multi-institutional Pooled Analysis on Adjuvant Chemoradiation in Pancreatic Cancer

    International Nuclear Information System (INIS)

    Morganti, Alessio G.; Falconi, Massimo; Stiphout, Ruud G.P.M. van; Mattiucci, Gian-Carlo; Alfieri, Sergio; Calvo, Felipe A.; Dubois, Jean-Bernard; Fastner, Gerd; Herman, Joseph M.; Maidment, Bert W.; Miller, Robert C.; Regine, William F.; Reni, Michele; Sharma, Navesh K.; Ippolito, Edy

    2014-01-01

    Purpose: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. Methods and Materials: A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT. Results: Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P<.001) and 27.8 months after CT alone (P<.001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [CI], 0.60-0.87; P=.001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >20 mm (HR = 1.14; CI = 1.05-1.23; P=.002). Multivariate analysis also showed a better prognosis in patients treated in centers with >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) Conclusion: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT

  16. The internet radiation oncology journal club - a multi-institutional collaborative education project

    International Nuclear Information System (INIS)

    Goldsmith, Brian J.; Donaldson, Sarah S.; Mendenhall, William M.; Recht, Abram; Hoppe, Richard T.; Grigsby, Perry W.; Turrisi, Andrew T.; Tepper, Joel E.; Roach, Mack; Larson, David A.; Withers, H. Rodney; Purdy, James A.

    1997-01-01

    Purpose/Objective: The high volume of literature publication in radiation oncology poses a substantial selection and reading challenge. Busy health care providers may, from time to time, fail to identify and read important papers, resulting in delays in improvement of practice standards. Residency training programs have historically used journal clubs as a solution to this education challenge. In June 1995, radiation oncologists and scientists from nine institutions began the Internet Radiation Oncology Journal Club (IROJC) - a pilot project created to improve radiation oncology education worldwide by identifying noteworthy literature and stimulating an internet-based forum for literature discussion. Materials and Methods: The IROJC is a free-of-charge, moderated e-mailing list hosted by BIOSCI - a set of electronic communication forums used by biological scientists worldwide. Eleven radiation oncologists and scientists with internationally-recognized subspecialty expertise serve as IROJC editors. Each month, editors select noteworthy contemporary literature for inclusion. Selected references, often accompanied by editorial comments, are transmitted over the internet to IROJC readers. Readers request subscription by sending an e-mail message to biosci-server at net.bio.net, with 'subscribe radoncjc' in the body of the message. A website (www.bio.net/hypermail/RADIATION-ONCOLOGY), which includes an archive of back issues, is also available. Results: By February 1997, the IROJC's email-format enrollment numbered more than 670 readers from over 14 countries, its website was browsed by an average of 25 unique readers per week, and both figures were increasing steadily. An exciting online dialogue of literature- and practice-based comments and questions had emerged with increasing readership participation. Conclusion: Our pilot experience with the IROJC project has been promising. The observed increase in enrollment, website use, and readership discourse suggests considerable interest in this forum, educational utility, as well as potential for further growth. As the IROJC reaches a wider participant audience, improved education and communication between health care providers is predicted

  17. Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

    Science.gov (United States)

    2017-10-01

    size, diagnostic Gleason (3+3 or 3+4), BMI ( obese , overweight or normal), race (Caucasian, African American or other), ethnicity (Hispanic versus...results were presented at the 2016 Meeting of the American Urological Association (AUA) and have been published in European Urology (v72, pp448-454.) A...prostate cancer in men in the Canary Prostate Active Surveillance Study (PASS).” Annual Meeting of the American Urological Association; 2016 May 6-10, San

  18. A Multi-Institution Look at College Students Seeking Counseling: Nature and Severity of Concerns

    Science.gov (United States)

    Krumrei, Elizabeth J.; Newton, Fred B.; Kim, Eunhee

    2010-01-01

    This study provides information about students seeking counseling (N = 3,844) at 9 institutions of higher education. The K-PIRS, an empirically validated measure, was used to assess 7 problem areas (mood difficulties, learning problems, food concerns, interpersonal conflicts, career uncertainties, self-harm indicators, and addiction issues).…

  19. Retrospective multi-institutional study of radiotherapy for intracranial non-germinomatous germ cell tumors

    International Nuclear Information System (INIS)

    Aoyama, H.; Shirato, H.; Miyasaka, K.; Yoshida, H.; Hareyama, M.; Nishio, M.; Yanagisawa, T.; Kakuto, Y.; Watarai, J.; Inakoshi, H.

    1998-01-01

    The treatment outcome of 24 patients with pathologically-proven non-germinomatous germ cell tumor was retrospectively investigated to determine the effectiveness of radiotherapy. The patients were divided into three groups as follows: group 1, five patients with mature teratoma with or without germinoma; group 2, six patients with immature teratoma with or without germinoma; group 3, 13 patients with other highly malignant tumors. The overall actuarial survival and relapse-free rates at 5 years were 82% and 59%, respectively, with a median follow-up period of 62 months. The actuarial relapse-free rate at 5 years was 100% for group 1, 63% for group 2 and 44% for group 3. There was no difference in the relapse-free rates between total resection and partial resection. Usage of chemotherapy was adversely related to survival probably due to selection bias. No local failure was observed with 10 Gy or more for group 1, 40 Gy or more for group 2 and 54 Gy or more for group 3. In groups 1 and 2, there was no spinal relapses without craniospinal irradiation. In group 3, three of eight patients who did not receive craniospinal irradiation and none of five patients who received craniospinal irradiation experienced spinal relapse. In conclusion, highly malignant GCTs show a high incidence of spinal metastasis and craniospinal irradiation may reduce the risk of spinal metastasis. Radiation dose and volume are to be determined according to the histopathological aggressiveness. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  20. A Prospective Multi-Institutional Cohort Study of Mediastinal Infections After Cardiac Operations.

    Science.gov (United States)

    Perrault, Louis P; Kirkwood, Katherine A; Chang, Helena L; Mullen, John C; Gulack, Brian C; Argenziano, Michael; Gelijns, Annetine C; Ghanta, Ravi K; Whitson, Bryan A; Williams, Deborah L; Sledz-Joyce, Nancy M; Lima, Brian; Greco, Giampaolo; Fumakia, Nishit; Rose, Eric A; Puskas, John D; Blackstone, Eugene H; Weisel, Richard D; Bowdish, Michael E

    2018-02-01

    Mediastinal infections are a potentially devastating complication of cardiac operations. This study analyzed the frequency, risk factors, and perioperative outcomes of mediastinal infections after cardiac operations. In 2010, 5,158 patients enrolled in a prospective study evaluating infections after cardiac operations and their effect on readmissions and mortality for up to 65 days after the procedure. Clinical and demographic characteristics, operative variables, management practices, and outcomes were compared for patients with and without mediastinal infections, defined as deep sternal wound infection, myocarditis, pericarditis, or mediastinitis. There were 43 mediastinal infections in 41 patients (cumulative incidence, 0.79%; 95% confidence interval [CI] 0.60% to 1.06%). Median time to infection was 20.0 days, with 65% of infections occurring after the index hospitalization discharge. Higher body mass index (hazard ratio [HR] 1.06; 95% CI, 1.01 to 1.10), higher creatinine (HR, 1.25; 95% CI, 1.13 to 1.38), peripheral vascular disease (HR, 2.47; 95% CI, 1.21 to 5.05), preoperative corticosteroid use (HR, 3.33; 95% CI, 1.27 to 8.76), and ventricular assist device or transplant surgery (HR, 5.81; 95% CI, 2.36 to 14.33) were associated with increased risk of mediastinal infection. Postoperative hyperglycemia (HR, 3.15; 95% CI, 1.32 to 7.51) was associated with increased risk of infection in nondiabetic patients. Additional length of stay attributable to mediastinal infection was 11.5 days (bootstrap 95% CI, 1.88 to 21.11). Readmission rates and mortality were five times higher in patients with mediastinal infection than in patients without mediastinal infection. Mediastinal infection after a cardiac operation is associated with substantial increases in length of stay, readmissions, and death. Reducing these infections remains a high priority, and improving post-operative glycemic management may reduce their risk in patients without diabetes. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. A multi-institutional survey evaluating patient related QA – phase II

    Directory of Open Access Journals (Sweden)

    Teichmann Tobias

    2017-09-01

    Full Text Available In phase I of the survey a planning intercomparison of patient-related QA was performed at 12 institutions. The participating clinics created phantom based IMRT and VMAT plans which were measured utilizing the ArcCheck diode array. Mobius3D (M3D was used in phase II. It acts as a secondary dose verification tool for patient-specific QA based on average linac beam data collected by Mobius Medical Systems. All Quasimodo linac plans will be analyzed for the continuation of the intercomparison. We aim to determine if Mobius3D is suited for use with diverse treatment techniques, if beam model customization is needed. Initially we computed first Mobius3D results by transferring all plans from phase I to our Mobius3D server. Because of some larger PTV mean dose differences we checked if output factor customization would be beneficial. We performed measurements and output factor correction to account for discrepancies in reference conditions. Compared to Mobius3D's preconfigured average beam data values, these corrected output factors differed by ±1.5% for field sizes between 7x7cm2 and 30x30cm2 and to −3.9% for 3x3cm2. Our method of correcting the output factors turns out good congruence to M3D's reference values for these medium field sizes.

  2. Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

    Science.gov (United States)

    2017-10-01

    25 4 1. INTRODUCTION Although prostate - specific antigen (PSA) testing and the resulting treatment of...details of this work are described in the attached paper titled “Refined analysis of prostate specific antigen kinetics to predict prostate cancer...Wagner; Daniel W. Lin,; and Yingye Zheng. “Refined analysis of prostate specific antigen kinetics to predict prostate cancer active surveillance outcomes

  3. A multi-institution evaluation of MLC log files and performance in IMRT delivery

    International Nuclear Information System (INIS)

    Kerns, James R; Childress, Nathan; Kry, Stephen F

    2014-01-01

    The multileaf collimator (MLC) is a critical component to accurate intensity-modulated radiotherapy (IMRT) delivery. This study examined MLC positional accuracy via MLC logs from Varian machines from six institutions and three delivery techniques to evaluate typical positional accuracy and treatment and mechanical parameters that affect accuracy. Typical accuracy achieved was compared against TG-142 recommendations for MLC performance; more appropriate recommendations are suggested. Over 85,000 Varian MLC treatment logs were collected from six institutions and analyzed with FractionCHECK. Data were binned according to institution and treatment type to determine overall root mean square (RMS) and 95 th percentile error values, and then to look for correlations between those errors and with mechanical and treatment parameters including mean and maximum leaf speed, gantry angle, beam-on time, mean leaf error, and number of segments. Results of treatment logs found that leaf RMS error and 95 th percentile leaf error were consistent between institutions, but varied by treatment type. The step and shoot technique had very small errors: the mean RMS leaf error was 0.008 mm. For dynamic treatments the mean RMS leaf error was 0.32 mm, while volumetric-modulated arc treatment (VMAT) showed an RMS leaf error of 0.46 mm. Most MLC leaf errors were found to be well below TG-142 recommended tolerances. For the dynamic and VMAT techniques, the mean and maximum leaf speeds were significantly linked to the leaf RMS error. Additionally, for dynamic delivery, the mean leaf error was correlated with RMS error, whereas for VMAT the average gantry speed was correlated. For all treatments, the RMS error and the 95 th percentile leaf error were correlated. Restricting the maximum leaf speed can help improve MLC performance for dynamic and VMAT deliveries. Furthermore, the tolerances of leaf RMS and error counts for all treatment types should be tightened from the TG-142 values to make them more appropriate for clinical performance. Values of 1 mm for the 95 th percentile of leaf RMS error and 1.5 mm for the 95 th percentile leaf error are suggested as action levels for all treatment types

  4. Multi-Institutional Survey of Medical Treatment for Late-Onset Hypogonadism in Japan.

    Science.gov (United States)

    Taniguchi, Hisanori; Matsuda, Tadashi

    2017-03-01

    The adequate criteria for late-onset hypogonadism (LOH) diagnosis, including serum testosterone levels, type (total or free testosterone) and duration of androgen replacement therapy, and evaluations of treatment effectiveness remain controversial. To evaluate the current status of medical treatment for LOH in Japan, the first nationwide survey were performed. A total of 35 questionnaires answered by urologists in high-volume facilities were analyzed. The median numbers of patients with hypogonadism-related symptoms per month were 10. Aging Male Symptom Score, International Index of Erectile Function, and International Prostate Symptom Score questionnaires were widely used for questionnaires. The diagnostic criteria for LOH varied. Among the patients who presented with hypogonadism-related symptoms, the mean proportion of patients undergoing treatment for LOH was 62.3%. In Japan, LOH was treated not only with testosterone enanthate injections or testosterone ointment but also with Kampo medicine. In many facilities, LOH treatment effectiveness was assessed after a 3-month period. Efficacy was assessed in different ways. Treatment effectiveness rate ranged from 30% to 80%. The duration of LOH treatment was not fixed and was established individually by both the patient and treating physician. This study showed that the real clinical practices for LOH are very diverse, and a general consensus is needed.

  5. Reusable Learning Objects for Medical Education: Evolving a Multi-institutional Collaboration

    NARCIS (Netherlands)

    D. Leeder; T. Davies; A. Hall

    2004-01-01

    textabstractIn early 2002 a number of UK HE institutions founded a collaborative project to produce a bank of high quality e-learning resources to support and enhance teaching in the traditionally difficult area of statistics, epidemiology and research skills. Creation of these resources is very

  6. Multi-institutional Validation Study of Commercially Available Deformable Image Registration Software for Thoracic Images

    International Nuclear Information System (INIS)

    Kadoya, Noriyuki; Nakajima, Yujiro; Saito, Masahide; Miyabe, Yuki; Kurooka, Masahiko; Kito, Satoshi; Fujita, Yukio; Sasaki, Motoharu; Arai, Kazuhiro; Tani, Kensuke; Yagi, Masashi; Wakita, Akihisa; Tohyama, Naoki; Jingu, Keiichi

    2016-01-01

    Purpose: To assess the accuracy of the commercially available deformable image registration (DIR) software for thoracic images at multiple institutions. Methods and Materials: Thoracic 4-dimensional (4D) CT images of 10 patients with esophageal or lung cancer were used. Datasets for these patients were provided by DIR-lab ( (dir-lab.com)) and included a coordinate list of anatomic landmarks (300 bronchial bifurcations) that had been manually identified. Deformable image registration was performed between the peak-inhale and -exhale images. Deformable image registration error was determined by calculating the difference at each landmark point between the displacement calculated by DIR software and that calculated by the landmark. Results: Eleven institutions participated in this study: 4 used RayStation (RaySearch Laboratories, Stockholm, Sweden), 5 used MIM Software (Cleveland, OH), and 3 used Velocity (Varian Medical Systems, Palo Alto, CA). The ranges of the average absolute registration errors over all cases were as follows: 0.48 to 1.51 mm (right-left), 0.53 to 2.86 mm (anterior-posterior), 0.85 to 4.46 mm (superior-inferior), and 1.26 to 6.20 mm (3-dimensional). For each DIR software package, the average 3-dimensional registration error (range) was as follows: RayStation, 3.28 mm (1.26-3.91 mm); MIM Software, 3.29 mm (2.17-3.61 mm); and Velocity, 5.01 mm (4.02-6.20 mm). These results demonstrate that there was moderate variation among institutions, although the DIR software was the same. Conclusions: We evaluated the commercially available DIR software using thoracic 4D-CT images from multiple centers. Our results demonstrated that DIR accuracy differed among institutions because it was dependent on both the DIR software and procedure. Our results could be helpful for establishing prospective clinical trials and for the widespread use of DIR software. In addition, for clinical care, we should try to find the optimal DIR procedure using thoracic 4D-CT data.

  7. Multi-Institutional, Multidisciplinary Study of the Impact of Course-Based Research Experiences†

    Science.gov (United States)

    Mader, Catherine M.; Beck, Christopher W.; Grillo, Wendy H.; Hollowell, Gail P.; Hennington, Bettye S.; Staub, Nancy L.; Delesalle, Veronique A.; Lello, Denise; Merritt, Robert B.; Griffin, Gerald D.; Bradford, Chastity; Mao, Jinghe; Blumer, Lawrence S.; White, Sandra L.

    2017-01-01

    Numerous national reports have called for reforming laboratory courses so that all students experience the research process. In response, many course-based research experiences (CREs) have been developed and implemented. Research on the impact of these CREs suggests that student benefits can be similar to those of traditional apprentice-model research experiences. However, most assessments of CREs have been in individual courses at individual institutions or across institutions using the same CRE model. Furthermore, which structures and components of CREs result in the greatest student gains is unknown. We explored the impact of different CRE models in different contexts on student self-reported gains in understanding, skills, and professional development using the Classroom Undergraduate Research Experience (CURE) survey. Our analysis included 49 courses developed and taught at seven diverse institutions. Overall, students reported greater gains for all benefits when compared with the reported national means for the Survey of Undergraduate Research Experiences (SURE). Two aspects of these CREs were associated with greater student gains: 1) CREs that were the focus of the entire course or that more fully integrated modules within a traditional laboratory and 2) CREs that had a higher degree of student input and results that were unknown to both students and faculty. PMID:28861141

  8. Surmounting the unique challenges in health disparities education: a multi-institution qualitative study.

    Science.gov (United States)

    Carter-Pokras, Olivia; Bereknyei, Sylvia; Lie, Desiree; Braddock, Clarence H

    2010-05-01

    The National Consortium for Multicultural Education for Health Professionals (Consortium) comprises educators representing 18 US medical schools, funded by the National Institutes of Health. Collective lessons learned from curriculum implementation by principal investigators (PIs) have the potential to guide similar educational endeavors. Describe Consortium PI's self-reported challenges with curricular development, solutions and their new curricular products. Information was collected from PIs over 2 months using a 53-question structured three-part questionnaire. The questionnaire addressed PI demographics, curriculum implementation challenges and solutions, and newly created curricular products. Study participants were 18 Consortium PIs. Descriptive analysis was used for quantitative data. Narrative responses were analyzed and interpreted using qualitative thematic coding. Response rate was 100%. Common barriers and challenges identified by PIs were: finding administrative and leadership support, sustaining the momentum, continued funding, finding curricular space, accessing and engaging communities, and lack of education research methodology skills. Solutions identified included engaging stakeholders, project-sharing across schools, advocacy and active participation in committees and community, and seeking sustainable funding. All Consortium PIs reported new curricular products and extensive dissemination efforts outside their own institutions. The Consortium model has added benefits for curricular innovation and dissemination for cultural competence education to address health disparities. Lessons learned may be applicable to other educational innovation efforts.

  9. Ketogenic diet using a Japanese ketogenic milk for patients with epilepsy: A multi-institutional study.

    Science.gov (United States)

    Kumada, Tomohiro; Imai, Katsumi; Takahashi, Yukitoshi; Nabatame, Shin; Oguni, Hirokazu

    2018-03-01

    In Japan, Meiji 817-B (M817-B), a powdered ketogenic milk, has been available since the ketogenic diet was introduced to infants and tube-fed children with medication-resistant epilepsy in the 1980s. We retrospectively evaluated the efficacy, tolerability, and side effects of the ketogenic diet using M817-B as the main source of daily food intake for patients with epilepsy by sending questionnaires to the members of a subcommittee of the Japan Epilepsy Society that focuses on the proper use of M817-B. A total of 42 patients were enrolled. Age at the initiation of the diet therapy ranged from 3 to 244 months (median, 32.5 months). Thirty-four patients were fed via tube, and the remaining 8 were fed orally. About 93% of patients were able to continue the diet for 1 month, 74% for 3 months, and 64% for 6 months. The median period of continuation was 16 months. One patient was able to continue as long as 7 years. The ketogenic ratio was maintained at about 3.0. The seizure-free rate and responder (>50% seizure reduction) rate were about 10% and 30-40%, respectively during the 12 months on the diet. Mean serum beta-hydroxybutyrate increased to almost 4 mM at 1 month and was maintained during the diet period. Side effects, which required discontinuation of the diet therapy, occurred in 11 of 42 patients and included hypertonia, weight loss, vomiting, hypoglycemia, metabolic acidosis, and hypokalemia. M817-B could be used long-term with demonstrated efficacy in seizure reduction, although there are some side effects that may require cessation of the diet therapy. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  10. Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study

    Directory of Open Access Journals (Sweden)

    Salvatore Sansalone

    2017-01-01

    Full Text Available Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients′ sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study (n = 25 represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up (mean: 14 months; range: 12-25. Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 (IIEF-15. Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function (IIEF-1-5 and -15, orgasmic function (IIEF-9 and -10, sexual desire (IIEF-11 and -12, intercourse satisfaction (IIEF-6-8, and overall satisfaction (IIEF-13 and -14. Then, we also used Quality of Erection Questionnaire (QEQ, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS and Self-Esteem and Relationship (SEAR to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.

  11. Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols.

    Science.gov (United States)

    Patel, Bhavik N; Alexander, Lauren; Allen, Brian; Berland, Lincoln; Borhani, Amir; Mileto, Achille; Moreno, Courtney; Morgan, Desiree; Sahani, Dushyant; Shuman, William; Tamm, Eric; Tublin, Mitchell; Yeh, Benjamin; Marin, Daniele

    2017-03-01

    To standardize workflow for dual-energy computed tomography (DECT) involving common abdominopelvic exam protocols. 9 institutions (4 rsDECT, 1 dsDECT, 4 both) with 32 participants [average # years (range) in practice and DECT experience, 12.3 (1-35) and 4.6 (1-14), respectively] filled out a single survey (n = 9). A five-point agreement scale (0, 1, 2, 3, 4-contra-, not, mildly, moderately, strongly indicated, respectively) and utilization scale (0-not performing and shouldn't; 1-performing but not clinically useful; 2-performing but not sure if clinically useful; 3-not performing it but would like to; 4-performing and clinically useful) were used. Consensus was considered with a score of ≥2.5. Survey results were discussed over three separate live webinar sessions. 5/9 (56%) institutions exclude large patients from DECT. 2 (40%) use weight, 2 (40%) use transverse dimension, and 1 (20%) uses both. 7/9 (78%) use 50 keV for low and 70 keV for medium monochromatic reconstructed images. DECT is indicated for dual liver [agreement score (AS) 3.78; utilization score (US) 3.22] and dual pancreas in the arterial phase (AS 3.78; US 3.11), mesenteric ischemia/gastrointestinal bleeding in both the arterial and venous phases (AS 2.89; US 2.79), RCC exams in the arterial phase (AS 3.33; US 2.78), and CT urography in the nephrographic phase (AS 3.11; US 2.89). DECT for renal stone and certain single-phase exams is indicated (AS 3.00). DECT is indicated during the arterial phase for multiphasic abdominal exams, nephrographic phase for CTU, and for certain single-phase and renal stone exams.

  12. The Search for Meaningful E-Learning at Canadian Universities: A Multi-Institutional Research Study

    Science.gov (United States)

    Salyers, Vincent; Carter, Lorraine; Carter, Alanna; Myers, Sue; Barrett, Penelope

    2014-01-01

    While e-learning is now characterized by a past and trends within that past, there continues to be uncertainty about how e-learning is defined and conceptualized, whether or not we like e-learning, and whether or not it is as meaningful to us as face to face learning. The purpose of this study was to document the e-learning perceptions of students…

  13. A comparative financial analysis of multi-institutional organizations by ownership type.

    Science.gov (United States)

    Coyne, J S

    1985-01-01

    Concern about future directions in healthcare exists, with corporate consolidation seen as likely and necessary. To understand this transformation, the author examines the financial growth trends among the nation's leading corporate providers. Investor-owned (IO) and not-for-profit (NFP) firms are compared using audited data on four financial accounts (assets, debt, equity and income) and three financial ratios (liquidity, leverage, and profitability). The author analyzes financial trends from 1978 to 1982 and looks beyond the significant differences in the balance sheet and income statement accounts to a significant similarity in ratio trends between the NFP and the IO firms' financial conditions. The implications of these findings are discussed in terms of future forms of corporate providers.

  14. Race/Ethnicity and Success in Academic Medicine: Findings From a Longitudinal Multi-Institutional Study.

    Science.gov (United States)

    Kaplan, Samantha E; Raj, Anita; Carr, Phyllis L; Terrin, Norma; Breeze, Janis L; Freund, Karen M

    2017-10-24

    To understand differences in productivity, advancement, retention, satisfaction, and compensation comparing underrepresented medical (URM) faculty with other faculty at multiple institutions. A 17-year follow-up was conducted of the National Faculty Survey, a random sample from 24 U.S. medical schools, oversampled for URM faculty. The authors examined academic productivity, advancement, retention, satisfaction, and compensation, comparing white, URM, and non-URM faculty. Retention, productivity, and advancement data were obtained from public sources for nonrespondents. Covariates included gender, specialty, time distribution, and years in academia. Negative binomial regression was used for count data, logistic regression for binary outcomes, and linear regression for continuous outcomes. In productivity analyses, advancement, and retention, 1,270 participants were included; 604 participants responded to the compensation and satisfaction survey. Response rates were lower for African American (26%) and Hispanic faculty (39%) than white faculty (52%, P career satisfaction, or compensation between URM and white faculty. URM and white faculty had similar career satisfaction, grant support, leadership, and compensation; URM faculty had fewer publications and were less likely to be promoted and retained in academic careers. Successful retention of URM faculty requires comprehensive institutional commitment to changing the academic climate and deliberative programming to support productivity and advancement.

  15. TU-G-BRD-05: Results From Multi-Institutional Measurements with An Anthropomorphic Spine Phantom

    International Nuclear Information System (INIS)

    Molineu, A; Hernandez, N; Alvarez, P; Followill, D

    2015-01-01

    Purpose: To analyze the results from an anthropomorphic spine phantom used for credentialing institutions for National Cancer Institute (NCI) sponsored clinical trial. Methods: An anthropomorphic phantom that contains left and right lungs, a heart, an esophagus, spinal cord, bony material and a PTV was sent to institutions wishing to be credentialed for NCI trials. The PTV holds 4 TLD and radiochromic film in the axial and sagittal planes. The heart holds one TLD. Institutions created IMRT plans to cover ≥90% of the PTV with 6 Gy and limit the cord dose to <0.35cc receiving 3.75 Gy and <1.2cc receiving 2.63 Gy. They were instructed to treat the phantom as they would a patient, including making plan specific IMRT/SBRT QA measurements before treatment. The TLD results in the PTV were required to be within ±7% of the plan dose. A gamma calculation was performed using the film results and the submitted DICOM plan. ≥85% of the analyzed region was required to pass a 5%/3 mm criteria. Results: 176 institutions irradiated the spine phantom for a total of 255 results. The pass rate was 73% (187 irradiations) overall. 44 irradiations failed only the gamma criteria, 2 failed only the dose criteria and 22 failed both. The most used planning systems were Eclipse (116) and Pinnacle (52) and they had pass rates of 76% and 71%, respectively. The AAA algorithm had a pass rate of 77% while superposition type algorithms had a 71% pass rate. The average TLD measurement to institution calculation ratio was 0.99 (0.04 std dev.). The average percent pixels passing the gamma criteria for films was 89% (12% std dev.) Conclusion: Results show that this phantom is an important part of credentialing and that we have room for improvement in IMRT/SBRT spine treatments. This work was supported by PHS CA180803 and CA037422 awarded by NCI, DHHS

  16. Retransplantation in 7,290 primary transplant patients: a 10-year multi-institutional study.

    Science.gov (United States)

    Radovancevic, Branislav; McGiffin, David C; Kobashigawa, Jon A; Cintron, Guillermo B; Mullen, G Martin; Pitts, Douglas E; O'Donnell, Jacqueline; Thomas, Cindi; Bourge, Robert C; Naftel, David C

    2003-08-01

    Cardiac retransplantation is a controversial procedure due to the disparity between donor heart demand and supply. Of 7,290 patients undergoing primary cardiac transplantation between January 1990 and December 1999 at 42 institutions contributing to the Cardiac Transplant Research Database (CTRD), 106 patients later underwent a second and 1 patient a third cardiac transplant procedure. The actuarial freedom from retransplantation was 99.2% and 96.8% at 1 and 10 years, respectively. Reasons for retransplantation included early graft failure (n = 34), acute cardiac rejection (n = 15), coronary allograft vasculopathy (CAV, n = 39), non-specific graft failure (n = 7), and miscellaneous (n = 10). The only risk factor associated with retransplantation was younger age, reflecting the policy of preferential retransplantation of younger patients. Survival after retransplantation was inferior to that after primary transplantation (56% and 38% at 1 and 5 years, respectively). Risk factors associated with death after retransplantation included retransplantation for acute rejection (p = 0.0005), retransplantation for early graft failure (p = 0.03), and use of a female donor (p = 0.005). Survival after retransplantation for acute rejection was poorest (32% and 8% at 1 and 5 years, respectively) followed by retransplantation for early graft failure (50% and 39% at 1 and 5 years, respectively). Survival after retransplantation for CAV has steadily improved with successive eras. The results of retransplantation for acute rejection and early graft failure are poor enough to suggest that this option is not advisable. However, retransplantation for CAV is currently associated with satisfactory survival and should continue to be offered to selected patients.

  17. Radioembolisation for liver metastases: results from a prospective 151 patient multi-institutional phase II study.

    Science.gov (United States)

    Benson, Al B; Geschwind, Jean-Francois; Mulcahy, Mary F; Rilling, William; Siskin, Gary; Wiseman, Greg; Cunningham, James; Houghton, Bonny; Ross, Mason; Memon, Khairuddin; Andrews, James; Fleming, Chad J; Herman, Joseph; Nimeiri, Halla; Lewandowski, Robert J; Salem, Riad

    2013-10-01

    To investigate the safety, response rate, progression-free and overall survival of patients with liver metastases treated with (90)Y (glass) radioembolisation in a prospective, multicenter phase II study. 151 patients with liver metastases (colorectal n=61, neuroendocrine n=43 and other tumour types n=47) refractory to standard of care therapies were enrolled in this prospective, multicenter, phase II study under an investigational device exemption. Clinical/laboratory/imaging follow-up were obtained at 30 days followed by 3-month intervals for 1 year and every 6 months thereafter. The primary end-point was progression-free survival (PFS); secondary end-points included safety, hepatic progression-free survival (HPFS), response rate and overall survival. Median age was 66 (range 25-88). Grade 3/4 adverse events included pain (12.8%), elevated alkaline phospatase (8.1%), hyperbilirubinemia (5.3%), lymphopaenia (4.1%), ascites (3.4%) and vomiting (3.4%). Treatment parameters including dose delivery were reproducible among centers. Disease control rates were 59%, 93% and 63% for colorectal, neuroendocrine and other primaries, respectively. Median PFS was 2.9 and 2.8 months for colorectal and other primaries, respectively. PFS was not achieved in the neuroendocrine group. Median survival from (90)Y treatment was 8.8 months for colorectal and 10.4 months for other primaries. Median survival for neuroendocrine patients has not been reached. Patients with liver metastases can be safely treated with (90)Y microspheres. This study is the first to demonstrate technical and dose reproducibility of (90)Y glass microspheres between centers in a prospective setting. Based on these promising data, three international, multicenter, randomised phase III studies in colorectal and hepatocellular carcinoma have been initiated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. The nitrogen footprint tool network: a multi-institution program to reduce nitrogen pollution

    Science.gov (United States)

    Anthropogenic sources of reactive nitrogen have local and global impacts on air and water quality and detrimental effects on human and ecosystem health. This paper uses the nitrogen footprint tool (NFT) to determine the amount of nitrogen (N) released as a result of institutional...

  19. Multi-institutional validation of a web-based core competency assessment system.

    Science.gov (United States)

    Tabuenca, Arnold; Welling, Richard; Sachdeva, Ajit K; Blair, Patrice G; Horvath, Karen; Tarpley, John; Savino, John A; Gray, Richard; Gulley, Julie; Arnold, Teresa; Wolfe, Kevin; Risucci, Donald A

    2007-01-01

    The Association of Program Directors in Surgery and the Division of Education of the American College of Surgeons developed and implemented a web-based system for end-of-rotation faculty assessment of ACGME core competencies of residents. This study assesses its reliability and validity across multiple programs. Each assessment included ratings (1-5 scale) on 23 items reflecting the 6 core competencies. A total of 4241 end-of-rotation assessments were completed for 332 general surgery residents (> or =5 evaluations each) at 5 sites during the 2004-2005 and 2005-2006 academic years. The mean rating for each resident on each item was computed for each academic year. The mean rating of items representing each competency was computed for each resident. Additional data included USMLE and ABSITE scores, PGY, and status in program (categorical, designated preliminary, and undesignated preliminary). Coefficient alpha was greater than 0.90 for each competency score. Mean ratings for each competency increased significantly (p competencies at all PGY levels. Competency ratings of PGY 1 residents correlated significantly with USMLE Step I, ranging from (r = 0.26, p competencies correlated significantly with the 2006 ABSITE Total Percentile Score (range: r = 0.20, p core competencies are internally consistent. The pattern of statistically significant correlations between competency ratings and USMLE and ABSITE scores supports the postdictive and concurrent validity, respectively, of faculty perceptions of resident knowledge. The pattern of increased ratings as a function of PGY supports the construct validity of faculty ratings of resident core competencies.

  20. The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study.

    Science.gov (United States)

    Fawley, Jason A; Abdelhafeez, Abdelhafeez H; Schultz, Jessica A; Ertl, Allison; Cassidy, Laura D; Peter, Shawn St; Wagner, Amy J

    2017-01-01

    The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure. A retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy. Of the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1±2.3weeks, and the mean birth weight was 2.57±0.7kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p=0.04). Patients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks. III; retrospective comparative study. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Multi-institutional Pooled Analysis on Adjuvant Chemoradiation in Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Morganti, Alessio G. [Department of Radiotherapy, Università Cattolica S. Cuore, Rome (Italy); Unit of Radiotherapy, Unit of General Oncology, Fondazione Giovanni Paolo II, Campobasso (Italy); Falconi, Massimo [Department of Surgery, University of Verona, Verona (Italy); Stiphout, Ruud G.P.M. van [Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht (Netherlands); Mattiucci, Gian-Carlo, E-mail: gcmattiucci@rm.unicatt.it [Department of Radiotherapy, Università Cattolica S. Cuore, Rome (Italy); Alfieri, Sergio [Department of Surgery, Università Cattolica S. Cuore, Rome (Italy); Calvo, Felipe A. [Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid (Spain); Dubois, Jean-Bernard [Département de Radiothérapie, CRLC, Montpellier Cedex (France); Fastner, Gerd [Department of Radiotherapy, PMU, Salzburg (Austria); Herman, Joseph M. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Maidment, Bert W. [Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia (United States); Miller, Robert C. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Regine, William F. [Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States); Reni, Michele [Department of Oncology, S. Raffaele Scientific Institute, Milan (Italy); Sharma, Navesh K. [Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States); Ippolito, Edy [Department of Radiation Oncology, University Campus Biomedico, Roma (Italy); and others

    2014-11-15

    Purpose: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. Methods and Materials: A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT. Results: Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P<.001) and 27.8 months after CT alone (P<.001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [CI], 0.60-0.87; P=.001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >20 mm (HR = 1.14; CI = 1.05-1.23; P=.002). Multivariate analysis also showed a better prognosis in patients treated in centers with >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) Conclusion: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT.

  2. Altered plasma apolipoprotein modifications in patients with pancreatic cancer: protein characterization and multi-institutional validation.

    Directory of Open Access Journals (Sweden)

    Kazufumi Honda

    Full Text Available BACKGROUND: Among the more common human malignancies, invasive ductal carcinoma of the pancreas has the worst prognosis. The poor outcome seems to be attributable to difficulty in early detection. METHODS: We compared the plasma protein profiles of 112 pancreatic cancer patients with those of 103 sex- and age-matched healthy controls (Cohort 1 using a newly developed matrix-assisted laser desorption/ionization (oMALDI QqTOF (quadrupole time-of-flight mass spectrometry (MS system. RESULTS: We found that hemi-truncated apolipoprotein AII dimer (ApoAII-2; 17252 m/z, unglycosylated apolipoprotein CIII (ApoCIII-0; 8766 m/z, and their summed value were significantly decreased in the pancreatic cancer patients [P = 1.36×10(-21, P = 4.35×10(-14, and P = 1.83×10(-24 (Mann-Whitney U-test; area-under-curve values of 0.877, 0.798, and 0.903, respectively]. The significance was further validated in a total of 1099 plasma/serum samples, consisting of 2 retrospective cohorts [Cohort 2 (n = 103 and Cohort 3 (n = 163] and a prospective cohort [Cohort 4 (n = 833] collected from 8 medical institutions in Japan and Germany. CONCLUSIONS: We have constructed a robust quantitative MS profiling system and used it to validate alterations of modified apolipoproteins in multiple cohorts of patients with pancreatic cancer.

  3. Nuclear grade and necrosis predict prognosis in malignant epithelioid pleural mesothelioma: a multi-institutional study.

    Science.gov (United States)

    Rosen, Lauren E; Karrison, Theodore; Ananthanarayanan, Vijayalakshmi; Gallan, Alexander J; Adusumilli, Prasad S; Alchami, Fouad S; Attanoos, Richard; Brcic, Luka; Butnor, Kelly J; Galateau-Sallé, Françoise; Hiroshima, Kenzo; Kadota, Kyuichi; Klampatsa, Astero; Stang, Nolween Le; Lindenmann, Joerg; Litzky, Leslie A; Marchevsky, Alberto; Medeiros, Filomena; Montero, M Angeles; Moore, David A; Nabeshima, Kazuki; Pavlisko, Elizabeth N; Roggli, Victor L; Sauter, Jennifer L; Sharma, Anupama; Sheaff, Michael; Travis, William D; Vigneswaran, Wickii T; Vrugt, Bart; Walts, Ann E; Tjota, Melissa Y; Krausz, Thomas; Husain, Aliya N

    2018-04-01

    A recently described nuclear grading system predicted survival in patients with epithelioid malignant pleural mesothelioma. The current study was undertaken to validate the grading system and to identify additional prognostic factors. We analyzed cases of epithelioid malignant pleural mesothelioma from 17 institutions across the globe from 1998 to 2014. Nuclear grade was computed combining nuclear atypia and mitotic count into a grade of I-III using the published system. Nuclear grade was assessed by one pathologist for three institutions, the remaining were scored independently. The presence or absence of necrosis and predominant growth pattern were also evaluated. Two additional scoring systems were evaluated, one combining nuclear grade and necrosis and the other mitotic count and necrosis. Median overall survival was the primary endpoint. A total of 776 cases were identified including 301 (39%) nuclear grade I tumors, 354 (45%) grade II tumors and 121 (16%) grade III tumors. The overall survival was 16 months, and correlated independently with age (P=0.006), sex (0.015), necrosis (0.030), mitotic count (0.001), nuclear atypia (0.009), nuclear grade (<0.0001), and mitosis and necrosis score (<0.0001). The addition of necrosis to nuclear grade further stratified overall survival, allowing classification of epithelioid malignant pleural mesothelioma into four distinct prognostic groups: nuclear grade I tumors without necrosis (29 months), nuclear grade I tumors with necrosis and grade II tumors without necrosis (16 months), nuclear grade II tumors with necrosis (10 months) and nuclear grade III tumors (8 months). The mitosis-necrosis score stratified patients by survival, but not as well as the combination of necrosis and nuclear grade. This study confirms that nuclear grade predicts survival in epithelioid malignant pleural mesothelioma, identifies necrosis as factor that further stratifies overall survival, and validates the grading system across multiple institutions and among both biopsy and resection specimens. An alternative scoring system, the mitosis-necrosis score is also proposed.

  4. Re-challenge with pemetrexed in advanced mesothelioma: a multi-institutional experience

    Directory of Open Access Journals (Sweden)

    Bearz Alessandra

    2012-09-01

    Full Text Available Abstract Background Although first-line therapy for patients affected by advanced mesothelioma is well established, there is a lack of data regarding the impact of second-line treatment. Methods We retrospectively collected data of patients affected by advanced mesothelioma, already treated with first-line therapy based on pemetrexed and platin, with a response (partial response or stable disease lasting at least 6 months, and re-treated with a pemetrexed-based therapy at progression. The primary objective was to describe time to progression and overall survival after re-treatment. Results Overall across several Italian oncological Institutions we found 30 patients affected by advanced mesothelioma, in progression after a 6-month lasting clinical benefit following a first-line treatment with cisplatin and pemetrexed, and re-challenged with a pemetrexed-based therapy. In these patients we found a disease control rate of 66%, with reduction of pain in 43% of patients. Overall time to progression and survival were promising for a second-line setting of patients with advanced mesothelioma, being 5.1 and 13.6 months, respectively. Conclusions In our opinion, when a patient has a long-lasting benefit from previous treatment with pemetrexed combined with a platin compound, the same treatment should be offered at progression.

  5. Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series

    International Nuclear Information System (INIS)

    Tonoli, Sandro; Vitali, Paola; Scotti, Vieri; Bertoni, Filippo; Spiazzi, Luigi; Ghedi, Barbara; Buonamici, Fabrizio Banci; Marrazzo, Livia; Guidi, Gabriele; Meattini, Icro; Bastiani, Paolo; Amichetti, Maurizio; Schwarz, Marco; Magrini, Stefano Maria

    2011-01-01

    Background and purpose: To evaluate survival, locoregional control and toxicity in a series of 56 mesothelioma patients treated from May 2005 to May 2010 with post-operative radiotherapy after extrapleural pneumonectomy (EPP) in three Italian Institutions (Brescia, Florence, and Modena). Material and methods: Fifty-six patients treated with adjuvant radiotherapy (RT) after EPP were analyzed. Four patients were treated with 3DCRT, 50 with IMRT and two with helical tomotherapy. Forty-five to 50 Gy in 25 fractions were given to the affected hemithorax and to ipsilateral mediastinum, with a simultaneous integrated boost to the sites of microscopically involved margins up to 60 Gy in 20/56 cases. Results: Three year locoregional control (LRC), distant metastasis free (DMF), disease free (DF), disease specific (DSS) and overall survival (OS) rates are 90%, 66%, 57%, 62%, and 60%, respectively. Conclusion: Postoperative RT with modern techniques is an effective method to obtain excellent local control and cure rates in mesothelioma patients submitted to EPP.

  6. A Multi-Institutional Investigation into Cheating on Tests in College Online Courses

    Science.gov (United States)

    Dille, Edith Turner

    2011-01-01

    Cheating in classes is not a new concern for higher education faculty. It has been studied extensively during the last 50 years by researchers such as Bowers, Cizek, McCabe, Passow, and Whitley. However, most of the research on cheating to date has been related to traditional courses and has often included a wide range of cheating types. With the…

  7. Enhancing Interdisciplinary Human System Risk Research Through Modeling and Network Approaches

    Science.gov (United States)

    Mindock, Jennifer; Lumpkins, Sarah; Shelhamer, Mark

    2015-01-01

    NASA's Human Research Program (HRP) supports research to reduce human health and performance risks inherent in future human space exploration missions. Understanding risk outcomes and contributing factors in an integrated manner allows HRP research to support development of efficient and effective mitigations from cross-disciplinary perspectives, and to enable resilient human and engineered systems for spaceflight. The purpose of this work is to support scientific collaborations and research portfolio management by utilizing modeling for analysis and visualization of current and potential future interdisciplinary efforts.

  8. When silence is not golden: an integrated approach to selective mutism.

    Science.gov (United States)

    McInnes, Alison; Manassis, Katharina

    2005-08-01

    Selective mutism (SM) is a rare disorder that is associated with both anxiety and communication impairments. Preliminary evidence suggests that educational attainment and development of social skills and self-esteem may be affected by SM in a significant proportion of cases. There is a critical need for cross-disciplinary research from the fields of speech-language pathology, psychiatry, and clinical psychology to develop protocols for assessing language and cognitive functioning in children with SM and developing interventions that address psychiatric, communicative, and social aspects of this disorder.

  9. 'n Praktykbenadering tot geloofsvorming vanuit die benadering van ...

    African Journals Online (AJOL)

    The article describes the dialogue between Thomas Groome's approach to faith formation and Gestalt theory in order to develop a practice approach to faith formation. The transversal model of cross-disciplinary dialogue, developed by Wentzel van Huyssteen, is utilised to develop a practice approach to faith formation.

  10. Advances in Remote Sensing Approaches for Hazard Mitigation and Natural Resource Protection in Pacific Latin America: A Workshop for Advanced Graduate Students, Post- Doctoral Researchers, and Junior Faculty

    Science.gov (United States)

    Gierke, J. S.; Rose, W. I.; Waite, G. P.; Palma, J. L.; Gross, E. L.

    2008-12-01

    Though much of the developing world has the potential to gain significantly from remote sensing techniques in terms of public health and safety, they often lack resources for advancing the development and practice of remote sensing. All countries share a mutual interest in furthering remote sensing capabilities for natural hazard mitigation and resource development. With National Science Foundation support from the Partnerships in International Research and Education program, we are developing a new educational system of applied research and engineering for advancing collaborative linkages among agencies and institutions in Pacific Latin American countries (to date: Guatemala, El Salvador, Nicaragua, Costa Rica, Panama, and Ecuador) in the development of remote sensing tools for hazard mitigation and water resources management. The project aims to prepare students for careers in science and engineering through their efforts to solve suites of problems needing creative solutions: collaboration with foreign agencies; living abroad immersed in different cultures; and adapting their academic training to contend with potentially difficult field conditions and limited resources. The ultimate goal of integrating research with education is to encourage cross-disciplinary, creative, and critical thinking in problem solving and foster the ability to deal with uncertainty in analyzing problems and designing appropriate solutions. In addition to traditional approaches for graduate and undergraduate research, we have built new educational systems of applied research and engineering: (1) the Peace Corp/Master's International program in Natural Hazards which features a 2-year field assignment during service in the U.S. Peace Corps, (2) the Michigan Tech Enterprise program for undergraduates, which gives teams of students from different disciplines the opportunity to work for three years in a business-like setting to solve real-world problems, and (3) a unique university exchange

  11. Applying the institutional review board data repository approach to manage ethical considerations in evaluating and studying medical education.

    Science.gov (United States)

    Thayer, Erin K; Rathkey, Daniel; Miller, Marissa Fuqua; Palmer, Ryan; Mejicano, George C; Pusic, Martin; Kalet, Adina; Gillespie, Colleen; Carney, Patricia A

    2016-01-01

    Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination. IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes. Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data.

  12. Pedagogical approaches

    DEFF Research Database (Denmark)

    Lund Larsen, Lea

    questions are: How (much) and what do teachers learn from experience? And how do teachers of adults develop their pedagogical approach? I examine the field of adult learners from the teachers’ perspective. Firstly, I identify some of the commonly described characteristics of adults as learners...... in formal settings, but in most teaching settings, the teachers act alone and develop their pedagogical approaches/- teaching strategies with no synchronous sparring from a colleague. Adult learners have particular needs and characteristics that their teachers must be able to address (cf. Knowles...

  13. Exploring indicators of interdisciplinary research and education success

    Science.gov (United States)

    Carr, Gemma; Blanch, Anicet; Blaschke, Alfred Paul; Brouwer, Roy; Bucher, Christian; Farnleitner, Andreas; Fürnkranz-Prskawetz, Alexia; Loucks, Daniel Pete; Morgenroth, Eberhard; Parajka, Juraj; Pfeifer, Norbert; Rechberger, Helmut; Wagner, Wolfgang; Zessner, Matthias; Blöschl, Günter

    2017-04-01

    Interdisciplinary research and education programmes aim to produce groundbreaking research, often on socially relevant topics, and to produce experts with the skills to work across disciplines. However, there are many outstanding questions on the effectiveness of interdisciplinary programmes. Such as whether they produce novel and groundbreaking research, whether interdisciplinary graduates are leading to a more interdisciplinary culture of research and practice in academia and beyond, and whether an interdisciplinary approach can more effectively address issues of societal relevance than a mono-disciplinary approach. The Vienna Doctoral Programme on Water Resource Systems at Vienna University of Technology is currently in its eighth year and offers a valuable case study to contribute to understanding interdisciplinary research and education. Ten different research fields are covered by the Programme and because collaborative research takes place both between researchers from different research fields (cross-disciplinary research) and from researchers from the same research field (mono-disciplinary research) we are able to compare the impacts of each research type. We specifically explored three questions: i) whether cross-disciplinary research leads to more innovative scientific findings than mono-disciplinary research, ii) whether cross-disciplinary researchers develop professional skills that benefit their future careers, and iii) whether cross-disciplinary research produces findings of greater societal relevance than mono-disciplinary research. To conduct the evaluation we identified a variety of indicators. Journal impact factors (IF) and citation rates of ISI indexed publications were used to compare scientific innovativeness. Based on these indicators, our findings suggest that cross-disciplinary work is more innovative. The cross-disciplinary work is published in journals with a slightly higher impact factor (mean IF is 2.36) and receives slightly more

  14. Capability approach

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal; Kjeldsen, Christian Christrup

    Lærebogen er den første samlede danske præsentation af den af Amartya Sen og Martha Nussbaum udviklede Capability Approach. Bogen indeholder en præsentation og diskussion af Sen og Nussbaums teoretiske platform. I bogen indgår eksempler fra såvel uddannelse/uddannelsespolitik, pædagogik og omsorg....

  15. Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach.

    Directory of Open Access Journals (Sweden)

    Philippe Bourgois

    2006-10-01

    engaging in drug-related crime. These historical-structural conditions generated distinct presentations of self. Whites styled themselves as outcasts, defeated by addiction. They professed to be injecting heroin to stave off "dopesickness" rather than to seek pleasure. African Americans, in contrast, cast their physical addiction as an oppositional pursuit of autonomy and pleasure. They considered themselves to be professional outlaws and rejected any appearance of abjection. Many, but not all, of these ethnographic findings were corroborated by our epidemiological data, highlighting the variability of behaviors within ethnic categories.Bringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.

  16. Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach.

    Science.gov (United States)

    Bourgois, Philippe; Martinez, Alexis; Kral, Alex; Edlin, Brian R; Schonberg, Jeff; Ciccarone, Dan

    2006-10-01

    drug-related crime. These historical-structural conditions generated distinct presentations of self. Whites styled themselves as outcasts, defeated by addiction. They professed to be injecting heroin to stave off "dopesickness" rather than to seek pleasure. African Americans, in contrast, cast their physical addiction as an oppositional pursuit of autonomy and pleasure. They considered themselves to be professional outlaws and rejected any appearance of abjection. Many, but not all, of these ethnographic findings were corroborated by our epidemiological data, highlighting the variability of behaviors within ethnic categories. Bringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.

  17. Environmental Influences on Genetic Expression: Biological and Behavioral Aspects of Sexual Differentiation.

    Science.gov (United States)

    Kretchmer, Norman, Ed.; Walcher, Dwain N., Ed.

    A cross-disciplinary approach to the topic of sexual differentiation comprises this volume. Diverse papers are included under a variety of headings: 1) critical Periods in development; 2) embryology; 3) RNA-DNA; 4) chromosomes-growth and development; 5) physiology; 6) primates; 7) cognition; 8) cultural differences in patterns of sexual behavior;…

  18. Llama Herders and Urban Elites: Interdisciplinary Readings of Early Colonial Narratives in the Americas

    Science.gov (United States)

    Beaule, Christine D.; Quintana, Benito

    2017-01-01

    We argue for an interdisciplinary pedagogical approach that we call the Integration of Research and Education in the Classroom, which highlights and crosses disciplinary boundaries to challenge each field's assumptions, limitations, conceptual and interpretive purview. We use a set of examples that center on problematizing various aspects of the…

  19. Trends in physics data analysis algorithms

    International Nuclear Information System (INIS)

    Denby, B.

    2004-01-01

    The paper provides a new look at algorithmic trends in modern physics experiments. Based on recently presented material, it attempts to draw conclusions in order to form a coherent historical picture of the past, present, and possible future of the field of data analysis techniques in physics. The importance of cross disciplinary approaches is stressed

  20. Monitoring catalysts at work in their final form: spectroscopic investigations on a monolithic catalyst

    DEFF Research Database (Denmark)

    Rasmussen, Søren B.; Bañares, Miguel A.; Bazin, Philippe

    2012-01-01

    . The observations reported here serve as a demonstration of the great potential for the application of operando spectroscopy on monolithic systems. This cross disciplinary approach aims to identify reaction pathways, active sites, intermediate- and spectator-species for catalytic reactions under truly industrial...

  1. Entrepreneurial learning requires action

    DEFF Research Database (Denmark)

    Brink, Tove; Madsen, Svend Ole

    2014-01-01

    that is enhanced by essential large-scale industry players and other SME managers are required to create action and value in learning. An open-mindedness to new learning approaches by SME managers and an open-mindedness to multi- and cross-disciplinary collaboration with SME managers by facilitators is required....

  2. Solidarity and the right to health in the era of healthcare commercialization

    NARCIS (Netherlands)

    Arenas Catalan, E.S.|info:eu-repo/dai/nl/369494059

    2018-01-01

    Taking a cross-disciplinary approach to international human rights law that combines public health, legal, political and social theory, this thesis analyses the right of access to healthcare and the ways in which commercialization has limited this human right. In doing so, the study develops a

  3. Beyond Borders: Participatory Design Research and the Changing Role of Design

    Science.gov (United States)

    Blair-Early, Adream

    2010-01-01

    University art and design programs are branching out and creating cross-disciplinary programs and research centers that connect design students and faculty across various disciplines such as business, engineering, architecture, information studies, health sciences and education. A human-centered, problem-based approach to design research looks to…

  4. Advances in multiphase flow and related problems

    International Nuclear Information System (INIS)

    Papanicolaou, G.

    1986-01-01

    Proceedings of a workshop in multiphase flow held at Leesburg, Va. in June 1986 representing a cross-disciplinary approach to theoretical as well as computational problems in multiphase flow. Topics include composites, phase transitions, fluid-particle systems, and bubbly liquids

  5. The Promise of Motivational Interviewing in School Mental Health

    Science.gov (United States)

    Frey, Andy J.; Cloud, Richard N.; Lee, Jon; Small, Jason W.; Seeley, John R.; Feil, Edward G.; Walker, Hill M.; Golly, Annemieke

    2011-01-01

    In recent years, the science of developing and implementing interventions addressing school-related risk factors has produced many advances. This article addresses the promise of a cross-disciplinary practice approach known as motivational interviewing in school settings. Specifically, the supporting evidence as well as the process and principles…

  6. Drug Taking Beliefs of Australian Adolescents: A Pilot Study

    Science.gov (United States)

    Skrzypiec, Grace; Owens, Laurence

    2013-01-01

    In this study adolescents offered their insights and perspectives of factors associated with adolescent illicit drug taking intentions. The factors explored were identified using a cross-disciplinary approach involving the Theory of Planned Behavior (TPB) and criminological theories, and these formed the framework for data analysis. Interviews…

  7. Urban design for mobilities

    DEFF Research Database (Denmark)

    Jensen, Ole B.

    2017-01-01

    . In this paper, we shall explore the potential for a better understanding of contemporary urban challenges through the cross-disciplinary approach of ‘Mobilities design’. The paper investigates how this notion is based on an understanding of materialities and social action that is framed under the heading...

  8. Using a Social Science--Fictional Play to Teach about Global Capitalism and Macro-Structural Systems in Introduction to Sociology

    Science.gov (United States)

    Pelak, Cynthia Fabrizio; Duncan, Stacey

    2017-01-01

    This article explores the use of a social science-fictional play to teach macro-structural concepts related to global capitalism and surplus labor in a small and large Introduction to Sociology course. Relying on a cross-disciplinary and critical pedagogical approach that combines theory and practice to empower students to develop a critical…

  9. Barriers and opportunities for integrating social science into natural resource management: lessons from National Estuarine Research Reserves.

    Science.gov (United States)

    Robinson, Patrick; Genskow, Ken; Shaw, Bret; Shepard, Robin

    2012-12-01

    The need for cross-disciplinary scientific inquiries that facilitate improved natural resource management outcomes through increased understanding of both the biophysical and human dimensions of management issues has been widely recognized. Despite this broad recognition, a number of obstacles and barriers still sometimes challenge the successful implementation of cross-disciplinary approaches. Improving understanding of these challenges and barriers will help address them and thereby foster appropriate and effective utilization of cross-disciplinary approaches to solve natural resource management challenges. This research uses a case study analysis of the United States National Estuarine Research Reserve System to improve understanding of the critical factors that influence practitioners' decisions related to incorporating social science into their natural resource management work. The case study research is analyzed and evaluated within a Theory of Planned Behavior framework to (1) determine and describe the factors that predict practitioners' intent to incorporate social science into their natural resource related activities and (2) recommend potential strategies for encouraging and enabling cross-disciplinary approaches to natural resource management. The results indicate that National Estuarine Research Reserve practitioners' decisions related to incorporating social science are primarily influenced by (1) confidence in their own capability to incorporate social science into their work and (2) beliefs about whether the outcomes of incorporating social science into their work would be valuable or beneficial.

  10. Narrative approaches

    DEFF Research Database (Denmark)

    Stelter, Reinhard

    2012-01-01

    Narrative coaching is representative of the new wave – or third generation – of coaching practice . The theory and practice of narrative coaching takes into account the social and cultural conditions of late modern society, and must be seen as intertwined with them. Some initial conceptualizations...... of narrative coaching were developed by David Drake (2006, 2007, 2008, 2009) in the USA and Australia, by Ho Law in the UK (Law, 2007a + b; Law & Stelter, 2009) and by Reinhard Stelter (2007, 2009, 2012, in preparation; Stelter & Law, 2010) in Denmark. In the following chapter the aim is to present coaching...... as a narrative-collaborative practice, an approach that is based on phenomenology, social constructionism and narrative theory. Seeing narrative coaching as a collaborative practice also leads to reflecting on the relationship between coach and coachee(s) in a new way, where both parts contribute to the dialogue...

  11. Oriented Approach

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Moghimi

    2013-12-01

    Full Text Available Promoting productivity is one of the goals of usinginformation technology in organizations. The purpose of this research isexamining the impact of IT on organizational productivity andrecognizing its mechanisms based on process-oriented approach. For thisend, by reviewing the literature of the subject a number of impacts of ITon organizational processes were identified. Then, through interviewswith IT experts, seven main factors were selected and presented in aconceptual model. This model was tested through a questionnaire in 148industrial companies. Data analysis shows that impact of IT onproductivity can be included in the eight major categories: Increasing ofthe Automation, Tracking, Communication, Improvement, Flexibility,Analytic, Coordination and Monitoring in organizational processes.Finally, to improve the impact of information technology onorganizational productivity, some suggestions are presented.

  12. Alimentación y cultura en España: una aproximación desde la antropología social Alimentation and culture in Spain: an anthropology-based approach

    Directory of Open Access Journals (Sweden)

    Mabel Gracia Arnaiz

    2010-01-01

    Full Text Available El hecho alimentario es, esencialmente, multidimensional: transita entre el espacio ecológico, biológico, psicológico, socioeconómico o político. Como ha sucedido con otros fenómenos de naturaleza compleja, hoy nadie discute que la alimentación pueda, o mejor dicho deba, ser estudiada atendiendo a una perspectiva interdisclipinar. En España, son numerosos los trabajos que hechos desde las ciencias experimentales, sociales o humanas dan cuenta, recurriendo a un conocimiento hiperespecializado, de las dimensiones nutricionales, psicológicas o económicas de las preferencias y aversiones alimentarias, del consumo de alimentos o de la obesidad, por poner algunos ejemplos. Se trata, sin embargo, de visiones normalmente unilineales sobre el mismo fenómeno, arropadas por los marcos epistémicos de cada ciencia. La colaboración científica apenas repliega las disciplinas más afines. Escatimar las intersecciones científicas no parece, como trataré de mostrar en este artículo, ni oportuno ni útil. Menos cuando se pretende dar cuenta y resolver problemas que, afectando a los grupos sociales, se desenvuelven en contextos plurales y cambiantes.The food fact is essentially multidimensional: it goes between ecological, biological, psychological, socio-economic or political spaces. As other complex phenomena, today no one can deny that food should be studied from a cross-disciplinary perspective. In Spain, there are many studies made from experimental, social or human sciences that, using hyper-specialized knowledge, show nutritional, psychological or economic dimensions, e.g., of food preferences and aversions, food consumption or malnutrition. However, they are usually unidirectional approaches of the same phenomenon, supported by the frameworks of each epistemic science. Scientific collaboration includes scarcely closer disciplines. But sparing scientific intersections does not seem, as I will try to show in this paper, appropriate or useful

  13. "I'm in a Professional School! Why Are You Making Me Do This?" A Cross-Disciplinary Study of the Use of Creative Classroom Projects on Student Learning

    Science.gov (United States)

    Reynolds, Candyce; Stevens, Dannelle D.; West, Ellen

    2013-01-01

    Creative thinking skills are essential for today's workplace. Three faculty members from different professional schools (business, higher education administration, teacher education) examined student responses to the creative assignments in their courses. The assignments exemplify the following criteria: invited taking risks, encouraged innovative…

  14. Using a multi-scale approach to identify and quantify oil and gas emissions: a case study for GHG emissions verification

    Science.gov (United States)

    Sweeney, C.; Kort, E. A.; Rella, C.; Conley, S. A.; Karion, A.; Lauvaux, T.; Frankenberg, C.

    2015-12-01

    Along with a boom in oil and natural gas production in the US, there has been a substantial effort to understand the true environmental impact of these operations on air and water quality, as well asnet radiation balance. This multi-institution effort funded by both governmental and non-governmental agencies has provided a case study for identification and verification of emissions using a multi-scale, top-down approach. This approach leverages a combination of remote sensing to identify areas that need specific focus and airborne in-situ measurements to quantify both regional and large- to mid-size single-point emitters. Ground-based networks of mobile and stationary measurements provide the bottom tier of measurements from which process-level information can be gathered to better understand the specific sources and temporal distribution of the emitters. The motivation for this type of approach is largely driven by recent work in the Barnett Shale region in Texas as well as the San Juan Basin in New Mexico and Colorado; these studies suggest that relatively few single-point emitters dominate the regional emissions of CH4.

  15. The splenic injury outcomes trial: An American Association for the Surgery of Trauma multi-institutional study.

    Science.gov (United States)

    Zarzaur, Ben L; Kozar, Rosemary; Myers, John G; Claridge, Jeffrey A; Scalea, Thomas M; Neideen, Todd A; Maung, Adrian A; Alarcon, Louis; Corcos, Alain; Kerwin, Andrew; Coimbra, Raul

    2015-09-01

    Delayed splenic hemorrhage after nonoperative management (NOM) of blunt splenic injury (BSI) is a feared complication, particularly in the outpatient setting. Significant resources, including angiography (ANGIO), are used in an effort to prevent delayed splenectomy (DS). No prospective, long-term data exist to determine the actual risk of splenectomy. The purposes of this trial were to ascertain the 180-day risk of splenectomy after 24 hours of NOM of BSI and to determine factors related to splenectomy. Eleven Level I trauma centers participated in this prospective observational study. Adult patients achieving 24 hours of NOM of their BSI were eligible. Patients were followed up for 180 days. Demographic, physiologic, radiographic, injury-related information, and spleen-related interventions were recorded. Bivariate and multivariable analyses were used to determine factors associated with DS. A total of 383 patients were enrolled. Twelve patients (3.1%) underwent in-hospital splenectomy between 24 hours and 9 days after injury. Of 366 discharged with a spleen, 1 (0.27%) required readmission for DS on postinjury Day 12. No Grade I injuries experienced DS. The splenectomy rate after 24 hours of NOM was 1.5 per 1,000 patient-days. Only extravasation from the spleen at time of admission (ADMIT-BLUSH) was associated with splenectomy (odds ratio, 3.6; 95% confidence interval, 1.4-12.4). Of patients with ADMIT-BLUSH (n = 49), 17 (34.7%) did not have ANGIO with embolization (EMBO), and 2 of those (11.8%) underwent splenectomy; 32 (65.3%) underwent ANGIO with EMBO, and 2 of those (6.3%, p = 0.6020 compared with no ANGIO with EMBO) required splenectomy. Splenectomy after 24 hours of NOM is rare. After the initial 24 hours, no additional interventions are warranted for patients with Grade I injuries. For Grades II to V, close observation as an inpatient or outpatient is indicated for 10 days to 14 days. ADMIT-BLUSH is a strong predictor of DS and should lead to close observation or earlier surgical intervention. Prognostic/epidemiological study, level III; therapeutic study, level IV.

  16. [The survival prediction model of advanced gallbladder cancer based on Bayesian network: a multi-institutional study].

    Science.gov (United States)

    Tang, Z H; Geng, Z M; Chen, C; Si, S B; Cai, Z Q; Song, T Q; Gong, P; Jiang, L; Qiu, Y H; He, Y; Zhai, W L; Li, S P; Zhang, Y C; Yang, Y

    2018-05-01

    Objective: To investigate the clinical value of Bayesian network in predicting survival of patients with advanced gallbladder cancer(GBC)who underwent curative intent surgery. Methods: The clinical data of patients with advanced GBC who underwent curative intent surgery in 9 institutions from January 2010 to December 2015 were analyzed retrospectively.A median survival time model based on a tree augmented naïve Bayes algorithm was established by Bayesia Lab software.The survival time, number of metastatic lymph nodes(NMLN), T stage, pathological grade, margin, jaundice, liver invasion, age, sex and tumor morphology were included in this model.Confusion matrix, the receiver operating characteristic curve and area under the curve were used to evaluate the accuracy of the model.A priori statistical analysis of these 10 variables and a posterior analysis(survival time as the target variable, the remaining factors as the attribute variables)was performed.The importance rankings of each variable was calculated with the polymorphic Birnbaum importance calculation based on the posterior analysis results.The survival probability forecast table was constructed based on the top 4 prognosis factors. The survival curve was drawn by the Kaplan-Meier method, and differences in survival curves were compared using the Log-rank test. Results: A total of 316 patients were enrolled, including 109 males and 207 females.The ratio of male to female was 1.0∶1.9, the age was (62.0±10.8)years.There was 298 cases(94.3%) R0 resection and 18 cases(5.7%) R1 resection.T staging: 287 cases(90.8%) T3 and 29 cases(9.2%) T4.The median survival time(MST) was 23.77 months, and the 1, 3, 5-year survival rates were 67.4%, 40.8%, 32.0%, respectively.For the Bayesian model, the number of correctly predicted cases was 121(≤23.77 months) and 115(>23.77 months) respectively, leading to a 74.86% accuracy of this model.The prior probability of survival time was 0.503 2(≤23.77 months) and 0.496 8(>23.77 months), the importance ranking showed that NMLN(0.366 6), margin(0.350 1), T stage(0.319 2) and pathological grade(0.258 9) were the top 4 prognosis factors influencing the postoperative MST.These four factors were taken as observation variables to get the probability of patients in different survival periods.Basing on these results, a survival prediction score system including NMLN, margin, T stage and pathological grade was designed, the median survival time(month) of 4-9 points were 66.8, 42.4, 26.0, 9.0, 7.5 and 2.3, respectively, there was a statistically significant difference in the different points( P advanced GBC who underwent curative resection.The survival prediction score system based on these four factors could be used to predict the survival and to guide the decision making of patients with advanced GBC.

  17. Participation in a Multi-Institutional Curriculum Development Project Changed Science Faculty Knowledge and Beliefs about Teaching Science

    Science.gov (United States)

    Donovan, Deborah A.; Borda, Emily J.; Hanley, Daniel M.; Landel, Carolyn C.

    2015-01-01

    Despite significant pressure to reform science teaching and learning in K12 schools, and a concurrent call to reform undergraduate courses, higher education science content courses have remained relatively static. Higher education science faculty have few opportunities to explore research on how people learn, examine state or national science…

  18. Salvage Radiation Therapy Dose Response for Biochemical Failure of Prostate Cancer After Prostatectomy—A Multi-Institutional Observational Study

    Energy Technology Data Exchange (ETDEWEB)

    Pisansky, Thomas M., E-mail: pisansky.thomas@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Agrawal, Shree [Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Hamstra, Daniel A. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Koontz, Bridget F. [Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina (United States); Liauw, Stanley L. [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States); Efstathiou, Jason A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Michalski, Jeff M. [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Feng, Felix Y. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Abramowitz, Matthew C.; Pollack, Alan [Department of Radiation Oncology, University of Miami, Miami, Florida (United States); Anscher, Mitchell S. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Moghanaki, Drew [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, Virginia (United States); Den, Robert B. [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Stephans, Kevin L. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Lee, W. Robert [Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina (United States); Kattan, Michael W. [Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (United States); and others

    2016-12-01

    Purpose: To determine whether a dose-response relationship exists for salvage radiation therapy (RT) of biochemical failure after prostatectomy for prostate cancer. Methods and Materials: Individual data from 1108 patients who underwent salvage RT at 10 academic centers were pooled. The cohort was enriched for selection criteria more likely associated with tumor recurrence in the prostate bed (margin positive and pre-RT prostate-specific antigen [PSA] level of ≤2.0 ng/mL) and without the confounding of planned androgen suppression. The cumulative incidence of biochemical failure and distant metastasis over time was computed, and competing risks hazard regression models were used to investigate the association between potential predictors and these outcomes. The association of radiation dose with outcomes was the primary focus. Results: With a 65.2-month follow-up duration, the 5- and 10-year estimates of freedom from post-RT biochemical failure (PSA level >0.2 ng/mL and rising) was 63.5% and 49.8%, respectively, and the cumulative incidence of distant metastasis was 12.4% by 10 years. A Gleason score of ≥7, higher pre-RT PSA level, extraprostatic tumor extension, and seminal vesicle invasion were associated with worse biochemical failure and distant metastasis outcomes. A salvage radiation dose of ≥66.0 Gy was associated with a reduced cumulative incidence of biochemical failure, but not of distant metastasis. Conclusions: The use of salvage radiation doses of ≥66.0 Gy are supported by evidence presented in the present multicenter pooled analysis of individual patient data. The observational reporting method, limited sample size, few distant metastasis events, modest follow-up duration, and elective use of salvage therapy might have diminished the opportunity to identify an association between the radiation dose and this endpoint.

  19. Fertility patients' views about frozen embryo disposition: results of a multi-institutional U.S. survey.

    Science.gov (United States)

    Lyerly, Anne Drapkin; Steinhauser, Karen; Voils, Corrine; Namey, Emily; Alexander, Carolyn; Bankowski, Brandon; Cook-Deegan, Robert; Dodson, William C; Gates, Elena; Jungheim, Emily S; McGovern, Peter G; Myers, Evan R; Osborn, Barbara; Schlaff, William; Sugarman, Jeremy; Tulsky, James A; Walmer, David; Faden, Ruth R; Wallach, Edward

    2010-02-01

    To describe fertility patients' preferences for disposition of cryopreserved embryos and determine factors important to these preferences. Cross-sectional survey conducted between June 2006 and July 2007. Nine geographically diverse U.S. fertility clinics. 1020 fertility patients with cryopreserved embryos. Self-administered questionnaire. Likelihood of selecting each of five conventional embryo disposition options: store for reproduction, thaw and discard, donate to another couple, freeze indefinitely, and donate for research; likelihood of selecting each of two alternative options identified in previous research: placement of embryos in the woman's body at an infertile time, or a disposal ceremony; importance of each of 26 considerations to disposition decisions; and views on the embryo's moral status. We found that 54% of respondents with cryopreserved embryos were very likely to use them for reproduction, 21% were very likely to donate for research, 7% or fewer were very likely to choose any other option. Respondents who ascribed high importance to concerns about the health or well-being of the embryo, fetus, or future child were more likely to thaw and discard embryos or freeze them indefinitely. Fertility patients frequently prefer disposition options that are not available to them or find the available options unacceptable. Restructuring and standardizing the informed consent process and ensuring availability of all disposition options may benefit patients, facilitate disposition decisions, and address problems of long-term storage. Copyright 2010 American Society for Reproductive Medicine. All rights reserved.

  20. A Multi-Institutional Study of Feasibility, Implementation, and Early Clinical Results With Noninvasive Breast Brachytherapy for Tumor Bed Boost

    International Nuclear Information System (INIS)

    Hamid, Subarna; Rocchio, Kathy; Arthur, Douglas; Vera, Robyn; Sha, Sandra; Jolly, Michele; Cavanaugh, Sean; Wooten, Eric; Benda, Rashmi; Greenfield, Brad; Prestidge, Bradley; Ackerman, Scot; Kuske, Robert; Quiet, Coral; Snyder, Margaret; Wazer, David E.

    2012-01-01

    Purpose: To evaluate the feasibility, implementation, and early results of noninvasive breast brachytherapy (NIBB) for tumor bed boost with whole breast radiation therapy (WBRT). Methods and Materials: NIBB is a commercially available (AccuBoost, Billerica, MA) mammography-based, brachytherapy system in which the treatment applicators are centered on the planning target volume (PTV) to direct 192 Ir emissions along orthogonal axes. A privacy-encrypted online data registry collected information from 8 independent academic and community-based institutions. Data were from 146 consecutive women with early-stage breast cancer after lumpectomy and WBRT receiving boost with NIBB between July 2007 and March 2010. Toxicity and cosmesis were graded according to the Common Toxicity Criteria (v. 3.0) and the Harvard scale. Median follow-up was 6 months (1–39 months). Results: Grade 1–2 skin toxicity was observed in 64%, 48%, and 21% during the acute (1–3 weeks), intermediate (4–26 weeks), and late-intermediate (>26 weeks) periods. There was no Grade 4 toxicity. At 6 months, for the entire cohort, cosmesis was excellent/good in 62%/38%. The subset receiving NIBB before WBRT had cosmetic scores of 32% and 63%, whereas during WBRT, 58% and 37% were rated as excellent and good, respectively. Breast compression was scored as “uncomfortable” in 12%, 29%, and 59% when NIBB was delivered before, during, or after WBRT. For each patient, the fraction-to-fraction variability in PTV was low. Skin flash was associated with a higher proportion of excellent cosmesis (58% vs. 42%) relative to having the applicator all within breast tissue. Conclusions: These data indicate that NIBB is feasible and can be consistently implemented in a broad array of practice settings. Preliminary evaluation suggests that NIBB is associated with acceptably mild normal tissue toxicity and favorable early cosmesis. The application of NIBB before WBRT may be associated with better patient tolerance at the expense of less favorable cosmetic outcome.

  1. What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey

    Energy Technology Data Exchange (ETDEWEB)

    Zaorsky, Nicholas G., E-mail: nicholaszaorsky@gmail.com [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Shaikh, Talha; Handorf, Elizabeth [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Eastwick, Gary [Temple University School of Medicine, Philadelphia, Pennsylvania (United States); Hesney, Adam [Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Scher, Eli D. [Rowan University School of Osteopathic Medicine, Stratford, New Jersey (United States); Jones, Ryan T.; Showalter, Timothy N. [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Avkshtol, Vladimir [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); University of Toledo College of Medicine, Toledo, Ohio (United States); Rice, Stephanie R. [University of Wisconsin School of Medicine, Madison, Wisconsin (United States); Horwitz, Eric M.; Meyer, Joshua E. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States)

    2016-02-01

    Purpose: The purposes of this study were to assess the exposure that medical students (MSs) have to radiation oncology (RO) during the course of their medical school career, as evidenced by 2 time points in current medical training (ie, first vs fourth year; MS1s and MS4s, respectively) and to assess the knowledge of MS1s, MS4s, and primary care physicians (PCPs) about the appropriateness of RT in cancer management in comparison with RO attendings. Methods: We developed and beta tested an electronic survey divided into 3 parts: RO job descriptions, appropriateness of RT, and toxicities of RT. The surveys were distributed to 7 medical schools in the United States. A concordance of >90% (either yes or no) among RO attendings in an answer was necessary to determine the correct answer and to compare with other subgroups using a χ{sup 2} test (P<.05 was significant). Results: The overall response rate for ROs, MS1s, MS4s, and PCPs was 26%; n (22 + 315 + 404 + 43)/3004. RT misconceptions decreased with increasing level of training. More than 1 of 10 MSs did not believe that RT alone could cure cancer. Emergent oncologic conditions for RT (eg, spinal cord compression, superior vena cava syndrome) could not be identified by >1 of 5 respondents. Multiple nontoxicities of RT (eg, emitting low-level radiation from the treatment site) were incorrectly identified as toxicities by >1 of 5 respondents. MS4s/PCPs with an RO rotation in medical school had improved scores in all prompts. Conclusions: Although MS knowledge of general RT principles improves from the first to the fourth year, a large knowledge gap still exists between MSs, current PCPs, and ROs. Some basic misconceptions of RT persist among a minority of MSs and PCPs. We recommend implementing formal education in RO fundamentals during the core curriculum of medical school.

  2. Oncologic outcomes and complication rates after laparoscopic-assisted cryoablation: a EuRECA multi-institutional study

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjaergaard; Lagerveld, Brunolf W; Keeley, Francis

    2017-01-01

    OBJECTIVE: To assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs). PATIENTS AND METHODS: A retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European inst...... invasive procedure, risk of complications should be considered when counselling patients....

  3. Phase I/II Multi-Institutional Study of Percutaneous Radiofrequency Ablation for Painful Osteoid Osteoma (JIVROSG-0704)

    Energy Technology Data Exchange (ETDEWEB)

    Miyazaki, Masaya, E-mail: mmiyazak@gunma-u.ac.jp [Gunma University Hospital, Department of Interventional Radiology and Clinical Ultrasound Center (Japan); Arai, Yasuaki [National Center Hospital, Division of Diagnostic Radiology (Japan); Myoui, Akira [Osaka University Hospital, Medical Center for Translational Research (Japan); Gobara, Hideo [Okayama University Medical School, Department of Radiology (Japan); Sone, Miyuki [National Center Hospital, Division of Diagnostic Radiology (Japan); Rosenthal, Daniel I. [Harvard Medical School, Department of Radiology, Massachusetts General Hospital (United States); Tsushima, Yoshito [Gunma University Hospital, Department of Interventional Radiology and Clinical Ultrasound Center (Japan); Kanazawa, Susumu [Okayama University Medical School, Department of Radiology (Japan); Ehara, Shigeru [Iwate Medical University School of Medicine, Department of Radiology (Japan); Endo, Keigo [Gunma University Hospital, Department of Interventional Radiology and Clinical Ultrasound Center (Japan)

    2016-10-15

    PurposeThis multicenter prospective study was conducted to evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) for painful osteoid osteoma (OO).Materials and MethodsPatients with OO (femur: n = 17, tibia: n = 2, humerus: n = 1, rib: n = 1) were enrolled and treated with RFA. In phase I, nine patients were evaluated for safety. In phase II, 12 patients were accrued, and an intent-to-treat analysis was performed on all patients. The primary endpoint was to evaluate the treatment safety. The secondary endpoint was to evaluate the efficacy for pain relief by the visual analogue scale (VAS) at 4 weeks after RFA. Treatment efficacy was classified as significantly effective (SE) when VAS score decreased by ≥5 or score was <2, moderately effective when VAS score decreased by <5–≥2 and score was ≥2, and not effective (NE) when VAS score decreased by <2 or score was increased. Cases where the need for analgesics increased after treatment were also NE.ResultsRFA procedures were completed in all patients. Minor adverse effects (AEs) were observed as 4.8–14.3 % in 12 patients, and no major AEs were observed. Mean VAS score was 7.1 before treatment, 1.6 at 1 week, 0.3 at 4 weeks, and 0.2 at 3 months. All procedures were classified as SE. Pain recurrence was not noted in any patient during follow-up (mean: 15.1 months).ConclusionRFA is a safe, highly effective, and fast-acting treatment for painful extraspinal OO. Future studies with a greater number of patients are needed.

  4. Local recurrence after surgery for non-small cell lung cancer: a recursive partitioning analysis of multi-institutional data.

    Science.gov (United States)

    Kelsey, Chris R; Higgins, Kristin A; Peterson, Bercedis L; Chino, Junzo P; Marks, Lawrence B; D'Amico, Thomas A; Varlotto, John M

    2013-10-01

    To define subgroups at high risk of local recurrence (LR) after surgery for non-small cell lung cancer using a recursive partitioning analysis (RPA). This Institutional Review Board-approved study included patients who underwent upfront surgery for I-IIIA non-small cell lung cancer at Duke Cancer Institute (primary set) or at other participating institutions (validation set). The 2 data sets were analyzed separately and identically. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered an LR. Recursive partitioning was used to build regression trees for the prediction of local recurrence-free survival (LRFS) from standard clinical and pathological factors. LRFS distributions were estimated with the Kaplan-Meier method. The 1411 patients in the primary set had a 5-year LRFS rate of 77% (95% confidence interval [CI], 0.74-0.81), and the 889 patients in the validation set had a 5-year LRFS rate of 76% (95% CI, 0.72-0.80). The RPA of the primary data set identified 3 terminal nodes based on stage and histology. These nodes and their 5-year LRFS rates were as follows: (1) stage I/adenocarcinoma, 87% (95% CI, 0.83-0.90); (2) stage I/squamous or large cell, 72% (95% CI, 0.65-0.79); and (3) stage II-IIIA, 62% (95% CI, 0.55-0.69). The validation RPA identified 3 terminal nodes based on lymphovascular invasion (LVI) and stage: (1) no LVI/stage IA, 82% (95% CI, 0.76-0.88); (2) no LVI/stage IB-IIIA, 73% (95% CI, 0.69-0.80); and (3) LVI, 58% (95% CI, 0.47-0.69). The risk of LR was similar in the primary and validation patient data sets. There was discordance between the 2 data sets regarding the clinical factors that best segregate patients into risk groups. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  5. Augmented-reality-based skills training for robot-assisted urethrovesical anastomosis: a multi-institutional randomised controlled trial.

    Science.gov (United States)

    Chowriappa, Ashirwad; Raza, Syed Johar; Fazili, Anees; Field, Erinn; Malito, Chelsea; Samarasekera, Dinesh; Shi, Yi; Ahmed, Kamran; Wilding, Gregory; Kaouk, Jihad; Eun, Daniel D; Ghazi, Ahmed; Peabody, James O; Kesavadas, Thenkurussi; Mohler, James L; Guru, Khurshid A

    2015-02-01

    To validate robot-assisted surgery skills acquisition using an augmented reality (AR)-based module for urethrovesical anastomosis (UVA). Participants at three institutions were randomised to a Hands-on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure-based training for UVA within the haptic-enabled AR-based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross-over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank-sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross-over group). A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention. Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand. © 2014 The Authors. BJU International © 2014 BJU International.

  6. OPREVENT2: Design of a multi-institutional intervention for obesity control and prevention for American Indian adults

    Directory of Open Access Journals (Sweden)

    Joel Gittelsohn

    2017-01-01

    Full Text Available Abstract Background Obesity and other nutrition-related chronic disease rates are high in American Indian (AI populations, and an urgent need exists to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component (MLMC interventions are needed, but there are significant knowledge gaps on how to deliver these types of interventions in low-income rural AI communities. Methods OPREVENT2 is a MLMC intervention targeting AI adults living in six rural reservations in New Mexico and Wisconsin. Aiming to prevent and reduce obesity in adults by working at multiple levels of the food and physical activity (PA environments, OPREVENT2 focuses on evidence-based strategies known to increase access to, demand for, and consumption of healthier foods and beverages, and increase worksite and home-based opportunities for PA. OPREVENT2 works to create systems-level change by partnering with tribal stakeholders, multiple levels of the food and PA environment (food stores, worksites, schools, and the social environment (children as change agents, families, social media. Extensive evaluation will be conducted at each level of the intervention to assess effectiveness via process and impact measures. Discussion Novel aspects of OPREVENT2 include: active engagement with stakeholders at many levels (policy, institutional, and at multiple levels of the food and PA system; use of community-based strategies to engage policymakers and other key stakeholders (community workshops, action committees; emphasis on both the built environment (intervening with retail food sources and the social environment. This paper describes the design of the intervention and the evaluation plan of the OPREVENT2. Trial registration Clinical Trial Registration: NCT02803853 (June 10, 2016

  7. Re-irradiation for oligo-recurrence from esophageal cancer with radiotherapy history: a multi-institutional study.

    Science.gov (United States)

    Jingu, Keiichi; Niibe, Yuzuru; Yamashita, Hideomi; Katsui, Kuniaki; Matsumoto, Toshihiko; Nishina, Tomohiro; Terahara, Atsuro

    2017-09-05

    Neoadjuvant chemoradiotherapy following surgery has recently become a standard therapy. The purpose of the present study was to determine the effectiveness and toxicity of re-irradiation for oligo-recurrence in lymph nodes from esophageal cancer treated by definitive radiotherapy or by surgery with additional radiotherapy. We reviewed retrospectively 248 patients treated with (chemo)radiotherapy for oligo-recurrence in lymph nodes from esophageal cancer in five Japanese high-volume centers between 2000 and 2015. Thirty-three patients in whom re-irradiation was performed were enrolled in this study, and the results for patients in whom re-irradiation was performed were compared with the results for other patients. Median maximum lymph node diameter was 22 mm. Median total radiation dose was 60 Gy. The median calculated biological effective dose using the LQ model with α/β = 10 Gy (BED10) in patients in whom re-irradiation was performed was significantly lower than the median BED10 in others. There was no different factor except for BED10, histology and irradiation field between patients with a past irradiation history and patients without a past irradiation history. The median observation period in surviving patients in whom re-irradiation was performed was 21.7 months. The 3-year overall survival rate in the 33 patients with a past irradiation history was 17.9%, with a median survival period of 16.0 months. Overall survival rate and local control rate in patients with a past irradiation history were significantly worse than those in patients without a past irradiation history (log-rank test, p = 0.016 and p = 0.0007, respectively). One patient in whom re-irradiation was performed died from treatment-related gastric hemorrhage. Results in the present study suggested that re-irradiation for oligo-recurrence in lymph nodes from esophageal cancer treated by definitive radiotherapy or by surgery with additional radiotherapy might be acceptable but unsatisfactory.

  8. Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease

    Directory of Open Access Journals (Sweden)

    Ashwinee Natu

    2017-01-01

    Full Text Available Objective. To compare three cases of Herpes simplex virus (HSV hepatitis to increase early diagnosis of the disease. Case  1. A 23-year-old man with Crohn’s disease and oral HSV. HSV hepatitis was diagnosed clinically and he improved with acyclovir. Case  2. An 18-year-old G1P0 woman with transaminitis. Despite early empiric acyclovir therapy, she died due to fulminant liver failure. Case  3. A 65-year-old woman who developed transaminitis after liver transplant. Diagnosis was confirmed by biopsy and she had resolution of acute liver failure with acyclovir. Conclusion. It is imperative that clinicians be aware of patients at high risk for developing HSV hepatitis to increase timely diagnosis and prevent morbidity and fatality.

  9. Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen.

    Science.gov (United States)

    Burlew, Clay Cothren; Moore, Ernest E; Cuschieri, Joseph; Jurkovich, Gregory J; Codner, Panna; Crowell, Kody; Nirula, Ram; Haan, James; Rowell, Susan E; Kato, Catherine M; MacNew, Heather; Ochsner, M Gage; Harrison, Paul B; Fusco, Cynthia; Sauaia, Angela; Kaups, Krista L

    2011-02-01

    Use of damage control surgery techniques has reduced mortality in critically injured patients but at the cost of the open abdomen. With the option of delayed definitive management of enteric injuries, the question of intestinal repair/anastomosis or definitive stoma creation has been posed with no clear consensus. The purpose of this study was to determine outcomes on the basis of management of enteric injuries in patients relegated to the postinjury open abdomen. Patients requiring an open abdomen after trauma from January 1, 2002 to December 31, 2007 were reviewed. Type of bowel repair was categorized as immediate repair, immediate anastomosis, delayed anastomosis, stoma and a combination. Logistic regression was used to determine independent effect of risk factors on leak development. During the 6-year study period, 204 patients suffered enteric injuries and were managed with an open abdomen. The majority was men (77%) sustaining blunt trauma (66%) with a mean age of 37.1 years±1.2 years and median Injury Severity Score of 27 (interquartile range=20-41). Injury patterns included 81 (40%) small bowel, 37 (18%) colonic, and 86 (42%) combined injuries. Enteric injuries were managed with immediate repair (58), immediate anastomosis (15), delayed anastomosis (96), stoma (10), and a combination (22); three patients died before definitive repair. Sixty-one patients suffered intra-abdominal complications: 35 (17%) abscesses, 15 (7%) leaks, and 11 (5%) enterocutaneous fistulas. The majority of patients with leaks had a delayed anastomosis; one patient had a right colon repair. Leak rate increased as one progresses toward the left colon (small bowel anastomoses, 3% leak rate; right colon, 3%; transverse colon, 20%; left colon, 45%). There were no differences in emergency department physiology, injury severity, transfusions, crystalloids, or demographic characteristics between patients with and without leak. Leak cases had higher 12-hour heart rate (148 vs. 125, p=0.02) and higher 12-hour base deficit (13.7 vs. 9.7, p=0.04), suggesting persistent shock and consequent hypoperfusion were related to leak development. There was a significant trend toward higher incidence of leak with closure day (χ for trend, p=0.01), with closure after day 5 having a four times higher likelihood of developing leak (3% vs. 12%, p=0.02). Repair or anastomosis of intestinal injuries should be considered in all patients. However, leak rate increases with fascial closure beyond day 5 and with left-sided colonic anastomoses. Investigating the physiologic basis for intestinal vulnerability of the left colon and in the open abdomen is warranted.

  10. Rejection with hemodynamic compromise in the current era of pediatric heart transplantation: a multi-institutional study.

    Science.gov (United States)

    Everitt, Melanie D; Pahl, Elfriede; Schechtman, Kenneth B; Zheng, Jie; Ringewald, Jeremy M; L'ecuyer, Thomas; Naftel, David C; Kirklin, James K; Blume, Elizabeth D; Bullock, Emily A; Canter, Charles E

    2011-03-01

    Survival after pediatric heart transplant has improved over time, as has the incidence of overall rejection. We studied the effect of era on the occurrence and outcome of rejection with hemodynamic compromise (HC). Data from 2227 patients who received allografts between 1993 and 2006 at 36 centers in the Pediatric Heart Transplant Study were analyzed to determine incidence, outcome, and risk factors for rejection with HC in early (1993-1999) and recent (2000-2006) eras. Rejection with HC was classified as severe (RSHC) when inotropes were used for circulatory support and mild (RMHC) when inotropes were not used. Of 1217 patients with any episode of rejection, 541 had rejection with HC. Freedom from RMHC improved at 1 year (81% vs 90%, p RMHC (87% at 1 year and 72% at 5 years, p RMHC was earlier era of transplant (HR, 1.94; 95% CI, 1.56-2.41; p RMHC has declined over time but the same era effect has not occurred with RSHC. Close follow-up after RSHC is crucial because mortality is so high. Copyright © 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  11. Toxicity of Irinotecan-Eluting Beads in the Treatment of Hepatic Malignancies: Results of a Multi-Institutional Registry

    International Nuclear Information System (INIS)

    Martin, R. C. G.; Howard, J.; Tomalty, D.; Robbins, K.; Padr, R.; Bosnjakovic, P. M.; Tatum, Cliff

    2010-01-01

    PurposeTo evaluate the predictors of toxicity of drug-eluting beads loaded with irinotecan (DEBIRI) in the treatment of hepatic malignancies.Materials and MethodsA total of 330 patients were enrolled in a prospective, open-label, multicenter, multinational, single-arm study administering two types of drug-eluting beads (DEBIRI and drug-eluting beads loaded with doxorubicin). Complications were graded by Cancer Therapy Evaluation Program's Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. All events requiring additional physician treatment or requiring extended hospital stay or readmission within 30 days were included.ResultsA total of 109 patients received 187 DEBIRI treatments (range 1 to 5 per patient). The most common histology was metastatic colorectal cancer in 76% of patients, cholangiocarcinoma in 7% of patients, and other metastatic disease in 17% of patients. There were 35 patients (19%) with irinotecan treatments who sustained 158 treatment-related adverse events, with the median CTCAE event grade being CTCAE grade 2 (range 1 to 5). The most common adverse events were postembolic symptoms (42%). Multivariate analysis identified pretreatment and treatment-related risk factors as follows: lack of pretreatment with hepatic arterial lidocaine (p = 0.005), ≥3 treatments (p = 0.05), achievement of complete stasis (p = 0.04), treatment with >100 mg DEBIRI in 1 treatment (p = 0.03), and bilirubin >2.0 μg/dl with >50% liver involvement (p = 0.05). These factors were predictive of adverse events and significantly greater hospital length of stay.ConclusionsDEBIRI is safe when appropriate technique and treatment are used. Adverse events can be predicted based on pretreatment- and treatment-related factors, and their occurrence can become part of the informed consent process. Continued standardization of this treatment will lead to fewer adverse events and improved patient quality of life.

  12. A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice.

    Science.gov (United States)

    Duncombe, Daphne C

    2018-03-01

    To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best method for successfully incorporating evidence-based practice into nursing practice in The Bahamas. © 2017 John Wiley & Sons Ltd.

  13. Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes.

    Science.gov (United States)

    Musi, Gennaro; Mistretta, Francesco A; Marenghi, Carlo; Russo, Andrea; Catellani, Michele; Nazzani, Sebastiano; Conti, Andrea; Luzzago, Stefano; Ferro, Matteo; Matei, Deliu V; Carmignani, Luca; de Cobelli, Ottavio

    2018-03-01

    To evaluate the efficacy and safety of ureteroscopic thulium laser (TL) treatment of upper urinary tract carcinoma (UTUC). Forty-two consecutive patients underwent conservative TL treatment for UTUC at two referral institutions. All patients underwent preliminary biopsy and then laser vaporization. A 272 μm and 365 μm laser fibers were used with a flexible and semirigid scope, respectively. Ablation was carried out with a 10 to 20 W power. Mean age at surgery was 68 years (SD 10.7). Mean tumor size was 14.3 mm (range 2-30 mm). Preliminary biopsy revealed the presence of low-grade disease in 29 (69.1%) patients, high-grade disease in 4 (9.5%) and 1 carcinoma in situ 1 (2.4%), whereas it was not conclusive in 8 (19%) cases. Final stage was pTa and pTis in 41 (97.6%) and 1 (2.4%) patients, respectively. Thirty eight percent (16) experienced Clavien-Dindo grade I complication, 47.6% (20) grade II, and 2.4% (1) grade III. Five (12%) patients underwent a second-look procedure due to residual disease. Eight (19%) patients experienced clinical recurrence. The median estimated recurrence-free survival was 44 months (SE 3.68). Four patients (9.5%) underwent a nephroureterectomy. Final pathological stage was pTis, pT3 high grade, pTa low grade, and pT0. Median follow-up was 26.3 months (range 2-54 months), and no progression or upstaging of disease occurred. TL management of UTUC is a safe and efficacious conservative treatment. Our experience shows optimal vaporization and hemostatic control in the absence of major complications.

  14. Evaluating factors that dictate struvite stone composition: A multi-institutional clinical experience from the EDGE Research Consortium

    Science.gov (United States)

    Battison, Andrew; De, Shubha; Humphreys, Mitchell R.; Bader, Markus; Lellig, Ekaterina; Monga, Manoj; Chew, Ben H.; Lange, Dirk

    2018-01-01

    Introduction Struvite stones account for 15% of urinary calculi and are typically associated with urease-producing urinary tract infections and carry significant morbidity. This study aims to characterize struvite stones based on purity of stone composition, bacterial speciation, risk factors, and clinical features. Methods Retrospective data was collected from patients diagnosed with infection stones between 2008 and 2012. Stone analysis, perioperative urine cultures, bacterial speciation, and clinical data were collected and analyzed. The purity of struvite stones was determined. Statistical comparisons were made among homogeneous and heterogeneous struvite stones. Results From the four participating centres, 121 struvite stones were identified. Only 13.2% (16/121) were homogenous struvite. Other components included calcium phosphate (42.1%), calcium oxalate (33.9%), calcium carbonate (27.3%), and uric acid (5.8%). Partial or full staghorn calculi occurred in 23.7% of cases. Urease-producing bacteria were only present in 30% of cases. Proteus, E. coli, and Enterococcus were the most common bacterial isolates from perioperative urine, and percutaneous nephrolithotomy was the most common modality of treatment. Only 40% of patients had a urinalysis that was nitrite-positive, indicating that urinalysis alone is not reliable for diagnosing infection stones. The study’s limitation is its retrospective nature; as such, the optimal timing of cultures with respect to stone analysis or treatment was not always possible, urine cultures were often not congruent with stone cultures in the same patient, and our findings of E. coli commonly cultured does not suggest causation. Conclusions Struvite stones are most often heterogeneous in composition. Proteus remains a common bacterial isolate; however, E. coli and Enterococcus were also frequently identified. This new data provides evidence that patients with struvite stones can have urinary tract pathogens other than urease-producing bacteria, thus challenging previous conventional dogma. PMID:29319486

  15. Multi institutional phase II study of concomitant stereotactic reirradiation and cetuximab for recurrent head and neck cancer

    International Nuclear Information System (INIS)

    Lartigau, Eric F.; Tresch, Emmanuelle; Thariat, Juliette; Graff, Pierre; Coche-Dequeant, Bernard; Benezery, Karen; Schiappacasse, Luis; Degardin, Marian; Bondiau, Pierre-Yves; Peiffert, Didier; Lefebvre, Jean-Louis; Lacornerie, Thomas; Kramar, Andrew

    2013-01-01

    Purpose: Recurrent head and neck cancer is associated to a poor survival prognosis. A high toxicity rate is demonstrated when surgery and/or radiotherapy and/or chemotherapy are combined. Furthermore, the duration of treatment is often not ethically compatible with the expected survival (median survival < 1 year). Normal tissues tolerance limits the use of reirradiation and stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. After completion of a feasibility study, results of a multicentric study (Lille, Nancy and Nice) using SBRT with cetuximab are reported. The aim of the study was to deliver non toxic short course SBRT (2 weeks) in order to get the same local control as the one demonstrated with longer protocols. Methods and materials: Patients with inoperable recurrent, or new primary tumor in a previously irradiated area, were included (WHO < 3). Reirradiation (RT) dose was 36 Gy in six fractions of 6 Gy to the 85% isodose line covering 95% of the PTV with 5 injections of concomitant cetuximab (CT). All patients had previous radiotherapy, 85% had previous surgery and 48% previous chemotherapy. Results: Between 11/2007 and 08/2010, 60 were included (46 men and 14 women), 56 received CT + RT, 3 were not treated and 1 received only CT. Median age was 60 (42–87)) and all 56 patients had squamous carcinoma and received concomitant cetuximab. Mean time between previous radiotherapy and the start of SBRT was 38 months. Cutaneous toxicity was observed for 41 patients. There was one toxic death from hemorrhage and denutrition. Median follow-up was 11.4 months. At 3 months, response rate was 58.4% (95% CI: 43.2–72.4%) and disease control rate was 91.7% (95% CI: 80.0–97.7%). The one-year OS rate was 47.5% (95% CI: 30.8–62.4). Conclusion: These results suggest that short SBRT with cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. This combination may be the reference treatment is this population

  16. Radiation Therapy for Primary Cutaneous Anaplastic Large Cell Lymphoma: An International Lymphoma Radiation Oncology Group Multi-institutional Experience

    Energy Technology Data Exchange (ETDEWEB)

    Million, Lynn, E-mail: lmillion@stanford.edu [Stanford Cancer Institute, Stanford, California (United States); Yi, Esther J.; Wu, Frank; Von Eyben, Rie [Stanford Cancer Institute, Stanford, California (United States); Campbell, Belinda A. [Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne (Australia); Dabaja, Bouthaina [The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tsang, Richard W. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Ng, Andrea [Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Wilson, Lynn D. [Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut (United States); Ricardi, Umberto [Department of Oncology, University of Turin, Turin (Italy); Kirova, Youlia [Institut Curie, Paris (France); Hoppe, Richard T. [Stanford Cancer Institute, Stanford, California (United States)

    2016-08-01

    Purpose: To collect response rates of primary cutaneous anaplastic large cell lymphoma, a rare cutaneous T-cell lymphoma, to radiation therapy (RT), and to determine potential prognostic factors predictive of outcome. Methods and Materials: The study was a retrospective analysis of patients with primary cutaneous anaplastic large cell lymphoma who received RT as primary therapy or after surgical excision. Data collected include initial stage of disease, RT modality (electron/photon), total dose, fractionation, response to treatment, and local recurrence. Radiation therapy was delivered at 8 participating International Lymphoma Radiation Oncology Group institutions worldwide. Results: Fifty-six patients met the eligibility criteria, and 63 tumors were treated: head and neck (27%), trunk (14%), upper extremities (27%), and lower extremities (32%). Median tumor size was 2.25 cm (range, 0.6-12 cm). T classification included T1, 40 patients (71%); T2, 12 patients (21%); and T3, 4 patients (7%). The median radiation dose was 35 Gy (range, 6-45 Gy). Complete clinical response (CCR) was achieved in 60 of 63 tumors (95%) and partial response in 3 tumors (5%). After CCR, 1 tumor recurred locally (1.7%) after 36 Gy and 7 months after RT. This was the only patient to die of disease. Conclusions: Primary cutaneous anaplastic large cell lymphoma is a rare, indolent cutaneous lymphoma with a low death rate. This analysis, which was restricted to patients selected for treatment with radiation, indicates that achieving CCR was independent of radiation dose. Because there were too few failures (<2%) for statistical analysis on dose response, 30 Gy seems to be adequate for local control, and even lower doses may suffice.

  17. Multi-Institutional Analysis of Solitary Extramedullary Plasmacytoma of the Head and Neck Treated With Curative Radiotherapy

    International Nuclear Information System (INIS)

    Sasaki, Ryohei; Yasuda, Koichi; Abe, Eisuke; Uchida, Nobue; Kawashima, Mitsuhiko; Uno, Takashi; Fujiwara, Masayuki; Shioyama, Yoshiyuki; Kagami, Yoshikazu; Shibamoto, Yuta; Nakata, Kensei; Takada, Yoshie; Kawabe, Tetsuya; Uehara, Kazuyuki; Nibu, Kenichi; Yamada, Syogo

    2012-01-01

    Purpose: The purpose of this study was to elucidate the efficacy and optimal method of radiotherapy in the management of solitary extramedullary plasmacytoma occurring in the head and neck regions (EMPHN). Methods and Materials: Sixty-seven patients (43 male and 24 female) diagnosed with EMPHN between 1983 and 2008 at 23 Japanese institutions were reviewed. The median patient age was 64 years (range, 12–83). The median dose administered was 50 Gy (range, 30–64 Gy). Survival data were calculated by the Kaplan-Meier method. Results: The median follow-up duration was 63 months. Major tumor sites were nasal or paranasal cavities in 36 (54%) patients, oropharynx or nasopharynx in 16 (23%) patients, orbita in 6 (9%) patients, and larynx in 3 (5%) patients. The 5- and 10-year local control rates were 95% and 87%, whereas the 5- and 10-year disease-free survival rates were 56% and 54%, respectively. There were 5 (7.5%), 12 (18%), and 8 (12%) patients who experienced local failure, distant metastasis, and progression to multiple myeloma, respectively. In total, 18 patients died, including 10 (15%) patients who died due to complications from EMPHN. The 5- and 10-year overall survival (OS) rates were 73% and 56%, respectively. Radiotherapy combined with surgery was identified as the lone significant prognostic factor for OS (p = 0.04), whereas age, gender, radiation dose, tumor size, and chemotherapy were not predictive. No patient experienced any severe acute morbidity. Conclusions: Radiotherapy was quite effective and safe for patients with EMPHN. Radiotherapy combined with surgery produced a better outcome according to survival rates. These findings require confirmation by further studies with larger numbers of patients with EMPHN.

  18. Influence of Pro-Qura-generated Plans on Postimplant Dosimetric Quality: A Review of a Multi-Institutional Database

    International Nuclear Information System (INIS)

    Allen, Zachariah; Merrick, Gregory S.; Grimm, Peter; Blasko, John; Sylvester, John; Butler, Wayne; Chaudry, Usman-Ul-Haq; Sitter, Michael

    2008-01-01

    The influence of Pro-Qura-generated plans vs. community-generated plans on postprostate brachytherapy dosimetric quality was compared. In the Pro-Qura database, 2933 postplans were evaluated from 57 institutions. A total of 1803 plans were generated by Pro-Qura and 1130 by community institutions. Iodine-125 ( 125 I) plans outnumbered Palladium 103 ( 103 Pd) plans by a ratio of 3:1. Postimplant dosimetry was performed in a standardized fashion by overlapping the preimplant ultrasound and the postimplant computed tomography (CT). In this analysis, adequacy was defined as a V 100 > 80% and a D 90 of 90% to 140% for both isotopes along with a V 150 125 I and 103 Pd. The mean postimplant V 100 and D 90 were 88.6% and 101.6% vs. 89.3% and 102.3% for Pro-Qura and community plans, respectively. When analyzed in terms of the first 8 sequence groups (10 patients/sequence group) for each institution, Pro-Qura planning resulted in less postimplant variability for V 100 (86.2-89.5%) and for D 90 (97.4-103.2%) while community-generated plans had greater V 100 (85.3-91.2%) and D 90 (95.9-105.2%) ranges. In terms of sequence groups, postimplant dosimetry was deemed 'too cool' in 11% to 30% of cases and 'too hot' in 12% to 27%. On average, no clinically significant postimplant dosimetric differences were discerned between Pro-Qura and community-based planning. However, substantially greater variability was identified in the community-based plan cohort. It is possible that the Pro-Qura plan and/or the routine postimplant dosimetric evaluation may have influenced dosimetric outcomes at community-based centers

  19. Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan.

    Science.gov (United States)

    Tatekawa, H; Sakamoto, S; Hori, M; Kaichi, Y; Kunimatsu, A; Akazawa, K; Miyasaka, T; Oba, H; Okubo, T; Hasuo, K; Yamada, K; Taoka, T; Doishita, S; Shimono, T; Miki, Y

    2018-05-03

    Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data. We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16-85 years; females, 77; aquaporin 4 immunoglobulin G-positive, 93%) and 89 with MS (median age, 36 years; range, 18-67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test. We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders ( P = .001), but not in MS ( P = .80). Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications. © 2018 by American Journal of Neuroradiology.

  20. SU-F-T-494: A Multi-Institutional Study of Independent Dose Verification Using Golden Beam Data

    Energy Technology Data Exchange (ETDEWEB)

    Itano, M; Yamazaki, T [Inagi Municipal Hospital, Inagi, Tokyo (Japan); Tachibana, R; Uchida, Y [National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Yamashita, M [Kobe City Medical Center General Hospital, Kobe, Hyogo (Japan); Shimizu, H [Kitasato University Medical Center, Kitamoto, Saitama (Japan); Sugawara, Y; Kotabe, K [National Center for Global Health and Medicine, Shinjuku, Tokyo (Japan); Kamima, T [Cancer Institute Hospital Japanese Foundation for Cancer Research, Koto, Tokyo (Japan); Takahashi, R [Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Tokyo (Japan); Ishibashi, S [Sasebo City General Hospital, Sasebo, Nagasaki (Japan); Tachibana, H [National Cancer Center, Kashiwa, Chiba (Japan)

    2016-06-15

    Purpose: In general, beam data of individual linac is measured for independent dose verification software program and the verification is performed as a secondary check. In this study, independent dose verification using golden beam data was compared to that using individual linac’s beam data. Methods: Six institutions were participated and three different beam data were prepared. The one was individual measured data (Original Beam Data, OBD) .The others were generated by all measurements from same linac model (Model-GBD) and all linac models (All-GBD). The three different beam data were registered to the independent verification software program for each institute. Subsequently, patient’s plans in eight sites (brain, head and neck, lung, esophagus, breast, abdomen, pelvis and bone) were analyzed using the verification program to compare doses calculated using the three different beam data. Results: 1116 plans were collected from six institutes. Compared to using the OBD, the results shows the variation using the Model-GBD based calculation and the All-GBD was 0.0 ± 0.3% and 0.0 ± 0.6%, respectively. The maximum variations were 1.2% and 2.3%, respectively. The plans with the variation over 1% shows the reference points were located away from the central axis with/without physical wedge. Conclusion: The confidence limit (2SD) using the Model-GBD and the All-GBD was within 0.6% and 1.2%, respectively. Thus, the use of golden beam data may be feasible for independent verification. In addition to it, the verification using golden beam data provide quality assurance of planning from the view of audit. This research is partially supported by Japan Agency for Medical Research and Development(AMED)

  1. An online spaced-education game to teach and assess residents: a multi-institutional prospective trial.

    Science.gov (United States)

    Kerfoot, B Price; Baker, Harley

    2012-03-01

    While games are frequently used in resident education, there is little evidence supporting their efficacy. We investigated whether a spaced-education (SE) game can be both a reliable and valid method of assessing residents' knowledge and an effective means of teaching core content. The SE game consisted of 100 validated multiple-choice questions and explanations on core urology content. Residents were sent 2 questions each day via email. Adaptive game mechanics re-sent the questions in 2 or 6 weeks if answered incorrectly and correctly, respectively. Questions expired if not answered on time (appointment dynamic). Residents retired questions by answering each correctly twice in a row (progression dynamic). Competition was fostered by posting relative performance among residents. Main outcomes measures were baseline scores (percentage of questions answered correctly on initial presentation) and completion scores (percentage of questions retired). Nine hundred thirty-one US and Canadian residents enrolled in the 45-week trial. Cronbach alpha reliability for the SE baseline scores was 0.87. Baseline scores (median 62%, interquartile range [IQR] 17%) correlated with scores on the 2008 American Urological Association in-service examination (ISE08), 2009 American Board of Urology qualifying examination (QE09), and ISE09 (r = 0.76, 0.46, and 0.64, respectively; all p games. An SE game is a reliable and valid means to assess residents' knowledge and is a well-accepted method by which residents can master core content. Published by Elsevier Inc.

  2. An online spaced-education game to teach and assess medical students: a multi-institutional prospective trial.

    Science.gov (United States)

    Kerfoot, B Price; Baker, Harley; Pangaro, Louis; Agarwal, Kathryn; Taffet, George; Mechaber, Alex J; Armstrong, Elizabeth G

    2012-10-01

    To investigate whether a spaced-education (SE) game can be an effective means of teaching core content to medical students and a reliable and valid method of assessing their knowledge. This nine-month trial (2008-2009) enrolled students from three U.S. medical schools. The SE game consisted of 100 validated multiple-choice questions-explanations in preclinical/clinical domains. Students were e-mailed two questions daily. Adaptive game mechanics re-sent questions in three or six weeks if answered, respectively, incorrectly or correctly. Questions expired if not answered on time (appointment dynamic). Students retired questions by answering each correctly twice consecutively (progression dynamic). Posting of relative performance fostered competition. Main outcome measures were baseline and completion scores. Seven-hundred thirty-one students enrolled. Median baseline score was 53% (interquartile range [IQR] 16) and varied significantly by year (Pgames. An SE game is an effective and well-accepted means of teaching core content and a reliable and valid method to assess student knowledge. SE games may be valuable tools to identify and remediate students who could benefit from additional educational support.

  3. OPREVENT2: Design of a multi-institutional intervention for obesity control and prevention for American Indian adults.

    Science.gov (United States)

    Gittelsohn, Joel; Jock, Brittany; Redmond, Leslie; Fleischhacker, Sheila; Eckmann, Thomas; Bleich, Sara N; Loh, Hong; Ogburn, Elizabeth; Gadhoke, Preety; Swartz, Jacqueline; Pardilla, Marla; Caballero, Benjamin

    2017-01-23

    Obesity and other nutrition-related chronic disease rates are high in American Indian (AI) populations, and an urgent need exists to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component (MLMC) interventions are needed, but there are significant knowledge gaps on how to deliver these types of interventions in low-income rural AI communities. OPREVENT2 is a MLMC intervention targeting AI adults living in six rural reservations in New Mexico and Wisconsin. Aiming to prevent and reduce obesity in adults by working at multiple levels of the food and physical activity (PA) environments, OPREVENT2 focuses on evidence-based strategies known to increase access to, demand for, and consumption of healthier foods and beverages, and increase worksite and home-based opportunities for PA. OPREVENT2 works to create systems-level change by partnering with tribal stakeholders, multiple levels of the food and PA environment (food stores, worksites, schools), and the social environment (children as change agents, families, social media). Extensive evaluation will be conducted at each level of the intervention to assess effectiveness via process and impact measures. Novel aspects of OPREVENT2 include: active engagement with stakeholders at many levels (policy, institutional, and at multiple levels of the food and PA system); use of community-based strategies to engage policymakers and other key stakeholders (community workshops, action committees); emphasis on both the built environment (intervening with retail food sources) and the social environment. This paper describes the design of the intervention and the evaluation plan of the OPREVENT2. Clinical Trial Registration: NCT02803853 (June 10, 2016).

  4. A multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis.

    Science.gov (United States)

    Kirkwood, Katherine A; Gulack, Brian C; Iribarne, Alexander; Bowdish, Michael E; Greco, Giampaolo; Mayer, Mary Lou; O'Sullivan, Karen; Gelijns, Annetine C; Fumakia, Nishit; Ghanta, Ravi K; Raiten, Jesse M; Lala, Anuradha; Ladowski, Joseph S; Blackstone, Eugene H; Parides, Michael K; Moskowitz, Alan J; Horvath, Keith A

    2018-02-01

    The incidence and severity of Clostridium difficile infection (CDI) have increased rapidly over the past 2 decades, particularly in elderly patients with multiple comorbidities. This study sought to characterize the incidence and risks of these infections in cardiac surgery patients. A total of 5158 patients at 10 Cardiothoracic Surgical Trials Network sites in the US and Canada participated in a prospective study of major infections after cardiac surgery. Patients were followed for infection, readmission, reoperation, or death up to 65 days after surgery. We compared clinical and demographic characteristics, surgical data, management practices, and outcomes for patients with CDI and without CDI. C difficile was the third most common infection observed (0.97%) and was more common in patients with preoperative comorbidities and complex operations. Antibiotic prophylaxis for >2 days, intensive care unit stay >2 days, and postoperative hyperglycemia were associated with increased risk of CDI. The median time to onset was 17 days; 48% of infections occurred after discharge. The additional length of stay due to infection was 12 days. The readmission and mortality rates were 3-fold and 5-fold higher, respectively, in patients with CDI compared with uninfected patients. In this large multicenter prospective study of major infections following cardiac surgery, CDI was encountered in nearly 1% of patients, was frequently diagnosed postdischarge, and was associated with extended length of stay and substantially increased mortality. Patients with comorbidities, longer surgery time, extended antibiotic exposure, and/or hyperglycemic episodes were at increased risk for CDI. Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.

  5. Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students.

    Science.gov (United States)

    Dyrbye, Liselotte N; Power, David V; Massie, F Stanford; Eacker, Anne; Harper, William; Thomas, Matthew R; Szydlo, Daniel W; Sloan, Jeff A; Shanafelt, Tait D

    2010-10-01

    Burnout is prevalent among medical students and is a predictor of subsequent serious consideration of dropping out of medical school and suicide ideation. Understanding of the factors that protect against burnout is needed to guide student wellness programmes. A total of 1321 medical students attending five institutions were studied longitudinally (2006-2007). The surveys included standardised instruments to evaluate burnout, quality of life, fatigue and stress. Additional items explored social support, learning climate, life events, employment status and demographics. Students who did not have burnout at either time-point (resilient students) were compared with those who indicated burnout at one or both time-points (vulnerable students) using a Wilcoxon-Mann-Whitney test or Fisher's exact test. Similarly, the differences between those who recovered and those who were chronically burned out were also compared in students with burnout at the first time-point. Logistic regression modelling was employed to evaluate associations between the independent variables and resiliency to and recovery from burnout. Overall, 792 (60.0%) students completed the burnout inventory at both time-points. No differences in demographic characteristics were observed between resilient (290/792 [36.6%]) and vulnerable (502/792 [63.4%]) students. Resilient students were less likely to experience depression, had a higher quality of life, were less likely to be employed, had experienced fewer stressful life events, reported higher levels of social support, perceived their learning climate more positively and experienced less stress and fatigue (all p students. On multivariable analysis, perceiving student education as a priority for faculty staff, experiencing less stress, not being employed and being a minority were factors independently associated with recovery from burnout. Modifiable individual factors and learning climate characteristics including employment status, stress level and perceptions of the prioritising of student education by faculty members relate to medical students' vulnerability to burnout. © Blackwell Publishing Ltd 2010.

  6. SU-F-T-494: A Multi-Institutional Study of Independent Dose Verification Using Golden Beam Data

    International Nuclear Information System (INIS)

    Itano, M; Yamazaki, T; Tachibana, R; Uchida, Y; Yamashita, M; Shimizu, H; Sugawara, Y; Kotabe, K; Kamima, T; Takahashi, R; Ishibashi, S; Tachibana, H

    2016-01-01

    Purpose: In general, beam data of individual linac is measured for independent dose verification software program and the verification is performed as a secondary check. In this study, independent dose verification using golden beam data was compared to that using individual linac’s beam data. Methods: Six institutions were participated and three different beam data were prepared. The one was individual measured data (Original Beam Data, OBD) .The others were generated by all measurements from same linac model (Model-GBD) and all linac models (All-GBD). The three different beam data were registered to the independent verification software program for each institute. Subsequently, patient’s plans in eight sites (brain, head and neck, lung, esophagus, breast, abdomen, pelvis and bone) were analyzed using the verification program to compare doses calculated using the three different beam data. Results: 1116 plans were collected from six institutes. Compared to using the OBD, the results shows the variation using the Model-GBD based calculation and the All-GBD was 0.0 ± 0.3% and 0.0 ± 0.6%, respectively. The maximum variations were 1.2% and 2.3%, respectively. The plans with the variation over 1% shows the reference points were located away from the central axis with/without physical wedge. Conclusion: The confidence limit (2SD) using the Model-GBD and the All-GBD was within 0.6% and 1.2%, respectively. Thus, the use of golden beam data may be feasible for independent verification. In addition to it, the verification using golden beam data provide quality assurance of planning from the view of audit. This research is partially supported by Japan Agency for Medical Research and Development(AMED)

  7. The current status of treatment for oropharyngeal cancer in Japan. A multi-institutional retrospective observation study

    International Nuclear Information System (INIS)

    Homma, Akihiro; Hayashi, Ryuichi; Kawabata, Kazuyoshi

    2013-01-01

    The purpose of this study was to assess the current status of the treatment for oropharyngeal cancer (OPC) in Japan to assist the planning of clinical trials in the future. The data for 523 patients with previously untreated OPC were obtained from 12 institutions from April 2005 to N/larch 2007. Of the 523 patients, 471 patients with squamous cell carcinoma and with curative intent were included in an analysis of the treatment and its results. Of the 471 patients with OPC treated with curative intent, 186 patients (39.5%) were treated with surgery, 118 (25.1%) with radiotherapy (RT) alone and 167 (355%) with CRT. Surgery was indicated for 60.4% of the patients with stage I, 47.8% in stage II, 29.4% in stage III, and 36.44% in stage IV. CRT was indicated for 8.3% in stage II, but the percentage increased with higher stage. The percentage of RT was around 30% among stage I-III, but in stage IV, 21.3% of the patients were indicated for RT. The median follow-up period was 4 years and 5 months. The 2-year and 5-year overall survival rates for the 471 patients were 85% and 69.9%, respectively. The 5-year overall survival rates for patients treated initially with surgery, RT and CRT were 73%, 69.1% and 65.6%, respectively. The 5-year overall survival rates for patients with stage I, II, III, IVA, and IVB were 78.9%. 87.3%, 69.7%, 66.6%, and 47.7%, respectively. Although this study was retrospective, we could understand the tendency of treatment choice according to various factors and treatment results. The information will be useful for planning clinical trials in the future. (author)

  8. Multi-institutional Comparison of Intensity Modulated Radiation Therapy (IMRT) Planning Strategies and Planning Results for Nasopharyngeal Cancer

    Science.gov (United States)

    Park, Sung Ho; Park, Suk Won; Oh, Do Hoon; Choi, Youngmin; Kim, Jeung Kee; Ahn, Yong Chan; Park, Won; Suh, Hyun Sook; Lee, Rena; Bae, Hoonsik

    2009-01-01

    The intensity-modulated radiation therapy (IMRT) planning strategies for nasopharyngeal cancer among Korean radiation oncology facilities were investigated. Five institutions with IMRT planning capacity using the same planning system were invited to participate in this study. The institutions were requested to produce the best plan possible for 2 cases that would deliver 70 Gy to the planning target volume of gross tumor (PTV1), 59.4 Gy to the PTV2, and 51.5 Gy to the PTV3 in which elective irradiation was required. The advised fractionation number was 33. The planning parameters, resultant dose distributions, and biological indices were compared. We found 2-3-fold variations in the volume of treatment targets. Similar degree of variation was found in the delineation of normal tissue. The physician-related factors in IMRT planning had more influence on the plan quality. The inhomogeneity index of PTV dose ranged from 4 to 49% in Case 1, and from 5 to 46% in Case 2. Variation in tumor control probabilities for the primary lesion and involved LNs was less marked. Normal tissue complication probabilities for parotid glands and skin showed marked variation. Results from this study suggest that greater efforts in providing training and continuing education in terms of IMRT planning parameters usually set by physician are necessary for the successful implementation of IMRT. PMID:19399266

  9. Postoperative chemoradiation for resected gastric cancer - is the Macdonald Regimen Tolerable? a retrospective multi-institutional study

    International Nuclear Information System (INIS)

    Kundel, Yulia; Fenig, Eyal; Sulkes, Aaron; Brenner, Baruch; Purim, Ofer; Idelevich, Efraim; Lavrenkov, Konstantin; Man, Sofia; Kovel, Svetlana; Karminsky, Natalia; Pfeffer, Raphael M; Nisenbaum, Bella

    2011-01-01

    Postoperative chemoradiation as per Intergroup-0116 trial ('Macdonald regimen') is considered standard for completely resected high risk gastric cancer. However, many concerns remain with regards to the toxicity of this regimen. To evaluate the safety and tolerability of this regimen in a routine clinical practice setting, we analyzed our experience with its use. As we did not expect a different toxic profile in patients (pts) with positive margins (R1 resection), these were studied together with pts after complete resection (R0). Postoperative chemoradiation therapy was given according to the original Intergroup-0116 regimen. Overall survival (OS) and disease free survival (DFS) rates were calculated using the Kaplan-Meier method. Comparison of OS and DFS between R0 and R1 pts was done using the log-rank test. Between 6/2000 and 12/2007, 166 pts after R0 (129 pts) or R1 (37 pts) resection of locally advanced gastric adenocarcinoma received postoperative chemoradiation; 61% were male and the median age was 63 years (range, 23-86); 78% had T ≥ 3 tumors and 81% had N+ disease; 87% of the pts completed radiotherapy and 54% completed the entire chemoradiation plan; 46.4% had grade ≥ 3 toxicity and 32% were hospitalized at least once for toxicity. Three pts (1.8%) died of toxicity: diarrhea (1), neutropenic sepsis (1) and neutropenic sepsis complicated by small bowel gangrene (1). The most common hematological toxicity was neutropenia, grade ≥ 3 in 30% of pts and complicated by fever in 15%. The most common non-hematological toxicities were nausea, vomiting and diarrhea. With a median follow-up of 51 months (range, 2-100), 62% of the R0 patients remain alive and 61% are free of disease. Median DFS and OS for R0 were not reached. R0 pts had a significantly higher 3-year DFS (60% vs. 29%, p = 0.001) and OS (61% vs. 33%, p = 0.01) compared with R1 pts. In our experience, postoperative chemoradiation as per Intergroup-0116 seems to be substantially toxic, with a mortality rate which seems higher than reported in that trial. Efficacy data appears comparable to the original report. Following postoperative chemoradiation, involvement of surgical margins still has a detrimental impact on patient outcome

  10. What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey

    International Nuclear Information System (INIS)

    Zaorsky, Nicholas G.; Shaikh, Talha; Handorf, Elizabeth; Eastwick, Gary; Hesney, Adam; Scher, Eli D.; Jones, Ryan T.; Showalter, Timothy N.; Avkshtol, Vladimir; Rice, Stephanie R.; Horwitz, Eric M.; Meyer, Joshua E.

    2016-01-01

    Purpose: The purposes of this study were to assess the exposure that medical students (MSs) have to radiation oncology (RO) during the course of their medical school career, as evidenced by 2 time points in current medical training (ie, first vs fourth year; MS1s and MS4s, respectively) and to assess the knowledge of MS1s, MS4s, and primary care physicians (PCPs) about the appropriateness of RT in cancer management in comparison with RO attendings. Methods: We developed and beta tested an electronic survey divided into 3 parts: RO job descriptions, appropriateness of RT, and toxicities of RT. The surveys were distributed to 7 medical schools in the United States. A concordance of >90% (either yes or no) among RO attendings in an answer was necessary to determine the correct answer and to compare with other subgroups using a χ"2 test (P 1 of 5 respondents. Multiple nontoxicities of RT (eg, emitting low-level radiation from the treatment site) were incorrectly identified as toxicities by >1 of 5 respondents. MS4s/PCPs with an RO rotation in medical school had improved scores in all prompts. Conclusions: Although MS knowledge of general RT principles improves from the first to the fourth year, a large knowledge gap still exists between MSs, current PCPs, and ROs. Some basic misconceptions of RT persist among a minority of MSs and PCPs. We recommend implementing formal education in RO fundamentals during the core curriculum of medical school.

  11. A multi-institutional joint study of contact dermatitis related to hair colouring and perming agents in Japan.

    Science.gov (United States)

    Ito, Akiko; Nishioka, Kazue; Kanto, Hiromi; Yagami, Akiko; Yamada, Shigeki; Sugiura, Mariko; Yasunaga, Chihiro; Yoshii, Keiko; Kobayashi, Hiromi; Adachi, Atsuko; Ikezawa, Yuko; Washizaki, Kumiko; Inui, Shigeki; Miyazawa, Hitoshi; Oiso, Naoki; Nakata, Tokio; Matsunaga, Kayoko

    2017-07-01

    In Japan, allergic contact dermatitis caused by hair colouring agents is a considerable problem for those occupationally exposed and also for consumers. Over the last 20 years, p-phenylenediamine (PPD) has been a common allergen, with ∼7% positive patch test reactions. To investigate which ingredients caused allergic contact dermatitis related to hair dye and perming solutions in Japan, to assess whether PPD is suitable for screening for hair dye allergy, and to propose allergens for a Japanese hairdresser series. We selected 19 hair cosmetic allergens, including PPD, Bandrowski's base, cysteamine HCl, and ammonium thioglycolate. Altogether 203 patients (26 males and 177 females) with suspected contact allergy to hair colouring or perming solutions at 14 hospitals in Japan were included. The highest prevalence of positive reactions (35.1%) was for PPD. p-Methylaminophenol and o-aminophenol were often positive, both in the PPD-positive and in the PPD-negative patients. Moreover, cysteamine HCl often yielded positive test reactions. PPD is insufficient to diagnose contact allergy caused by to hair dyes. We recommend 13 allergens to be included in a Japanese hairdresser series. © 2017 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

  12. Results of a dummy run of postimplant dosimetry between multi-institutional centers in prostate brachytherapy with 125I seeds

    International Nuclear Information System (INIS)

    Aoki, Manabu; Yorozu, Atsunori; Dokiya, Takushi

    2009-01-01

    The purpose of this study was to determine the reproducibility and precision of postimplant dosimetry following 125 I prostate brachytherapy (PB) and to evaluate the effects of learning and experience in CT-based postimplant dosimetry. One-month postimplant CT data from two patients who underwent PB alone or combined therapy (PB+external beam radiation therapy (EBRT)) were sent to 28 institutions for postimplant dosimetry and analyzed in 2006 (study 1). Similarly, 1-month postimplant CT data from two other patients were also analyzed in 2008 (study 2; 23 institutions). For both modalities in studies 1 and 2, the variance of the difference between CT-based D90 at each institution and CT/MRI fusion-based D90 was estimated. In monotherapy, F test and Mann-Whitney U test revealed no significant difference in the variance in studies 1 and 2 (P=0.72, 0.46). In combined therapy, the variance significantly converged in study 2 compared with study 1 (P<0.05). Even in the two studies, however, the difference between the median CT-based D90 and fusion-based D90 was at least 20-30 Gy. Marked interobserver variability was seen in the prostate volume and D90 with CT alone. The precision of postimplant dosimetry based on CT alone was revealed to be limited. (author)

  13. A multi-institution evaluation of deformable image registration algorithms for automatic organ delineation in adaptive head and neck radiotherapy

    International Nuclear Information System (INIS)

    Hardcastle, Nicholas; Kumar, Prashant; Oechsner, Markus; Richter, Anne; Song, Shiyu; Myers, Michael; Polat, Bülent; Bzdusek, Karl; Tomé, Wolfgang A; Cannon, Donald M; Brouwer, Charlotte L; Wittendorp, Paul WH; Dogan, Nesrin; Guckenberger, Matthias; Allaire, Stéphane; Mallya, Yogish

    2012-01-01

    Adaptive Radiotherapy aims to identify anatomical deviations during a radiotherapy course and modify the treatment plan to maintain treatment objectives. This requires regions of interest (ROIs) to be defined using the most recent imaging data. This study investigates the clinical utility of using deformable image registration (DIR) to automatically propagate ROIs. Target (GTV) and organ-at-risk (OAR) ROIs were non-rigidly propagated from a planning CT scan to a per-treatment CT scan for 22 patients. Propagated ROIs were quantitatively compared with expert physician-drawn ROIs on the per-treatment scan using Dice scores and mean slicewise Hausdorff distances, and center of mass distances for GTVs. The propagated ROIs were qualitatively examined by experts and scored based on their clinical utility. Good agreement between the DIR-propagated ROIs and expert-drawn ROIs was observed based on the metrics used. 94% of all ROIs generated using DIR were scored as being clinically useful, requiring minimal or no edits. However, 27% (12/44) of the GTVs required major edits. DIR was successfully used on 22 patients to propagate target and OAR structures for ART with good anatomical agreement for OARs. It is recommended that propagated target structures be thoroughly reviewed by the treating physician

  14. Variability in Women Faculty’s Preferences Regarding Mentor Similarity: A Multi-Institution Study in Academic Medicine

    Science.gov (United States)

    Carapinha, René; Ortiz-Walters, Rowena; McCracken, Caitlin M.; Hill, Emorcia V.; Reede, Joan Y.

    2016-01-01

    Purpose To investigate which mentor similarity characteristics women faculty in academic medicine rate most important and to determine whether the importance of similarity differs among women faculty based on current and prior mentoring, demographic and personal factors, and career factors. Method Cross-sectional survey data from 3,100 women faculty at 13 purposively sampled U.S. medical schools were collected in 2012. The preferences of participants regarding the importance of mentor similarity in terms of race/ethnicity, gender, personal and career interests, and department and institution were studied. Analysis entailed chi square tests and multivariable ordered logistic models. Results Overall, respondents ranked having a mentor in the same department and institution as most important. Same department and institution were less important for those without a current mentor and for senior faculty, and were more important for Asian faculty. Same career and personal interests were less important for older faculty and more important for those with a doctorate only. Same gender was more important for Black faculty, faculty at the rank of instructor, and those without current mentoring. Overall, same race/ethnicity was rated least important; however, it was more important for racial/ethnic minorities, foreign-born faculty, and those who had never had a mentor. Conclusions Mentor preferences, as indicated by level of importance assigned to types of mentor similarity, varied among women faculty. To advance effective mentoring, characterized by high degree of mentor-mentee fit, the authors provide recommendations on matching strategies to be used in academic medicine when considering the diverse mentor preferences of women faculty. PMID:27332871

  15. Palliation of AIDS-related primary lymphoma of the brain: observations from a multi-institutional database

    International Nuclear Information System (INIS)

    Corn, Benjamin W.; Donahue, Bernadine R.; Rosenstock, Jeffrey G.; Cooper, Jay S.; Yang, Xie; Brandon, Alfred H.; Hegde, Hradaya H.; Sherr, David L.; Fisher, Scot A.; Berson, Anthony; Han, Hoke; Wahab, Maye Abdel; Koprowski, Christopher D.; Ruffer, James E.; Curran, Walter J.

    1997-01-01

    Purpose: To catalogue the presenting symptoms of patients with AIDS who are presumed to have primary central nervous system lymphoma (PCNSL). To document the palliative efficacy of cranial irradiation (RT) relative to the endpoints of complete and overall response for the respective symptoms. Methods: An analysis of 163 patients with AIDS-related PCNSL who were evaluated at nine urban hospitals was performed. These patients were treated for PCNSL after the establishment of a tissue diagnosis or on a presumptive basis after failing empiric treatment for toxoplasmosis. All patients were treated between 1983 and 1995 with radiotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids (>90% dexamethasone). Because multiple fractionation schemes were used, prescriptions were converted to biologically effective doses according to the formula, Gy 10 = Total Dose x (1 + fractional dose/α-β); using an α-β value of 10. Results: The overall palliative response rate for the entire group was 53%. In univariate analysis, trends were present associating complete response rates with higher performance status (KPS ≥ 70 vs. KPS ≤ 60 = 17% vs. 5%), female gender (women vs. men = 29% vs. 8%), and the delivery of higher biologically effective doses (BED) of RT (Gy 10 > 39 vs. ≤ 39 = 20% vs. 5%). In multivariate analysis of factors predicting complete response, both higher KPS and higher BED retained independent significance. A separate univariate analysis identified high performance status (KPS ≥ 70 vs. KPS ≤ 60 = 71% vs. 47%), and young age (≤ 35 vs. > 35 = 61% vs. 40%) as factors significantly correlating with the endpoint of the overall response. In multivariate analysis, high performance status and the delivery of higher biologically effective doses of irradiation correlated significantly with higher overall response rates. Conclusion: Most AIDS patients who develop symptoms from primary lymphoma of the brain can achieve some palliation from a management program that includes cranial irradiation. Young patients with excellent performance status are most likely to respond to treatment. The delivery of higher biologically effective doses of irradiation also may increase the probability of achieving a palliative response

  16. SU-F-J-127: Multi-Institutional Evaluation of Setup, Organ Deformation, Precision Dosimetry in Total Marrow Irradiation

    International Nuclear Information System (INIS)

    Zuro, D; Hui, S

    2016-01-01

    Purpose: Totals Marrow Irradiation (TMI) is a highly focused radiation delivery to the human skeleton structure therefore requiring a high amount of precision and accuracy for a quality treatment. Not much is known on how the patient position varies across multiple treatment fractions and how that positioning impacts the dose delivery. Currently TMI is studied as an international collaboration with multiple centers around the world; however, many of these centers used different pretreatment techniques. The goal of this work is to measure the accuracy of patient positioning, its impact on dose delivery and compare the impact of each technique for multiple institutions. Methods: Using Tomotherapy pretreatment MVCTs and the planning KVCTs measurements are made of the 3D setup uncertainties of the TMI treatment. Then, using the dose and plan files of the treatment impact of patient position on dose can be measured. Measurement of organ deformation and center of mass change were done using the Velocity AI program from Varian. We are looking at four the boney targets (skull, spine, pelvis, and femur) and three key sensitive tissues (eyes, lungs, kidneys). Results: Position measurements have been made for 3 different institutions using 3 different pre-treatment techniques. Comparing the translation motion we can observe the greatest change in the Y and Z direction of patient set up. For intra-fractional motion the shoulder and clavicle represent the greatest potential for motion and therefore most likely to have a dose change. Conclusion: All centers use different techniques for their treatment and this study shows that these techniques do not produce the same pretreatment results. We hope to expand this study further. Currently we have 3 centers participating in this study with more centers joining every day.

  17. Evaluating Multi-Institutional Partnership Sustainability: A Case Study of Collaborative Workforce Development in Renewable Energy Assessment

    Science.gov (United States)

    Diaz, John M.; Stallings, Kevin D.; KC, Birendra; Seekamp, Erin

    2015-01-01

    Partnership evaluation typically occurs during the final stages either to assess why a collaborative effort did not work or to identify the indicators of success. Partnerships are rarely evaluated at their incipient stage, which is a critical time to assess their potential for long-term sustainability. In this paper, we present an early-stage…

  18. Patient-related quality assurance with different combinations of treatment planning systems, techniques, and machines. A multi-institutional survey

    Energy Technology Data Exchange (ETDEWEB)

    Steiniger, Beatrice; Schwedas, Michael; Weibert, Kirsten; Wiezorek, Tilo [University Hospital Jena, Department of Radiation Oncology, Jena (Germany); Berger, Rene [SRH Hospital Gera, Department of Radiation Oncology, Gera (Germany); Eilzer, Sabine [Martin-Luther-Hospital, Radiation Therapy, Berlin (Germany); Kornhuber, Christine [University Hospital Halle, Department of Radiation Oncology, Halle (Saale) (Germany); Lorenz, Kathleen [Hospital of Chemnitz, Department for Radiation Oncology, Chemnitz (Germany); Peil, Torsten [MVZ Center for Radiation Oncology Halle GmbH, Halle (Saale) (Germany); Reiffenstuhl, Carsten [University Hospital Carl Gustav Carus, Department of Radiation Oncology, Dresden (Germany); Schilz, Johannes [Helios Hospital Erfurt, Department of Radiation Oncology, Erfurt (Germany); Schroeder, Dirk [SRH Central Hospital Suhl, Department of Radiation Oncology, Suhl (Germany); Pensold, Stephanie [Community Hospital Dresden-Friedrichstadt, Department of Radiation Oncology, Dresden (Germany); Walke, Mathias [Otto-von-Guericke University Magdeburg, Department of Radiation Oncology, Magdeburg (Germany); Wolf, Ulrich [University Hospital Leipzig, Department of Radiation Oncology, Leipzig (Germany)

    2017-01-15

    This project compares the different patient-related quality assurance systems for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques currently used in the central Germany area with an independent measuring system. The participating institutions generated 21 treatment plans with different combinations of treatment planning systems (TPS) and linear accelerators (LINAC) for the QUASIMODO (Quality ASsurance of Intensity MODulated radiation Oncology) patient model. The plans were exposed to the ArcCHECK measuring system (Sun Nuclear Corporation, Melbourne, FL, USA). The dose distributions were analyzed using the corresponding software and a point dose measured at the isocenter with an ionization chamber. According to the generally used criteria of a 10 % threshold, 3 % difference, and 3 mm distance, the majority of plans investigated showed a gamma index exceeding 95 %. Only one plan did not fulfill the criteria and three of the plans did not comply with the commonly accepted tolerance level of ±3 % in point dose measurement. Using only one of the two examined methods for patient-related quality assurance is not sufficiently significant in all cases. (orig.) [German] Im Rahmen des Projekts sollten die verschiedenen derzeit im mitteldeutschen Raum eingesetzten patientenbezogenen Qualitaetssicherungssysteme zur intensitaetsmodulierten Radiotherapie (IMRT) und volumenmodulierten Arc-Radiotherapie (VMAT) mit einem unabhaengigen Messsystem verglichen werden. Die teilnehmenden Einrichtungen berechneten insgesamt 21 Bestrahlungsplaene mit verschiedenen Planungssystemen (TPS) und Linearbeschleunigern (LINAC) fuer das Patientenmodell QUASIMODO (Quality ASsurance of Intensity MODulated radiation Oncology), die dann auf das ArcCHECK-Phantom (Sun Nuclear Corporation, Melbourne, FL, USA) uebertragen und abgestrahlt wurden. Zur Auswertung wurde sowohl eine Punktmessung im Isozentrum als auch die Dosisverteilung in der Diodenebene des Messphantoms betrachtet. Nach den allgemein ueblichen Kriterien von 10 %-Schwellenwert, 3 %-Abweichung und 3-mm-Abstand zeigten die meisten Plaene dieser Studie einen Gamma-Index groesser 95 %, lediglich ein Plan erfuellte diese Kriterien nicht. Bei der Dosispunktmessung lagen drei Plaene ausserhalb der ueblichen Toleranz der 3 %-Abweichung. Fuer die patientenbezogene Qualitaetssicherung ist die Punktmessung der Dosis oder die alleinige Gammaanalyse zur Planverifizierung nicht in allen Faellen ausreichend signifikant. (orig.)

  19. A Multi-Institutional Study of Feasibility, Implementation, and Early Clinical Results With Noninvasive Breast Brachytherapy for Tumor Bed Boost

    Energy Technology Data Exchange (ETDEWEB)

    Hamid, Subarna, E-mail: shamid@tuftsmedicalcenter.org [Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA (United States); Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (United States); Rocchio, Kathy [Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (United States); Arthur, Douglas; Vera, Robyn [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Sha, Sandra; Jolly, Michele [Central Florida Cancer Institute, Davenport, FL (United States); Cavanaugh, Sean; Wooten, Eric [Atlanta Oncology Associates, Hawkinsville, GA (United States); Benda, Rashmi; Greenfield, Brad [Department of Radiation Oncology, Boca Raton Community Hospital, Boca Raton, FL (United States); Prestidge, Bradley [Texas Cancer Clinic, San Antonio, TX (United States); Ackerman, Scot [First Coast Oncology, Jacksonville, FL (United States); Kuske, Robert; Quiet, Coral; Snyder, Margaret [Arizona Breast Cancer Specialists, Phoenix, AZ (United States); Wazer, David E. [Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA (United States); Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (United States)

    2012-08-01

    Purpose: To evaluate the feasibility, implementation, and early results of noninvasive breast brachytherapy (NIBB) for tumor bed boost with whole breast radiation therapy (WBRT). Methods and Materials: NIBB is a commercially available (AccuBoost, Billerica, MA) mammography-based, brachytherapy system in which the treatment applicators are centered on the planning target volume (PTV) to direct {sup 192}Ir emissions along orthogonal axes. A privacy-encrypted online data registry collected information from 8 independent academic and community-based institutions. Data were from 146 consecutive women with early-stage breast cancer after lumpectomy and WBRT receiving boost with NIBB between July 2007 and March 2010. Toxicity and cosmesis were graded according to the Common Toxicity Criteria (v. 3.0) and the Harvard scale. Median follow-up was 6 months (1-39 months). Results: Grade 1-2 skin toxicity was observed in 64%, 48%, and 21% during the acute (1-3 weeks), intermediate (4-26 weeks), and late-intermediate (>26 weeks) periods. There was no Grade 4 toxicity. At 6 months, for the entire cohort, cosmesis was excellent/good in 62%/38%. The subset receiving NIBB before WBRT had cosmetic scores of 32% and 63%, whereas during WBRT, 58% and 37% were rated as excellent and good, respectively. Breast compression was scored as 'uncomfortable' in 12%, 29%, and 59% when NIBB was delivered before, during, or after WBRT. For each patient, the fraction-to-fraction variability in PTV was low. Skin flash was associated with a higher proportion of excellent cosmesis (58% vs. 42%) relative to having the applicator all within breast tissue. Conclusions: These data indicate that NIBB is feasible and can be consistently implemented in a broad array of practice settings. Preliminary evaluation suggests that NIBB is associated with acceptably mild normal tissue toxicity and favorable early cosmesis. The application of NIBB before WBRT may be associated with better patient tolerance at the expense of less favorable cosmetic outcome.

  20. A Multi-Institutional Longitudinal Faculty Development Program in Humanism Supports the Professional Development of Faculty Teachers.

    Science.gov (United States)

    Branch, William T; Frankel, Richard M; Hafler, Janet P; Weil, Amy B; Gilligan, MaryAnn C; Litzelman, Debra K; Plews-Ogan, Margaret; Rider, Elizabeth A; Osterberg, Lars G; Dunne, Dana; May, Natalie B; Derse, Arthur R

    2017-12-01

    The authors describe the first 11 academic years (2005-2006 through 2016-2017) of a longitudinal, small-group faculty development program for strengthening humanistic teaching and role modeling at 30 U.S. and Canadian medical schools that continues today. During the yearlong program, small groups of participating faculty met twice monthly with a local facilitator for exercises in humanistic teaching, role modeling, and related topics that combined narrative reflection with skills training using experiential learning techniques. The program focused on the professional development of its participants. Thirty schools participated; 993 faculty, including some residents, completed the program.In evaluations, participating faculty at 13 of the schools scored significantly more positively as rated by learners on all dimensions of medical humanism than did matched controls. Qualitative analyses from several cohorts suggest many participants had progressed to more advanced stages of professional identity formation after completing the program. Strong engagement and attendance by faculty participants as well as the multimodal evaluation suggest that the program may serve as a model for others. Recently, most schools adopting the program have offered the curriculum annually to two or more groups of faculty participants to create sufficient numbers of trained faculty to positively influence humanistic teaching at the institution.The authors discuss the program's learning theory, outline its curriculum, reflect on the program's accomplishments and plans for the future, and state how faculty trained in such programs could lead institutional initiatives and foster positive change in humanistic professional development at all levels of medical education.

  1. Reflective Practice in the Clinical Setting: A Multi-Institutional Qualitative Study of Pediatric Faculty and Residents.

    Science.gov (United States)

    Plant, Jennifer; Li, Su-Ting T; Blankenburg, Rebecca; Bogetz, Alyssa L; Long, Michele; Butani, Lavjay

    2017-11-01

    To explore when and in what form pediatric faculty and residents practice reflection. From February to June 2015, the authors conducted focus groups of pediatric faculty and residents at the University of California, Davis; Stanford University; and the University of California, San Francisco, until thematic saturation occurred. Transcripts were analyzed based on Mezirow's and Schon's models of reflection, using the constant comparative method associated with grounded theory. Two investigators independently coded transcripts and reconciled codes to develop themes. All investigators reviewed the codes and developed a final list of themes through consensus. Through iterative discussions, investigators developed a conceptual model of reflection in the clinical setting. Seventeen faculty and 20 residents from three institutions participated in six focus groups. Five themes emerged: triggers of reflection, intrinsic factors, extrinsic factors, timing, and outcome of reflection. Various triggers led to reflection; whether a specific trigger led to reflection depended on intrinsic and extrinsic factors. When reflection occurred, it happened in action or on action. Under optimal conditions, this reflection was goal and action directed and became critical reflection. In other instances, this process resulted in unproductive rumination or acted as an emotional release or supportive therapy. Participants reflected in clinical settings, but did not always explicitly identify it as reflection or reflect in growth-promoting ways. Strategies to enhance critical reflection include developing knowledge and skills in reflection, providing performance data to inform reflection, creating time and space for safe reflection, and providing mentorship to guide the process.

  2. SU-F-T-435: Helical Tomotherapy for Craniospinal Irradiation: What We Have Learned from a Multi-Institutional Study

    Energy Technology Data Exchange (ETDEWEB)

    Du, D; Kaprealian, T; Low, D; Qi, X [University of California Los Angeles, Los Angeles, CA (United States); Han, C [City of Hope National Medical Center, Los Angeles, CA (United States); Chen, J; Perez-Andujar, A [University of California San Francisco, Lafayette, CA (United States); Lee, B [University of California, Los Angeles, Los Angeles, CA (United States)

    2016-06-15

    Purpose: To report cranio-spinal irradiation (CSI) planning experience, compare dosimetric quality and delivery efficiency with Tomotherapy from different institutions, and to investigate effect of planning parameters on plan quality and treatment time. Methods: Clinical helical tomotherapy IMRT plans for thirty-nine CSI cases from three academic institutions were retrospectively evaluated. The planning parameters: field width (FW), pitch, modulation factor (MF), and achieved dosimetric endpoints were cross-compared. A fraction-dose-delivery-timing index (FDTI), defined as treatment time per fraction dose per PTV length, was utilized to evaluate plan delivery efficiency. A lower FDTI indicates higher delivery efficiency. We studied the correlation between planning quality, treatment time and planning parameters by grouping the plans under specific planning parameters. Additionally, we created new plans using 5cm jaw for a subset of plans that used 2.5cm jaw to exam if treatment efficiency can be improved without sacrificing plan quality. Results: There were significant dosimetric differences for organ at risks (OARs) among different institutions (A,B,C). Using the lowest average MF (1.9±0.4) and 5cm field width, C had the highest lung, heart, kidney, liver mean doses and maximum doses for lens. Using the same field width of 5cm, but higher MF (2.6±0.6), B had lower doses to the OARs in the thorax and abdomen area. Most of A’s plans were planned with 2.5cm jaw, the plans yielded better PTV coverage, higher OAR doses and slightly shorter FDTI compare