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The increasing use of patient-reported outcome (PRO) measures is forcing clinicians and health care systems to decide which to select and how to incorporate them into their records and clinical workflows. This overview addresses 3 topics related to these concerns. First, a literature review summarizes key psychometric and practical factors (such as reliability, responsiveness, computer adaptive testing, and interpretability) in choosing PROs for clinical practice. Second, 3 clinical decision support issues are highlighted: gathering PROs, electronic health record effect on providers, and incorporating PROs into clinical decision support design and implementation. Lastly, the salience of crosscutting domains as well as 9 key pragmatic decisions are reviewed. Crosscutting domains are those that are relevant across most medical and mental health conditions, such as the SPADE symptom pentad (sleep problems, pain, anxiety, depression, low energy/fatigue) and physical functioning. The 9 pragmatic decisions include (1) generic vs disease-specific scales; (2) single- vs multidomain scales; (3) universal scales vs user-choice selection; (4) number of domains to measure; (5) prioritization of domains when multiple domains are assessed; (6) action thresholds; (7) clinical purpose (screening vs monitoring); as well as the (8) frequency and (9) logistical aspects of PRO administration. [ABSTRACT FROM AUTHOR]

For Hepatocellular carcinoma (HCC) surgery either through resection or transplantation often provides the only chance for cure. Since hepatocarcinogenesis and postsurgical prognosis is not only dependent on cirrhosis but also on immune activation and exhaustion, many studies have investigated tumor infiltrating leukocyte (TIL) subsets. This systematic review and meta-analysis aims at describing the cell groups and their predictive power regarding overall (OS), disease free (DFS) and recurrence free survival (RFS). A systematic search of the PubMed database was conducted (PROSPERO 172324). Data on CD3+, CD8+, Treg, B cells, macrophages, neutrophil and NK-cells were collected from Pubmed and related references up to December 2018. Overall (OS), disease-free (DFS) and recurrence free survival (RFS) in dependence of high vs. low infiltration rates were compared using a random effects meta-analysis. Altogether data from 3541 patients enrolled in 20 publications were included. Except for Tregs and Neutrophils, heterogeneity analysis was found to be moderate to high across the studies. High CD3+, CD8+, NK-cell infiltration predicted better survival (OS, DFS and RFS; p < 0.05). Higher Treg and Neutrophil infiltration predicted lower OS and DFS. For Macrophages and B cells no difference in survival could be found. As with other solid tumors immune infiltration has a great influence on survival after resection. However, a considerable publication bias cannot be ruled out in mostly retrospective analyses. Nevertheless, in light of novel immune modulatory treatments this opens a new avenue towards effective and well-tolerated adjuvant treatment. [ABSTRACT FROM AUTHOR]

Autoimmune pancreatitis (AIP) is an immune-mediated disease of the pancreas with distinct pathophysiology and manifestations. Our aims were to characterize type 1 AIP in a large pan-European cohort and study the effectiveness of current treatment regimens. We retrospectively analyzed adults diagnosed since 2005 with type 1 or not-otherwise-specified AIP in 42 European university hospitals. Type 1 AIP was uniformly diagnosed using specific diagnostic criteria. Patients with type 2 AIP and those who had undergone pancreatic surgery were excluded. The primary end point was complete remission, defined as the absence of clinical symptoms and resolution of the index radiologic pancreatic abnormalities attributed to AIP. We included 735 individuals with AIP (69% male; median age, 57 years; 85% White). Steroid treatment was started in 634 patients, of whom 9 (1%) were lost to follow-up. The remaining 625 had a 79% (496/625) complete, 18% (111/625) partial, and 97% (607/625) cumulative remission rate, whereas 3% (18/625) did not achieve remission. No treatment was given in 95 patients, who had a 61% complete (58/95), 19% partial (18/95), and 80% cumulative (76/95) spontaneous remission rate. Higher (≥0.4 mg/kg/day) corticosteroid doses were no more effective than lower (<0.4 mg/kg/day) doses (odds ratio, 0.428; 95% confidence interval, 0.054–3.387) and neither was a starting dose duration >2 weeks (odds ratio, 0.908; 95% confidence interval, 0.818–1.009). Elevated IgG4 levels were independently associated with a decreased chance of complete remission (odds ratio, 0.639; 95% confidence interval, 0.427–0.955). Relapse occurred in 30% of patients. Relapses within 6 months of remission induction were independent of the steroid-tapering duration, induction treatment duration, and total cumulative dose. Patients with type 1 AIP and elevated IgG4 level may need closer monitoring. For remission induction, a starting dose of 0.4 mg/kg/day for 2 weeks followed by a short taper period seems effective. This study provides no evidence to support more aggressive regimens. [ABSTRACT FROM AUTHOR]

Surgical resection improves survival in pancreatic ductal adenocarcinoma (PDAC) and adjuvant chemotherapy adds an additional survival-benefit. While surgical technique has improved in recent years, it remains unclear whether these improvements translate into a survival benefit independent of adjuvant chemotherapy. Thus, we aimed to clarify whether survival of patients who were treated with either Gemcitabine (GEM) or who were observed only in randomized controlled trials on adjuvant chemotherapy of PDAC improved over time. A systematic search of MEDLINE/PubMed was performed to identify randomized controlled trials on adjuvant chemotherapy of PDAC. The search was limited to studies with arms on GEM monotherapy or postoperative observation and studies were grouped by the median year of enrolment and the use of GEM. Subsequently, a meta-regression on the effect of the median year of enrolment on patient survival was performed. A total of 13 studies with 2469 patients was included, with median years of enrollment ranging from 1996 to 2015. While disease-free survival decreased in patients with postoperative observation (18.0 vs. 5.0 months, p = 0.001), median survival improved over time in patients with postoperative observation (15.8 vs. 18.4 months, p = 0.01) and in patients treated with adjuvant GEM (22.8 vs. 35.0 months, p < 0.001). One- (p ≤ 0.01) and two-year survival (p = 0.056) improved in both patients treated with adjuvant GEM and those observed only. Survival after surgical resection of PDAC has improved since 1996, even in patients who did not receive adjuvant chemotherapy. Improved surgical technique and postoperative management are likely to be causative factors. • Median survival has improved after survival of PDAC since 1996 • Median survival improved in patients observed only over time • Median survival improved in patients treated with adjuvant gemcitabine over time [ABSTRACT FROM AUTHOR]

Objective: Clinical practice guidelines (CPGs) are means to provide evidence-based medical knowledge. In order to make up-to-date "best" scientific evidence available these documents need to be updated on an ongoing basis. An effective method to accomplish this aim is offered by the so-called "living guidelines": Living guidelines are documents presenting up-to-date and state-of-the-art knowledge to practitioners. To have guidelines implemented by computer-support they have to be formalized in a computer-interpretable form in a first step. Due to the complexity of such formats the formalization process is burdensome and time-consuming. Automating parts of the modeling process and, consequently, modeling updates of these guideline documents are demanded.Methods and Material: The LASSIE methodology supports this task by formalizing guidelines in several steps from the textual form to the guideline representation language Asbru using a document-centric approach. LASSIE uses information extraction techniques to semi-automatically accomplish these steps. We apply LASSIE to support the implementation of living guidelines.Results: Based on a living guideline published by the Scottish Intercollegiate Guidelines Network (SIGN) we show that adaptations of previously formalized guidelines can be accomplished easily and fast. Thereby, the different versions of guideline documents are compared and updates are identified. Due to the traceable formalization method of linking text parts and their corresponding formal models, we are able to inherit unchanged models from previously formalized versions. Thus, we only need to formalize updated text parts using the semi-automatic formalization method LASSIE.Conclusion: We propose a simple, time-saving, but effective method called LASSIE to formalize new guideline versions of previously formalized CPGs. Furthermore, models that have been added or modified by knowledge engineers in previous versions can also be transferred easily. This will result in a faster implementation of new guideline versions also known as living guidelines to provide up-to-date knowledge necessary for accomplishing the daily work of health care professionals. [ABSTRACT FROM AUTHOR]

Abstract: Increasing amounts of data offer great opportunities to promote technological progress and business success. Visual analytics (VA) aims at enabling the exploration and the understanding of large and complex data sets by intertwining interactive visualization, data analysis, human–computer interaction, as well as cognitive and perceptual science. We propose a design triangle, which considers three main aspects to ease the design: (1) the characteristics of the data, (2) the users, and (3) the users' tasks. Addressing the particular characteristics of time and time-oriented data focuses the VA methods, but turns the design space into a more complex and challenging one. We demonstrate the applicability of the design triangle by three use cases tackling the time-oriented aspects explicitly. Our design triangle provides a high-level framework, which is simple and very effective for the design process as well as easily applicable for both, researchers and practitioners. [Copyright &y& Elsevier]

Three major outbreaks of salmonellosis linked to consumption of peanut butter during the last 6 years have underscored the need to investigate the potential sources of Salmonella contamination in the production process flow. We conducted a study to determine the prevalence and levels of Salmonella in raw peanuts. Composite samples (1,500 g, n = 8) of raw, shelled runner peanuts representing the crop years 2009, 2010, and 2011 were drawn from 10,162 retained 22-kg lot samples of raw peanuts that were negative for aflatoxin. Subsamples (350 g) were analyzed for the presence of Salmonella and enterohemorrhagic Escherichia colt. Salmonella was found in 68 (0.67%) of 10,162 samples. The highest prevalence rate (P < 0.05) was for 2009 (1.35%) compared with 2010 (0.36%) and 2011 (0.14%). Among four runner peanut market grades (Jumbo, Medium, No. 1, and Splits), Splits had the highest prevalence (1.46%; P < 0.05). There was no difference (P > 0.05) in the prevalence by region (Eastern versus Western). Salmonella counts in positive samples (most-probable-number [MPN] method) averaged 1.05 (range, 0.74 to 5.25) MPN per 350 g. Enterohemorrhagic E. coli was found in only three samples (0.030%). Typing of Salmonella isolates showed that the same strains found in Jumbo and Splits peanuts in 2009 were also isolated from Splits in 2011. Similarly, strains isolated in 2009 were also isolated in 2010 from different peanut grades. These results indicated the persistence of environmental sources throughout the years. For five samples, multiple isolates were obtained from the same sample that had different pulsed-field gel electrophoresis types. This multistrain contamination was primarily observed in Splits peanuts, in which the integrity of the kernel is usually compromised. The information from the study can be used to develop quantitative microbial risk assessments models. [ABSTRACT FROM AUTHOR]

Fresh water and energy are essential resources, which have become expensive and scarce. Moreover, their production requires nowadays high technologies and multidisciplinary advanced research. In order to combat this problem, the European Commission supports cooperative research activities in the mentioned areas by means of research grants. Open Gain is a cooperation project financed by the European Commission, whose main objective is to develop optimal systems engineering methods with embedded automation for reverse osmosis desalination plants powered by renewable energies. Thus, the present paper describes objectives, the consortium, work packages and dissemination plan of Open Gain as an example of narrow cooperation between Europe and the Mediterranean Partner Countries (MPC). [ABSTRACT FROM AUTHOR]

Abstract: The analysis of time-oriented data is an important task in many application scenarios. In recent years, a variety of techniques for visualizing such data have been published. This variety makes it difficult for prospective users to select methods or tools that are useful for their particular task at hand. In this article, we develop and discuss a systematic view on the diversity of methods for visualizing time-oriented data. With the proposed categorization we try to untangle the visualization of time-oriented data, which is such an important concern in Visual Analytics. The categorization is not only helpful for users, but also for researchers to identify future tasks in Visual Analytics. [Copyright &y& Elsevier]

Fresh beef samples (n = 1,022) obtained from two processing plants in the Midwest (July to December 2003) were analyzed for levels of microbial populations (total aerobic plate count, total coliform count, and Escherichia coli count) and for the presence or absence of E. coli O157:H7 and Salmonella. A fresh beef cut sample was a 360-g composite of 6-g portions excised from the surface of 60 individual representative cuts in a production lot. Samples of fresh beef cuts yielded levels of 4.0 to 6.2, 1.1 to 1.8, and 0.8 to 1.0 log CFU/g for total aerobic plate count, total coliform count, and E. coli count, respectively. There did not appear to be substantial differences or obvious trends in bacterial populations on different cuts. These data may be useful in establishing a baseline or a benchmark of microbiological levels of contamination of beef cuts. Mean incidence rates of E. coli O157:H7 and Salmonella on raw beef cuts were 0.3 and 2.2%, respectively. Of the 1,022 samples analyzed, cuts testing positive for F. coli O157:H7 included top sirloin butt (0.9%) and butt, ball tip (2.1%) and for Salmonella included short loins (3.4%), strip loins (9.6%), rib eye roll (0.8%), shoulder clod (3.4%), and clod, top blade (1.8%). These data provide evidence of noticeable incidence of pathogens on whole muscle beef and raise the importance of such contamination on product that may be mechanically tenderized. Levels of total aerobic plate count, total coliform count, and E. coli count did not (P ⩾ 0.05) appear to be associated with the presence of E. coli O157:H7 and Salmonella on fresh beef cuts. E. O157:H7 was exclusively isolated from cuts derived from the sirloin area of the carcass. Salmonella was exclusively isolated from cuts derived from the chuck, rib, and loin areas of the carcass. Results of this study suggest that contamination of beef cuts may be influenced by the region of the carcass from which they are derived. [ABSTRACT FROM AUTHOR]

Preevisceration carcass washing prior to bung bagging during beef slaughter may allow pooling of wash water in the rectal area and consequent spread of potential pathogens. The objective of this study was to compare protocols for bung bagging after preevisceration washing with an alternative method for bung bagging before preevisceration washing for the potential to spread enterohemorrhagic Escherichia coli, E. coli O157:H7, and Salmonella on carcass surfaces. The study evaluated incidence rates of pathogens in preevisceration wash water (10 ml) samples (n = 120) and on surface (100 cm²) sponge samples (n = 120) in the immediate bung region when bagging occurred before (prewash bagging) and after (postwash bagging) preevisceration washing. Surface sampling from postwash bagging yielded incidence rates of 58.3, 5, and 8.3%, whereas wash water sampling yielded 28.3, 1.7, and 5% for enterohemorrhagic Escherichia coli, E. coli O157:H7, and Salmonella, respectively. Surface sampling from prewash bagging yielded incidence rates of 35, 1.7, and 0%, whereas wash water sampling yielded 18.3, 0, and 8.3% for enterohemorrhagic Escherichia coli, E. coli O157:H7, and Salmonella, respectively. Results of this research indicate that the rectal area is a significant source of pathogen contamination on carcasses and that wash water is an important mechanism for potential transfer of pathogen contamination from the rectal area. Results from this study suggest that bung bagging, as proposed in this study, before (prewash bagging) rather than after (postwash bagging) preevisceration washing was generally more effective in controlling pathogen contamination and potential spread from the rectal area of carcasses. [ABSTRACT FROM AUTHOR]

Fresh beef products, such as steaks, may become contaminated with potential specified risk materials (SRMs), such as central nervous system tissue, during the fabrication of bone-in loin subprimals. The objective of this study was to evaluate current and alternative cutting methods that could be used to minimize the transfer of nervous system tissue (NST) tissue during preparation of steaks from bone-in short loins. Bone-in short loins were cut according to three methods. (i) Cutting method I—The vertebral column bones were removed prior to cutting the loin into steaks from the medial (vertebral column) to lateral (flank) side. (ii) Cutting method Il—The loin was cut into steaks from the vertebral column side to the flank side prior to removal of the vertebral column bones. (iii) Cutting method III—The loin was cut into steaks from the flank side to the vertebral column side prior to removal of the vertebral column bones. Results indicated that surface areas along the vertebral column cutting line had detectable (0.10 and 0.22% NST/100 cm²) and, thus, higher potential SRM contamination than resulting steak surfaces or the cutting blade. Overall, there were no detectable (<0.10% NST/100 cm²) differences in NST contamination of steaks produced by the three cutting methods. Immunohistochemical evaluation of areas on excised and ground steak surfaces indicated that regardless of cutting method, there was generally "no" to "moderate" staining, suggesting that detectable (0.137 to 0.201% NST) contamination from these samples was most likely due to peripheral nerve detection. These results imply that steaks may be cut from bone-in short loins prior to removal of the vertebral column bones without affecting the transfer of NST to resulting steaks at concentrations <0.10% NST/100 cm². [ABSTRACT FROM AUTHOR]

Abstract: The results of four toxicity bioassays of selected anionic and nonionic surface active agents were presented. Three widely used anionic surfactants that belong to alkyl sulphates (AS), alkylbenzene sulphonates (LAS) and alkylpolyoxyethylene sulphates (AES) as well as nonionic surfactants: polyoxyethylene alkyl ethers (AE) and polyoxylethylene alkylphenyl ethers (APE) were tested. Three different toxicity assays to aquatic organisms: Physa acuta Draparnaud, Artemia salina and Raphidocelis subcapitata were applied. Additionally, the genotoxicity test with Bacillus subtilis M45 Rec− and H17 Rec+ strains was performed. The obtained results showed that none of the surfactants studied was genotoxic at the concentration 1000mgl−1. On the basis of toxicity tests to aquatic organisms all tested anionic surfactants were harmful (LC50 between 10 and 100mgl−1), whereas nonionic ones were toxic (LC50 between 1 and 10mgl−1) or even highly toxic (LC50 below 1mgl−1). Moreover, the bigger was the molecular weight of the tested compound, the higher toxicity was observed. [Copyright &y& Elsevier]

Time plays an important role in medicine, both the past and the future. The medical history of a patient represents the past, which needs to be understood by the physician to make the right decisions. The past contains two different kinds of information: measured data (such as blood pressure) and incidents (such as seizures). Planning therapies, on the other hand, requires looking into the future to a certain extent. Visual representations exist for both the past and the future, and they are very useful for getting a better understanding of data or a plan. This paper surveys visualization techniques for both data analysis and planning, and compares them based on a number of criteria. [Copyright &y& Elsevier]