Risk communication in a patient decision aid for radiotherapy in breast cancer: How to deal with uncertainty?

Background and aimPatient decision aids for oncological treatment options, provide information on the effect on recurrence rates and/or survival benefit, and on side-effects and/or burden of different treatment options. However, often uncertainty exists around the probability estimates for recurrence/survival and side-effects which is too relevant to be ignored. Evidence is lacking on the best way to communicate these uncertainties. The aim of this study is to develop a method to incorporate uncertainties in a patient decision aid for breast cancer patients to support their decision on radiotherapy.MethodsFirstly, qualitative interviews were held with patients and health care professionals. Secondly, in the development phase, thinking aloud sessions were organized with four patients and 12 health care professionals, individual and group-wise.ResultsConsensus was reached on a pictograph illustrating the whole range of uncertainty for local recurrence risks, in combination with textual explanation that a more exact personalized risk would be given by their own physician. The pictograph consisted of 100 female icons in a 10 x 10 array. Icons with a stepwise gradient color indicated the uncertainty margin. The prevalence and severity of possible side-effects were explained using verbal labels.ConclusionsWe developed a novel way of visualizing uncertainties in recurrence rates in a patient decision aid. The effect of this way of communicating risk uncertainty is currently being tested in the BRASA study (NCT03375801).     

数字疼痛量表和描述疼痛量表的相关性研究和改进

目的探讨"长海痛尺"的科学性和可行性.方法研究证明数字疼痛量表(NRS)和描述疼痛量表(VRS)的相关性,并设计"长海痛尺".结果 NRS和VRS之间相关性良好,相关系数r为0.8241.结论 "长海痛尺"的设计具有一定的科学依据,且具有简便、易理解、结果相对准确的特点,可以满足临床一线工作的需要.     

The spectrum of opportunistic filamentous fungi present in the CBS culture collection

The mould collection of the Centraalbureau voor Schimmelcultures, Baarn, The Netherlands, was screened for isolates originating from warm-blooded animals. The range of species indicates that distribution of clinically relevant, pathogenic or opportunistic strains over the fungal kingdom is non-random. Some opportunistic fungi possess adaptations to life under hostile environmental conditions, enabling them to survive inside the human body. Presence of melanin or carotene seems to be an important virulence factor. Opportunistic fungi which sporulate in submersion are able to disseminate or cause severe local mycoses when the aspecific immune system of the host is impaired. Mycoses caused by a few dimorphic fungi, mostly in their natural ecological niche living in association with vertebrates, are promoted by specific immune deficiencies.     

An evaluation of numerical integration algorithms for the estimation of the area under the curve (AUC) in pharmacokinetic studies

Six numerical integration algorithms based on linear and log trapezoidal methods as well as four cubic-spline methods were proposed for estimation of area under the curve (AUC). These six different algorithms were implemented using IMSL/IDL^TM command language and evaluated using data simulated under five different dosing conditions and two different sampling conditions. Comparisons between AUC estimations using these six different algorithms and the theoretical results were made in terms of both overall AUC values and the superimposability of the concentration-time profiles. In well designed studies with ample data points, the algorithm based on IMSL/IDL^TM function CSSHAPE with concavity preservation gave the best performance. In contrast, when the frequency of blood collection was limited, the algorithm based on the log trapezoidal rule proved to be stable with reasonable accuracy, and is recommended as the practical method for numerical interpolation and integration in pharmacokinetic studies. Algorithms based on the combination of the log trapezoidal rule and cubic-spline methods using IMSL/IDL^TM function CSSHAPE can be developed to enhance overall performance.     

Challenging the world: patient safety and health care-associated infection.

Improving the safety of patient care is an issue which affects health systems in both developed and developing countries. To co-ordinate and accelerate improvements in patient safety, the World Health Organization (WHO) has supported the creation of the World Alliance for Patient Safety which was launched in October 2004. The six action areas of the Alliance are Patients for Patient Safety, Taxonomy, Research, Solutions for Patient Safety, Reporting and Learning, and a biennial Global Patient Safety Challenge. The first Challenge covering 2005-2006 was launched in October 2005 under the banner 'Clean Care is Safer Care'. The Challenge addresses health care-associated infection, a major, patient safety problem affecting hundreds of millions of people worldwide.     

Numerical data on neocortical neurons in adult rat, with special reference to the GABA population

The disector method was used to estimate the numerical density of neurons (number per unit volume) and their actual number per column (number under a given area of pial surface), in the occipital (monocular segment of the primary visual area, Oc1M), the parietal (somatosensory barrelfield area, Par1) and the frontal cortex (primary motor area, Fr1) of adult rat. Values were first obtained for all neurons in each layer, and then for GABA neurons as identified with postembedding immunocytochemistry on semithin sections. The numerical density of neurons in the frontal cortex (34,000/mm³) was significantly lower than in the two other neocortical areas (occipital: 52,000; parietal: 48,000/mm³). The GABA population showed a similar difference and consequently represented an equivalent proportion of total (15%) in the three cortical areas. Across layers, there was an alternate distribution of low and high density of neurons from layers II–III to VI in the three cortical areas, with the highest density in layer IV of the two sensory areas. The laminar changes in density of the GABA neurons were not as pronounced as those of the overall population. Consequently, the layers with the highest overall neuronal densities tended to have a lower proportion of GABA neurons and vice versa. There were more neurons under 1 mm² of surface in the parietal (90,000) than the occipital or the frontal cortex (71,000), which was also true of the GABA neurons. The greater number of neurons per column in the parietal cortex was mostly imputable to layer IV, the main recipient of thalamic axons. Comparing these values from the rat with those previously obtained in cat and monkey, it seemed that the number of neurons per cortical column was the highest in the sensory area preferentially used by each species.     

Time-frequency analysis of heart murmurs. Part II: Optimisation of time-frequency representations and performance evaluation

The basic parameters of the spectrogram, the Choi-Williams, and the Bessel distributions are adjusted to provide the best time-frequency representations (TFRs) of the simulated murmur signals of mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, and of two musical murmurs. The initial adjustment of the parameters of each TFR technique is performed by computing and minimising the relative averaged absolute error between the frequency contours at −3dB and −10dB of each TFR of the simulated murmurs and those of the theoretical distribution of the same signals. The results show that the spectrogram generally provides very good to excellent performance in representing the TFRs of stenotic and regurgitant murmurs. Improvements provided by the Choi-Williams and the Bessel distributions are minor but not systematic for the two signal-to-noise ratios tested (0 and 30 dB) and for the two frequency contours estimated. The Bessel and the Choi-Williams distributions provide the best performance for the musical murmurs. The study shows that although a single technique cannot be optimal for all six murmurs, the spectrogram using a Hamming window of 30 ms is an acceptable compromise to detect the six simutated heart murmurs.     

数值模拟鼻甲的切除对鼻腔内气体流场的影响

量化研究鼻腔结构的变化对鼻腔内气体流场分布的影响.通过CT图像对鼻腔结构进行三维重建并用有限元方法对气体流场进行数值分析.对重建的鼻腔模型的一侧,分别去掉部分中鼻甲和部分下鼻甲并用有限元方法再次进行数值分析,将得到的结果与原始模型进行比较.观察气体流场分布的变化,在两侧鼻腔的流量分布均有变化,在去掉部分鼻甲的一侧流场和气压的分布也有所改变.通过数值模拟,我们量化的显示了鼻腔结构的变化对鼻腔内气体流场分布的影响.     

Symptom patterns and causes of somatization in men: I. Differentiation of two discrete disorders

Two distinct patterns of somatization were identified in 807 Swedish adopted men, using comprehensive lifetime psychiatric and sick-leave records. "Diversiform" somatizers had a high frequency of brief sickness occasions for a wide diversity of complaints, particularly pain in the head, joints, and abdomen. "Asthenic" somatizers had a lower frequency and diversity of complaints. They recuperate more slowly, however, and were more often disabled by fatigue, weakness, and minor illnesses such as upper respiratory infections. Both types of somatizers had associated psychosocial maladjustment, but they had discrete clinical patterns, with infrequent overlap. Diversiform somatizers had a higher risk of alcohol abuse, psychiatric hospitalization, and substandard income than either asthenic somatizers or non-somatizers. Asthenic somatizers had a higher risk of divorce than either diversiform somatizers or non-somatizers. Men with prominent somatization had an excess of psychiatric treatment for alcoholism or anxiety disorders, but, unlike female somatizers, no excess of criminality. These clinical differences suggest that the psychiatric processes associated with somatization may be qualitatively different in men and women. The method used here is generally applicable in genetic epidemiology to identify natural clinical subtypes within a heterogeneous phenotype.     

社科领域期刊作者贡献声明政策的调研与建议

【目的】 对国内外社科领域期刊作者贡献声明(Author Contribution Statement,ACS)政策进行调研,为国内社科领域期刊编辑部制定和完善ACS政策提供借鉴和参考。【方法】 调研国内外社科领域期刊网站上发布的ACS政策,调查内容包括:是否有ACS强制性要求及理由;提交ACS的时间与方式;ACS呈现形式;写作格式;ACS要素术语等。【结果】 在国外的17个社科领域内,都有期刊制定并实施了ACS,而ACS在我国社科期刊中没有得到普及。782种CSSCI收录的社科期刊中只有18种期刊有ACS政策,占比仅2.3%,涉及的领域包括中国文学、考古学、新闻学与传播学和图书馆、情报与文献学。国外期刊采用自由文本和采用CRediT受控词汇的期刊约各占一半。国内社科期刊都是采用自由文本表述形式,没有采用CRediT受控词汇表述方法。国内期刊ACS政策存在ACS表述较为简单、没有规定提交时间与方式、呈现形式不统一、写作格式不统一等问题,可从建立分层ACS政策、鼓励作者提交ACS,采用CRediT贡献分类法为基础规范表达ACS,与ORCID建立关联3个方面进行补充完善。【结论】 我国社科期刊很少制定实施ACS政策。建议社科期刊编辑部采用分层政策来推广实施ACS,采用规范的作者贡献要素术语,提高作者贡献的透明性和可获取性。