How feasible is remote 3D dosimetry for MR guided Radiation Therapy (MRgRT)?

NASA Astrophysics Data System (ADS)

Mein, S.; Rankine, L.; Miles, D.; Juang, T.; Cai, B.; Curcuru, A.; Mutic, S.; Fenoli, J.; Adamovics, J.; Li, H.; Oldham, M.

2017-05-01

To develop and apply a remote dosimetry protocol with PRESAGE® radiochromic plastic and optical-CT readout in the validation of MRI guided radiation therapy (MRgRT) treatments (MRIdian® by ViewRay®). Through multi-institutional collaboration we performed PRESAGE® dosimetry studies in 4ml cuvettes to investigate dose-response linearity, MR-compatibility, and energy-independence. An open calibration field and symmetrical 3-field plans were delivered to 10cm diameter PRESAGE® to examine percent depth dose and response uniformity under a magnetic field. Evidence of non-linear dose response led to a large volume PRESAGE® study where small corrections were developed for temporally- and spatially-dependent behaviors observed between irradiation and delayed readout. TG-119 plans were created in the MRIdian® TPS and then delivered to 14.5cm 2kg PRESAGE® dosimeters. Through the domestic investigation of an off-site MRgRT system, a refined 3D remote dosimetry protocol is presented capable of validation of advanced MRgRT radiation treatments.

Clinical staging and operative reporting for multi-institutional trials in head and neck squamous cell carcinoma.

PubMed

Weymuller, E A

1997-12-01

A Strategic Planning Conference (jointly supported by NCI and NIDCD) was convened to consider potential improvements in surgical patient data for multi-institutional trials. The thesis underlying this project is that inadequacies in staging, pretreatment patient stratification, and the details of surgical resection may have obscured the detection of treatment effect. The goals of this project were multiple: (1) to consider the utility of new clinical stratification variables, (2) to increase the precision of tumor staging, and (3) to improve operative reporting for multi-institutional trials in head and neck cancer. The conference attendees came to a number of important conclusions: (1) TNM status is inadequate for describing head and neck cancer in a multi-institutional trial setting. A detailed anatomic reporting scheme is proposed; (2) comorbidity measures should be included as patient descriptors, especially those that meet the criteria "definitely important and easy to obtain"; (3) surgical reporting in multi-institutional trials should use a format that is compatible with computer analysis and use the same items as the revised (anatomic) staging system; (4) the surgeon should be personally responsible for data coding and should interact directly with the pathologist in marking the surgical specimen; (5) pathologic reporting should use an anatomic template identical to the staging and operative reporting formats.

A Phase II Study of Intensity Modulated Radiation Therapy to the Pelvis for Postoperative Patients With Endometrial Carcinoma: Radiation Therapy Oncology Group Trial 0418

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jhingran, Anuja, E-mail: ajhingra@mdanderson.org; Winter, Kathryn; Portelance, Lorraine

2012-09-01

Purpose: To determine the feasibility of pelvic intensity modulated radiation therapy (IMRT) for patients with endometrial cancer in a multi-institutional setting and to determine whether this treatment is associated with fewer short-term bowel adverse events than standard radiation therapy. Methods: Patients with adenocarcinoma of the endometrium treated with pelvic radiation therapy alone were eligible. Guidelines for target definition and delineation, dose prescription, and dose-volume constraints for the targets and critical normal structures were detailed in the study protocol and a web-based atlas. Results: Fifty-eight patients were accrued by 25 institutions; 43 were eligible for analysis. Forty-two patients (98%) had anmore » acceptable IMRT plan; 1 had an unacceptable variation from the prescribed dose to the nodal planning target volume. The proportions of cases in which doses to critical normal structures exceeded protocol criteria were as follows: bladder, 67%; rectum, 76%; bowel, 17%; and femoral heads, 33%. Twelve patients (28%) developed grade {>=}2 short-term bowel adverse events. Conclusions: Pelvic IMRT for endometrial cancer is feasible across multiple institutions with use of a detailed protocol and centralized quality assurance (QA). For future trials, contouring of vaginal and nodal tissue will need continued monitoring with good QA and better definitions will be needed for organs at risk.« less

Collaborative Teaching and Learning through Multi-Institutional Integrated Group Projects

ERIC Educational Resources Information Center

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…

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

ERIC Educational Resources Information Center

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…

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.

PubMed

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 needed.

Research priorities for multi-institutional collaborative research in surgical education.

PubMed

Stefanidis, Dimitrios; Cochran, Amalia; Sevdalis, Nick; Mellinger, John; Phitayakorn, Roy; Sullivan, Maura; Barney, Linda

2015-01-01

Research in surgical education has seen unprecedented growth but originates from single institutions and remains uncoordinated; this study aimed to generate a list of research priorities in surgical educational topics. The membership of the Association for Surgical Education was asked to submit up to 5 research questions concerned with multi-institutional collaborative surgical education research and to identify challenges faced by surgical education researchers. A modified Delphi methodology was used to create the research agenda based on these responses. Surgical educators responded to 3 survey rounds. Categories of submitted questions included teaching methods and curriculum development; assessment and competency; simulation; medical student preparation and selection; impact of work hour restrictions; and faculty development. Participants cited institutional culture and practice variability and lack of institutional review board coordination as common barriers to collaborative research, while identifying extensive planning, frequent communication, and availability of dedicated research coordinators as the most important facilitators. Using a Delphi methodology, a prioritized agenda for multi-institutional surgical education research was developed that may help advance surgeon education. Copyright © 2015 Elsevier Inc. All rights reserved.

A Successful Model of Collaborative Undergraduate Research: A Multi-Faculty, Multi-Project, Multi-Institution Team Approach

ERIC Educational Resources Information Center

Woodzicka, Julie A.; Ford, Thomas E.; Caudill, Abbie; Ohanmamooreni, Alyna

2015-01-01

A collaborative research grant from the National Science Foundation allowed the first two authors to provide students at primarily undergraduate institutions with a multi-faculty, multi-institution team research experience. Teams of undergraduate students at Western Carolina University and Washington and Lee University collaborated with one…

Phase II multi-institutional clinical trial on a new mixed beam RT scheme of IMRT on pelvis combined with a carbon ion boost for high-risk prostate cancer patients.

PubMed

Marvaso, Giulia; Jereczek-Fossa, Barbara A; Vischioni, Barbara; Ciardo, Delia; Giandini, Tommaso; Hasegawa, Azusa; Cattani, Federica; Carrara, Mauro; Ciocca, Mario; Bedini, Nice; Villa, Sergio; Morlino, Sara; Russo, Stefania; Zerini, Dario; Colangione, Sarah Pia; Panaino, Costanza Maria Vittoria; Fodor, Cristiana; Santoro, Luigi; Pignoli, Emanuele; Valvo, Francesca; Valdagni, Riccardo; De Cobelli, Ottavio; Orecchia, Roberto

2017-05-12

Definition of the optimal treatment schedule for high-risk prostate cancer is under debate. A combination of photon intensity modulated radiotherapy (IMRT) on pelvis with a carbon ion boost might be the optimal treatment scheme to escalate the dose on prostate and deliver curative dose with respect to normal tissue and quality of dose distributions. In fact, carbon ion beams offer the advantage to deliver hypofractionated radiotherapy (RT) using a significantly smaller number of fractions compared to conventional RT without increasing risks of late effects. This study is a prospective phase II clinical trial exploring safety and feasibility of a mixed beam scheme of carbon ion prostate boost followed by photon IMRT on pelvis. The study is designed to enroll 65 patients with localized high-risk prostate cancer at 3 different oncologic hospitals: Istituto Europeo di Oncologia, Fondazione IRCCS Istituto Nazionale dei Tumori, and Centro Nazionale di Adroterapia Oncologica. The primary endpoint is the evaluation of safety and feasibility with acute toxicity scored up to 1 month after the end of RT. Secondary endpoints are treatment early (3 months after the end of RT) and long-term tolerability, quality of life, and efficacy. The study is not yet recruiting; in silico studies are ongoing and we expect to start recruitment by 2017. The present clinical trial aims at improving the current treatment for high-risk prostate cancer, evaluating safety and feasibility of a new RT mixed-beam scheme including photons and carbon ions. Encouraging results are coming from carbon ion facilities worldwide on the treatment of different tumors including prostate cancers. Carbon ions combine physical properties allowing for high dose conformity and advantageous radiobiological characteristics. The proposed mixed beam treatment has the advantage to combine a photon high conformity standard of care IMRT phase with a hypofractionated carbon ion RT boost delivered in a short overall treatment time.

The Harvard Catalyst Common Reciprocal IRB Reliance Agreement: An Innovative Approach to Multisite IRB Review and Oversight

PubMed Central

Winkler, Sabune J.; Witte, Elizabeth

2014-01-01

Abstract Reduction of duplicative Institutional Review Board (IRB) review for multiinstitutional studies is a desirable goal to improve IRB efficiency while enhancing human subject protections. Here we describe the Harvard Catalyst Master Reciprocal Common IRB Reliance Agreement (MRA), a system that provides a legal framework for IRB reliance, with the potential to streamline IRB review processes and reduce administrative burden and barriers to collaborative, multiinstitutional research. The MRA respects the legal autonomy of the signatory institutions while offering a pathway to eliminate duplicative IRB review when appropriate. The Harvard Catalyst MRA provides a robust and flexible model for reciprocal reliance that is both adaptable and scalable. PMID:25196592

Assessing the financial characteristics of multi-institutional organizations.

PubMed Central

Coyne, J S

1985-01-01

The prospective pricing of health services is precipitating greater attention to financial characteristics and greater development of multi-institutional organizations (MIOs). This study compares the financial characteristics of 1,590 MIO hospitals with 2,819 freestanding hospitals by ownership type: church-operated, other not-for-profit, and investor-owned. Using 1981 data from the American Hospital Association, the hospitals' capital structure and profitability are measured using three financial ratios: total assets-to-equity, return on equity, and operating margin. The results indicate both greater leverage and greater profitability among MIO hospitals, particularly in the investor-owned sector. The implications of these findings are discussed relative to financial performance by hospital ownership type in the future. PMID:4038697

Assessing the financial characteristics of multi-institutional organizations.

PubMed

Coyne, J S

1985-02-01

The prospective pricing of health services is precipitating greater attention to financial characteristics and greater development of multi-institutional organizations (MIOs). This study compares the financial characteristics of 1,590 MIO hospitals with 2,819 freestanding hospitals by ownership type: church-operated, other not-for-profit, and investor-owned. Using 1981 data from the American Hospital Association, the hospitals' capital structure and profitability are measured using three financial ratios: total assets-to-equity, return on equity, and operating margin. The results indicate both greater leverage and greater profitability among MIO hospitals, particularly in the investor-owned sector. The implications of these findings are discussed relative to financial performance by hospital ownership type in the future.

The Harvard Catalyst Common Reciprocal IRB Reliance Agreement: an innovative approach to multisite IRB review and oversight.

PubMed

Winkler, Sabune J; Witte, Elizabeth; Bierer, Barbara E

2015-02-01

Reduction of duplicative Institutional Review Board (IRB) review for multiinstitutional studies is a desirable goal to improve IRB efficiency while enhancing human subject protections. Here we describe the Harvard Catalyst Master Reciprocal Common IRB Reliance Agreement (MRA), a system that provides a legal framework for IRB reliance, with the potential to streamline IRB review processes and reduce administrative burden and barriers to collaborative, multiinstitutional research. The MRA respects the legal autonomy of the signatory institutions while offering a pathway to eliminate duplicative IRB review when appropriate. The Harvard Catalyst MRA provides a robust and flexible model for reciprocal reliance that is both adaptable and scalable. © 2014 Wiley Periodicals, Inc.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hendrickson, K; Phillips, M; Fishburn, M

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 clinicalmore » 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, and support research. The project has demonstrated the feasibility of deploying a federated database environment for research purposes to multiple institutions.« less

Multi-institutional tumor banking: lessons learned from a pancreatic cancer biospecimen repository.

PubMed

Demeure, Michael J; Sielaff, Timothy; Koep, Larry; Prinz, Richard; Moser, A James; Zeh, Herb; Hostetter, Galen; Black, Jodi; Decker, Ardis; Rosewell, Sandra; Bussey, Kimberly J; Von Hoff, Daniel

2010-10-01

Clinically annotated pancreatic cancer samples are needed for progress to be made toward developing more effective treatments for this deadly cancer. As part of a National Cancer Institute-funded program project, we established a biospecimen core to support the research efforts. This article summarizes the key hurdles encountered and solutions we found in the process of developing a successful multi-institution biospecimen repository.

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

PubMed

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.

Integrative clinical genomics of advanced prostate cancer

PubMed Central

Dan, Robinson; Van Allen, Eliezer M.; Wu, Yi-Mi; Schultz, Nikolaus; Lonigro, Robert J.; Mosquera, Juan-Miguel; Montgomery, Bruce; Taplin, Mary-Ellen; Pritchard, Colin C; Attard, Gerhardt; Beltran, Himisha; Abida, Wassim M.; Bradley, Robert K.; Vinson, Jake; Cao, Xuhong; Vats, Pankaj; Kunju, Lakshmi P.; Hussain, Maha; Feng, Felix Y.; Tomlins, Scott A.; Cooney, Kathleen A.; Smith, David C.; Brennan, Christine; Siddiqui, Javed; Mehra, Rohit; Chen, Yu; Rathkopf, Dana E.; Morris, Michael J.; Solomon, Stephen B.; Durack, Jeremy C.; Reuter, Victor E.; Gopalan, Anuradha; Gao, Jianjiong; Loda, Massimo; Lis, Rosina T.; Bowden, Michaela; Balk, Stephen P.; Gaviola, Glenn; Sougnez, Carrie; Gupta, Manaswi; Yu, Evan Y.; Mostaghel, Elahe A.; Cheng, Heather H.; Mulcahy, Hyojeong; True, Lawrence D.; Plymate, Stephen R.; Dvinge, Heidi; Ferraldeschi, Roberta; Flohr, Penny; Miranda, Susana; Zafeiriou, Zafeiris; Tunariu, Nina; Mateo, Joaquin; Lopez, Raquel Perez; Demichelis, Francesca; Robinson, Brian D.; Schiffman, Marc A.; Nanus, David M.; Tagawa, Scott T.; Sigaras, Alexandros; Eng, Kenneth W.; Elemento, Olivier; Sboner, Andrea; Heath, Elisabeth I.; Scher, Howard I.; Pienta, Kenneth J.; Kantoff, Philip; de Bono, Johann S.; Rubin, Mark A.; Nelson, Peter S.; Garraway, Levi A.; Sawyers, Charles L.; Chinnaiyan, Arul M.

2015-01-01

SUMMARY Toward development of a precision medicine framework for metastatic, castration resistant prostate cancer (mCRPC), we established a multi-institutional clinical sequencing infrastructure to conduct prospective whole exome and transcriptome sequencing of bone or soft tissue tumor biopsies from a cohort of 150 mCRPC affected individuals. Aberrations of AR, ETS genes, TP53 and PTEN were frequent (40–60% of cases), with TP53 and AR alterations enriched in mCRPC compared to primary prostate cancer. We identified novel genomic alterations in PIK3CA/B, R-spondin, BRAF/RAF1, APC, β-catenin and ZBTB16/PLZF. Aberrations of BRCA2, BRCA1 and ATM were observed at substantially higher frequencies (19.3% overall) than seen in primary prostate cancers. 89% of affected individuals harbored a clinically actionable aberration including 62.7% with aberrations in AR, 65% in other cancer-related genes, and 8% with actionable pathogenic germline alterations. This cohort study provides evidence that clinical sequencing in mCRPC is feasible and could impact treatment decisions in significant numbers of affected individuals. PMID:26000489

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

ERIC Educational Resources Information Center

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…

Head-and-Neck Target Delineation Among Radiation Oncology Residents After a Teaching Intervention: A Prospective, Blinded Pilot Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bekelman, Justin E.; Wolden, Suzanne; Lee, Nancy

Purpose: We conducted this study to determine the feasibility of incorporating a teaching intervention on target delineation into the educational curriculum of a radiation oncology residency program and to assess the short-term effects on resident skills. Methods and Materials: The study schema consisted of a baseline evaluation, the teaching intervention, and a follow-up evaluation. At the baseline evaluation, the participants contoured three clinical tumor volumes (CTVs) (70 Gy, 59.4 Gy, and 54 Gy) on six contrast-enhanced axial computed tomography images of a de-identified patient with Stage T2N2bM0 squamous cell carcinoma of the right base of the tongue. The participants attendedmore » a series of head-and-neck oncology and anatomy seminars. The teaching intervention consisted of a didactic lecture and an interactive hands-on practical session designed to improve the knowledge and skills for target delineation in the head and neck. At the follow-up evaluation, the residents again contoured the CTVs. Results: Of the 14 eligible residents, 11 (79%) actually participated in the study. For all participants, but especially for those who had not had previous experience with head-and-neck target delineation, the teaching intervention was associated with improvement in the delineation of the node-negative neck (CTV 54 Gy contour). Regardless of clinical experience, participants had difficulty determining what should be included in the CTV 59.4 Gy contour to ensure adequate coverage of potential microscopic disease. Conclusion: Incorporating a teaching intervention into the education curriculum of a radiation oncology residency program is feasible and was associated with short-term improvements in target delineation skills. Subsequent interventions will require content refinement, additional validation, longer term follow-up, and multi-institutional collaboration.« less

A self-scaling, distributed information architecture for public health, research, and clinical care.

PubMed

McMurry, Andrew J; Gilbert, Clint A; Reis, Ben Y; Chueh, Henry C; Kohane, Isaac S; Mandl, Kenneth D

2007-01-01

This study sought to define a scalable architecture to support the National Health Information Network (NHIN). This architecture must concurrently support a wide range of public health, research, and clinical care activities. The architecture fulfils five desiderata: (1) adopt a distributed approach to data storage to protect privacy, (2) enable strong institutional autonomy to engender participation, (3) provide oversight and transparency to ensure patient trust, (4) allow variable levels of access according to investigator needs and institutional policies, (5) define a self-scaling architecture that encourages voluntary regional collaborations that coalesce to form a nationwide network. Our model has been validated by a large-scale, multi-institution study involving seven medical centers for cancer research. It is the basis of one of four open architectures developed under funding from the Office of the National Coordinator of Health Information Technology, fulfilling the biosurveillance use case defined by the American Health Information Community. The model supports broad applicability for regional and national clinical information exchanges. This model shows the feasibility of an architecture wherein the requirements of care providers, investigators, and public health authorities are served by a distributed model that grants autonomy, protects privacy, and promotes participation.

The Influence of Study Away Experiences on Global Perspective-Taking

ERIC Educational Resources Information Center

Engberg, Mark E.

2013-01-01

This article examines the relationship between 2 study away experiences--study abroad and service-learning--and the development of a global perspective. Three different studies are presented using cross-sectional and longitudinal designs and multi-institutional samples. The results specifically link involvement in study abroad and service-learning…

Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial).

PubMed

Hasegawa, Seiki; Okada, Morihito; Tanaka, Fumihiro; Yamanaka, Takeharu; Soejima, Toshinori; Kamikonya, Norihiko; Tsujimura, Tohru; Fukuoka, Kazuya; Yokoi, Kohei; Nakano, Takashi

2016-06-01

We conducted a prospective multi-institutional study to determine the feasibility of trimodality therapy (TMT) comprising induction chemotherapy followed by extrapleural pneumonectomy (EPP) and radiation therapy in Japanese patients with malignant pleural mesothelioma (MPM). Major eligibility criteria were histologically confirmed diagnosis of MPM, including clinical subtypes T0-3, N0-2, M0 disease; no prior treatment for the disease; age 20-75 years; Eastern Cooperative Oncology Group performance status 0 or 1; predicted postoperative forced expiratory volume >1000 ml in 1 s; written informed consent. Treatment methods comprised induction chemotherapy using pemetrexed (500 mg/m(2)) plus cisplatin (60 mg/m(2)) for three cycles, followed by EPP and postoperative hemithoracic radiation therapy (54 Gy). Primary endpoints were macroscopic complete resection (MCR) rate for EPP and treatment-related mortality for TMT. Forty-two eligible patients were enrolled: median age 64.5 (range 43-74) years; M:F = 39:3, clinical stage I:II:III = 14:13:15; histological type epithelioid were sarcomatoid; biphasic; others = 28:1:9:4. Of 42 patients, 30 completed EPP with MCR and 17 completed TMT. The trial met the primary endpoints, with an MCR rate of 71 % (30/42) and treatment-related mortality of 9.5 % (4/42). Overall median survival time and 2-year survival rate for 42 registered patients were 19.9 months and 42.9 %, respectively. Two-year relapse-free survival rate of 30 patients who completed EPP with MCR was 37.0 %. This phase II study met the predefined primary endpoints, but its risk/benefit ratio was not satisfactory.

Multicenter Feasibility Study of Tumor Molecular Profiling to Inform Therapeutic Decisions in Advanced Pediatric Solid Tumors: The Individualized Cancer Therapy (iCat) Study.

PubMed

Harris, Marian H; DuBois, Steven G; Glade Bender, Julia L; Kim, AeRang; Crompton, Brian D; Parker, Erin; Dumont, Ian P; Hong, Andrew L; Guo, Dongjing; Church, Alanna; Stegmaier, Kimberly; Roberts, Charles W M; Shusterman, Suzanne; London, Wendy B; MacConaill, Laura E; Lindeman, Neal I; Diller, Lisa; Rodriguez-Galindo, Carlos; Janeway, Katherine A

2016-01-28

Pediatric cancers represent a unique case with respect to cancer genomics and precision medicine, as the mutation frequency is low, and targeted therapies are less available. Consequently, it is unknown whether clinical sequencing can be of benefit. To assess the feasibility of identifying actionable alterations and making individualized cancer therapy (iCat) recommendations in pediatric patients with extracranial solid tumors. Clinical sequencing study at 4 academic medical centers enrolling patients between September 5, 2012, and November 19, 2013, with 1 year of clinical follow-up. Participants were 30 years or younger with high-risk, recurrent, or refractory extracranial solid tumors. The data analysis was performed October 28, 2014. Tumor profiling performed on archived clinically acquired specimens consisted of mutation detection by a Sequenom assay or targeted next-generation sequencing and copy number assessment by array comparative genomic hybridization. Results were reviewed by a multidisciplinary expert panel, and iCat recommendations were made if an actionable alteration was present, and an appropriate drug was available. Feasibility was assessed using a 2-stage design based on the proportion of patients with recommendations. Of 100 participants (60 male; median [range] age, 13.4 [0.8-29.8] years), profiling was technically successful in 89 (89% [95% CI, 83%-95%]). Median (range) follow-up was 6.8 (2.0-23.6) months. Overall, 31 (31% [95% CI, 23%-41%]) patients received an iCat recommendation and 3 received matched therapy. The most common actionable alterations leading to an iCat recommendation were cancer-associated signaling pathway gene mutations (n = 10) and copy number alterations in MYC/MYCN (n = 6) and cell cycle genes (n = 11). Additional alterations with implications for clinical care but not resulting in iCat recommendations were identified, including mutations indicating the possible presence of a cancer predisposition syndrome and translocations suggesting a change in diagnosis. In total, 43 (43% [95% CI, 33%-53%]) participants had results with potential clinical significance. A multi-institution clinical genomics study in pediatric oncology is feasible and a substantial proportion of relapsed or refractory pediatric solid tumors have actionable alterations. clinicaltrials.gov Identifier: NCT01853345.

Multicenter Guidelines | Division of Cancer Prevention

Cancer.gov

A Lead Organization conducting multi-institutional studies in the consortium has specific responsibilities in order to comply with the DCP Multicenter Guidelines. The Lead Organization is responsible for the following at all Participating Organizations as well as the Lead Organization: |

Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naïve Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis.

PubMed

Magnuson, William J; Lester-Coll, Nataniel H; Wu, Abraham J; Yang, T Jonathan; Lockney, Natalie A; Gerber, Naamit K; Beal, Kathryn; Amini, Arya; Patil, Tejas; Kavanagh, Brian D; Camidge, D Ross; Braunstein, Steven E; Boreta, Lauren C; Balasubramanian, Suresh K; Ahluwalia, Manmeet S; Rana, Niteshkumar G; Attia, Albert; Gettinger, Scott N; Contessa, Joseph N; Yu, James B; Chiang, Veronica L

2017-04-01

Purpose Stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT), and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are treatment options for brain metastases in patients with EGFR-mutant non-small-cell lung cancer (NSCLC). This multi-institutional analysis sought to determine the optimal management of patients with EGFR-mutant NSCLC who develop brain metastases and have not received EGFR-TKI. Materials and Methods A total of 351 patients from six institutions with EGFR-mutant NSCLC developed brain metastases and met inclusion criteria for the study. Exclusion criteria included prior EGFR-TKI use, EGFR-TKI resistance mutation, failure to receive EGFR-TKI after WBRT/SRS, or insufficient follow-up. Patients were treated with SRS followed by EGFR-TKI, WBRT followed by EGFR-TKI, or EGFR-TKI followed by SRS or WBRT at intracranial progression. Overall survival (OS) and intracranial progression-free survival were measured from the date of brain metastases. Results The median OS for the SRS (n = 100), WBRT (n = 120), and EGFR-TKI (n = 131) cohorts was 46, 30, and 25 months, respectively ( P < .001). On multivariable analysis, SRS versus EGFR-TKI, WBRT versus EGFR-TKI, age, performance status, EGFR exon 19 mutation, and absence of extracranial metastases were associated with improved OS. Although the SRS and EGFR-TKI cohorts shared similar prognostic features, the WBRT cohort was more likely to have a less favorable prognosis ( P = .001). Conclusion This multi-institutional analysis demonstrated that the use of upfront EGFR-TKI, and deferral of radiotherapy, is associated with inferior OS in patients with EGFR-mutant NSCLC who develop brain metastases. SRS followed by EGFR-TKI resulted in the longest OS and allowed patients to avoid the potential neurocognitive sequelae of WBRT. A prospective, multi-institutional randomized trial of SRS followed by EGFR-TKI versus EGFR-TKI followed by SRS at intracranial progression is urgently needed.

Perception of Personal Civic Responsibility among Undergraduate Students at the University of Kansas

ERIC Educational Resources Information Center

Everhart, Clinton Dale

2017-01-01

This study identified predictors of student perceptions of personal civic responsibility (civic-mindedness) among undergraduate students at the University of Kansas (KU). Using KU-specific data from the 2015 Multi-Institutional Study of Leadership (MSL), relationships between student interaction with specific components of the KU institutional…

Assessing Factors Influencing Student Academic Success in Law School

ERIC Educational Resources Information Center

Detwiler, Robert R.

2011-01-01

The literature on student academic success of law students is limited to mostly single institution studies, and as such, a nationwide, multi-institutional empirical study of the factors that predict student academic success is greatly needed by higher education scholars, law school admission officers, faculty, and administrators. This dissertation…

Examining the Influence of Campus Leadership Programs at a Catholic University

ERIC Educational Resources Information Center

Whitney, Rich; Meents-DeCaigny, Ellen

2014-01-01

This study uses the socially responsible leadership and leadership efficacy scales in the Multi-Institutional Study of Leadership (MSL) to examine leadership programs at one Catholic campus, and their influence on socially responsible leadership and leadership efficacy. Examining students that identified as involved in 14 campus leadership…

Undergraduate Music Program Alumni's Career Path, Retrospective Institutional Satisfaction, and Financial Status

ERIC Educational Resources Information Center

Miksza, Peter; Hime, Lauren

2015-01-01

The purpose of this study was to examine undergraduate music education and performance alumni's career path, retrospective institutional satisfaction, and financial status. Data for this study were drawn from respondents from the 2010 administration of the nationwide, multi-institutional survey conducted by the Strategic National Arts Alumni…

Mentors and College Student Leadership Outcomes: The Importance of Position and Process

ERIC Educational Resources Information Center

Campbell, Corbin M.; Smith, Meredith; Dugan, John P.; Komives, Susan R.

2012-01-01

Mentorship is empirically related to several desired outcomes in college students including academic success and career development. Yet little is known about how mentorship aids leadership development in college students. This study uses data from the Multi-Institutional Study of Leadership, a national study with more than 110,000 participants…

Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study.

PubMed

Sato, Yasushi; Ohnuma, Hiroyuki; Nobuoka, Takayuki; Hirakawa, Masahiro; Sagawa, Tamotsu; Fujikawa, Koshi; Takahashi, Yasuo; Shinya, Minami; Katsuki, Shinich; Takahashi, Minoru; Maeda, Masahiro; Okagawa, Yutaka; Naoki, Uemura; Kikuch, Syouhei; Okamoto, Koichi; Miyamoto, Hiroshi; Shimada, Mitsuo; Takemasa, Ichiro; Kato, Junji; Takayama, Tetsuji

2017-05-01

Conversion therapy is an option for unresectable metastatic gastric cancer when distant metastases are controlled by chemotherapy; however, the feasibility and efficacy remain unclear. This study aimed to assess the feasibility and efficacy of conversion therapy in patients with initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy by evaluating clinical outcomes. One hundred unresectable metastatic gastric cancer patients, enrolled in three DCS chemotherapy clinical trials, were retrospectively evaluated. The patients received oral S-1 (40 mg/m 2 b.i.d.) on days 1-14 and intravenous cisplatin (60 mg/m 2 ) and docetaxel (50-60 mg/m 2 ) on day 8 every 3 weeks. Conversion therapy was defined when the patients could undergo R0 resection post-DCS chemotherapy and were able to tolerate curative surgery. Conversion therapy was achieved in 33/100 patients, with no perioperative mortality. Twenty-eight of the 33 patients (84.8 %) achieved R0 resection, and 78.8 % were defined as histological chemotherapeutic responders. The median overall survival (OS) of patients who underwent conversion therapy was 47.8 months (95 % CI 28.0-88.5 months). Patients who underwent R0 resection had significantly longer OS than those who underwent R1 and R2 resections (P = 0.0002). Of the patients with primarily unresectable metastases, 10 % lived >5 years. Among patients who underwent conversion therapy, multivariate analysis showed that the pathological response was a significant independent predictor for OS. DCS safely induced a high conversion rate, with very high R0 and pathological response rates, and was associated with a good prognosis; these findings warrant further prospective investigations.

Phase II Results of RTOG 0537: A Phase II/III Study Comparing Acupuncture-like Transcutaneous Electrical Nerve Stimulation Versus Pilocarpine in Treating Early Radiation-Induced Xerostomia

PubMed Central

Wong, Raimond K. W.; James, Jennifer L.; Sagar, Stephen; Wyatt, Gwen; Nguyen-Tân, Phuc Felix; Singh, Anurag K.; Lukaszczyk, Barbara; Cardinale, Francis; Yeh, Alexander M.; Berk, Lawrence

2011-01-01

Purpose This phase II component of a multi-institutional phase II/III randomized trial assessed the feasibility and preliminary efficacy of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) in reducing radiation-induced xerostomia. Methods Head and neck cancer patients who were 3–24 months from completing radiotherapy ± chemotherapy (RT±C) and experiencing xerostomia symptoms with basal whole saliva production ≥0.1 ml/min and without recurrence were eligible. Patients received twice weekly ALTENS sessions (24 over 12 weeks) using a Codetron™ unit. The primary objective assessed the feasibility of ALTENS treatment. A patient was considered compliant if 19/24 ALTENS were delivered, with a targeted 85% compliance rate. Secondary objectives measured treatment-related toxicities and ALTENS effect on overall radiation-induced xerostomia burden using the University of Michigan Xerostomia-Related Quality of Life Scale (XeQOLS). Results Of 48 accrued patients, 47 were evaluable. Median age was 60 years; 84% were male, 70% completed RT±C for > 12 months and 21% had received prior pilocarpine. All ALTENS sessions were completed in 34 patients, but 9 and 1 completed 20–23 and 19 sessions respectively, representing a 94% total compliance rate. 6-month XeQOLS scores were available for 35 patients; 30 (86%) achieved a positive treatment response with a mean reduction of 35.9% (SD 36.1). Five patients developed grade 1–2 gastrointestinal toxicity and one had grade 1 pain event. Conclusions ALTENS treatment for radiation-induced xerostomia can be uniformly delivered in a cooperative multicenter setting and has possible beneficial treatment response. Given these results, the phase III component of this study was initiated. PMID:22252927

Impact of Intercollegiate Athletic Participation on Leadership Development

ERIC Educational Resources Information Center

Huntrods, Clint S.; An, Brian P.; Pascarella, Ernest T.

2017-01-01

This study examined the effects of participation in intercollegiate athletics on leadership development using a multi-institutional, longitudinal sample of students at four-year institutions. Using Astin's (1993) Input-Environment-Outcome model, we examined whether athletic participation influenced leadership development using the Socially…

Lessons from the Wabash National Study of Liberal Arts Education

ERIC Educational Resources Information Center

Pascarella, Ernest T.; Blaich, Charles

2013-01-01

Funded by the Center of Inquiry in the Liberal Arts (CILA) at Wabash College, the Wabash National Study of Liberal Arts Education (WNS) is a multi-institution, multi-year, longitudinal study designed to identify the academic and non-academic collegiate experiences that foster liberal learning. This article describes how the study was done and…

Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PubMed

Kaban, Leonard B; Cappetta, Alyssa; George, Brian C; Lahey, Edward T; Bohnen, Jordan D; Troulis, Maria J

2017-10-01

There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Associations between Medical Student Empathy and Personality: A Multi-Institutional Study

PubMed Central

Costa, Patrício; Alves, Raquel; Neto, Isabel; Marvão, Pedro; Portela, Miguel; Costa, Manuel João

2014-01-01

Background More empathetic physicians are more likely to achieve higher patient satisfaction, adherence to treatments, and health outcomes. In the context of medical education, it is thus important to understand how personality might condition the empathetic development of medical students. Single institutional evidence shows associations between students' personality and empathy. This multi-institutional study aimed to assess such associations across institutions, looking for personality differences between students with high empathy and low empathy levels. Methods Participants were 472 students from three medical schools in Portugal. They completed validated adaptations to Portuguese of self-report measures of the NEO-Five Factor Inventory(NEO-FFI) and the Jefferson Scale of Physician Empathy(JSPE-spv). Students were categorized into two groups: “Bottom” (low empathy, N = 165) and “Top” (high empathy, N = 169) according to their empathy JSPE-spv total score terciles. Correlation analysis, binary logistic regression analysis and ROC curve analysis were conducted. Results A regression model with gender, age and university had a predictive power (pseudo R2) for belonging to the top or bottom group of 6.4%. The addition of personality dimensions improved the predictive power to 16.8%. Openness to experience and Agreeableness were important to predict top or bottom empathy scores when gender, age and university were considered.” Based on the considered predictors the model correctly classified 69.3% of all students. Conclusions The present multi-institutional cross-sectional study in Portugal revealed across-school associations between the Big5 dimensions Agreeableness and Openness to experience and the empathy of medical students and that personality made a significant contribution to identify the more empathic students. Therefore, medical schools may need to pay attention to the personality of medical students to understand how to enhance the empathy of medical students. PMID:24637613

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

PubMed

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.

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

PubMed

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.

A Multi-Institutional Study of Feasibility, Implementation, and Early Clinical Results With Noninvasive Breast Brachytherapy for Tumor Bed Boost

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hamid, Subarna, E-mail: shamid@tuftsmedicalcenter.org; Department of Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI; Rocchio, Kathy

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 cosmesismore » 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.« less

Predictors of College Students Engaging in Social Change Behaviors

ERIC Educational Resources Information Center

Johnson, Matthew

2014-01-01

Using data from the 2009 Multi-Institutional Study of Leadership, this article examines the personal characteristics and environmental experiences that contribute to college students' involvement in social change. Results indicate that collegiate environmental characteristics (i.e., student group membership, leadership training, discussions…

Fraternity at the Crossroads

ERIC Educational Resources Information Center

Dowiak, Shawn M.

2016-01-01

Are fraternities still relevant to the college student experience? By examining the moral, student, and leadership development of IFC fraternity men, while controlling for institutional and student characteristics, the current study analyzed the roots of the purported value-added nature of fraternities using data from the Multi-Institutional Study…

The Hazard of Graduation: Analysis of Three Multivariate Statistics Used to Study Multi-Institutional Attendance

ERIC Educational Resources Information Center

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…

Expectation-Based Efficiency and Quality Improvements in Research Administration: Multi-Institutional Case Studies

ERIC Educational Resources Information Center

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…

Identifying the Camouflage: Uncovering and Supporting the Transition Experiences of Military and Veteran Students

ERIC Educational Resources Information Center

Williams-Klotz, Denise N.; Gansemer-Topf, Ann M.

2017-01-01

This study summarizes the qualitative findings from a multi-institutional study about the college transition experiences of military and veteran students, specifically students' articulation of their needs. Findings reveal (a) a lack of inprocessing, (b) need for community, and (c) institutional invisibility. Using the Student Veteran Transition…

Debugging: Finding, Fixing and Flailing, a Multi-Institutional Study of Novice Debuggers

ERIC Educational Resources Information Center

Fitzgerald, Sue; Lewandowski, Gary; McCauley, Renee; Murphy, Laurie; Simon, Beth; Thomas, Lynda; Zander, Carol

2008-01-01

Debugging is often difficult and frustrating for novices. Yet because students typically debug outside the classroom and often in isolation, instructors rarely have the opportunity to closely observe students while they debug. This paper describes the details of an exploratory study of the debugging skills and behaviors of contemporary novice Java…

What Incentives Can Teach Us about Missing Data in Longitudinal Assessment

ERIC Educational Resources Information Center

Martin, Georgianna L.; Loes, Chad N.

2010-01-01

In this chapter, the authors explore the effect of incentives on attrition and nonresponse in a multi-institutional longitudinal study. They organize this chapter into three sections. First, they review the literature regarding nonresponse among students and the effects of incentives on attrition and nonresponse in studies that employ…

Predictors of Sense of Belonging for Students with Psychological Conditions

ERIC Educational Resources Information Center

Mackie, Michele Matteo

2013-01-01

The purpose of this study was to develop a portrait of students with psychological conditions, to determine the predictors of sense of belonging for these students, and to draw comparisons between the collegiate experiences of students with, and those without, psychological conditions. Using data from the 2009 Multi-Institutional Study of…

Network Access to Visual Information: A Study of Costs and Uses.

ERIC Educational Resources Information Center

Besser, Howard

This paper summarizes a subset of the findings of a study of digital image distribution that focused on the Museum Educational Site Licensing (MESL) project--the first large-scale multi-institutional project to explore digital delivery of art images and accompanying text/metadata from disparate sources. This Mellon Foundation-sponsored study…

The Development of the Leader and the Spirit: Integrating the Concepts toward Meaning-Making

ERIC Educational Resources Information Center

Stonecipher, Paul

2012-01-01

Using data from the Multi-Institutional Study of Leadership, this study examines the relationship between the eight values of the Social Change Model of Leadership Development with a student's spiritual quest. Finding consistent positive relationship between the two constructs, the article discusses the intentional use of reflection in student…

A Multi-Institutional Study of High School Mathematics Curricula and College Mathematics Achievement and Course Taking

ERIC Educational Resources Information Center

Harwell, Michael R.; Post, Thomas R.; Medhanie, Amanuel; Dupuis, Danielle N.; LeBeau, Brandon

2013-01-01

This study examined the relationship between high school mathematics curricula and student achievement and course-taking patterns over 4 years of college course taking for a sample of over 10,000 students from 32 postsecondary 4-year institutions. Three types of curricula were studied: National Science Foundation (NSF) funded curricula, the…

Using Mixed Methods to Study First-Year College Impact on Liberal Arts Learning Outcomes

ERIC Educational Resources Information Center

Seifert, Tricia A.; Goodman, Kathleen; King, Patricia M.; Baxter Magolda, Marcia B.

2010-01-01

This study details the collection, analysis, and interpretation of data from a national multi-institutional longitudinal mixed methods study of college impact and student development of liberal arts outcomes. The authors found three sets of practices in the quantitative data that corroborated with the themes that emerged from the qualitative data:…

The Impact of Mentorship on Leadership Development Outcomes of International Students

ERIC Educational Resources Information Center

Shalka, Tricia R.

2017-01-01

The purpose of this quantitative study of 6,076 undergraduates in the United States (3,038 international and 3,038 domestic) was to examine leadership development outcomes for international students in the United States and the potential role of mentorship in this process. Data for this study were derived from the 2009 Multi-Institutional Study of…

A financial model for assessing hospital performance: an application to multi-institutional organizations.

PubMed

Coyne, J S

1986-01-01

The financial growth of investor-owned and not-for-profit hospitals has become an increasingly important research topic. More hospitals are forming multi-institutional organizations (MIOs) in an attempt to achieve greater market share and improve financial self-sufficiency. Few studies have provided a model for systematically analyzing financial growth in MIOs. A financial model is presented here to analyze equity growth. The model is applied to MIOs using recent audited financial data from more than 500 hospitals in 18 MIOs, eight investor-owned and ten not-for-profit. The results indicate that investor-owned MIO hospitals achieve significantly greater equity growth primarily through greater profit margins. The implications of these findings are discussed relative to the increasing price-competitive healthcare environment. The usefulness of the financial model is assessed in terms of its value as a financial diagnostic tool.

The Community of Inquiry Instrument: Validation and Results in Online Health Care Disciplines

ERIC Educational Resources Information Center

Carlon, S.; Bennett-Woods, D.; Berg, B.; Claywell, L.; LeDuc, K.; Marcisz, N.; Mulhall, M.; Noteboom, T.; Snedden, T.; Whalen, K.; Zenoni, L.

2012-01-01

This descriptive study using survey design sought to establish the efficacy of the Community of Inquiry instrument utilized in a study published by Shea and Bidjerano in 2009 exploring an online community of business students in a multi-institutional study. The current study sought to validate the instrument with a population of students in three…

College Students' Appreciative Attitudes toward Atheists

ERIC Educational Resources Information Center

Bowman, Nicholas A.; Rockenbach, Alyssa N.; Mayhew, Matthew J.; Riggers-Piehl, Tiffani A.; Hudson, Tara D.

2017-01-01

Atheists are often marginalized in discussions of religious and spiritual pluralism on college campuses and beyond. As with other minority worldview groups, atheists face challenges with hostile campus climates and misunderstanding of their views. The present study used a large, multi-institutional sample to explore predictors of non-atheist…

Undergraduate Student Leadership and Social Change

ERIC Educational Resources Information Center

Soria, Krista M.; Fink, Alexander; Lepkowski, Christine; Snyder, Lynn

2013-01-01

Colleges are under increasing pressure to develop future citizens who are interested in-and capable of-creating positive social change and improving their communities. Using data from the multiinstitutional SERU survey, this study suggests college students' participation in leadership positions can promote their engagement in greater social change.

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

PubMed

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.

Examining the Intersections between Undergraduates' Engagement in Community Service and Development of Socially Responsible Leadership

ERIC Educational Resources Information Center

Soria, Krista; Nobbe, June; Fink, Alex

2013-01-01

This paper examined relationships between students' engagement in community service in different contexts through classes, student organizations, work study, and on their own as well as their development of socially responsible leadership at a large, public, research university in the Upper Midwest. Results from the Multi-Institutional Study of…

Development and Evaluation of a Multi-Institutional Case Studies-Based Course in Food Safety

ERIC Educational Resources Information Center

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…

Multi-Institution Study of Student Demographics and Outcomes in Electrical and Computer Engineering in the USA

ERIC Educational Resources Information Center

Lord, Susan M.; Layton, Richard A.; Ohland, Matthew W.

2015-01-01

Electrical Engineering (EE) and Computer Engineering (CpE) programs have similar curricula, but different demographics and student outcomes. This paper extends earlier longitudinal studies to a larger and more diverse dataset with 90,000 first-time-in-college and 26,000 transfer students who majored in engineering at USA institutions, including…

Ubiquitous Writing, Technologies, and the Social Practice of Literacies of Coordination

ERIC Educational Resources Information Center

Pigg, Stacey; Grabill, Jeffrey T.; Brunk-Chavez, Beth; Moore, Jessie L.; Rosinski, Paula; Curran, Paul G.

2014-01-01

This article shares results from a multi-institutional study of the role of writing in college students' lives. Using case studies built from a larger population survey along with interviews, diaries, and a daily SMS texting protocol, we found that students report SMS texting, lecture notes, and emails to be the most frequent writing…

Developing College Students' Civic Identity: The Role of Social Perspective Taking and Sociocultural Issues Discussions

ERIC Educational Resources Information Center

Johnson, Matthew

2015-01-01

The development of college students' civic identity is understudied, but worthy of attention because of its salience to many students and higher education's commitment to fostering an engaged citizenry. Using 45,271 participants from the 2009 Multi-Institutional Study of Leadership, this study uses structural equation modeling to explore…

Qualitative Insights from a Canadian Multi-Institutional Research Study: In Search of Meaningful E-Learning

ERIC Educational Resources Information Center

Carter, Lorraine M.; Salyers, Vince; Myers, Sue; Hipfner, Carol; Hoffart, Caroline; MacLean, Christa; White, Kathy; Matus, Theresa; Forssman, Vivian; Barrett, Penelope

2014-01-01

This paper reports the qualitative findings of a mixed methods research study conducted at three Canadian post-secondary institutions. Called the Meaningful E-learning or MEL project, the study was an exploration of the teaching and learning experiences of faculty and students as well as their perceptions of the benefits and challenges of…

Understanding Graduate School Aspirations: The Effect of Good Teaching Practices

ERIC Educational Resources Information Center

Hanson, Jana Marie

2013-01-01

This study examined the effects of good teaching practices on post-baccalaureate degree aspirations using logistic regression techniques on a multi-institutional, longitudinal sample of students at four-year colleges and universities. Using College Choice and College Outcomes models as a theoretical foundation, I examined whether eight good…

Understanding Graduate School Aspirations: The Effect of Good Teaching Practices

ERIC Educational Resources Information Center

Hanson, Jana M.; Paulsen, Michael B.; Pascarella, Ernest T.

2016-01-01

This study examined the effects of good teaching practices on post-baccalaureate degree aspirations using logistic regression techniques on a multi-institutional, longitudinal sample of students at 4-year colleges and universities in the USA. We examined whether eight good teaching practices (non-classroom interactions with faculty, prompt…

The Impact of Diversity Courses on College Students' Moral Development

ERIC Educational Resources Information Center

Parker, Eugene T., III; Barnhardt, Cassie L.; Pascarella, Ernest T.; McCowin, Jarvis A.

2016-01-01

We utilized data from a multi-institutional longitudinal study to investigate the association between diversity-related coursework and moral development among students over 4 years of college. Our findings parallel the prior research, which support the positive effects of diversity on college students, by offering new evidence that diversity…

Living with Smartphones: Does Completion Device Affect Survey Responses?

ERIC Educational Resources Information Center

Lambert, Amber D.; Miller, Angie L.

2015-01-01

With the growing reliance on tablets and smartphones for internet access, understanding the effects of completion device on online survey responses becomes increasing important. This study uses data from the Strategic National Arts Alumni Project, a multi-institution online alumni survey designed to obtain knowledge of arts education, to explore…

Assessing Distributed Leadership for Learning and Teaching Quality: A Multi-Institutional Study

ERIC Educational Resources Information Center

Carbone, Angela; Evans, Julia; Ross, Bella; Drew, Steve; Phelan, Liam; Lindsay, Katherine; Cottman, Caroline; Stoney, Susan; Ye, Jing

2017-01-01

Distributed leadership has been explored internationally as a leadership model that will promote and advance excellence in learning and teaching in higher education. This paper presents an assessment of how effectively distributed leadership was enabled at five Australian institutions implementing a collaborative teaching quality development…

Debugging from the Student Perspective

ERIC Educational Resources Information Center

Fitzgerald, S.; McCauley, R.; Hanks, B.; Murphy, L.; Simon, B.; Zander, C.

2010-01-01

Learning to debug is a difficult, yet essential, aspect of learning to program. Students in this multi-institutional study report that finding bugs is harder than fixing them. They use a wide variety of debugging strategies, some of them unexpected. Time spent on understanding the problem can be effective. Pattern matching, particularly at the…

Using Generalizability Analysis to Estimate Parameters for Anatomy Assessments: A Multi-institutional Study

ERIC Educational Resources Information Center

Byram, Jessica N.; Seifert, Mark F.; Brooks, William S.; Fraser-Cotlin, Laura; Thorp, Laura E.; Williams, James M.; Wilson, Adam B.

2017-01-01

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…

Speaking of Vocation in an Age of Spirituality

ERIC Educational Resources Information Center

VanZanten Gallagher, Susan

2007-01-01

In 2003, the UCLA Higher Education Research Institute (HERI) began surveying undergraduates and faculty in a multi-institutional, longitudinal study designed to identify patterns of spirituality and religiousness among college students. Initial results revealed a high level of student interest in spiritual values, but they also showed that most…

Students' Precollege Engagement and the Development of a Global Perspective

ERIC Educational Resources Information Center

Engberg, Mark E.; Davidson, Lisa M.

2016-01-01

Given the growing emphasis on internationalization and the requisite intercultural skills and temperament necessary in a global society, this study examines the relationship between precollege engagement and entering dispositions on a developmentally based set of global perspective outcomes. Based on a multi-institutional sample of 3,131 entering,…

The Influence of Climate on the Academic and Athletic Success of Student-Athletes: Results from a Multi-Institutional National Study

ERIC Educational Resources Information Center

Rankin, Susan; Merson, Dan; Garvey, Jason C.; Sorgen, Carl H.; Menon, India; Loya, Karla; Oseguera, Leticia

2016-01-01

Students' perceptions of the campus climate can affect their success and outcomes. Student-athletes' experiences with campus life are unique. The Student-Athletes Climate Study (SACS) is a national study of over 8,000 student athletes from all NCAA sports and divisions. The purpose of the study was to examine the influence of individual and…

Comparison of methods for profiling O-glycosylation: Human Proteome Organisation Human Disease Glycomics/Proteome Initiative multi-institutional study of IgA1.

PubMed

Wada, Yoshinao; Dell, Anne; Haslam, Stuart M; Tissot, Bérangère; Canis, Kévin; Azadi, Parastoo; Bäckström, Malin; Costello, Catherine E; Hansson, Gunnar C; Hiki, Yoshiyuki; Ishihara, Mayumi; Ito, Hiromi; Kakehi, Kazuaki; Karlsson, Niclas; Hayes, Catherine E; Kato, Koichi; Kawasaki, Nana; Khoo, Kay-Hooi; Kobayashi, Kunihiko; Kolarich, Daniel; Kondo, Akihiro; Lebrilla, Carlito; Nakano, Miyako; Narimatsu, Hisashi; Novak, Jan; Novotny, Milos V; Ohno, Erina; Packer, Nicolle H; Palaima, Elizabeth; Renfrow, Matthew B; Tajiri, Michiko; Thomsson, Kristina A; Yagi, Hirokazu; Yu, Shin-Yi; Taniguchi, Naoyuki

2010-04-01

The Human Proteome Organisation Human Disease Glycomics/Proteome Initiative recently coordinated a multi-institutional study that evaluated methodologies that are widely used for defining the N-glycan content in glycoproteins. The study convincingly endorsed mass spectrometry as the technique of choice for glycomic profiling in the discovery phase of diagnostic research. The present study reports the extension of the Human Disease Glycomics/Proteome Initiative's activities to an assessment of the methodologies currently used for O-glycan analysis. Three samples of IgA1 isolated from the serum of patients with multiple myeloma were distributed to 15 laboratories worldwide for O-glycomics analysis. A variety of mass spectrometric and chromatographic procedures representative of current methodologies were used. Similar to the previous N-glycan study, the results convincingly confirmed the pre-eminent performance of MS for O-glycan profiling. Two general strategies were found to give the most reliable data, namely direct MS analysis of mixtures of permethylated reduced glycans in the positive ion mode and analysis of native reduced glycans in the negative ion mode using LC-MS approaches. In addition, mass spectrometric methodologies to analyze O-glycopeptides were also successful.

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

PubMed

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 to enhance the frequency and timeliness of intraoperative performance assessment. We believe SIMPL could help facilitate a national competency-based surgical training system, although local and systemic challenges still need to be addressed. Copyright © 2016. Published by Elsevier Inc.

From Beginning to End: How Engineering Students Think and Talk about Sustainability across the Life Cycle. Research Brief

ERIC Educational Resources Information Center

Kilgore, Deborah; Jocuns, Andrew; Yasuhara, Ken; Atman, Cynthia J.

2009-01-01

The Academic Pathways Study (APS) is a multi-institution, mixed-methods, longitudinal study which examines engineering students' learning and development as they move into, through, and beyond their undergraduate institutions (Atman et al., 2008; Sheppard et al., 2004). It is part of the Center for the Advancement of Engineering Education…

Preservice Teachers' Beliefs about Using Maker Activities in Formal K-12 Educational Settings: A Multi-Institutional Study

ERIC Educational Resources Information Center

Jones, W. Monty; Smith, Shaunna; Cohen, Jonathan

2017-01-01

This qualitative study examined preservice teachers' beliefs about using maker activities in formal educational settings. Eighty-two preservice and early-career teachers at three different universities in the United States took part in one-time workshops designed to introduce them to various maker tools and activities applicable to K-12…

The Conditional Nature of High Impact/Good Practices on Student Learning Outcomes

ERIC Educational Resources Information Center

Seifert, Tricia A.; Gillig, Benjamin; Hanson, Jana M.; Pascarella, Ernest T.; Blaich, Charles F.

2014-01-01

Using a multi-institutional sample of undergraduate students, this study found that the relationships between engaging in high impact/good practices and liberal arts outcomes differ based on students' precollege and background characteristics. Findings suggest that high impact/good practices are not a panacea and require a greater degree of…

A Multi-Institutional Assessment of Moral Reasoning Development among First-Year Students

ERIC Educational Resources Information Center

Mayhew, Matthew J.; Seifert, Tricia A.; Pascarella, Ernest T.

2010-01-01

The purpose of this study was to investigate the co-curricular experiences, course-taking behaviors, and educational practices that influence the moral reasoning development of 1,469 first-year students at 19 American colleges and universities. Results showed that contexts and practices that encourage students to engage divergent perspectives when…

Effects of Numeric Representation of Women on Interest in Engineering as a Career

ERIC Educational Resources Information Center

Creamer, Elizabeth G.

2012-01-01

Little is known about how the presence of women influences undergraduates' experiences in engineering. This paper presents results from a mixed methods, multivariate, and multi-institutional study to determine the impact of the numeric representation of women on the intent to be employed in engineering following graduation. Results from the…

A Multi-Institution Look at College Students Seeking Counseling: Nature and Severity of Concerns

ERIC Educational Resources Information Center

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).…

Are Noncovalent Interactions an Achilles Heel in Chemistry Education? A Comparison of Instructional Approaches

ERIC Educational Resources Information Center

Williams, Leah C.; Underwood, Sonia M.; Klymkowsky, Michael W.; Cooper, Melanie M.

2015-01-01

Intermolecular forces (IMFs), or more broadly, noncovalent interactions either within or between molecules, are central to an understanding of a wide range of chemical and biological phenomena. In this study, we present a multiyear, multi-institutional, longitudinal comparison of how students enrolled in traditional general chemistry courses and…

Hard but Not Too Hard: Challenging Courses and Engineering Students

ERIC Educational Resources Information Center

Martin, Jason H.; Hands, Krista B.; Lancaster, Stephen M.; Trytten, Deborah A.; Murphy, Teri J.

2008-01-01

Some professors claim college students seek the easy way out and prefer classes that lack challenge. In a multidisciplinary and multi-institutional ethnographic research study of the attainment of gender parity in an engineering department, it emerged that student attitudes toward challenge did not support this perception. By far, the majority of…

Environmental sustainability of intercropping switchgrass in a loblolly pine forest

Treesearch

George Chescheir; Francois Birgand; Mohamed Youssef; Jami Nettles; Devendra Amatya

2016-01-01

A multi-institutional watershed study has been conducted since 2010 to quantify the environmental sustainability of planting switchgrass (Panicum virgatum L.) between wide rows of loblolly pine (Pinus taeda L.). The hypothesized advantage of this intercropping system is the production of biofuel feedstock to provide additional...

Identity and Philanthropy: Designing a Survey Instrument to Operationalize Lesbian, Gay, Bisexual, Transgender, and Queer Alumni Giving

ERIC Educational Resources Information Center

Garvey, Jason C.

2013-01-01

This study investigated philanthropic giving to higher education among lesbian, gay, bisexual, transgender, and queer (LGBTQ) alumni. The primary purpose was to create a multi-institutional survey instrument that operationalizes philanthropic involvement and motivation among LGBTQ alumni. Additional objectives included creating factors and items…

A Multi-Institutional Investigation of Students' Preinstructional Ideas about Cosmology

ERIC Educational Resources Information Center

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…

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.

PubMed

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.

The clinical features and prognosis of mumps-associated hearing loss: a retrospective, multi-institutional investigation in Japan.

PubMed

Morita, Shinya; Fujiwara, Keishi; Fukuda, Atsushi; Fukuda, Satoshi; Nishio, Shin-Ya; Kitoh, Ryosuke; Hato, Naohito; Ikezono, Tetsuo; Ishikawa, Kotaro; Kaga, Kimitaka; Matsubara, Atsushi; Matsunaga, Tatsuo; Murata, Takaaki; Naito, Yasushi; Nishizaki, Kazunori; Ogawa, Kaoru; Sano, Hajime; Sato, Hiroaki; Sone, Michihiko; Suzuki, Mikio; Takahashi, Haruo; Tono, Tetsuya; Yamashita, Hiroshi; Yamasoba, Tatsuya; Usami, Shin-Ichi

2017-01-01

The majority of hearing loss due to mumps presents as unilateral profound sensorineural hearing loss, which is refractory to treatment. In rare cases of bilateral total deafness, cochlear implants were beneficial for speech perception. Vaccination against mumps is recommended to prevent mumps-associated hearing loss. The objective of this study is to investigate the clinical characteristics of hearing loss due to mumps and to evaluate hearing outcomes. The clinical parameters were analyzed under a retrospective multi-institutional study design in patients diagnosed with hearing loss due to mumps at the Otolaryngology departments of 19 hospitals between 1987 and 2016. Sixty-seven patients with hearing loss due to mumps were enrolled. The study population consisted of 35 males and 32 females, ranging in age from 1 to 54, with a median age of 9.5 years. Sixty-three patients presented with unilateral, and 4 with bilateral hearing loss. Profound hearing loss was observed in 65 ears. Only one ear with severe hearing loss showed complete recovery. Four patients with bilateral hearing loss received cochlear implant surgery. Most of the patients with hearing loss due to mumps had no history of vaccination.

The result of adjuvant chemotherapy for localized pT3 upper urinary tract carcinoma in a multi-institutional study.

PubMed

Kawashima, Atsunari; Nakai, Yasutomo; Nakayama, Masashi; Ujike, Takeshi; Tanigawa, Go; Ono, Yutaka; Kamoto, Akihito; Takada, Tsuyosi; Yamaguchi, Yuichiro; Takayama, Hitoshi; Nishimura, Kazuo; Nonomura, Norio; Tsujimura, Akira

2012-10-01

To determine through the analysis of our multi-institutional database whether postoperative adjuvant chemotherapy for upper urinary tract carcinoma with localized invasive upper urinary tract carcinoma (UUTC) is beneficial. A study population of 93 patients with pT3N0/xM0 UUTC was eligible for this study. Clinical features evaluated were sex, tumor location, adjuvant chemotherapy status, tumor pathology (histology, grade, infiltrating growth, lymphovascular invasion (LVI)), and cause of death. Cancer-specific survival (CSS) was estimated by Kaplan-Meier method. Prognostic factors related to CSS were analyzed by Cox proportional hazards regression model for multivariate analysis. In pT3 patients, overall 5-year CSS rate was 68.4% and median CSS time was 31 months (range 3-114 months). In the adjuvant chemotherapy group, 5-year CSS rate was 80.8%, whereas 5-year CSS rate was 64.4% in the non-adjuvant chemotherapy group. By multivariate analysis, adjuvant chemotherapy status was significantly associated with CSS (P = 0.008) were sex, tumor grade, tumor histology, and LVI presence. This study, although it was retrospective study, revealed that adjuvant chemotherapy after RNU may be beneficial in pT3N0/X patients by multivariate analysis. Prospective studies evaluating adjuvant therapy regimens for UTTC are required.

Prostate Cancer Biospecimen Cohort Study

DTIC Science & Technology

2016-10-01

goal of the study is development of a Prostate Cancer Biorepository Network (PCBN) resource site with high quality and well-annotated urine , blood...with no coordinating center and each site will be responsible for maintaining/storing their own data/ samples . 15. SUBJECT TERMS Prostate cancer...Biorepository Network (PCBN) resource site with high quality and well-annotated urine , blood, and tissue specimens as part of a multi-institutional Department of

A PILOT STUDY OF TOPICAL IMIQUIMOD THERAPY FOR THE TREATMENT OF RECURRENT EXTRAMAMMARY PAGET'S DISEASE

PubMed Central

Cowan, Renee A.; Black, Destin R.; Hoang, Lien N.; Park, Kay J.; Soslow, Robert A.; Backes, Floor J.; Gardner, Ginger J.; Abu-Rustum, Nadeen R.; Leitao, Mario M.; Eisenhauer, Eric L.; Chi, Dennis S.

2016-01-01

Objective The objective of this prospective pilot study was to assess the clinical and histologic effects of topical imiquimod therapy on recurrent extramammary Paget's disease of the vulva. Methods Patients with biopsy-proven recurrent extramammary Paget's disease presenting to the gynecology outpatient services at two participating institutions were recruited for conservative treatment with 5% imiquimod cream from 2007 to 2011. The topical cream was to be applied 3 times per week for 12 weeks. Punch biopsy and photography were performed at baseline and at the 12-week time point. Results Eight patients from two institutions were enrolled. Complete clinical and histologic response was achieved in 6 (75%) patients by the 12-week follow-up appointment. Of the two remaining patients, one had a complete clinical response but no significant histologic response; the other patient was removed from the study protocol secondary to intolerable local irritation. Two patients continue to have no evidence of disease after a median follow-up of 35 months. Five are alive with disease. No patients progressed to invasive cancer while receiving therapy. Conclusion Topical 5% imiquimod cream is a safe and feasible option for women suffering from recurrent extramammary Paget's disease of the vulva, and should be considered as a viable alternative to surgical management. Given the rare nature of this disease, additional multi-institutional prospective studies should be conducted to explore the efficacy of this treatment regime. PMID:27112632

Putting vision into practice to meet the needs of the poor.

PubMed

Stanley, J; Hankins, J W

1988-12-01

In 1986 the Sisters of Charity of the Incarnate Word, a multi-institutional system based in Houston, established specific mission objectives for all its healthcare facilities to meet the challenge of caring for the medically indigent in their communities. In response, St. Michael's Hospital, Texarkana, AR, established the Medical Indigent Committee to develop project proposals. To gain approval, proposals had to meet criteria established by the Sisters of Charity corporate office. These were consistency with mission, evidence of need, operational feasibility, and financial feasibility. The committee's first task was to collect information on the health status of the poor in its service area. Based on their findings, the committee decided to target the elderly and the very young for programs. After some brainstorming sessions, the committee developed three proposals: 1. Home Care Skills. 2. Pulmonary Rehabilitation Program. 3. Sick Child Clinic. By the end of 1986 the first two proposals were approved and funded; the Sick Child Clinic was not, because of operational concerns. The hospital offered the first Home Care Skills course in June 1987 and repeated it later that year. The 16-hour program proved so successful that the hospital is now considering having the class videotaped. The Pulmonary Rehabilitation Program began in May 1987. Although the hospital has not yet determined whether it has achieved its goal of reducing readmissions for poor patients with chronic obstructive pulmonary disease, program attendance exceeds that of other classes by more than 50 percent.

A Multi-Institutional Examination of the Relationships between High School Activity Involvement and Leadership Characteristics

ERIC Educational Resources Information Center

Simonsen, Jon C.; Velez, Jonathan J.; Foor, Ryan M.; Birkenholz, Robert J.; Foster, Daniel D.; Wolf, Kattlyn J.; Epps, Rebekah B.

2014-01-01

Developing leaders is vital to the future of our nation. As institutions of higher education address the need for leadership through courses and experiences, there is a need to recognize and acknowledge the potential impact of high school activity participation on leadership development. This descriptive-correlational study surveyed first-time…

Reading, Learning, and Growing: An Examination of the Benefits of Common Book Programs for First-Year Students' Development

ERIC Educational Resources Information Center

Soria, Krista M.

2015-01-01

Despite the continued growth of common book reading programs on college and university campuses, little is known about the benefits of such programs on first-year students' development. Using a multi-institutional survey of undergraduates attending six large, public universities (n = 1,237), the present study examined relationships between…

Enhancing Junior Faculty Research Productivity through Multiinstitution Collaboration: Participants' Impressions of the School Psychology Research Collaboration Conference

ERIC Educational Resources Information Center

Rush, S. Craig; Wheeler, Joanna

2011-01-01

In addition to teaching and service responsibilities, junior faculty members are required to be productive researchers. Despite the demand on junior faculty to produce published research, studies suggest that they often do not receive adequate assistance with their research endeavors. Mentoring is an effective form of support for junior faculty…

Multi-Institutional Partnerships for Higher Education in Africa: A Case Study of Assumptions of International Academic Collaboration

ERIC Educational Resources Information Center

Semali, Ladislaus M.; Baker, Rose; Freer, Rob

2013-01-01

Public and private universities in Kenya, Tanzania, Uganda, South Africa, and elsewhere in Africa, were experiencing all time high enrollments since the late 1990s. To address these demands, university administrators sought partnerships with universities of the global North to facilitate the necessary educational reform and curriculum…

The Effectiveness of Off Campus Multi-Institutional Teaching Centers as Perceived by Students

ERIC Educational Resources Information Center

Flores-Mejorado, Dina; Edmonson, Stacey; Fisher, Alice

2008-01-01

The purpose of this study was to examine and compare the perceptions of undergraduate and graduate students of a selected state university in Texas attending the Multi Institutional Teaching Center (MITC)/The University Center (TUC) or the main campus regarding the effectiveness of student services. As universities face limited resources and…

The Role of Multi-Institutional Partnerships in Supply Chain Management Course Design and Improvement

ERIC Educational Resources Information Center

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…

Evaluating Geoscience Students' Spatial Thinking Skills in a Multi-Institutional Classroom Study

ERIC Educational Resources Information Center

Ormand, Carol J.; Manduca, Cathryn; Shipley, Thomas F.; Tikoff, Basil; Harwood, Cara L.; Atit, Kinnari; Boone, Alexander P.

2014-01-01

Spatial thinking skills are critical to success in many subdisciplines of the geosciences. We tested students' spatial skills in geoscience courses at three institutions (a public research university, a comprehensive university, and a liberal arts college, all in the midwest) over a two-year period. We administered standard psychometric tests of…

The Multiple-Institution Database for Investigating Engineering Longitudinal Development: An Experiential Case Study of Data Sharing and Reuse

ERIC Educational Resources Information Center

Ohland, Matthew W.; Long, Russell A.

2016-01-01

Sharing longitudinal student record data and merging data from different sources is critical to addressing important questions being asked of higher education. The Multiple-Institution Database for Investigating Engineering Longitudinal Development (MIDFIELD) is a multi-institution, longitudinal, student record level dataset that is used to answer…

Report from a Multi-Institutional Randomized Clinical Trial Examining Computer-Assisted Problem-Solving Skills Training for English- and Spanish-Speaking Mothers of Children with Newly Diagnosed Cancer

PubMed Central

Sahler, Olle Jane Z.; Sherman, Sandra A.; Fairclough, Diane L.; Butler, Robert W.; Katz, Ernest R.; Dolgin, Michael J.; Varni, James W.; Noll, Robert B.; Phipps, Sean

2009-01-01

Objectives To evaluate the feasibility and efficacy of a handheld personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training (PSST) and to explore Spanish-speaking mothers’ experiences with it. Methods Mothers (n = 197) of children with newly diagnosed cancer were randomized to traditional PSST or PSST + PDA 8-week programs. Participants completed the Social Problem-Solving Inventory-Revised, Beck Depression Inventory-II, Profile of Mood States, and Impact of Event Scale-Revised pre-, post-treatment, and 3 months after completion of the intervention. Mothers also rated optimism, logic, and confidence in the intervention and technology. Results Both groups demonstrated significant positive change over time on all psychosocial measures. No between-group differences emerged. Despite technological “glitches,” mothers expressed moderately high optimism, appreciation for logic, and confidence in both interventions and rated the PDA-based program favorably. Technology appealed to all Spanish-speaking mothers, with younger mothers showing greater proficiency. Conclusions Well-designed, supported technology holds promise for enhancing psychological interventions. PMID:19091804

Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan.

PubMed

Sato, Takahiro; Sugiyama, Takashi; Kurakata, Michiyo; Saito, Masatoshi; Sugawara, Junichi; Yaegashi, Nobuo; Sagawa, Norimasa; Sanaka, Mayumi; Akazawa, Shoichi; Anazawa, Sonoko; Waguri, Masako; Sameshima, Hiroshi; Hiramatsu, Yuji; Toyoda, Nagayasu

2014-01-01

The present study was performed to evaluate pregnancy outcomes in women with type 1 and type 2 diabetes mellitus (DM) in Japan. This multi-institutional retrospective study was conducted in 40 general hospitals in Japan during 2003-2009. We evaluated 369 and 579 pregnant women with type 1 and type 2 DM, respectively, and compared pregnancy outcomes between the two groups. Glycosylated hemoglobin levels in the first trimester did not differ significantly between the studied groups. Gestational weight gain was lower in type 2 DM than in type 1 DM. Although there were no significant differences in perinatal outcomes between the groups, the primary cesarean section rate was higher in type 2 DM than in type 1 DM. Multiple logistic regression analysis revealed that primigravida status, pre-gestational body mass index (BMI), gestational weight gain, chronic hypertension, and microvascular disease including diabetic retinopathy or nephropathy were associated with onset of pregnancy-induced hypertension. Further, pre-gestational BMI was associated with the need for primary cesarean section. This study demonstrated that no differences were observed in the rates of perinatal mortality and congenital malformation between pregnant women with type 1 DM and type 2 DM; however, women with type 2 DM displayed a higher risk of primary cesarean section.

Preoperative Modified FOLFIRINOX Treatment Followed by Capecitabine-Based Chemoradiation for Borderline Resectable Pancreatic Cancer

PubMed Central

Katz, Matthew H. G.; Shi, Qian; Ahmad, Syed A.; Herman, Joseph M.; Marsh, Robert de W.; Collisson, Eric; Schwartz, Lawrence; Frankel, Wendy; Martin, Robert; Conway, William; Truty, Mark; Kindler, Hedy; Lowy, Andrew M.; Bekaii-Saab, Tanios; Philip, Philip; Talamonti, Mark; Cardin, Dana; LoConte, Noelle; Shen, Perry; Hoffman, John P.; Venook, Alan P.

2016-01-01

IMPORTANCE Although consensus statements support the preoperative treatment of borderline resectable pancreatic cancer, no prospective, quality-controlled, multicenter studies of this strategy have been conducted. Existing studies are retrospective and confounded by heterogeneity in patients studied, therapeutic algorithms used, and outcomes reported. OBJECTIVE To determine the feasibility of conducting studies of multimodality therapy for borderline resectable pancreatic cancer in the cooperative group setting. DESIGN, SETTING, AND PARTICIPANTS A prospective, multicenter, single-arm trial of a multimodality treatment regimen administered within a study framework using centralized quality control with the cooperation of 14 member institutions of the National Clinical Trials Network. Twenty-nine patients with biopsy-confirmed pancreatic cancer preregistered, and 23 patients with tumors who met centrally reviewed radiographic criteria registered. Twenty-two patients initiated therapy (median age, 64 years [range, 50–76 years]; 55% female). Patients registered between May 29, 2013, and February 7,2014. INTERVENTIONS Patients received modified FOLFIRINOX treatment (85 mg/m2 of oxaliplatin, 180 mg/m2 of irinotecan hydrochloride, 400 mg/m2 of leucovorin calcium, and then 2400 mg/m2 of 5-fluorouracil for 4 cycles) followed by 5.5 weeks of external-beam radiation (50.4 Gy delivered in 28 daily fractions) with capecitabine (825 mg/m2 orally twice daily) prior to pancreatectomy. MAIN OUTCOMES AND MEASURES Feasibility, defined by the accrual rate, the safety of the preoperative regimen, and the pancreatectomy rate. RESULTS The accrual rate of 2.6 patients per month was superior to the anticipated rate. Although 14 of the 22 patients (64% [95% CI, 41%–83%]) had grade 3 or higher adverse events, 15 of the 22 patients (68% [95% CI, 49%–88%]) underwent pancreatectomy. Of these 15 patients, 12 (80%) required vascular resection, 14 (93%) had microscopically negative margins, 5 (33%) had specimens that had less than 5% residual cancer cells, and 2 (13%) had specimens that had pathologic complete responses. The median overall survival of all patients was 21.7 months (95% CI, 15.7 to not reached) from registration. CONCLUSIONS AND RELEVANCE The successful completion of this collaborative study demonstrates the feasibility of conducting quality-controlled trials for this disease stage in the multi-institutional setting. The data generated by this study and the logistical elements that facilitated the trial's completion are currently being used to develop cooperative group trials with the goal of improving outcomes for this subset of patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01821612 PMID:27275632

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases From a Small Bowel Adenocarcinoma: Multi-Institutional Experience.

PubMed

Liu, Yang; Yonemura, Yutaka; Levine, Edward A; Glehen, Olivier; Goere, Diane; Elias, Dominique; Morris, David L; Sugarbaker, Paul H; Tuech, Jean J; Cashin, Peter; Spiliotis, John D; de Hingh, Ignace; Ceelen, Wim; Baumgartner, Joel M; Piso, Pompiliu; Katayama, Kanji; Deraco, Marcello; Kusamura, Shigeki; Pocard, Marc; Quenet, François; Fushita, Sachio

2018-05-01

The multi-institutional registry in this study evaluated the outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastases (PM) from small bowel adenocarcinoma (SBA). A multi-institutional data registry including 152 patients with PM from SBA was established. The primary end point was overall survival (OS) after CRS plus HIPEC. Between 1989 and 2016, 152 patients from 21 institutions received a treatment of CRS plus HIPEC. The median follow-up period was 20 months (range 1-100 months). Of the 152 patients, 70 (46.1%) were women with a median age of 54 years. The median peritoneal cancer index (PCI) was 10 (mean 12; range 1-33). Completeness of cytoreduction (CCR) 0 or 1 was achieved for 134 patients (88.2%). After CRS and HIPEC, the median OS was 32 months (range 1-100 months), with survival rates of 83.2% at 1 year, 46.4% at 3 years, and 30.8% at 5 years. The median disease-free survival after CCR 0/1 was 14 months (range 1-100 months). The treatment-related mortality rate was 2%, and 29 patients (19.1%) experienced grades 3 or 4 operative complications. The period between detection of PM and CRS plus HIPEC was 6 months or less (P = 0.008), and multivariate analysis identified absence of lymph node metastasis (P = 0.037), well-differentiated tumor (P = 0.028), and PCI of 15 or lower (P = 0.003) as independently associated with improved OS. The combined treatment strategy of CRS plus HIPEC achieved prolonged survival for selected patients who had PM from SBA with acceptable morbidity and mortality.

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

PubMed

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.

Towards the creation of a multi-institutional HF Radar Network in the Gulf of Mexico.

NASA Astrophysics Data System (ADS)

Flores-vidal, X.; Flament, P. J.; Durazo, R.; Navarro, L. F.; Salles, P.; Alvarez, P.; Carrillo, L.; Kurczyn, J. A.; Ulloa, M. J.; Rodriguez, I.; Toro Valencia, V. G.; Marin, M.; Perales, H.; Sanay, R.

2016-12-01

The Gulf of Mexico is source of important resources for both Mexico and USA, its beaches and coasts bring economical resources for these countries through the generation of jobs on the fisheries, touristic and industrial sectors. However, systematic monitoring is still necessary to evaluate its health and dynamics. This work is part of a multi-institutional project named "Implementation of oceanographic observational networks (physical, geochemical and ecological) to generate scenarios for possible contingencies related to the exploration and production of hydrocarbons in the deep waters of the Gulf of Mexico" (funded by SENER-CONACyT) which is an unprecedented Mexican joint effort to better understand the dynamics in the Gulf of Mexico. We will present the first actions towards the creation of the Mexican multi-Institutional HF Radar Network, which will allow us to synoptically map in real time the sea surface currents up to 200 km offshore. We expect to attract collaborations with the active or ongoing USA HF radar stations and institutions along the Gulf of Mexico, as well as to share methodologies and to evaluate standard data formats. The Radar Network in the Gulf of Mexico is planned to be active during 2017-2018, and it is expected to be permanent.

The Search for Meaningful E-Learning at Canadian Universities: A Multi-Institutional Research Study

ERIC Educational Resources Information Center

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…

Underserved Students Who Earn Credit through Prior Learning Assessment (PLA) Have Higher Degree Completion Rates and Shorter Time-to-Degree. Research Brief

ERIC Educational Resources Information Center

Klein-Collins, Rebecca

2011-01-01

In 2010, the Council for Adult and Experiential Learning (CAEL) released a report on a multi-institutional study on prior learning assessment (PLA) and adult student outcomes. The study examined data from 62,475 adult students at 48 colleges and universities, following the students' academic progress over the course of seven years. The data from…

Organizational principles of cloud storage to support collaborative biomedical research.

PubMed

Kanbar, Lara J; Shalish, Wissam; Robles-Rubio, Carlos A; Precup, Doina; Brown, Karen; Sant'Anna, Guilherme M; Kearney, Robert E

2015-08-01

This paper describes organizational guidelines and an anonymization protocol for the management of sensitive information in interdisciplinary, multi-institutional studies with multiple collaborators. This protocol is flexible, automated, and suitable for use in cloud-based projects as well as for publication of supplementary information in journal papers. A sample implementation of the anonymization protocol is illustrated for an ongoing study dealing with Automated Prediction of EXtubation readiness (APEX).

Hypothermia in the sepsis syndrome and clinical outcome. The Methylprednisolone Severe Sepsis Study Group.

PubMed

Clemmer, T P; Fisher, C J; Bone, R C; Slotman, G J; Metz, C A; Thomas, F O

1992-10-01

To evaluate the consequences of clinical hypothermia associated with sepsis syndrome and septic shock. Analysis of data from a multi-institutional, randomized, placebo-controlled, prospective study with predetermined end-point analysis of development of shock, recovery from shock, hospital length of stay, and death. Multi-institutional medical and surgical ICUs. Patients meeting predetermined criteria for severe sepsis syndrome. Appropriate sepsis and shock care with 50% of patients receiving methylprednisolone and 50% receiving placebo. The occurrence rate of hypothermia (< 35.5 degrees C) is 9% in this population. When compared with febrile patients, hypothermic patients had a higher frequency of central nervous system dysfunction (88% vs. 60%), increased serum bilirubin concentration (35% vs. 15%), prolonged prothrombin times (50% vs. 23%), shock (94% vs. 61%), failure to recover from shock (66% vs. 26%), and death (62% vs. 26%). The hypothermic patients were also more likely to be classified as having a rapidly or ultimately fatal disease upon study admission. This prospective study confirms that hypothermia associated with sepsis syndrome has a significant relationship to outcome manifest by increased frequency of shock and death from shock. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man.

Inverse treatment planning for spinal robotic radiosurgery: an international multi-institutional benchmark trial.

PubMed

Blanck, Oliver; Wang, Lei; Baus, Wolfgang; Grimm, Jimm; Lacornerie, Thomas; Nilsson, Joakim; Luchkovskyi, Sergii; Cano, Isabel Palazon; Shou, Zhenyu; Ayadi, Myriam; Treuer, Harald; Viard, Romain; Siebert, Frank-Andre; Chan, Mark K H; Hildebrandt, Guido; Dunst, Jürgen; Imhoff, Detlef; Wurster, Stefan; Wolff, Robert; Romanelli, Pantaleo; Lartigau, Eric; Semrau, Robert; Soltys, Scott G; Schweikard, Achim

2016-05-08

Stereotactic radiosurgery (SRS) is the accurate, conformal delivery of high-dose radiation to well-defined targets while minimizing normal structure doses via steep dose gradients. While inverse treatment planning (ITP) with computerized optimization algorithms are routine, many aspects of the planning process remain user-dependent. We performed an international, multi-institutional benchmark trial to study planning variability and to analyze preferable ITP practice for spinal robotic radiosurgery. 10 SRS treatment plans were generated for a complex-shaped spinal metastasis with 21 Gy in 3 fractions and tight constraints for spinal cord (V14Gy < 2 cc, V18Gy < 0.1 cc) and target (coverage > 95%). The resulting plans were rated on a scale from 1 to 4 (excellent-poor) in five categories (constraint compliance, optimization goals, low-dose regions, ITP complexity, and clinical acceptability) by a blinded review panel. Additionally, the plans were mathemati-cally rated based on plan indices (critical structure and target doses, conformity, monitor units, normal tissue complication probability, and treatment time) and compared to the human rankings. The treatment plans and the reviewers' rankings varied substantially among the participating centers. The average mean overall rank was 2.4 (1.2-4.0) and 8/10 plans were rated excellent in at least one category by at least one reviewer. The mathematical rankings agreed with the mean overall human rankings in 9/10 cases pointing toward the possibility for sole mathematical plan quality comparison. The final rankings revealed that a plan with a well-balanced trade-off among all planning objectives was preferred for treatment by most par-ticipants, reviewers, and the mathematical ranking system. Furthermore, this plan was generated with simple planning techniques. Our multi-institutional planning study found wide variability in ITP approaches for spinal robotic radiosurgery. The participants', reviewers', and mathematical match on preferable treatment plans and ITP techniques indicate that agreement on treatment planning and plan quality can be reached for spinal robotic radiosurgery.

Evaluating Multi-Institutional Partnership Sustainability: A Case Study of Collaborative Workforce Development in Renewable Energy Assessment

ERIC Educational Resources Information Center

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…

Shifting Tides in Global Higher Education: Agency, Autonomy, and Governance in the Global Network. Global Studies in Education, Volume 9

ERIC Educational Resources Information Center

Witt, Mary Allison

2011-01-01

The increasing connection among higher education institutions worldwide is well documented. What is less understood is how this connectivity is enacted and manifested on specific levels of the global education network. This book details the planning process of a multi-institutional program in engineering between institutions in the US and…

Value Added or Misattributed? A Multi-Institution Study on the Educational Benefit of Labs for Reinforcing Physics Content

ERIC Educational Resources Information Center

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

2017-01-01

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…

A Multi-Institutional Study of Students' Perceptions and Experiences in the Research-Based Capstone Course in Sociology

ERIC Educational Resources Information Center

McKinney, Kathleen; Day, Melissa D.

2012-01-01

In this article, we describe student perceptions of, and experiences in, a one-semester, required sociology research capstone course. The data come from 106 students in eight sections of the course taught at three institutions. We used multiple methods for data collection: questionnaires, focus groups, and learning reflection essays. Our results…

Leadership Attitudes and Beliefs of Incoming First-Year College Students: A Multi-Institutional Study of Gender Differences

ERIC Educational Resources Information Center

Wielkiewicz, Richard M.; Fischer, Donald V.; Stelzner, Stephen P.; Overland, Maribeth; Sinner, Alyssa M.

2012-01-01

Incoming first-year college students (N = 4,292) were surveyed regarding attitudes and beliefs about leadership. Students' opinions about their leadership ability were high and were related to having an outgoing personality, as well as the number of high school activities in which they had been involved. In addition, students' understanding of…

An Evaluation of the First Year Experience from the Mature Students' Perspective: A Multi-Institutional Comparison

ERIC Educational Resources Information Center

Chapman, Amanda; Parmar, Deeba; Trotter, Eileen

2007-01-01

This study investigates the experiences of mature students across three higher education institutions in the UK. The issues arising are of relevance to academics who are involved in widening participation and in evaluating support in their own programmes for the diversity of students. The sample includes mature students from programmes in Health,…

Community Service during the First Year of College: What Is the Role of Past Behavior?

ERIC Educational Resources Information Center

Cruce, Ty M.; Moore, John V., III

2012-01-01

This longitudinal multi-institution study examines the effects of students' involvement in high school service clubs and their level of civic-mindedness when entering college on their propensity and intentions to volunteer during college. The level of civic-mindedness was measured by a self-rating of their ability to work effectively with others…

The Role of Living-Learning Programs in Women's Plans to Attend Graduate School in STEM Fields

ERIC Educational Resources Information Center

Szelenyi, Katalin; Inkelas, Karen Kurotsuchi

2011-01-01

This paper examines the role of living-learning (L/L) programs in undergraduate women's plans to attend graduate school in STEM fields. Using data from the 2004-2007 National Study of Living Learning Programs (NSLLP), the only existing multi-institutional, longitudinal dataset examining L/L program outcomes, the findings show that women's…

North American Multicenter Volumetric CT Study for Clinical Staging of Malignant Pleural Mesothelioma: Feasibility and Logistics of Setting Up a Quantitative Imaging Study.

PubMed

Gill, Ritu R; Naidich, David P; Mitchell, Alan; Ginsberg, Michelle; Erasmus, Jeremy; Armato, Samuel G; Straus, Christopher; Katz, Sharyn; Patios, Demetrois; Richards, William G; Rusch, Valerie W

2016-08-01

Clinical tumor (T), node, and metastasis staging is based on a qualitative assessment of features defining T descriptors and has been found to be suboptimal for predicting the prognosis of patients with malignant pleural mesothelioma (MPM). Previous work suggests that volumetric computed tomography (VolCT) is prognostic and, if found practical and reproducible, could improve clinical MPM classification. Six North American institutions electronically submitted clinical, pathologic, and imaging data on patients with stages I to IV MPM to an established multicenter database and biostatistical center. Two reference radiologists blinded to clinical data independently reviewed the scans; calculated clinical T, node, and metastasis stage by standard criteria; performed semiautomated tumor volume calculations using commercially available software; and submitted the findings to the biostatistical center. Study end points included the feasibility of a multi-institutional VolCT network, concordance of independent VolCT assessments, and association of VolCT with pathological T classification. Of 164 submitted cases, 129 were evaluated by both reference radiologists. Discordant clinical staging of most cases confirmed the inadequacy of current criteria. The overall correlation between VolCT estimates was good (Spearman correlation 0.822), but some were significantly discordant. Root cause analysis of the most discordant estimates identified four common sources of variability. Despite these limitations, median tumor volume estimates were similar within subgroups of cases representing each pathological T descriptor and increased monotonically for each reference radiologist with increasing pathological T status. The good correlation between VolCT estimates obtained for most cases reviewed by two independent radiologists and qualitative association of VolCT with pathological T status combine to encourage further study. The identified sources of user error will inform design of a follow-up prospective trial to more formally assess interobserver variability of VolCT and its potential contribution to clinical MPM staging. Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Biomarkers for Early Detection of Clinically Relevant Prostate Cancer. A Multi-Institutional Validation Trial

DTIC Science & Technology

2016-10-01

Study (PASS). We are in the process of evaluating these three biomarker panels in tissue, blood, and urine samples with well annotated clinical and...impacting both the initial choice of therapy and decision-making during AS. The objective of the study is to utilize analytically validated assays that...predict reclassification from Gleason 6 cancer to Gleason 7 or greater. The analysis plan was determined before specimens were selected for the study

Biomarkers for Early Detection of Clinically Relevant Prostate Cancer. A Multi-Institutional Validation Trial

DTIC Science & Technology

2016-10-01

Study (PASS). We are in the process of evaluating these three biomarker panels in tissue, blood, and urine samples with well annotated clinical and...choice of therapy and decision-making during AS. The objective of the study is to utilize analytically validated assays that take into account tumor...Gleason 6 cancer to Gleason 7 or greater. The analysis plan was determined before specimens were selected for the study , and included 7 breaking

Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

DTIC Science & Technology

2017-10-01

been shown in many studies to improve predictive accuracy for cancer on initial biopsy,3,7-9 and to be correlated with more aggressive cancer at...our multi-center, prospectively accrued prostate cancer active surveillance cohort – the Canary Prostate Active Surveillance Study (PASS). We are in...objective of the study is to utilize analytically validated assays that take into account tumor heterogeneity to measure biomarkers in specimens that were

Interdisciplinary multiinstitutional alliances in support of educational programs for health sciences librarians.

PubMed Central

Smith, L C

1996-01-01

This project responds to the need to identify the knowledge, skills, and expertise required by health sciences librarians in the future and to devise mechanisms for providing this requisite training. The approach involves interdisciplinary multiinstitutional alliances with collaborators drawn from two graduate schools of library and information science (University of Illinois at Urbana-Champaign and Indiana University) and two medical schools (University of Illinois at Chicago and Washington University). The project encompasses six specific aims: (1) investigate the evolving role of the health sciences librarian; (2) analyze existing programs of study in library and information science at all levels at Illinois and Indiana; (3) develop opportunities for practicums, internships, and residencies; (4) explore the possibilities of computing and communication technologies to enhance instruction; (5) identify mechanisms to encourage faculty and graduate students to participate in medical informatics research projects; and (6) create recruitment strategies to achieve better representation of currently underrepresented groups. The project can serve as a model for other institutions interested in regional collaboration to enhance graduate education for health sciences librarianship. PMID:8913560

A phase II study of flavopiridol in patients with advanced renal cell carcinoma: results of Southwest Oncology Group Trial 0109.

PubMed

Van Veldhuizen, Peter J; Faulkner, James R; Lara, Primo N; Gumerlock, Paul H; Goodwin, J Wendall; Dakhil, Shaker R; Gross, Howard M; Flanigan, Robert C; Crawford, E David

2005-07-01

Flavopiridol is a cyclin-dependent kinase inhibitor that prevents cell cycle progression and tumor growth. In initial phase I studies, encouraging responses were seen in advanced renal cell cancer (RCC). In a phase II study of flavopiridol given as a 72-h continuous infusion every 2 weeks in RCC, a response rate of 6% was seen but with considerable grade 3 or 4 asthenia, diarrhea, and thrombosis. Subsequently, an alternative 1-h bolus schedule was reported to have enhanced tolerability in a phase I trial. We therefore conducted a phase II study of this bolus regimen. A total of 38 patients with advanced RCC were entered into this multi-institutional phase II study. Flavopiridol (50 mg/m(2) per day) was administered by bolus intravenous injection daily for three consecutive days, repeated every 3 weeks. Out of 34 eligible patients, one complete response and three partial responses were observed, for an overall response rate of 12% (95% CI 3-27%). Of the 34 patients, 14 (41%) had stable disease (SD). The probability of not failing treatment by 6 months was 21% (95% CI 9-35%). Median overall survival time was 9 months (95% CI 8-18 months). The most common grade 3 or 4 toxicities were diarrhea (35%) and tumor pain (12%) along with anemia, dyspnea, and fatigue (9% each). Flavopiridol at this dose and schedule is feasible with an acceptable toxicity profile. Flavopiridol has some modest biologic activity against advanced RCC, as evidenced by its single-agent objective response and SD rates.

Phase 2 results from Radiation Therapy Oncology Group Study 0537: a phase 2/3 study comparing acupuncture-like transcutaneous electrical nerve stimulation versus pilocarpine in treating early radiation-induced xerostomia.

PubMed

Wong, Raimond K W; James, Jennifer L; Sagar, Stephen; Wyatt, Gwen; Nguyen-Tân, Phuc Felix; Singh, Anurag K; Lukaszczyk, Barbara; Cardinale, Francis; Yeh, Alexander M; Berk, Lawrence

2012-09-01

In this phase 2 component of a multi-institutional, phase 2/3, randomized trial, the authors assessed the feasibility and preliminary efficacy of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) in reducing radiation-induced xerostomia. Patients with cancer of the head and neck who were 3 to 24 months from completing radiotherapy with or without chemotherapy (RT ± C) and who were experiencing xerostomia symptoms with basal whole saliva production ≥0.1 mL per minute and were without recurrence were eligible. Patients received twice weekly ALTENS sessions (24 sessions over 12 weeks) using a proprietary electrical stimulation unit. The primary study objective was to assess the feasibility of ALTENS treatment. Patients were considered compliant if 19 of 24 ALTENS sessions were delivered, and the targeted compliance rate was 85%. Secondary objectives measured treatment-related toxicities and the effect of ALTENS on overall radiation-induced xerostomia burden using the University of Michigan Xerostomia-Related Quality of Life Scale (XeQOLS). Of 48 accrued patients, 47 were evaluable. The median age was 60 years, 84% of patients were men, 70% completed RT ± C for >12 months, and 21% had previously received pilocarpine. Thirty-four patients completed all 24 ALTENS sessions, 9 patients completed 20 to 23 sessions, and 1 patient completed 19 sessions, representing a 94% total compliance rate. Six-month XeQOLS scores were available for 35 patients and indicated that 30 patients (86%) achieved a positive treatment response with a mean ± standard deviation reduction of 35.9% ± 36.1%. Five patients developed grade 1 or 2 gastrointestinal toxicity, and 1 had a grade 1 pain event. The current results indicated that ALTENS treatment for radiation-induced xerostomia can be delivered uniformly in a cooperative, multicenter setting and produces possible beneficial treatment response. Given these results, the phase 3 component of this study was initiated. Copyright © 2011 American Cancer Society.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krasheninnikov, Sergei I.; Angus, Justin; Lee, Wonjae

The goal of the Edge Simulation Laboratory (ESL) multi-institutional project is to advance scientific understanding of the edge plasma region of magnetic fusion devices via a coordinated effort utilizing modern computing resources, advanced algorithms, and ongoing theoretical development. The UCSD team was involved in the development of the COGENT code for kinetic studies across a magnetic separatrix. This work included a kinetic treatment of electrons and multiple ion species (impurities) and accurate collision operators.

A Multi-Institutional Study of Black and Latina/o Community College Students' Transfer Intentions: A Theory of Planned Behavior Reconceptualization

ERIC Educational Resources Information Center

Nellum, Christopher James

2014-01-01

Community colleges currently enroll over one-third of all undergraduates and serve as the gateway to postsecondary education for increasing numbers of Americans in the 21st century, especially students of color. A significant portion of community college students aspire to transfer to a four-year college or university, but only 23% to 40% make…

Benchmarking Curriculum Content in Entry-Level Health Professional Education with Special Reference to Health Promotion Practice in Physical Therapy: A Multi-Institutional International Study

ERIC Educational Resources Information Center

Bodner, Michael E.; Rhodes, Ryan E.; Miller, William C.; Dean, Elizabeth

2013-01-01

Health promotion (HP) warrants being a clinical competency for health professionals given the global burden of lifestyle-related conditions; these are largely preventable with lifestyle behavior change. Physical therapists have a practice pattern conducive to HP, including lifestyle behavior change. The extent to which HP content is included in…

Usability in the real world: assessing medical information technologies in patients' homes.

PubMed

Kaufman, David R; Patel, Vimla L; Hilliman, Charlyn; Morin, Philip C; Pevzner, Jenia; Weinstock, Ruth S; Goland, Robin; Shea, Steven; Starren, Justin

2003-01-01

This paper presents an approach to usability evaluation of computer-based health care systems designed for patient use in their homes. Although such devices are becoming more prevalent, there is very little known about their usability. The theoretical foundations for the methods are discussed. The approach incorporates a cognitive walkthrough usability evaluation and new methods for usability testing that can be conducted in patient's homes. The method was applied to the IDEATel intervention, a multi-institution randomized controlled trial of the feasibility, acceptability, and clinical utility of a home-based telemedicine system for diabetic Medicare population. The usability study was designed to assess barriers to optimal use of the system. The focus was both on dimensions of the interface and on dimensions of patient skills and competency. The usability field research involved testing 25 patients in their homes using the system. The analysis included a range of video-analytic methods of varying levels of granularity. The usability evaluation revealed aspects of the interface that were sub-optimal and impeded the performance of certain tasks. It also found a range of patient-related factors such as numeracy and psychomotor skills that constituted barriers to productive use. A multifaceted usability approach provided important insight regarding use of technology by an elderly chronic-care patient population and more generally, for understanding how home health initiatives can more effectively use such technology.

Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

DTIC Science & Technology

2017-10-01

mRNA and has been shown in many studies to improve predictive accuracy for cancer on initial biopsy,3,7-9 and to be correlated with more aggressive... Study (PASS). We are in the process of evaluating these three biomarker panels in tissue, blood, and urine samples with well annotated clinical and...during AS. The objective of the study is to utilize analytically validated assays that take into account tumor heterogeneity to measure biomarkers in

Sunitinib Plus Androgen Deprivation and Radiation Therapy for Patients With Localized High-Risk Prostate Cancer: Results From a Multi-institutional Phase 1 Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Corn, Paul G., E-mail: pcorn@mdanderson.org; Song, Danny Y.; Heath, Elisabeth

Purpose: To evaluate the feasibility of administering sunitinib in combination with androgen deprivation therapy and external-beam intensity modulated radiation therapy (XRT) in patients with localized high-risk prostate cancer. Methods and Materials: Seventeen men with localized adenocarcinoma of the prostate with cT2c-cT4 or Gleason 8-10 or prostate-specific antigen >20 ng/mL received initial androgen deprivation (leuprolide 22.5 mg every 12 weeks plus oral bicalutamide 50 mg daily) for 4-8 weeks before oral sunitinib 12.5, 25, or 37.5 mg daily for 4 weeks as lead-in, then concurrently with and 4 weeks after XRT (75.6 Gy in 42 fractions to prostate and seminal vesicles).more » A 3+3 sequential dose-escalation design was used to assess the frequency of dose-limiting toxicity (DLT) and establish a maximal tolerated dose of sunitinib. Results: Sunitinib at 12.5- and 25-mg dose levels was well tolerated. The first 4 patients enrolled at 37.5 mg experienced a DLT during lead-in, and a drug interaction between sunitinib and bicalutamide was suspected. The protocol was revised and concurrent bicalutamide omitted. Of the next 3 patients enrolled at 37.5 mg, 2 of 3 receiving concurrent therapy experienced DLTs during radiation: grade 3 diarrhea and grade 3 proctitis, respectively. Only 1 of 7 patients completed sunitinib at 37.5 mg daily, whereas 3 of 3 patients (25 mg as starting dose) and 3 of 4 patients (25 mg as reduced dose) completed therapy. Conclusions: The feasibility of combined vascular endothelial growth factor receptor (VEGFR)/platelet-derived growth factor receptor (PDGFR) inhibitor therapy, androgen deprivation, and radiation therapy for prostate cancer was established. Using a daily dosing regimen with lead-in, concurrent, and post-XRT therapy, the recommended phase 2 dose of sunitinib is 25 mg daily.« less

Perceptions about the Role of Race in the Job Acquisition Process: At the Nexus of Attributional Ambiguity and Aversive Racism in Technology and Engineering Education

ERIC Educational Resources Information Center

Niemann, Yolanda Flores; Sánchez, Nydia C.

2015-01-01

This study explored the role of race in the negative job acquisition outcomes of African American graduates of a federally funded multi-institution doctoral training program. Because the credentials of African American graduates were similar, equal to, and/or, in some cases, exceeded those of their white peers, qualifications were ruled out as…

A multi-institutional analysis of the untreated course of cerebral dural arteriovenous fistulas.

PubMed

Gross, Bradley A; Albuquerque, Felipe C; McDougall, Cameron G; Jankowitz, Brian T; Jadhav, Ashutosh P; Jovin, Tudor G; Du, Rose

2017-12-15

OBJECTIVE The rarity of cerebral dural arteriovenous fistulas (dAVFs) has precluded analysis of their natural history across large cohorts. Investigators from a considerable proportion of the few reports that do exist have evaluated heterogeneous groups of untreated and partially treated lesions. In the present study, the authors exclusively evaluated the untreated course of dAVFs across a multi-institutional data set to delineate demographic, angiographic, and natural history data. METHODS A multi-institutional database of dAVFs was queried for demographic and angiographic data as well as untreated disease course. After dAVFs were stratified by Djindjian type, annual nonhemorrhagic neurological deficit (NHND) and hemorrhage rates were derived, as were risk factors for each. A multivariable Cox proportional-hazards regression model was used to calculate hazard ratios. RESULTS Two hundred ninety-five dAVFs had at least 1 month of untreated follow-up. For 126 Type I dAVFs, there were no episodes of NHND or hemorrhage over 177 lesion-years. Respective annualized NHND and hemorrhage rates were 4.5% and 3.4% for Type II, 6.0% and 4.0% for Type III, and 4.5% and 9.1% for Type IV dAVFs. The respective annualized NHND and hemorrhage rates were 2.3% and 2.9% for asymptomatic Type II-IV dAVFs, 23.1% and 3.3% for dAVFs presenting with NHND, and 0% and 46.2% for lesions presenting with hemorrhage. On multivariate analysis, NHND presentation (HR 11.49, 95% CI 3.19-63) and leptomeningeal venous drainage (HR 5.03, 95% CI 0.42-694) were significant risk factors for NHND; hemorrhagic presentation (HR 17.67, 95% CI 2.99-117) and leptomeningeal venous drainage (HR 10.39, 95% CI 1.11-1384) were significant risk factors for hemorrhage. CONCLUSIONS All Type II-IV dAVFs should be considered for treatment. Given the high risk of rebleeding, lesions presenting with NHND and/or hemorrhage should be treated expediently.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Verma, Vivek; Shostrom, Valerie K.; Zhen, Weining

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 institutionsmore » 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.« less

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.

PubMed

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%, 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). 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.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kato, Shingo, E-mail: s_kato@saitama-med.ac.jp; National Institute of Radiological Sciences of Japan, Chiba; Ohno, Tatsuya

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 evaluatedmore » 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.« less

Medical Library Association

MedlinePlus

... CST, Fri Nov 10th, 2017 Harlingen, Texas Metadata Transformation Librarian Updated 9:27AM CDT, Wed Nov 1st, ... 05 PM Characteristics of multi-institutional health sciences education research: a systematic review Posted on: October 2, ...

Statistical monitoring of data quality and consistency in the Stomach Cancer Adjuvant Multi-institutional Trial Group Trial.

PubMed

Timmermans, Catherine; Doffagne, Erik; Venet, David; Desmet, Lieven; Legrand, Catherine; Burzykowski, Tomasz; Buyse, Marc

2016-01-01

Data quality may impact the outcome of clinical trials; hence, there is a need to implement quality control strategies for the data collected. Traditional approaches to quality control have primarily used source data verification during on-site monitoring visits, but these approaches are hugely expensive as well as ineffective. There is growing interest in central statistical monitoring (CSM) as an effective way to ensure data quality and consistency in multicenter clinical trials. CSM with SMART™ uses advanced statistical tools that help identify centers with atypical data patterns which might be the sign of an underlying quality issue. This approach was used to assess the quality and consistency of the data collected in the Stomach Cancer Adjuvant Multi-institutional Trial Group Trial, involving 1495 patients across 232 centers in Japan. In the Stomach Cancer Adjuvant Multi-institutional Trial Group Trial, very few atypical data patterns were found among the participating centers, and none of these patterns were deemed to be related to a quality issue that could significantly affect the outcome of the trial. CSM can be used to provide a check of the quality of the data from completed multicenter clinical trials before analysis, publication, and submission of the results to regulatory agencies. It can also form the basis of a risk-based monitoring strategy in ongoing multicenter trials. CSM aims at improving data quality in clinical trials while also reducing monitoring costs.

Interorganizational Collaboration in Emergency Cardiovascular Care.

PubMed

Langabeer, James R; Champagne-Langabeer, Tiffany; Helton, Jeffrey R; Segrest, Wendy; Kash, Bita; DelliFraine, Jami; Fowler, Raymond

Interorganizational collaboration management theory contends that cooperation between distinct but related organizations can yield innovation and competitive advantage to the participating organization. Yet, it is unclear if a multi-institutional collaborative can improve quality outcomes across communities. We developed a large regional collaborative network of 15 hospitals and 24 emergency medical service agencies surrounding Dallas, Texas, and collected patient-level data on treatment times for acute myocardial infarctions. Using a pre-/posttest research design, we applied median tests of differences to explore outcome changes between groups and over the 6-year period, using data extracted from participating hospital electronic health records. We analyzed temporal trends and changes in treatment times for 2302 patients with ST-elevation myocardial infarction between the pre- and posttest groups. We found a statistically significant 19-minute median reduction in the key outcome metric (total ischemic time, the time difference between the patient's first reported symptoms and the definitive opening of the artery). This represents a 10.8% community-wide improvement over time. Interorganizational collaboration focused on quality improvement can impact population health across a community. This study provides a basis for broader understanding and participation by health care organizations in multi-institutional community change efforts.

CARES: Completely Automated Robust Edge Snapper for carotid ultrasound IMT measurement on a multi-institutional database of 300 images: a two stage system combining an intensity-based feature approach with first order absolute moments

NASA Astrophysics Data System (ADS)

Molinari, Filippo; Acharya, Rajendra; Zeng, Guang; Suri, Jasjit S.

2011-03-01

The carotid intima-media thickness (IMT) is the most used marker for the progression of atherosclerosis and onset of the cardiovascular diseases. Computer-aided measurements improve accuracy, but usually require user interaction. In this paper we characterized a new and completely automated technique for carotid segmentation and IMT measurement based on the merits of two previously developed techniques. We used an integrated approach of intelligent image feature extraction and line fitting for automatically locating the carotid artery in the image frame, followed by wall interfaces extraction based on Gaussian edge operator. We called our system - CARES. We validated the CARES on a multi-institutional database of 300 carotid ultrasound images. IMT measurement bias was 0.032 +/- 0.141 mm, better than other automated techniques and comparable to that of user-driven methodologies. Our novel approach of CARES processed 96% of the images leading to the figure of merit to be 95.7%. CARES ensured complete automation and high accuracy in IMT measurement; hence it could be a suitable clinical tool for processing of large datasets in multicenter studies involving atherosclerosis.pre-

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

PubMed

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.

Benign Breast Disease: Toward Molecular Prediction of Breast Cancer Risk

DTIC Science & Technology

2006-06-01

with benign breast disease ( BBD ) (1967-1991); 2) the application of potential biomarkers of risk to this archival tissue set; and 3) the discovery...of new, potentially relevant biomarkers of risk in fresh and frozen specimens of BBD . The Center includes a multi-institutional team of basic...State). I. Task 1: Establish Retrospective Cohort of BBD and Nested Case-Control Study A. Complete cohort follow-up We provide here an update of

Final Technical Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Glasser, Alan H.

Final technical report on DE-SC0016106. This is the final technical report for a portion of the multi-institutional CEMM project. This report is centered around 3 publications and a seminar presentation, which have been submitted to E-Link.

Progress on Establishing the Feasibility of Lead Slowing Down Spectroscopy for Direct Measurement of Plutonium in Used Fuel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kulisek, Jonathan A.; Anderson, Kevin K.; Bowyer, Sonya M.

2012-07-19

Developing a method for the accurate, direct, and independent assay of the fissile isotopes in bulk materials (such as used fuel) of next-generation domestic nuclear fuel cycles is a goal of the Office of Nuclear Energy, Fuel Cycle R&D, Material Protection and Control Technology (MPACT) Campaign. To meet this goal, MPACT continues to support a multi-institutional collaboration to address the feasibility of Lead Slowing Down Spectroscopy (LSDS) as an active nondestructive assay method that has the potential to provide independent, direct measurement of Pu and U isotopic masses in used fuel with an uncertainty considerably lower than the approximately 10%more » typical of today’s confirmatory assay methods. An LSDS is comprised of a stack of lead (typically 1-6 m3) in which materials to be measured are placed in the lead and a pulse of neutrons is injected. The neutrons in this pulse lose energy due to inelastic and (subsequently) elastic scattering and the average energy of the neutrons decreases as the time increases by a well-defined relationship. In the interrogation energy region (~0.1-1000 eV) the neutrons have little energy spread (~30%) about the average neutron energy. Due to this characteristic, the energy of the (assay) neutrons can then be determined by measuring the time elapsed since the neutron pulse. By measuring the induced fission neutrons emitted from the used fuel, it is possible to determine isotopic-mass content by unfolding the unique structure of isotopic resonances across the interrogation energy region. This paper will present efforts on the development of time-spectral analysis algorithms, fast neutron detector advances, and validation and testing measurements.« less

Library Automation.

ERIC Educational Resources Information Center

Husby, Ole

1990-01-01

The challenges and potential benefits of automating university libraries are reviewed, with special attention given to cooperative systems. Aspects discussed include database size, the role of the university computer center, storage modes, multi-institutional systems, resource sharing, cooperative system management, networking, and intelligent…

Computing Properties of Hadrons, Nuclei and Nuclear Matter from Quantum Chromodynamics (LQCD)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Negele, John W.

Building on the success of two preceding generations of Scientific Discovery through Advanced Computing (SciDAC) projects, this grant supported the MIT component (P.I. John Negele) of a multi-institutional SciDAC-3 project that also included Brookhaven National Laboratory, the lead laboratory with P. I. Frithjof Karsch serving as Project Director, Thomas Jefferson National Accelerator Facility with P. I. David Richards serving as Co-director, University of Washington with P. I. Martin Savage, University of North Carolina with P. I. Rob Fowler, and College of William and Mary with P. I. Andreas Stathopoulos. Nationally, this multi-institutional project coordinated the software development effort that themore » nuclear physics lattice QCD community needs to ensure that lattice calculations can make optimal use of forthcoming leadership-class and dedicated hardware, including that at the national laboratories, and to exploit future computational resources in the Exascale era.« less

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

USGS Publications Warehouse

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.

Pediatric American College of Surgeons National Surgical Quality Improvement Program: feasibility of a novel, prospective assessment of surgical outcomes.

PubMed

Raval, Mehul V; Dillon, Peter W; Bruny, Jennifer L; Ko, Clifford Y; Hall, Bruce L; Moss, R Lawrence; Oldham, Keith T; Richards, Karen E; Vinocur, Charles D; Ziegler, Moritz M

2011-01-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) provides validated assessment of surgical outcomes. This study reports initiation of an ACS NSQIP Pediatric at 4 children's hospitals. From October 2008 to June 2009, 121 data variables were prospectively collected for 3315 patients, including 30-day outcomes and tailoring the ACS NSQIP methodology to children's surgical specialties. Three hundred seven postoperative complications/occurrences were detected in 231 patients representing 7.0% of the study population. Of the patients with complications, 175 (75.7%) had 1, 39 (16.9%) had 2, and 17 (7.4%) had 3 or more complications. There were 13 deaths (0.39%) and 14 intraoperative occurrences (0.42%) detected. The most common complications were infection, 105 (34%) (SSI, 54; sepsis, 31; pneumonia, 13; urinary tract infection, 7); airway/respiratory events, 27 (9%); wound disruption, 18 (6%); neurologic events, 8 (3%) (nerve injury, 4; stroke/vascular event, 2; hemorrhage, 2); deep vein thrombosis, 3 (<1%); renal failure, 3 (<1%); and cardiac events, 3 (<1%). Current sampling captures 17.5% of cases across institutions with unadjusted complication rates ranging from 6.8% to 10.2%. Completeness of data collection for all variables exceeded 95% with 98% interrater reliability and 87% of patients having full 30-day follow-up. These data represent the first multiinstitutional prospective assessment of specialty-specific surgical outcomes in children. The ACS NSQIP Pediatric is poised for institutional expansion and future development of risk-adjusted models. Copyright © 2011 Elsevier Inc. All rights reserved.

Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study.

PubMed

Lavery, Hugh J; Thaly, Rahul; Albala, David; Ahlering, Thomas; Shalhav, Arieh; Lee, David; Fagin, Randy; Wiklund, Peter; Dasgupta, Prokar; Costello, Anthony J; Tewari, Ashutosh; Coughlin, Geoff; Patel, Vipul R

2008-09-01

Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity as a treatment option for prostate cancer. As a new technology, little is known regarding the reliability of the da Vinci robotic system. Intraoperative robotic equipment malfunction may force the surgeon to convert the procedure to an open or pure laparoscopic procedure, or possibly even abort the procedure. We report the first large-scale, multi-institutional review of robotic equipment malfunction. A questionnaire was designed to evaluate the rate of perioperative robotic malfunction during RALP. High-volume, experienced surgeons were asked to complete this evaluation based on the analysis of their data. Questions included the overall number of RALPs performed, the number of equipment malfunctions, the number of procedures that had to be converted or aborted, and the part of the robotic system that malfunctioned. Eleven institutions participated in the study with a median surgeon volume of 700 cases, accounting for a total case volume of 8240. Critical failure occurred in 34 cases (0.4%) leading to the cancellation of 24 cases prior to the procedure, and the conversion to two laparoscopic and eight open procedures. The most common components of the robot to malfunction were the arms and optical system. Critical robotic equipment malfunction is extremely rare in institutions that perform high volumes of RALPs, with a nonrecoverable malfunction rate of only 0.4%.

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

PubMed

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 < 0.05). Compared to perineal single-cuff 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.

Development of an International Canine Spinal Cord Injury observational registry: a collaborative data-sharing network to optimize translational studies of SCI.

PubMed

Moore, Sarah A; Zidan, Natalia; Spitzbarth, Ingo; Nout-Lomas, Yvette S; Granger, Nicolas; da Costa, Ronaldo C; Levine, Jonathan M; Jeffery, Nick D; Stein, Veronika M; Tipold, Andrea; Olby, Natasha J

2018-05-23

Prospective cross-sectional cohort study. The canine spontaneous model of spinal cord injury (SCI) is as an important pre-clinical platform as it recapitulates key facets of human injury in a naturally occurring context. The establishment of an observational canine SCI registry constitutes a key step in performing epidemiologic studies and assessing the impact of therapeutic strategies to enhance translational research. Further, accumulating information on dogs with SCI may contribute to current "big data" approaches to enhance understanding of the disease using heterogeneous multi-institutional, multi-species datasets from both pre-clinical and human studies. Multiple veterinary academic institutions across the United States and Europe. Common data elements recommended for experimental and human SCI studies were reviewed and adapted for use in a web-based registry, to which all dogs presenting to member veterinary tertiary care facilities were prospectively entered over ~1 year. Analysis of data accumulated during the first year of the registry suggests that 16% of dogs with SCI present with severe, sensorimotor-complete injury and that 15% of cases are seen by a tertiary care facility within 8 h of injury. Similar to the human SCI population, 34% were either overweight or obese. Severity of injury and timing of presentation suggests that neuroprotective studies using the canine clinical model could be conducted efficiently using a multi-institutional approach. Additionally, pet dogs with SCI experience similar comorbidities to people with SCI, in particular obesity, and could serve as an important model to evaluate the effects of this condition.

American Zoo and Aquarium Association Multi-Institutional Research Project.

ERIC Educational Resources Information Center

Dierking, Lynn D.

2001-01-01

Summarizes the results of a literature review of the level of conservation-related knowledge, attitudes, affect, and behavior among visitors to zoos and aquariums. Includes some details of the pilot project related to the literature review. (DDR)

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.

PubMed

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.

An imaging informatics-based system to support animal studies for treating pain in spinal cord injury utilizing proton-beam radiotherapy

NASA Astrophysics Data System (ADS)

Verma, Sneha K.; Liu, Brent J.; Gridley, Daila S.; Mao, Xiao W.; Kotha, Nikhil

2015-03-01

In previous years we demonstrated an imaging informatics system designed to support multi-institutional research focused on the utilization of proton radiation for treating spinal cord injury (SCI)-related pain. This year we will demonstrate an update on the system with new modules added to perform image processing on evaluation data using immunhistochemistry methods to observe effects of proton therapy. The overarching goal of the research is to determine the effectiveness of using the proton beam for treating SCI-related neuropathic pain as an alternative to invasive surgical lesioning. The research is a joint collaboration between three major institutes, University of Southern California (data collection/integration and image analysis), Spinal Cord Institute VA Healthcare System, Long Beach (patient subject recruitment), and Loma Linda University and Medical Center (human and preclinical animal studies). The system that we are presenting is one of its kind which is capable of integrating a large range of data types, including text data, imaging data, DICOM objects from proton therapy treatment and pathological data. For multi-institutional studies, keeping data secure and integrated is very crucial. Different kinds of data within the study workflow are generated at different stages and different groups of people who process and analyze them in order to see hidden patterns within healthcare data from a broader perspective. The uniqueness of our system relies on the fact that it is platform independent and web-based which makes it very useful in such a large-scale study.

WE-G-BRB-02: The Role of Program Project Grants in Study of 3D Conformal Therapy, Dose Escalation and Motion Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fraass, B.

2015-06-15

Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01-type and P01-type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue-guided dose escalation and motion management will be described. An overview willmore » be provided regarding how these technological innovations have been applied to multi-institutional NIH-sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy. Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH-funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi-institutional clinical trials NIH.« less

CPTAC Team Releases Targeted Proteomic Assays for Ovarian Cancer | Office of Cancer Clinical Proteomics Research

Cancer.gov

Pacific Northwest National Laboratory (PNNL) investigators in the Clinical Proteomic Tumor Analysis Consortium (CPTAC) of the National Cancer Institute (NCI), announces the public release of 98 targeted mass spectrometry-based assays for ovarian cancer research studies.  Chosen based on proteogenomic observations from the recently published multi-institutional collaborative project between PNNL and Johns Hopkins University that comprehensively examined the collections of proteins in the tumors of ovarian cancer patients (highlighted in a paper in

A multi-institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students.

PubMed

Multak, Nina; Newell, Karen; Spear, Sherrie; Scalese, Ross J; Issenberg, S Barry

2015-06-01

Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population. This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments. Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly. This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.

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

PubMed

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 <1 year old commonly had alterations in the shape and density of the mandibular condyle. Older 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.

Medical Student Perceptions of the Learning Environment: Learning Communities Are Associated With a More Positive Learning Environment in a Multi-Institutional Medical School Study.

PubMed

Smith, Sunny D; Dunham, Lisette; Dekhtyar, Michael; Dinh, An; Lanken, Paul N; Moynahan, Kevin F; Stuber, Margaret L; Skochelak, Susan E

2016-09-01

Many medical schools have implemented learning communities (LCs) to improve the learning environment (LE) for students. The authors conducted this study to determine whether a relationship exists between medical student perceptions of the LE and presence of LCs during the preclerkship years. Students from 24 schools participating in the American Medical Association Learning Environment Study completed the 17-item Medical Student Learning Environment Survey (MSLES) at the end of their first and second years of medical school between 2011 and 2013. Mean total MSLES scores and individual item scores at the end of the first and second years in schools with and without LCs were compared with t tests, and effect sizes were calculated. Mixed-effects longitudinal models were used to control for student demographics and random school and student effects on the relationship between LC status and MSLES score. A total of 4,980 students (81% of 6,148 matriculants) from 18 schools with LCs and 6 without LCs participated. Mean [SD] MSLES scores were significantly higher in LC schools compared with non-LC schools at the end of year one (3.72 [0.44] versus 3.57 [0.43], P < .001) and year two (3.69 [0.49] versus 3.42 [0.54], P < .001). The effect size increased from 0.35 (small) at the end of year one to 0.53 (medium) at the end of year two. This large multi-institutional cohort study found that LCs at medical schools were associated with more positive perceptions of the LE by preclerkship students.

FNL Scientists Introduce Concept That Could Help the Immune System Respond to Vaccines | FNLCR Staging

Cancer.gov

Scientists have discovered an efficient and straightforward model to manipulate RNA nanoparticles, a new concept that could help trigger desirable activation of the immune system with vaccines and therapies. A multi-institutional team of researchers

Incorporating Inland Port Strategies Into TXDOT Planning: an Implementation Manual

DOT National Transportation Integrated Search

2005-07-01

In the year 2000 the Texas Department of Transportation (TxDOT) commissioned a research project (0-4083) on the growth of inland ports along transportation corridors in Texas and the United States. This project was staffed by a multi-institutional te...

Multi-institutional oncogenic driver mutation analysis in lung adenocarcinoma: The Lung Cancer Mutation Consortium experience

PubMed Central

Dias-Santagata, Dora; Wistuba, Ignacio I.; Chen, Heidi; Fujimoto, Junya; Kugler, Kelly; Franklin, Wilbur A.; Iafrate, A. John; Ladanyi, Marc; Kris, Mark G.; Johnson, Bruce E.; Bunn, Paul A.; Minna, John D.; Kwiatkowski, David J.

2015-01-01

Introduction Molecular genetic analyses of lung adenocarcinoma have recently become standard of care for treatment selection. The Lung Cancer Mutation Consortium was formed to enable collaborative multi-institutional analyses of 10 potential oncogenic driver mutations. Technical aspects of testing, and clinicopathologic correlations are presented. Methods Mutation testing in at least one of 8 genes (EGFR, KRAS, ERBB2, AKT1, BRAF, MEK1, NRAS, PIK3CA) using SNaPshot, mass spectrometry, Sanger sequencing +/− PNA and/or sizing assays, along with ALK and/or MET FISH were performed in 6 labs on 1007 patients from 14 institutions. Results 1007 specimens had mutation analysis performed, and 733 specimens had all 10 genes analyzed. Mutation identification rates did not vary by analytic method. Biopsy and cytology specimens were inadequate for testing in 26% and 35% of cases compared to 5% of surgical specimens. Among the 1007 cases with mutation analysis performed, EGFR, KRAS, ALK, and ERBB2 alterations were detected in 22, 25, 8.5, and 2.4% of cases, respectively. EGFR mutations were highly associated with female sex, Asian race, and never smoking status; and less strongly associated with stage IV disease, presence of bone metastases, and absence of adrenal metastases. ALK rearrangements were strongly associated with never smoking status, and more weakly associated with presence of liver metastases. ERBB2 mutations were strongly associated with Asian race and never smoking status. Two mutations were seen in 2.7% of samples, all but one of which involved one or more of PIK3CA, ALK or MET. Conclusion Multi-institutional molecular analysis across multiple platforms, sample types, and institutions can yield consistent results and novel clinicopathological observations. PMID:25738220

Identifying predictors of hospital readmission following congenital heart surgery through analysis of a multiinstitutional administrative Database.

PubMed

Smith, Andrew H; Doyle, Thomas P; Mettler, Bret A; Bichell, David P; Gay, James C

2015-01-01

Despite resource burdens associated with hospital readmission, there remains little multiinstitutional data available to identify children at risk for readmission following congenital heart surgery. Children undergoing congenital heart surgery and discharged home between January of 2011 and December 2012 were identified within the Pediatric Health Information System database, a multiinstitutional collection of clinical and administrative data. Patient discharges were assigned to derivation and validation cohorts for the purposes of predictive model design, with 17 871 discharges meeting inclusion criteria. Readmission within 30 days was noted following 956 (11%) of discharges within the derivation cohort (n = 9104), with a median time to readmission of 9 days (interquartile range [IQR] 5-18 days). Readmissions resulted in a rehospitalization length of stay of 4 days (IQR 2-8 days) and were associated with an intensive care unit (ICU) admission in 36% of cases. Independent perioperative predictors of readmission included Risk Adjustment in Congenital Heart Surgery score of 6 (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.8-3.7, P < .001) and ICU length of stay of at least 7 days (OR 1.9 95% CI 1.6-2.2, P < .001). Demographic predictors included Hispanic ethnicity (OR 1.2, 95% CI 1.1-1.4, P = .014) and government payor status (OR 1.2, 95% CI 1.1-1.4, P = .007). Predictive model performance was modest among validation cohort (c statistic 0.68, 95% CI 0.66-0.69, P < .001). Readmissions following congenital heart surgery are common and associated with significant resource consumption. While we describe independent predictors that may identify patients at risk for readmission prior to hospital discharge, there likely remains other unreported factors that may contribute to readmission following congenital heart surgery. © 2014 Wiley Periodicals, Inc.

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

USDA-ARS?s Scientific Manuscript database

Federal investments by U.S. agencies to enhance climate resilience at regional scales have grown dramatically over the last five years. This leads to questions about how best to leverage existing agency-specific research, infrastructure, and capacity while avoiding redundancy. This article discusses...

Large-scale standardized phenotyping of strawberry in RosBREED

USDA-ARS?s Scientific Manuscript database

A large, multi-institutional, international, research project with the goal of bringing genomicists and plant breeders together was funded by USDA-NIFA Specialty Crop Research Initiative. Apple, cherry, peach, and strawberry are the Rosaceous crops included in the project. Many (900+) strawberry g...

Redesigning Technology Integration into World Language Education

ERIC Educational Resources Information Center

Rodríguez, Julio C.

2018-01-01

This article describes how a multi-institutional, proficiency-based program engages stakeholders in design thinking to discover and explore solutions to perennial problems in technology integration into world language education (WLE). Examples of replicable activities illustrate the strategies used to fuel innovation efforts, including fostering…

ECOSYSTEM MODELING IN COBSCOOK BAY, MAINE:A SUMMARY, PERSPECTIVE, AND LOOK FORWARD

EPA Science Inventory

In the mid-1990s, an interdisciplinary, multi-institutional team of scientists was assembled to address basic issues concerning biological productivity and the unique co-occurrence of many unusual ecological features in Cobscook Bay, Maine. Cobscook Bay is a geologically complex,...

Toward Data-Driven Radiology Education-Early Experience Building Multi-Institutional Academic Trainee Interpretation Log Database (MATILDA).

PubMed

Chen, Po-Hao; Loehfelm, Thomas W; Kamer, Aaron P; Lemmon, Andrew B; Cook, Tessa S; Kohli, Marc D

2016-12-01

The residency review committee of the Accreditation Council of Graduate Medical Education (ACGME) collects data on resident exam volume and sets minimum requirements. However, this data is not made readily available, and the ACGME does not share their tools or methodology. It is therefore difficult to assess the integrity of the data and determine if it truly reflects relevant aspects of the resident experience. This manuscript describes our experience creating a multi-institutional case log, incorporating data from three American diagnostic radiology residency programs. Each of the three sites independently established automated query pipelines from the various radiology information systems in their respective hospital groups, thereby creating a resident-specific database. Then, the three institutional resident case log databases were aggregated into a single centralized database schema. Three hundred thirty residents and 2,905,923 radiologic examinations over a 4-year span were catalogued using 11 ACGME categories. Our experience highlights big data challenges including internal data heterogeneity and external data discrepancies faced by informatics researchers.

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

PubMed

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.

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’

PubMed Central

Classe, J. M.; Baffert, S.; Sigal-Zafrani, B.; Fall, M.; Rousseau, C.; Alran, S.; Rouanet, P.; Belichard, C.; Mignotte, H.; Ferron, G.; Marchal, F.; Giard, S.; Tunon de Lara, C.; Le Bouedec, G.; Cuisenier, J.; Werner, R.; Raoust, I.; Rodier, J.-F.; Laki, F.; Colombo, P.-E.; Lasry, S.; Faure, C.; Charitansky, H.; Olivier, J.-B.; Chauvet, M.-P.; Bussières, E.; Gimbergues, P.; Flipo, B.; Houvenaeghel, G.; Dravet, F.; Livartowski, A.

2012-01-01

Background: Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. Patients and methods: We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. Results: Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€2947 (σ = 580) versus €3331 (σ = 902); P = 0.0001]. Conclusion: ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources. PMID:21896543

A Multi-Institutional Analysis of the Socioeconomic Determinants of Breast Reconstruction

PubMed Central

Christian, Caprice K.; Niland, Joyce; Edge, Stephen B.; Ottesen, Rebecca A.; Hughes, Melissa E.; Theriault, Richard; Wilson, John; Hergrueter, Charles A.; Weeks, Jane C.

2006-01-01

Objective: To determine the rate of postmastectomy reconstruction and investigate the impact of socioeconomic status on the receipt of reconstruction. Summary Background Data: The National Comprehensive Cancer Network (NCCN) Outcomes Project is a prospective, multi-institutional database that contains data on all newly diagnosed breast cancer patients treated at one of the participating comprehensive cancer centers. Methods: The study cohort consisted of 2174 patients with DCIS and stage I, II, and III invasive breast cancer who underwent mastectomy at one of 8 NCCN centers. Rates of reconstruction were determined. Logistic regression analyses were used to evaluate whether socioeconomic characteristics are associated with breast reconstruction. Results: Overall, 42% of patients had breast reconstruction following mastectomy. Patients with Medicaid and Medicare were less likely to undergo reconstruction than those with managed care insurance; however, there was no difference for indemnity versus managed care insurance. Homemakers and retired patients had fewer reconstructions than those employed outside the home. Patients with a high school education or less were less likely to have reconstruction than those with more education. Race and ethnicity were not significant predictors of reconstruction. Conclusions: The reconstruction rate in this study (42%) is markedly higher than those previously reported. The type of insurance, education level, and employment status of a patient, but not her race or ethnicity, appear to influence the use of breast reconstruction. Because all patients were treated at an NCCN institution, these socioeconomic differences cannot be explained by access to care. PMID:16432358

Remote Versus Local Forcing of Chlorophyll Variability in the South Atlantic Bight

NASA Technical Reports Server (NTRS)

Signorini, Sergio R.; McClain, Charles R.

2006-01-01

This TM documents results of analyses addressing the local versus remote forcing of chlorophyll variability on the shelf and slope regions of the South Atlantic Bight (SAB) based on satellite-derived products and a limited amount of in situ data. This study is part of a larger multi-disciplinary, multi-institutional effort to study the Eastern U.S. Continental Shelf carbon budget (U.S. Eastern Continental Shelf Carbon Budget: Modeling, Data Assimilation, and Analysis, U.S. ECoS), a project funded by the NASA Earth System Enterprise Interdisciplinary Science Program that started in the summer of 2004.

SU-E-T-49: A Multi-Institutional Study of Independent Dose Verification for IMRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baba, H; Tachibana, H; Kamima, T

2015-06-15

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 radiologicalmore » 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%.« less

SU-F-T-494: A Multi-Institutional Study of Independent Dose Verification Using Golden Beam Data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Itano, M; Yamazaki, T; Tachibana, R

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,more » 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)« less

Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma.

PubMed

Martin, Robert C G; McFarland, Kelli; Ellis, Susan; Velanovich, Vic

2012-09-01

Locally advanced pancreatic cancer patients have limited options for disease control. Local ablation technologies based on thermal damage have been used but are associated with major complications in this region of the pancreas. Irreversible electroporation (IRE) is a nonthermal ablation technology that we have shown is safe near vital vascular and ductal structures. The aim of this study was to evaluate the safety and efficacy of IRE as a therapy in the treatment of locally advanced pancreatic cancer. We performed a prospective multi-institutional pilot evaluation of patients undergoing IRE for locally advanced pancreatic cancer from December 2009 to March 2011. These patients were evaluated for 90-day morbidity, mortality, and local disease control. Twenty-seven patients (13 women and 14 men) underwent IRE, with median age of 61 years (range 45 to 80 years). Eight patients underwent margin accentuation with IRE in combination with left-sided resection (n = 4) or pancreatic head resection (n = 4). Nineteen patients had in situ IRE. All patients underwent successful IRE, with intraoperative imaging confirming effective delivery of therapy. All 27 patients demonstrated nonclinically relevant elevation of their amylase and lipase, which peaked at 48 hours and returned to normal at 72 hour postprocedure. There has been one 90-day mortality. No patient has shown evidence of clinical pancreatitis or fistula formation. After all patients have completed 90-day follow-up, there has been 100% ablation success. IRE ablation of locally advanced pancreatic cancer tumors is a safe and feasible primary local treatment in unresectable, locally advanced disease. Confirming these early results must occur in a planned phase II investigational device exemption (IDE) study to be initiated in 2012. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Recurrence patterns and survival endpoints in women with stage II uterine endometrioid carcinoma: a multi-institution study.

PubMed

Elshaikh, Mohamed A; Al-Wahab, Zaid; Mahdi, Haider; Albuquerque, Kevin; Mahan, Meredith; Kehoe, Siobhan M; Ali-Fehmi, Rouba; Rose, Peter G; Munkarah, Adnan R

2015-02-01

There is paucity of data in regard to prognostic factors and outcome of women with 2009 FIGO stage II disease. The objective of this study was to investigate prognostic factors, recurrence patterns and survival endpoints in this group of patients. Data from four academic institutions were analyzed. 130 women were identified with 2009 FIGO stage II. All patients underwent hysterectomy, oophorectomy and lymph node evaluation with or without pelvic and paraaortic lymph node dissections and peritoneal cytology. The Kaplan-Meier approach and Cox regression analysis were used to estimate recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). Median follow-up was 44months. 120 patients (92%) underwent simple hysterectomy, 78% had lymph node dissection and 95% had peritoneal cytology examination. 99 patients (76%) received adjuvant radiation treatment (RT). 5-year RFS, DSS and OS were 77%, 90%, and 72%, respectively. On multivariate analysis of RFS, adjuvant RT, the presence of lymphovascular space invasion (LVSI) and high tumor grades were significant predictors. For DSS, LVSI and high tumor grades were significant predictors while older age and high tumor grade were the only predictors of OS. In this multi-institutional study, disease-specific survival for women with FIGO stage II uterine endometrioid carcinoma is excellent. High tumor grade, lymphovascular space invasion, adjuvant radiation treatment and old age are important prognostic factors. There was no significant difference in the outcome between patients who received vaginal cuff brachytherapy compared to those who received pelvic external beam radiation treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

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

PubMed Central

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 <10 cm3. Overall, neurological and qualitative survivals (OS, NS, QS) of cases with >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

Definitive salvage radiation therapy and chemoradiation therapy for lymph node oligo-recurrence of esophageal cancer: a Japanese multi-institutional study of 237 patients.

PubMed

Yamashita, Hideomi; Jingu, Keiichi; Niibe, Yuzuru; Katsui, Kuniaki; Matsumoto, Toshihiko; Nishina, Tomohiro; Terahara, Atsuro

2017-02-20

This study evaluated the treatment results of lymph node (LN) oligo-recurrence in esophageal cancer patients treated with salvage radiotherapy (RT) in a multi-institutional retrospective study. Eligibility criteria for this retrospective analysis were: the primary lesion of esophageal cancer was controlled; from one to five LN recurrences; total RT dose ≥45 Gy to exclude palliative RT; without recurrence other than LN; and salvage RT for LN recurrence was given between January 2000 and April 2015. The median follow-up time for the 93 living patients was 29.6 months. Two hundred thirty-seven patients were matched in five hospitals. The 3-year overall survival (OS) was 37%, local control was 45%, progression-free survival was 24%, and esophageal cancer-specific survival was 42%. On univariate analysis for OS, combined chemotherapy (p = 0.000055), disease-free interval (DFI) ≥12 months (p = 0.0013), LN max diameter ≤22 mm (p = 0.0052), and Karnofsky performance status ≥80% (p = 0.030) were associated with a significantly better prognosis. On multivariate analysis, significant differences were seen for combined chemotherapy (p = 0.000018), DFI (p = 0.0027), and LN max diameter (p = 0.018). LN oligo-recurrence following treatment for esophageal cancer was not a terminal-stage event. Moreover, cure may be possible by chemoradiation therapy with a long DFI (≥12 months) and small size (≤22 mm).

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, B; Pang, D; Kusters, M

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 amore » 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 generate plans of comparable quality in a multi-institutional setting. Variations in clinical protocols can be effectively addressed for cross-institutional adaptations. Binbin Wu and Todd McNutt are the co-inventors of a patent associated with the proposed knowledge-based planning system which was licensed to Varian Medical Systems in 2015; This research was in part supported by Philips Radiation Oncology Systems.« less

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.

PubMed

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 <3 cups/day) was associated with a significantly lower OR for high plasma glucose (OR = 0.51, 95% CI 0.28-0.93). Green tea consumption was not associated with the prevalence of metabolic syndrome or any of its components. Coffee consumption was 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.

FNL Scientists Introduce Concept That Could Help the Immune System Respond to Vaccines | Frederick National Laboratory for Cancer Research

Cancer.gov

Scientists have discovered an efficient and straightforward model to manipulate RNA nanoparticles, a new concept that could help trigger desirable activation of the immune system with vaccines and therapies. A multi-institutional team of researchers

Opportunities across Boundaries: Lessons from a Collaboratively Delivered Cross-Institution Master's Programme

ERIC Educational Resources Information Center

de Róiste, Mairéad; Breetzke, Gregory; Reitsma, Femke

2015-01-01

Advances in technology have created opportunities for collaborative multi-institution programme delivery which are increasingly attractive within a constrained financial environment. This paper details the development of a cross-institution collaboratively delivered masters and postgraduate diploma programme in Geographical Information Science in…

Addressing the Global Burden of Breast Cancer

Cancer.gov

The US National Cancer Institute’s Center for Global Health (CGH) has been a key partner in a multi-institutional expert team that has developed a set of publications to address foundational concerns in breast cancer care across the cancer care continuum and within limited resource settings.

The Changing Medical Care System: Some Implications for Medical Education.

ERIC Educational Resources Information Center

Foreman, Spencer

1986-01-01

The medical care system is undergoing widespread and significant changes. Individual hospitals may be disappearing as mergers, acquisitions, and a variety of multi-institutional arrangements become the dominant form and as a host of free-standing medical enterprises spread out into the community. (MLW)

Automated Student Aid Processing: The Challenge and Opportunity.

ERIC Educational Resources Information Center

St. John, Edward P.

1985-01-01

To utilize automated technology for student aid processing, it is necessary to work with multi-institutional offices (student aid, admissions, registration, and business) and to develop automated interfaces with external processing systems at state and federal agencies and perhaps at need-analysis organizations and lenders. (MLW)

Collaborative Graduate Education across Multiple Campuses

ERIC Educational Resources Information Center

Thompson, J. R.; Hess, G. R.; Bowman, T. A.; Magnusdottir, H.; Stubbs-Gipson, C. E.; Groom, M.; Miller, J. R.; Steelman, T. A.; Stokes, D. L.

2009-01-01

Multi-institutional approaches to graduate education continue to emerge as a way to better prepare students for collaborative work. In this article, we describe a graduate course designed to investigate application of conservation biology principles by local land use planners. "Where is Conservation Science in Local Planning?" was…

Supporting Working-Class Students in Higher Education

ERIC Educational Resources Information Center

Soria, Krista; Bultmann, Mark

2014-01-01

Utilizing data from the multi-institutional "Student Experience in the Research University" survey, we examined self-identified working-class students' experiences in higher education. The results suggest that working-class students experience a lower sense of belonging, perceive a less welcoming campus climate, and pursue fewer social…

Is VATS lobectomy standard of care for operable non-small cell lung cancer?

PubMed

Vannucci, Fernando; Gonzalez-Rivas, Diego

2016-10-01

Video-Assisted Thoracic Surgery (VATS) for treatment of lung cancer is being increasingly applied worldwide in the last few years. Since its introduction, many publications have been providing strong evidences that this minimally invasive approach is feasible, safe and oncologically efficient; offering to patients several advantages over traditional open thoracotomy, particularly for early-stage disease (I and II). The application of VATS for locally advanced disease treatment has also been largely described, but probably requires a further level of experience, which is more likely to be found in reference centers, with skilled experts. Although a large multi-institutional prospective randomized-controlled trial is the best way to confirm the superiority of one technique over another, such study comparing VATS versus open lobectomy for lung cancer is unlikely to ever come out. And in this scenario, retrospective data remains as the most reliable source of scientific information. Based on a literature review, the main objective of this article is to discuss to what extent VATS lobectomy can be considered the gold standard in the surgical treatment of lung cancer, taking into account the most important comparison aspects between the minimally invasive approach and open thoracotomy technique. This review addresses questions regarding lymph node dissection, oncologic efficacy, extended resections beyond standard lobectomy, post-operative complications/pain/quality of life, survival rates and the present limits of indication (and contraindication) for VATS, in order to define the real role of this technique on the surgical treatment of lung cancer in a minimally invasive, but safe and effective manner. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Librarians in Evidence-Based Medicine Curricula: A Qualitative Study of Librarian Roles, Training, and Desires for Future Development.

PubMed

Maggio, Lauren A; Durieux, Nancy; Tannery, Nancy H

2015-01-01

This study aims to describe librarians' roles in evidence-based medicine (EBM) from the librarian perspective, identify how librarians are trained to teach, and highlight preferences for professional development. A multiinstitution qualitative study was conducted. Nine medical librarians identified by their faculty as integrated into EBM training were interviewed. Participants' descriptions indicated that they were active in curriculum development, deployment (including teaching activities), and assessment to support EBM. Participants identified direct experience and workshop participation as primary methods of learning to teach. Participants desired continuing development as teachers and requested opportunities for in-person workshops, shadowing physicians, and online training.

Outcomes and healthcare utilization in children and young adults with aplastic anemia: A multiinstitutional analysis.

PubMed

Gupta, Ashish; Fu, Pingfu; Hashem, Hasan; Vatsayan, Anant; Shein, Steven; Dalal, Jignesh

2017-12-01

Aplastic anemia is a bone marrow failure syndrome with high mortality affecting children and young adults. Although current treatment guidelines recommend hematopoietic stem cell transplant (HCT) for patients with matched sibling donors, outcomes with alternate donor options have been improving. We analyzed a validated multiinstitutional pediatric cohort using one of the largest pediatric and young adult database, the Pediatric Health Information System, for patients diagnosed with aplastic anemia (AA) from 2006 to 2015. Outcomes with upfront and salvage transplants were analyzed along with healthcare utilization. Among 2,169 patients in the study period, almost 20% underwent HCT, while others received immunosuppressive therapy. In a multivariate model, there was no significant difference in mortality with upfront or salvage transplants (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.6-2.58, P = 0.567), while every platelet transfusion was associated with higher mortality (OR 1.37, 95% CI 1.12-1.67, P = 0.002). Healthcare utilization was significantly higher in salvage transplants requiring frequent hospitalization and transfusion requirements. Treatment mortality and graft failure rates were significantly reduced in the salvage transplant group in recent years (2011-2015 as compared to 2006-2010). As outcomes with HCT continue to improve in severe AA, transplant with good alternate donors should be considered upfront in children and young adults. © 2017 Wiley Periodicals, Inc.

Deep seismic sounding in northern Eurasia

USGS Publications Warehouse

Benz, H.M.; Unger, J.D.; Leith, W.S.; Mooney, W.D.; Solodilov, L.; Egorkin, A.V.; Ryaboy, V.Z.

1992-01-01

For nearly 40 years, the former Soviet Union has carried out an extensive program of seismic studies of the Earth's crust and upper mantle, known as “Deep Seismic Sounding” or DSS [Piwinskii, 1979; Zverev and Kosminskaya, 1980; Egorkin and Pavlenkova, 1981; Egorkin and Chernyshov, 1983; Scheimer and Borg, 1985]. Beginning in 1939–1940 with a series of small-scale seismic experiments near Moscow, DSS profiling has broadened into a national multiinstitutional exploration effort that has completed almost 150,000 km of profiles covering all major geological provinces of northern Eurasia [Ryaboy, 1989].

Project SYNERGY: Software Support for Underprepared Students. Software Implementation Report.

ERIC Educational Resources Information Center

Anandam, Kamala; And Others

Miami-Dade Community College's (MDCC's) implementation and assessment of computer software as a part of Project SYNERGY, a multi-institutional project funded by the International Business Machines (IBM) Corporation designed to seek technological solutions for helping students underprepared in reading, writing and mathematics, is described in this…

Social Science Methods Used in the RESTORE Project

Treesearch

Lynne M. Westphal; Cristy Watkins; Paul H. Gobster; Liam Heneghan; Kristen Ross; Laurel Ross; Madeleine Tudor; Alaka Wali; David H. Wise; Joanne Vining; Moira Zellner

2014-01-01

The RESTORE (Rethinking Ecological and Social Theories of Restoration Ecology) project is an interdisciplinary, multi-institutional research endeavor funded by the National Science Foundation's Dynamics of Coupled Natural Human Systems program. The goal of the project is to understand the links between organizational type, decision making processes, and...

Premature mortality in the U.S.-- trends by race, ethnicity, age, and region

Cancer.gov

DCEG scientists are spearheading the Premature Mortality Project—an interdisciplinary, multi-institutional effort to characterize U.S. trends in premature mortality. In the process, the team has uncovered distinct mortality trends by race, ethnicity, age, and region, and provided crucial information about the ongoing,

Community-Based Research Networks: Development and Lessons Learned in an Emerging Field.

ERIC Educational Resources Information Center

Stoecker, Randy; Ambler, Susan H.; Cutforth, Nick; Donohue, Patrick; Dougherty, Dan; Marullo, Sam; Nelson, Kris S.; Stutts, Nancy B.

2003-01-01

Compares seven multi-institutional community-based research networks in Appalachia; Colorado; District of Columbia; Minneapolis-St. Paul; Philadelphia; Richmond, Virginia; and Trenton, New Jersey. After reviewing the histories of the networks, conducts a comparative SWOT analysis, showing their common and unique strengths, weaknesses,…

Project Triple E Update: A Multi-Institution Implementation of a Faculty Support System.

ERIC Educational Resources Information Center

Robinson Group, Ltd., Tempe, AZ.

Project "Triple E" is cooperative endeavor initiated by The Robinson Group and International Business Machines, involving six community colleges in efforts to "empower" faculty by increasing access to information about, and communication with, students; to increase faculty "efficiency" by automating record keeping; and to enhance faculty…

Enhancing Mathematics (STEM) Teacher Education in Regional Australia: Pedagogical Interactions and Affect

ERIC Educational Resources Information Center

Woolcott, Geoff; Yeigh, Tony

2015-01-01

This article reports on initial findings, including the mathematics components, of a multi-institutional Science, Technology, Engineering, and Mathematics (STEM) project, "It's part of my life: Engaging university and community to enhance science and mathematics education." This project is focussed on improving the scientific and…

The nitrogen footprint tool network: a multi-institution program to reduce nitrogen pollution

EPA Science Inventory

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...

Training a New Generation of Biostatisticians: A Successful Consortium Model

ERIC Educational Resources Information Center

Simpson, Judy M.; Ryan, Philip; Carlin, John B.; Gurrin, Lyle; Marschner, Ian

2009-01-01

In response to the worldwide shortage of biostatisticians, Australia has established a national consortium of eight universities to develop and deliver a Masters program in biostatistics. This article describes our successful innovative multi-institutional training model, which may be of value to other countries. We first present the issues…

The VLAB OER Experience: Modeling Potential-Adopter Student Acceptance

ERIC Educational Resources Information Center

Raman, Raghu; Achuthan, Krishnashree; Nedungadi, Prema; Diwakar, Shyam; Bose, Ranjan

2014-01-01

Virtual Labs (VLAB) is a multi-institutional Open Educational Resources (OER) initiative, exclusively focused on lab experiments for engineering education. This project envisages building a large OER repository, containing over 1650 virtual experiments mapped to the engineering curriculum. The introduction of VLAB is a paradigm shift in an…

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

ERIC Educational Resources Information Center

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,…

Correction to: Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements.

PubMed

Hu, Eric M; Zhang, Andrew; Silverman, Stuart G; Pedrosa, Ivan; Wang, Zhen J; Smith, Andrew D; Chandarana, Hersh; Doshi, Ankur; Shinagare, Atul B; Remer, Erick M; Kaffenberger, Samuel D; Miller, David C; Davenport, Matthew S

2018-05-16

The original version of this article contained an error in author name. The co-author's name was published as Ivan M. Pedrosa, instead it should be Ivan Pedrosa. The original article has been corrected.

Community College Student Success: What Institutional Characteristics Make a Difference?

ERIC Educational Resources Information Center

Calcagno, Juan Carlos; Bailey, Thomas; Jenkins, Davis; Kienzl, Gregory; Leinbach, Timothy

2008-01-01

Most of the models developed to examine student persistence and attainment in postsecondary education largely fail to account for the influence of institutional factors, particularly when attendance is observed at multiple institutions. Multi-institutional attendance is common for students who begin at a community college, but until now an…

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

PubMed Central

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

A randomized multi-institutional crossover comparison of the GlideScope® Cobalt Video laryngoscope to the flexible fiberoptic bronchoscope in a Pierre Robin manikin.

PubMed

Fiadjoe, John E; Hirschfeld, Matthew; Wu, Stephan; Markley, James; Gurnaney, Harshad; Jawad, Abbas F; Stricker, Paul; Kilbaugh, Todd; Ross, Patrick; Kovatsis, Pete

2015-08-01

The GlideScope Cobalt Video laryngoscope is being used more often in children with challenging laryngoscopy. There are, however, no pediatric trials comparing it to flexible fiberoptic bronchoscopy, the current accepted gold standard. This preliminary manikin study compares the first-attempt intubation success of the GlideScope Cobalt video laryngoscope to the flexible fiberoptic bronchoscope when performed by attending pediatric anesthesiologists at two major pediatric centers. This prospective randomized, crossover study evaluated 120 attempts (60 with each study device) to intubate the AirSim Pierre Robin manikin (PRM) with fiberoptic bronchoscopy and video laryngoscopy (VL). Attending pediatric anesthesiologists from two quaternary pediatric centers were eligible to participate. Each attending anesthesiologist randomly performed a single tracheal intubation attempt with one of the study devices followed by the alternate method. The primary outcome was the first-attempt success rate of tracheal intubation. Blinding was not feasible. We hypothesized that first-attempt success would be higher with fiberoptic bronchoscopy. Thirty anesthesiologists from each center were randomized to use one of the study devices followed by the alternate method. We analyzed all participants' data. There was no overall difference in first-attempt success between VL and fiberoptic bronchoscopy (88.3% vs 85% respectively, P = 0.59). There were significant institutional differences in first-attempt success using VL (76.7% vs 100%). There was no difference in first-attempt success of tracheal intubation using VL vs fiberoptic bronchoscopy when performed by attending anesthesiologists at two large pediatric centers. However, institutional differences exist in success rates with VL across the two centers. Results from single-center device evaluations should be verified by multi-center evaluations. A significant proportion of attending anesthesiologists lack experience with advanced airway devices; targeted education may enhance intubation success and patient safety. © 2015 John Wiley & Sons Ltd.

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

PubMed

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 clinical trial is to assess the impact of audiovisual biofeedback on breathing motion, the patient experience and clinical confidence in the system, clinical workflow, treatment margins, and toxicity outcomes. This clinical trial marks an important milestone in breathing guidance studies as it will be the first randomised, controlled trial providing the most comprehensive evaluation of the clinical impact of breathing guidance on cancer radiation therapy to date. This study is powered to determine the impact of AV biofeedback on breathing regularity and medical image quality. Objectives such as determining the indications and contra-indications for the use of AV biofeedback, evaluation of patient experience, radiation toxicity occurrence and severity, and clinician confidence will shed light on the design of future phase III clinical trials. This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), its trial ID is ACTRN12613001177741 .

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Romesser, Paul B.; Cahlon, Oren; ProCure Proton Therapy Center, Somerset, New Jersey

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 toxicitiesmore » 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 (9.9%), dysphagia (9.1%), esophagitis (9.1%), and dermatitis (3.3%). There was 1 death during PBRT due to disease progression. Grade 3 or greater late skin and dysphagia toxicities were noted in 6 patients (8.7%) and 4 patients (7.1%), respectively. Two patients had grade 5 toxicity due to treatment-related bleeding. Conclusions: Proton beam re-RT of the head and neck can provide effective tumor control with acceptable acute and late toxicity profiles likely because of the decreased dose to the surrounding normal, albeit previously irradiated, tissue, although longer follow-up is needed to confirm these findings.« less

Examination of high-antibiotic users in a multi-institutional cohort of CRS patients

PubMed Central

Ramakrishnan, Vijay R.; Mace, Jess C.; Soler, Zachary M.; Smith, Timothy L.

2016-01-01

Background In addition to known concerns regarding antibiotic overuse, recent research indicates that excessive antibiotic use is associated with poorer long-term health. Given that rhinosinusitis is the leading condition accounting for antibiotic prescriptions in the ambulatory setting, we aimed to evaluate characteristics associated with greater antibiotic use in CRS. Methods Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study evaluating treatment outcomes were included in this analysis. Study participants were asked to report the number of days out of the previous 90 days that systemic antibiotics were taken for sinus disease. Patient demographics, disease characteristics, and measures of disease severity were evaluated. Results 561 patients from 4 institutions were included in the analysis, with mean antibiotic use of 17.4 +/−22.4 out of the prior 90 days. No differences between antibiotic-use groups were found for objective measures of disease severity (CT, endoscopy, BSIT scores), however, increased patient-reported symptom burden (SNOT-22, RSDI) was associated with more antibiotic use. Patients reporting the most antibiotic use were older (p=0.004) but no ethnic or gender differences were seen. Comorbid diagnoses of allergy, asthma, diabetes, depression, or fibromyalgia, were not associated with increased antibiotic use. In accordance with literature recommendations, CRSwNP patients were less likely to have used antibiotics. ESS significantly decreased antibiotic use. Conclusion Variability in antibiotic use in CRS appears to be driven by symptom burden, independent of objective measures of disease severity, patient demographics, and presence of comorbid disease. Clear guidelines are essential to define appropriate antibiotic use in CRS. PMID:28084683

How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study.

PubMed

Sheu, Leslie; O'Sullivan, Patricia S; Aagaard, Eva M; Tad-Y, Darlene; Harrell, Heather E; Kogan, Jennifer R; Nixon, James; Hollander, Harry; Hauer, Karen E

2016-10-01

Although residents trust interns to provide patient care, little is known about how trust forms. Using a multi-institutional mixed-methods study design, the authors interviewed (March-September 2014) internal medicine (IM) residents in their second or third postgraduate year at a single institution to address how they develop trust in interns. Transcript analysis using grounded theory yielded a model for resident trust. Authors tested (January-March 2015) the model with residents from five IM programs using a two-section quantitative survey (38 items; 31 rated 0 = not at all to 100 = very much; 7 rated 0 = strongly disagree to 100 = strongly agree) to identify influences on how residents form trust. Qualitative analysis of 29 interviews yielded 14 themes within five previously identified factors of trust (resident, intern, relationship, task, and context). Of 478 residents, 376 (78.7%) completed the survey. Factor analysis yielded 11 factors that influence trust. Respondents rated interns' characteristics (reliability, competence, and propensity to make errors) highest when indicating importance to trust (respective means 86.3 [standard deviation = 9.7], 76.4 [12.9], and 75.8 [20.0]). They also rated contextual factors highly as influencing trust (access to an electronic medical record, duty hours, and patient characteristics; respective means 79.8 [15.3], 73.1 [14.4], and 71.9 [20.0]). Residents form trust based on primarily intern- and context-specific factors. Residents appear to consider trust in a way that prioritizes interns' execution of essential patient care tasks safely within the complexities and constraints of the hospital environment.

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

PubMed

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 < 0.05). Some barriers were common to both environments, but a few were unique to each setting. Organized by percentage of severity of interference, cultural values/beliefs about 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 < 0.05. There are significant differences in perceived barriers and degree of prohibitive factors to cancer 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

Multi-Institutional Study of Women and Underrepresented Minority Faculty Members in Academic Pharmacy

PubMed Central

Spivey, Christina A.; Billheimer, Dean; Schlesselman, Lauren S.; Flowers, Schwanda K.; Hammer, Dana; Engle, Janet P.; Nappi, Jean M.; Pasko, Mary T.; Ann Ross, Leigh; Sorofman, Bernard; Rodrigues, Helena A.; Vaillancourt, Allison M.

2012-01-01

Objectives. To examine trends in the numbers of women and underrepresented minority (URM) pharmacy faculty members over the last 20 years, and determine factors influencing women faculty members’ pursuit and retention of an academic pharmacy career. Methods. Twenty-year trends in women and URM pharmacy faculty representation were examined. Women faculty members from 9 public colleges and schools of pharmacy were surveyed regarding demographics, job satisfaction, and their academic pharmacy career, and relationships between demographics and satisfaction were analyzed. Results. The number of women faculty members more than doubled between 1989 and 2009 (from 20.7% to 45.5%), while the number of URM pharmacy faculty members increased only slightly over the same time period. One hundred fifteen women faculty members completed the survey instrument and indicated they were generally satisfied with their jobs. The academic rank of professor, being a nonpharmacy practice faculty member, being tenured/tenure track, and having children were associated with significantly lower satisfaction with fringe benefits. Women faculty members who were tempted to leave academia for other pharmacy sectors had significantly lower salary satisfaction and overall job satisfaction, and were more likely to indicate their expectations of academia did not match their experiences (p<0.05). Conclusions. The significant increase in the number of women pharmacy faculty members over the last 20 years may be due to the increased number of female pharmacy graduates and to women faculty members’ satisfaction with their careers. Lessons learned through this multi-institutional study and review may be applicable to initiatives to improve recruitment and retention of URM pharmacy faculty members. PMID:22412206

Validation of the Survey of Pre-Service Teachers' Knowledge of Teaching and Technology: A Multi-Institutional Sample

ERIC Educational Resources Information Center

Ritzhaupt, Albert D.; Huggins-Manley, Anne Corinne; Ruggles, Krista; Wilson, Matthew

2016-01-01

The TPACK (technological pedagogical content knowledge) framework (Mishra & Koehler, 2006) has gained tremendous momentum from within the educational technology community. Specifically, much discourse has focused on how to measure this multidimensional construct to further define the contours of the framework and potentially make some…

Project WISE: Building STEM-Focused Youth-Programs that Serve the Community

ERIC Educational Resources Information Center

DiLisi, Gregory A.; McMillin, Keith A.; Virostek, Margaret E.

2011-01-01

We describe the design and implementation of Project WISE, a multi-institutional partnership that assembles interdisciplinary teams of undergraduate and high school students charged with developing STEM-focused community youth-programs. Our goal is twofold: (i.) to promote young women's interest in STEM-oriented careers through an early, positive…

A Model Food Entrepreneur Assistance and Education Program: The Northeast Center for Food Entrepreneurship

ERIC Educational Resources Information Center

Cranwell, Michele R.; Kolodinsky, Jane M.; Donnelly, Catherine W.; Downing, Donald L.; Padilla-Zakour, Olga I.

2005-01-01

The Northeast Center for Food Entrepreneurship (NECFE) is a collaborative effort between Cornell Univ. and the Univ. of Vermont. NECFE uses a multi-institutional and regional collaboration approach, with specific expertise and necessary facilities and resources, to provide technical assistance and education for businesses in the food industry. The…

The Computer Science Technical Report (CS-TR) Project: A Pioneering Digital Library Project Viewed from a Library Perspective.

ERIC Educational Resources Information Center

Anderson, Greg; And Others

1996-01-01

Describes the Computer Science Technical Report Project, one of the earliest investigations into the system engineering of digital libraries which pioneered multiinstitutional collaborative research into technical, social, and legal issues related to the development and implementation of a large, heterogeneous, distributed digital library. (LRW)

Science 101: An Integrated, Inquiry-Oriented Science Course for Education Majors

ERIC Educational Resources Information Center

Edgcomb, Michelle; Britner, Shari L.; McConnaughay, Kelly; Wolffe, Robert

2008-01-01

Science 101 was designed by a multidisciplinary, multi-institutional team, with leadership from the Departments of Biology and Teacher Education, and participation by faculty in the Departments of Chemistry, Physics, and Mathematics, the College of Engineering, and master teachers from school districts in the state of Illinois. Their goal was to…

The Impact of Being a Resident Assistant on Intercultural Effectiveness and and Socially Responsible Leadership Development during College

ERIC Educational Resources Information Center

Martin, Georgianna L.; Blechschmidt, Sally

2014-01-01

The developmental benefits of being a resident Assistant include several positive educational outcomes. This article explores the effects of being a resident assistant on intercultural effectiveness and socially responsible leadership over four years of college. This is a quantitative, longitudinal, multi-institutional exploration employing…

"Try to See It My Way": What Influences Social Perspective Taking among College Students?

ERIC Educational Resources Information Center

Johnson, Matthew R.; Dugan, John P.; Soria, Krista M.

2017-01-01

The ability to understand and incorporate other perspectives into one's own perspective is an important overarching outcome of higher education and a necessary precursor for the development of most higher-order learning outcomes. Utilizing a multi-institutional survey of 21,548 college seniors, we examined background characteristics and…

Motivation Filtering on a Multi-Institution Assessment of General College Outcomes

ERIC Educational Resources Information Center

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…

Bringing a needle to a laser fight: comparing greenhouse gas sampling methods with gas chromatography and fourier transform infrared spectroscopy

USDA-ARS?s Scientific Manuscript database

As scientists, producers, policymakers, and the general public become more concerned about impacts of climate change, there is an increasing need to understand and quantify greenhouse gas emissions from agricultural practices, which often feed into global, multi-institution databases. Current best p...

Using Enrollment Data to Predict Retention Rate

ERIC Educational Resources Information Center

Bingham, Melissa A.; Solverson, Natalie Walleser

2016-01-01

First- to second-year retention rates are one metric reported by colleges and universities to convey institutional success to a variety of external constituents. But how much of a retention rate is institutional inputs, and how much can be understood by examining student inputs? The authors utilize multi-year, multi-institutional data to examine…

A Coordinated Approach to Peach SNP Discovery in RosBREED

USDA-ARS?s Scientific Manuscript database

In the USDA-funded multi-institutional and trans-disciplinary project, “RosBREED”, crop-specific SNP genome scan platforms are being developed for peach, apple, strawberry, and cherry at a resolution of at least one polymorphic SNP marker every 5 cM in any random cross, for use in Pedigree-Based Ana...

A Multi-Institution Exploration of Secondary Socialization and Occupational Identity among Undergraduate Music Majors

ERIC Educational Resources Information Center

Austin, James R.; Isbell, Daniel S.; Russell, Joshua A.

2012-01-01

Researchers are increasingly interested in the psychological and sociological processes by which college students develop competence and confidence as musicians. We surveyed 454 undergraduate music majors enrolled in one of three NASM-accredited music schools in the US. Participants completed a questionnaire that addressed beliefs about…

Major Decisions: Motivations for Selecting a Major, Satisfaction, and Belonging

ERIC Educational Resources Information Center

Soria, Krista M.; Stebleton, Michael

2013-01-01

In this paper, we analyzed the relationship between students' motivations for choosing academic majors and their satisfaction and sense of belonging on campus. Based on a multi-institutional survey of students who attended large, public, research universities in 2009, the results suggest that external extrinsic motivations for selecting a major…

Multi-institutional arrangements: relationships between governing boards and hospital chief executive officers.

PubMed

Alexander, J; Morlock, L L

1985-02-01

This investigation focuses on the impact of multi-institutional arrangements on the role of governing boards in limiting or enhancing the managerial autonomy of individual hospitals. Data from a 1979 Special Survey by the American Hospital Association (N = 4213) are used to examine governing board-administrator relationships as a function of the degree of autonomy and scope of responsibility of the hospital governing board. It is hypothesized that governing boards responsible for multiple hospitals or for multiple nonhospital organizations and those boards accountable to a higher organizational authority will exercise more formal control over hospital chief executive officers (CEOs) than will boards of single or autonomous hospitals. The analysis assumes that formal control by the governing board over the management function of the individual hospital is exercised partly through soliciting or limiting participation by hospital administrators in key policy decisions and through the evaluation of administrative performance. Therefore, it is anticipated that hospitals governed by boards with multiple responsibilities as well as hospitals governed by boards accountable to a higher authority will be (1) less likely to have CEOs who are members of the governing board executive committee, (2) more likely to have annual performance reviews of the CEO by the governing board, and (3) more likely to have such reviews conducted according to preestablished criteria. Study results provide general support for the hypotheses with respect to hospital boards with multiple responsibilities: the data suggest that such boards do exercise greater control over hospital administrators and these effects do appear to be stronger for hospitals in the private sector. Hospitals governed by boards accountable to a higher authority, however, are more likely to have CEOs who are members of the governing board executive committee--a pattern in direct opposition to that hypothesized. Furthermore, these boards are no more likely to conduct annual CEO performance reviews than are boards with more autonomy. Boards accountable to higher authorities are more likely, however, to use preestablished criteria when such reviews are conducted. This general pattern is similar whether hospital boards are accountable to religious authorities, to investor-owned corporate boards, or to the boards of not-for-profit multi-institutional systems. A different pattern emerges, however, for boards accountable to a state, county, or local government authority.(ABSTRACT TRUNCATED AT 400 WORDS)

Multi-institutional arrangements: relationships between governing boards and hospital chief executive officers.

PubMed Central

Alexander, J; Morlock, L L

1985-01-01

This investigation focuses on the impact of multi-institutional arrangements on the role of governing boards in limiting or enhancing the managerial autonomy of individual hospitals. Data from a 1979 Special Survey by the American Hospital Association (N = 4213) are used to examine governing board-administrator relationships as a function of the degree of autonomy and scope of responsibility of the hospital governing board. It is hypothesized that governing boards responsible for multiple hospitals or for multiple nonhospital organizations and those boards accountable to a higher organizational authority will exercise more formal control over hospital chief executive officers (CEOs) than will boards of single or autonomous hospitals. The analysis assumes that formal control by the governing board over the management function of the individual hospital is exercised partly through soliciting or limiting participation by hospital administrators in key policy decisions and through the evaluation of administrative performance. Therefore, it is anticipated that hospitals governed by boards with multiple responsibilities as well as hospitals governed by boards accountable to a higher authority will be (1) less likely to have CEOs who are members of the governing board executive committee, (2) more likely to have annual performance reviews of the CEO by the governing board, and (3) more likely to have such reviews conducted according to preestablished criteria. Study results provide general support for the hypotheses with respect to hospital boards with multiple responsibilities: the data suggest that such boards do exercise greater control over hospital administrators and these effects do appear to be stronger for hospitals in the private sector. Hospitals governed by boards accountable to a higher authority, however, are more likely to have CEOs who are members of the governing board executive committee--a pattern in direct opposition to that hypothesized. Furthermore, these boards are no more likely to conduct annual CEO performance reviews than are boards with more autonomy. Boards accountable to higher authorities are more likely, however, to use preestablished criteria when such reviews are conducted. This general pattern is similar whether hospital boards are accountable to religious authorities, to investor-owned corporate boards, or to the boards of not-for-profit multi-institutional systems. A different pattern emerges, however, for boards accountable to a state, county, or local government authority.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3972592

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

PubMed

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.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takahashi, R; Kamima, T; Tachibana, H

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 sitesmore » (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.« less

Diffuse malignant peritoneal mesothelioma: Evaluation of systemic chemotherapy with comprehensive treatment through the RENAPE Database: Multi-Institutional Retrospective Study.

PubMed

Kepenekian, V; Elias, D; Passot, G; Mery, E; Goere, D; Delroeux, D; Quenet, F; Ferron, G; Pezet, D; Guilloit, J M; Meeus, P; Pocard, M; Bereder, J M; Abboud, K; Arvieux, C; Brigand, C; Marchal, F; Classe, J M; Lorimier, G; De Chaisemartin, C; Guyon, F; Mariani, P; Ortega-Deballon, P; Isaac, S; Maurice, C; Gilly, F N; Glehen, O

2016-09-01

Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). All groups (NA: n = 42; ADJ: n = 16; PO: n = 16; NoC: n = 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P = 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P = 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07-4.94; P = 0.033). This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adjuvant Chemoradiation Therapy for Pancreatic Adenocarcinoma: Who Really Benefits?

PubMed Central

Merchant, Nipun B; Rymer, Jennifer; Koehler, Elizabeth AS; Ayers, G Daniel; Castellanos, Jason; Kooby, David A; Weber, Sharon H; Cho, Clifford S; Schmidt, C Max; Nakeeb, Atilla; Matos, Jesus M; Scoggins, Charles R; Martin, Robert CG; Kim, Hong Jin; Ahmad, Syed A; Chu, Carrie K; McClaine, Rebecca; Bednarski, Brian K; Staley, Charles A; Sharp, Kenneth; Parikh, Alexander A

2014-01-01

BACKGROUND The role of adjuvant chemoradiation therapy (CRT) in pancreatic cancer remains controversial. The primary aim of this study was to determine if CRT improved survival in patients with resected pancreatic cancer in a large, multiinstitutional cohort of patients. STUDY DESIGN Patients undergoing resection for pancreatic adenocarcinoma from seven academic medical institutions were included. Exclusion criteria included patients with T4 or M1 disease, R2 resection margin, preoperative therapy, chemotherapy alone, or if adjuvant therapy status was unknown. RESULTS There were 747 patients included in the initial evaluation. Primary analysis was performed between patients that had surgery alone (n = 374) and those receiving adjuvant CRT (n = 299). Median followup time was 12.2 months and 14.5 months for survivors. Median overall survival for patients receiving adjuvant CRT was significantly longer than for those undergoing operation alone (20.0 months versus 14.5 months, p = 0.001). On subset and multivariate analysis, adjuvant CRT demonstrated a significant survival advantage only among patients who had lymph node (LN)-positive disease (hazard ratio 0.477, 95% CI 0.357 to 0.638) and not for LN-negative patients (hazard ratio 0.810, 95% CI 0.556 to 1.181). Disease-free survival in patients with LN-negative disease who received adjuvant CRT was significantly worse than in patients who had surgery alone (14.5 months versus 18.6 months, p = 0.034). CONCLUSIONS This large multiinstitutional study emphasizes the importance of analyzing subsets of patients with pancreas adenocarcinoma who have LN metastasis. Benefit of adjuvant CRT is seen only in patients with LN-positive disease, regardless of resection margin status. CRT in patients with LN-negative disease may contribute to reduced disease-free survival. PMID:19476845

The Stillbirth Classification System for the Safe Passage Study: Incorporating Mechanism, Etiology, and Recurrence

PubMed Central

Boyd, Theonia K.; Wright, Colleen A.; Odendaal, Hein J.; Elliott, Amy J.; Sens, Mary Ann; Folkerth, Rebecca D.; Roberts, Drucilla J.; Kinney, Hannah C.

2017-01-01

OBJECTIVE Describe the classification system for the assignment of the cause of death for stillbirth in the Safe Passage Study, an international, multi-institutional, prospective analysis conducted by the NIAAA/NICHD funded PASS Network (The Prenatal Alcohol in SIDS and Stillbirth (PASS) Research Network). The study mission is to determine the role of prenatal alcohol and/or cigarette smoke exposure in adverse pregnancy outcomes, including stillbirth, in a high-risk cohort of 12,000 maternal/fetal dyads. METHODS The PASS Network classification system is based upon 5 ‘sites of origin’ for cause of stillbirth (Fetal, Placental, Maternal, External/Environmental, or Undetermined), further subdivided into mechanism subcategories (e.g., Placental Perfusion Failure). Both site of origin and mechanism stratification are employed to assign an ultimate cause of death. Each PASS stillbirth (n=19) in the feasibility study was assigned a cause of death, and status of sporadic versus recurrent. Adjudication involved review of the maternal and obstetrical records, and fetal autopsy and placental findings, with complete consensus in each case. Two published classification systems, i.e., INCODE and ReCoDe, were used for comparison. RESULTS Causes of stillbirth classified were: fetal (n=5, 26%), placental (n=10, 53%), external (n=1, 5%), and undetermined (n=3, 16%). Nine cases (47%) had placental causes of death due to maternal disorders that carry recurrence risks. There was complete agreement for the cause of death across the three classification systems in 26% of cases, and a combination of partial or complete agreement in 68% of cases. Complete vs. partial agreements were predicated upon the classification schemes used for comparison. CONCLUSIONS The proposed PASS system is a user-friendly classification system that provides comparable information to previously published systems. Advantages include its simplicity, mechanistic formulations, tight clinicopathologic integration, provision for an undetermined category, and its wide applicability for use by perinatal mortality review boards with access to information routinely collected during clinicopathologic evaluations. PMID:27116324

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

PubMed

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. Published by Elsevier Inc. All rights reserved.

Grad Students Talk: Development and Process of a Student-Led Social Justice Initiative

ERIC Educational Resources Information Center

Lantz, Melanie M.; Fix, Rebecca L.; Davis, Brittan L.; Harrison, Leighna N.; Oliver, Ashley; Crowell, Candice; Mitchell, Amanda M.; García, James J.

2016-01-01

College student activism has long been a staple of campus life, often driven by the sociopolitical issues of the time. In response to recent and continuous violent deaths of members of the Black community, rising instances of overt racism, and perceived silence among our institutes and professional groups, a multiinstitutional and diverse…

Leading at the Coal-Face: The World as Experienced by Subject Coordinators in Australian Higher Education

ERIC Educational Resources Information Center

Holt, Dale; Cohen, Lynne; Campbell-Evans, Glenda; Chang, Paul; Macdonald, Ian; McDonald, Jacquie

2013-01-01

This article is based on nationally funded research into the role, capabilities, challenges and professional development needs of subject coordinators in Australian higher education. The second of three data collection phases involved a multi-institutional survey of staff in the role of subject coordinator with the aim of understanding the role…

Participation in a Multi-Institutional Curriculum Development Project Changed Science Faculty Knowledge and Beliefs about Teaching Science

ERIC Educational Resources Information Center

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…

Berkeley Lab Scientist Co-Leads Breast Cancer Dream Team

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gray, Joe

2009-05-19

An $16.5 million, three-year grant to develop new and more effective therapies to fight breast cancer was awarded today to a multi-institutional Dream Team of scientists and clinicians that is co-led by Joe Gray, a renowned cancer researcher with the U.S. Department of Energys Lawrence Berkeley National Laboratory. http://newscenter.lbl.gov/

Berkeley Lab Scientist Co-Leads Breast Cancer Dream Team

ScienceCinema

Gray, Joe

2017-12-27

An $16.5 million, three-year grant to develop new and more effective therapies to fight breast cancer was awarded today to a multi-institutional Dream Team of scientists and clinicians that is co-led by Joe Gray, a renowned cancer researcher with the U.S. Department of Energys Lawrence Berkeley National Laboratory. http://newscenter.lbl.gov/

Multiple Paths to Success: Degree Completion of 4-Year Starters Taking Various Pathways

ERIC Educational Resources Information Center

Li, Dai

2016-01-01

With the use of data from the institutional research office at a comprehensive public 4-year university, this chapter describes an in-depth analysis of the institutional attendance, transfer, and graduation of three first-time student cohorts, revealing that not all types of multi-institutional attendance hurt degree completion, and strategic…

Prevention educational program of human rabies transmitted by bats in rain forest preserved area of southern Brazilian coast.

PubMed

Kikuti, M; Paploski, I A D; Silva, M d C P; de Oliveira, E A; da Silva, A W C; Biondo, A W

2011-12-01

Guaraqueçaba city is a rain forest environmental protected area located on the southern coast of Brazil. Recently, the local Animal Health Service has noticed haematophagous bats feeding from humans and domestic animals, as well as bat colonies located in houses and public schools. In 2007, two non-haematophagous bats were tested positive by direct immunofluorescence for rabies in a nearby city. Native fauna and environmental laws protect non-haematophagous bats in Brazilian preserved areas such as Guaraqueçaba, making non-haematophagous bat population control almost impossible. Accordingly, the aim of this study was to evaluate a simple and feasible educational protocol applied by a multi-institutional task force in local elementary schools to prevent rabies transmitted by bats. Information was transmitted to children by video, lectures and oral question-answer section; evaluation was made by written questionnaires to teachers and students. Interinstitutional task force included public and animal health public services, a federal university and the city secretary of environment, of education, of agriculture and of animal health, and also participation of local community. Information was effectively absorbed by children when evaluated just after being given. As important, questionnaires showed that handling and playing with bats at day time was common in several elementary school students, exposing themselves to what may represent higher risk of rabies transmission than haematophagous bat feeding directly from humans. Training of teachers and students may effectively prevent rabies by bats in such communities. Insertion of this subject into science content of local elementary school educational programme was proposed in order to establish a continuing education programme on rabies transmitted by bats in environmental preserved areas. © 2011 Blackwell Verlag GmbH.

Phase II double-blind placebo-controlled randomized study of armodafinil for brain radiation-induced fatigue

PubMed Central

Page, Brandi R.; Shaw, Edward G.; Lu, Lingyi; Bryant, David; Grisell, David; Lesser, Glenn J.; Monitto, Drew C.; Naughton, Michelle J.; Rapp, Stephen R.; Savona, Steven R.; Shah, Sunjay; Case, Doug; Chan, Michael D.

2015-01-01

Background Common acute-term side effects of brain radiotherapy (RT) include fatigue, drowsiness, decreased physical functioning, and decreased quality of life (QOL). We hypothesized that armodafinil (a wakefulness-promoting drug known to reduce fatigue and increase cognitive function in breast cancer patients receiving chemotherapy) would result in reduced fatigue and sleepiness for patients receiving brain RT. Methods A phase II, multi-institutional, placebo-controlled randomized trial assessed feasibility of armodafinil 150 mg/day in participants receiving brain RT, from whom we obtained estimates of variability for fatigue, sleepiness, QOL, cognitive function, and treatment effect. Results From September 20, 2010, to October 20, 2012, 54 participants enrolled with 80% retention and 94% self-reported compliance. There were no grade 4–5 toxicities, and the incidence of grade 2–3 toxicities was similar between treatment arms, the most common of which were anxiety and nausea (15%), headaches (19%), and insomnia (20%). There were no statistically significant differences in end-RT or 4 week post-RT outcomes between armodafinil and placebo in any outcomes (Functional Assessment of Chronic Illness Therapy [FACIT]-Fatigue, Brief Fatigue Inventory, Epworth Sleepiness Scale, FACT-Brain, and FACIT-cognitive function). However, in participants with more baseline fatigue, those treated with armodafinil did better than those who received the placebo on the end-RT assessments for several outcomes. Conclusion Armodafinil 150 mg/day was well tolerated in primary brain tumor patients undergoing RT with good compliance. While there was no overall significant effect on fatigue, those with greater baseline fatigue experienced improved QOL and reduced fatigue when using armodafinil. These data suggest that a prospective, phase III randomized trial is warranted for patients with greater baseline fatigue. PMID:25972454

CogState computerized memory tests in patients with brain metastases: secondary endpoint results of NRG Oncology RTOG 0933.

PubMed

Caine, Chip; Deshmukh, Snehal; Gondi, Vinai; Mehta, Minesh; Tomé, Wolfgang; Corn, Benjamin W; Kanner, Andrew; Rowley, Howard; Kundapur, Vijayananda; DeNittis, Albert; Greenspoon, Jeffrey Noah; Konski, Andre A; Bauman, Glenn S; Raben, Adam; Shi, Wenyin; Wendland, Merideth; Kachnic, Lisa

2016-01-01

Whole brain radiotherapy (WBRT) is associated with memory dysfunction. As part of NRG Oncology RTOG 0933, a phase II study of WBRT for brain metastases that conformally avoided the hippocampal stem cell compartment (HA-WBRT), memory was assessed pre- and post-HA-WBRT using both traditional and computerized memory tests. We examined whether the computerized tests yielded similar findings and might serve as possible alternatives for assessment of memory in multi-institution clinical trials. Adult patients with brain metastases received HA-WBRT to 30 Gy in ten fractions and completed Hopkins Verbal Learning Test-Revised (HVLT-R), CogState International Shopping List Test (ISLT) and One Card Learning Test (OCLT), at baseline, 2 and 4 months. Tests' completion rates were 52-53 % at 2 months and 34-42 % at 4 months. All baseline correlations between HVLT-R and CogState tests were significant (p ≤ 0.003). At baseline, both CogState tests and one component of HVLT-R differentiated those who were alive at 6 months and those who had died (p ≤ 0.01). At 4 months, mean relative decline was 7.0 % for HVLT-R Delayed Recall and 18.0 % for ISLT Delayed Recall. OCLT showed an 8.0 % increase. A reliable change index found no significant changes from baseline to 2 and 4 months for ISLT Delayed Recall (z = -0.40, p = 0.34; z = -0.68, p = 0.25) or OCLT (z = 0.15, p = 0.56; z = 0.41, p = 0.66). Study findings support the possibility that hippocampal avoidance may be associated with preservation of memory test performance, and that these computerized tests also may be useful and valid memory assessments in multi-institution adult brain tumor trials.

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

PubMed

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.

A multi-institutional study of independent calculation verification in inhomogeneous media using a simple and effective method of heterogeneity correction integrated with the Clarkson method.

PubMed

Jinno, Shunta; Tachibana, Hidenobu; Moriya, Shunsuke; Mizuno, Norifumi; Takahashi, Ryo; Kamima, Tatsuya; Ishibashi, Satoru; Sato, Masanori

2018-05-21

In inhomogeneous media, there is often a large systematic difference in the dose between the conventional Clarkson algorithm (C-Clarkson) for independent calculation verification and the superposition-based algorithms of treatment planning systems (TPSs). These treatment site-dependent differences increase the complexity of the radiotherapy planning secondary check. We developed a simple and effective method of heterogeneity correction integrated with the Clarkson algorithm (L-Clarkson) to account for the effects of heterogeneity in the lateral dimension, and performed a multi-institutional study to evaluate the effectiveness of the method. In the method, a 2D image reconstructed from computed tomography (CT) images is divided according to lines extending from the reference point to the edge of the multileaf collimator (MLC) or jaw collimator for each pie sector, and the radiological path length (RPL) of each line is calculated on the 2D image to obtain a tissue maximum ratio and phantom scatter factor, allowing the dose to be calculated. A total of 261 plans (1237 beams) for conventional breast and lung treatments and lung stereotactic body radiotherapy were collected from four institutions. Disagreements in dose between the on-site TPSs and a verification program using the C-Clarkson and L-Clarkson algorithms were compared. Systematic differences with the L-Clarkson method were within 1% for all sites, while the C-Clarkson method resulted in systematic differences of 1-5%. The L-Clarkson method showed smaller variations. This heterogeneity correction integrated with the Clarkson algorithm would provide a simple evaluation within the range of -5% to +5% for a radiotherapy plan secondary check.

Intratumoral gene expression of 5-fluorouracil pharmacokinetics-related enzymes in stage I and II non-small cell lung cancer patients treated with uracil-tegafur after surgery: a prospective multi-institutional study in Japan.

PubMed

Eguchi, Keisuke; Oyama, Takahiko; Tajima, Atsushi; Abiko, Tomohiro; Sawafuji, Makoto; Horio, Hirotoshi; Hashizume, Toshinori; Matsutani, Noriyuki; Kato, Ryoichi; Nakayama, Mitsuo; Kawamura, Masafumi; Kobayashi, Koichi

2015-01-01

This investigation was conducted to assess the use of the intratumoral mRNA expression levels of nucleic acid-metabolizing enzymes as biomarkers of adjuvant chemotherapy for non-small cell lung cancer (NSCLC) using uracil-tegafur in a multi-institutional prospective study. 236 patients with a completely resected NSCLC (adenocarcinoma and squamous cell carcinoma) of pathological stage IA (maximum tumor diameter of 2 cm or greater), IB, and II tumors were given a dose of 250 mg of uracil-tegafur per square meter of body surface area per day orally for two years after surgery. Intratumoral mRNA levels of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), and thymidine phosphorylase (TP) genes relative to an internal standard, β-actin, were determined using laser-capture microdissection and fluorescence-based real time PCR detection systems. Among 5-FU target enzymes, TS was the only one that showed a significant difference in the level of gene expression between the high and low gene expression groups, for both disease-free survival (DFS) and overall survival (OS), when patients were divided according to median values; 5-year DFS rates in high/low TS gene expression were 60.4% and 72.6%, respectively (p=0.050), 5-year OS rates were 78.1% and 88.6%, respectively (p=0.011). Cox's proportional hazard model indicated that the pathological stage and TS gene expression level were independent values for predicting DFS. The TS gene expression level was shown to be an independent predictive factor for DFS in stage I and II NSCLC patients who were treated with uracil-tegafur following surgery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Prospective multi-institutional study evaluating the performance of prostate cancer risk calculators.

PubMed

Nam, Robert K; Kattan, Michael W; Chin, Joseph L; Trachtenberg, John; Singal, Rajiv; Rendon, Ricardo; Klotz, Laurence H; Sugar, Linda; Sherman, Christopher; Izawa, Jonathan; Bell, David; Stanimirovic, Aleksandra; Venkateswaran, Vasundara; Diamandis, Eleftherios P; Yu, Changhong; Loblaw, D Andrew; Narod, Steven A

2011-08-01

Prostate cancer risk calculators incorporate many factors to evaluate an individual's risk for prostate cancer. We validated two common North American-based, prostate cancer risk calculators. We conducted a prospective, multi-institutional study of 2,130 patients who underwent a prostate biopsy for prostate cancer detection from five centers. We evaluated the performance of the Sunnybrook nomogram-based prostate cancer risk calculator (SRC) and the Prostate Cancer Prevention Trial (PCPT) -based risk calculator (PRC) to predict the presence of any cancer and high-grade cancer. We examined discrimination, calibration, and decision curve analysis techniques to evaluate the prediction models. Of the 2,130 patients, 867 men (40.7%) were found to have cancer, and 1,263 (59.3%) did not have cancer. Of the patients with cancer, 403 (46.5%) had a Gleason score of 7 or more. The area under the [concentration-time] curve (AUC) for the SRC was 0.67 (95% CI, 0.65 to 0.69); the AUC for the PRC was 0.61 (95% CI, 0.59 to 0.64). The AUC was higher for predicting aggressive disease from the SRC (0.72; 95% CI, 0.70 to 0.75) compared with that from the PRC (0.67; 95% CI, 0.64 to 0.70). Decision curve analyses showed that the SRC performed better than the PRC for risk thresholds of more than 30% for any cancer and more than 15% for aggressive cancer. The SRC performed better than the PRC, but neither one added clinical benefit for risk thresholds of less than 30%. Further research is needed to improve the AUCs of the risk calculators, particularly for higher-grade cancer.

Solitary Fibrous Tumors of the Head and Neck: A Multi-Institutional Clinicopathologic Study.

PubMed

Smith, Steven C; Gooding, William E; Elkins, Matthew; Patel, Rajiv M; Harms, Paul W; McDaniel, Andrew S; Palanisamy, Nallasivam; Uram-Tuculescu, Cora; Balzer, Bonnie B; Lucas, David R; Seethala, Raja R; McHugh, Jonathan B

2017-12-01

Solitary fibrous tumors (SFTs) of the head and neck are uncommon. Lesions previously diagnosed in the head and neck as hemangiopericytomas (HPCs), giant cell angiofibromas (GCAs), and orbital fibrous histiocytomas (OFHs) are now recognized as within the expanded spectrum of SFTs. To better understand the clinicopathologic profile of head and neck SFTs, we performed a multi-institutional study of 88 examples. There was no sex predilection (F:M ratio 1.2), and the median patient age was 52 years (range: 15 to above 89 y). The sinonasal tract and orbit were the most common sites involved (30% and 25%), followed by the oral cavity and salivary glands (15% and 14%). Original diagnoses included HPC (25%), SFT (67%), and OFH (6%), with 1 SFT and 1 OFH noted as showing GCA-like morphology. On review, the predominant histologic pattern was classic SFT-like in 53% and cellular (former HPC-like) in 47%; lipomatous differentiation (8%) and GCA-like pattern (7%) were less prevalent. Subsets demonstrated nuclear atypia (23%), epithelioid morphology (15%), or coagulative necrosis (6%). Infiltrative growth (49%) and osseous invasion (82%) were prevalent among evaluable cases. Of the 48 SFTs with follow-up (median: 43 mo), 19 showed recurrence (40%). Of these, 4 patients were alive with disease and 4 dead of disease. Size and mitotic rate were negative prognosticators using a joint prognostic proportional hazards regression model. Three patients experienced metastasis, to lungs, parotid, bone, and skull base, including one case showing overtly sarcomatous "dedifferentiation." As a group, SFTs present in a wide anatomic and morphologic spectrum in the head and neck. Only rare examples metastasize or cause death from disease. However, the fairly high local recurrence rate underscores their aggressive potential and highlights the importance of prospective recognition.

Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection.

PubMed

Beswick, Daniel M; Mace, Jess C; Soler, Zachary M; Ayoub, Noel F; Rudmik, Luke; DeConde, Adam S; Smith, Timothy L

2018-05-14

Appropriateness criteria to determine surgical candidacy for chronic rhinosinusitis (CRS) have recently been described. This study stratified patients who underwent endoscopic sinus surgery (ESS) according to these new appropriateness criteria and evaluated postoperative improvements among appropriateness categories. Adult patients with uncomplicated CRS electing ESS were prospectively enrolled in a multi-institutional cohort study between March 2011 and June 2015 to assess outcomes. Subsequently, appropriateness criteria that consider preoperative medical therapy, 22-item SinoNasal Outcome Test (SNOT-22) scores, and Lund-Mackay computed tomography scores were retrospectively applied. A total of 92.6% (436 of 471) were categorized as "appropriate" ESS candidates, 3.8% (18 of 471) as "uncertain," and 3.6% (17 of 471) as "inappropriate." Among uncertain patients, two-thirds (12 of 18) had identifiable reasons for undergoing ESS, most commonly oral corticosteroid intolerance (n = 6). Postoperative follow-up was available for 79% (n = 372). Clinically significant SNOT-22 improvements occurred in both appropriate and uncertain groups (all P < 0.050) but not among the inappropriate group. The inappropriate group reported less mean improvement in SNOT-22 total score compared to appropriate (P = 0.008) and uncertain (P = 0.006) groups. The vast majority of patients (∼93%) who underwent ESS in a multi-institutional research program were identified as appropriate candidates for surgical intervention, as defined by current appropriateness criteria. Valid considerations frequently exist for offering ESS to patients categorized as uncertain. Appropriate and uncertain candidates report similar, clinically significant SNOT-22 improvements following surgery. Patients classified as inappropriate reported significantly less improvement following ESS. Surgical appropriateness criteria may assist in predicting outcomes of ESS. 2b. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Overcoming Barriers to Public Engagement through a Multi-Institution Consortium

NASA Astrophysics Data System (ADS)

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, and research design).

Transition to surgical residency: a multi-institutional study of perceived intern preparedness and the effect of a formal residency preparatory course in the fourth year of medical school.

PubMed

Minter, Rebecca M; Amos, Keith D; Bentz, Michael L; Blair, Patrice Gabler; Brandt, Christopher; D'Cunha, Jonathan; Davis, Elisabeth; Delman, Keith A; Deutsch, Ellen S; Divino, Celia; Kingsley, Darra; Klingensmith, Mary; Meterissian, Sarkis; Sachdeva, Ajit K; Terhune, Kyla; Termuhlen, Paula M; Mullan, Patricia B

2015-08-01

To evaluate interns' perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses ("bootcamps") facilitate transition to internship. The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns' reflections. Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P < .05) with medium effect sizes. Themes identified in interns' characterizations of their greatest internship challenges included anxiety or lack of preparation related to performance of technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications. Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.

Using Systems Thinking in the Design, Implementation, and Evaluation of Complex Educational Innovations, with Examples from the InTeGrate Project

ERIC Educational Resources Information Center

Kastens, Kim A.; Manduca, Cathryn A.

2017-01-01

Many geoscience education initiatives now involve cross-departmental or multi-institutional programs. However, the geoscientists who lead such programs typically have little experience or training in program design, leadership, or evaluation. In this commentary, we make the case that geoscientists taking on these ambitious leadership roles can…

Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stinis, Panos

2016-08-07

This is the final report for the work conducted at the University of Minnesota (during the period 12/01/12-09/18/14) by PI Panos Stinis as part of the "Collaboratory on Mathematics for Mesoscopic Modeling of Materials" (CM4). CM4 is a multi-institution DOE-funded project whose aim is to conduct basic and applied research in the emerging field of mesoscopic modeling of materials.

Words Spoken with Insistence: "Wak'as" and the Limits of the Bolivian Multi-Institutional Democracy

ERIC Educational Resources Information Center

Cuelenaere, Laurence Janine

2009-01-01

Building on 18 months of fieldwork in the Bolivian highlands, this dissertation examines how traversing landscapes, through the mediation of spatial practices and spoken words, are embedded in systems of belief. By focusing on "wak'as" (i.e. sacred objects) and on how the inhabitants of the Altiplano relate to the Andean deities known as…

Student Issues in Distance Education Programs: Do Inter-institutional Programs Offer Students More Confusion or More Opportunities?

ERIC Educational Resources Information Center

Fey, Susan; Emery, Mary; Flora, Cornelia

2008-01-01

The Community Development Master's Program is an inter-institutional, trans-disciplinary degree program that began in 2005 online at five participating universities in the North Central region. This article discusses outcomes of interviews with current and past students in the program to determine if a multi-institutional program, versus a program…

Components for consideration by emerging consortia.

PubMed Central

Moulton, B

1975-01-01

The Consortium for Information Resources of the West Suburban Hospital Association in Boston is presented as one model for library cooperation. It is described in generalized terms that may be of interest to other consortia planners, rather than as a model for exact replication. Four components are discussed in detail: (1) composite resources, (2) multi-institutional environment, (3) leadership, and (4) activities. PMID:1109615

Women, Men, and Academic Performance in Science and Engineering: The Gender Difference in Undergraduate Grade Point Averages

ERIC Educational Resources Information Center

Sonnert, Gerhard; Fox, Mary Frank

2012-01-01

Using longitudinal and multi-institutional data, this article takes an innovative approach in its analyses of gender differences in grade point averages (GPA) among undergraduate students in biology, the physical sciences, and engineering over a 16-year period. Assessed are hypotheses about (a) the gender ecology of science/engineering and (b) the…

A Community-Based, Environmental Chronic Disease Prevention Intervention to Improve Healthy Eating Psychosocial Factors and Behaviors in Indigenous Populations in the Canadian Arctic

ERIC Educational Resources Information Center

Mead, Erin L.; Gittelsohn, Joel; Roache, Cindy; Corriveau, André; Sharma, Sangita

2013-01-01

Diet-related chronic diseases are highly prevalent among indigenous populations in the Canadian Arctic. A community-based, multi-institutional nutritional and lifestyle intervention--Healthy Foods North--was implemented to improve food-related psychosocial factors and behaviors among Inuit and Inuvialuit in four intervention communities (with two…

Staff and Program Development for a New Pupil Personnel Services Professional: Final Report 1.

ERIC Educational Resources Information Center

Ruch, Charles P.

This is the first in a series of final reports to the Office of Education on the Northeastern EPDA/PPS Center-Satellite Project. This multi-year, multi-institutional project was an attempt to redesign the training of pupil personnel specialists for the schools through preservice training for entry-level personnel and pre- or inservice training for…

WE-G-BRB-01: The Importance of NIH Funding in Innovation in Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Deye, J.

Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01-type and P01-type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue-guided dose escalation and motion management will be described. An overview willmore » be provided regarding how these technological innovations have been applied to multi-institutional NIH-sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy. Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH-funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi-institutional clinical trials NIH.« less

WE-G-BRB-04: Leveraging Innovation to Design Future Clinical Trials

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michalski, J.

Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01-type and P01-type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue-guided dose escalation and motion management will be described. An overview willmore » be provided regarding how these technological innovations have been applied to multi-institutional NIH-sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy. Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH-funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi-institutional clinical trials NIH.« less

WE-G-BRB-00: NIH-Funded Research: Instrumental in the Pursuit of Clinical Trials and Technological Innovations

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01-type and P01-type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue-guided dose escalation and motion management will be described. An overview willmore » be provided regarding how these technological innovations have been applied to multi-institutional NIH-sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy. Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH-funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi-institutional clinical trials NIH.« less

A Belief-based Trust Model for Dynamic Service Selection

NASA Astrophysics Data System (ADS)

Ali, Ali Shaikh; Rana, Omer F.

Provision of services across institutional boundaries has become an active research area. Many such services encode access to computational and data resources (comprising single machines to computational clusters). Such services can also be informational, and integrate different resources within an institution. Consequently, we envision a service rich environment in the future, where service consumers can intelligently decide between which services to select. If interaction between service providers/users is automated, it is necessary for these service clients to be able to automatically chose between a set of equivalent (or similar) services. In such a scenario trust serves as a benchmark to differentiate between service providers. One might therefore prioritize potential cooperative partners based on the established trust. Although many approaches exist in literature about trust between online communities, the exact nature of trust for multi-institutional service sharing remains undefined. Therefore, the concept of trust suffers from an imperfect understanding, a plethora of definitions, and informal use in the literature. We present a formalism for describing trust within multi-institutional service sharing, and provide an implementation of this; enabling the agent to make trust-based decision. We evaluate our formalism through simulation.

WE-G-BRB-03: Innovating the Delivery of Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bortfeld, T.

2015-06-15

Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01-type and P01-type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue-guided dose escalation and motion management will be described. An overview willmore » be provided regarding how these technological innovations have been applied to multi-institutional NIH-sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy. Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH-funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi-institutional clinical trials NIH.« less

A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

NASA Astrophysics Data System (ADS)

Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

2013-07-01

The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

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

PubMed Central

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

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

PubMed

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 < 0.001) and intensive care unit (9.7 vs. 6.9, p = 0.003) length of stay. Almost all 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.

Patient Positioning Based on a Radioactive Tracer Implanted in Patients With Localized Prostate Cancer: A Performance and Safety Evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kruijf, Willy J.M. de, E-mail: kruijf.de.w@bvi.nl; Verstraete, Jan; Neustadter, David

2013-02-01

Purpose: To evaluate the performance and safety of a radiation therapy positioning system (RealEye) based on tracking a radioactive marker (Tracer) implanted in patients with localized prostate cancer. Methods and Materials: We performed a single-arm multi-institutional trial in 20 patients. The iridium-192 ({sup 192}Ir)-containing Tracer was implanted in the patient together with 4 standard gold seed fiducials. Patient prostate-related symptoms were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Computed tomography (CT) was performed for treatment planning, during treatment, and after treatment to evaluate the migration stability of the Tracer. At 5 treatment sessions, cone beam CT was performedmore » to test the positioning accuracy of the RealEye. Results: The Tracer was successfully implanted in all patients. No device or procedure-related adverse events occurred. Changes in IPSS scores were limited. The difference between the mean change in Tracer-fiducial distance and the mean change in fiducial-fiducial distance was -0.39 mm (95% confidence interval [CI] upper boundary, -0.22 mm). The adjusted mean difference between Tracer position according to RealEye and the Tracer position on the CBCT for all patients was 1.34 mm (95% CI upper boundary, 1.41 mm). Conclusions: Implantation of the Tracer is feasible and safe. Migration stability of the Tracer is good. Prostate patients can be positioned and monitored accurately by using RealEye.« less

Patient positioning based on a radioactive tracer implanted in patients with localized prostate cancer: a performance and safety evaluation.

PubMed

de Kruijf, Willy J M; Verstraete, Jan; Neustadter, David; Corn, Benjamin W; Hol, Sandra; Venselaar, Jack L M; Davits, Rob J; Wijsman, Bart P; Van den Bergh, Laura; Budiharto, Tom; Oyen, Raymond; Haustermans, Karin; Poortmans, Philip M P

2013-02-01

To evaluate the performance and safety of a radiation therapy positioning system (RealEye) based on tracking a radioactive marker (Tracer) implanted in patients with localized prostate cancer. We performed a single-arm multi-institutional trial in 20 patients. The iridium-192 ((192)Ir)-containing Tracer was implanted in the patient together with 4 standard gold seed fiducials. Patient prostate-related symptoms were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Computed tomography (CT) was performed for treatment planning, during treatment, and after treatment to evaluate the migration stability of the Tracer. At 5 treatment sessions, cone beam CT was performed to test the positioning accuracy of the RealEye. The Tracer was successfully implanted in all patients. No device or procedure-related adverse events occurred. Changes in IPSS scores were limited. The difference between the mean change in Tracer-fiducial distance and the mean change in fiducial-fiducial distance was -0.39 mm (95% confidence interval [CI] upper boundary, -0.22 mm). The adjusted mean difference between Tracer position according to RealEye and the Tracer position on the CBCT for all patients was 1.34 mm (95% CI upper boundary, 1.41 mm). Implantation of the Tracer is feasible and safe. Migration stability of the Tracer is good. Prostate patients can be positioned and monitored accurately by using RealEye. Copyright © 2013 Elsevier Inc. All rights reserved.

Dealing with requests for pharmacological cognitive enhancement from healthy students.

PubMed

Chandramouleeswaran, Susmita; Edwin, Natasha Catherine; Rajaleelan, Wesley

2016-01-01

The use of drugs to enhance cognitive function and academic performance is clearly a global phenomenon, with the reported prevalence of stimulant use among medical students ranging from 15-20%. A multi-institution study from the USA reported a 6.9% lifetime prevalence of non-prescription use of cognitive enhancers among college students. A comprehensive systematic review indicates a 16-29% use of non-prescribed stimulants among all students for reasons that include increasing concentration and alertness. While mental health professionals and guidance counsellors anecdotally recall requests for pharmacological cognitive enhancement from otherwise healthy students, the exact magnitude of this problem in the Indian context is not clear.

A multi-institutional approach to delivering shared curricula for developing a next-generation energy workforce

DOE PAGES

Holloway, Lawrence E.; Qu, Zhihua; Mohr-Schroeder, Margaret J.; ...

2017-02-06

In this study, we consider collaborative power systems education through the FEEDER consortium. To increase students' access to power engineering educational content, the consortium of seven universities was formed. A framework is presented to characterize different collaborative education activities among the universities. Three of these approaches of collaborative educational activities are presented and discussed. These include 1) cross-institutional blended courses ("MS-MD''); 2) cross-institutional distance courses ("SS-MD''); and 3) single-site special experiential courses and concentrated on-site programs available to students across consortium institutions ("MS-SD''). As a result, this paper presents the advantages and disadvantages of each approach.

Challenges in Credentialing Institutions and Participants in Advanced Technology Multi-institutional Clinical Trials

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ibbott, Geoffrey S.; Followill, David S.; Molineu, H. Andrea

The Radiological Physics Center (RPC) has functioned continuously for 38 years to assure the National Cancer Institute and the cooperative groups that institutions participating in multi-institutional trials can be expected to deliver radiation treatments that are clinically comparable to those delivered by other institutions in the cooperative groups. To accomplish this, the RPC monitors the machine output, the dosimetry data used by the institutions, the calculation algorithms used for treatment planning, and the institutions' quality control procedures. The methods of monitoring include on-site dosimetry review by an RPC physicist and a variety of remote audit tools. The introduction of advancedmore » technology clinical trials has prompted several study groups to require participating institutions and personnel to become credentialed, to ensure their familiarity and capability with techniques such as three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy, and brachytherapy. The RPC conducts a variety of credentialing activities, beginning with questionnaires to evaluate an institution's understanding of the protocol and their capabilities. Treatment-planning benchmarks are used to allow the institution to demonstrate their planning ability and to facilitate a review of the accuracy of treatment-planning systems under relevant conditions. The RPC also provides mailable anthropomorphic phantoms to verify tumor dose delivery for special treatment techniques. While conducting these reviews, the RPC has amassed a large amount of data describing the dosimetry at participating institutions. Representative data from the monitoring programs are discussed, and examples are presented of specific instances in which the RPC contributed to the discovery and resolution of dosimetry errors.« less

Medical education research and IRB review: an analysis and comparison of the IRB review process at six institutions.

PubMed

Dyrbye, Liselotte N; Thomas, Matthew R; Mechaber, Alex J; Eacker, Anne; Harper, William; Massie, F Stanford; Power, David V; Shanafelt, Tait D

2007-07-01

To compare how different institutional review boards (IRBs) process and evaluate the same multiinstitutional educational research proposal of medical students' quality of life. Prospective collection in 2005 of key variables regarding the IRB submission and review process of the same educational research proposal involving medical students, which was submitted to six IRBs, each associated with a different medical school. Four IRBs determined the protocol was appropriate for expedited review, and the remaining two required full review. Substantial variation existed in the time to review the protocol by an IRB administrator/IRB member (range 1-101 days) and by the IRB committee (range 6-115 days). One IRB committee approved the study as written. The remaining five IRB committees had a median of 13 requests for additional information/changes to the protocol. Sixty-eight percent of requests (36 of 53) pertained to the informed consent letter; one third (12 of 36) of these requests were unique modifications requested by one IRB but not the others. Although five IRB committees approved the survey after a median of 47 days (range 6-73), one committee had not responded six months after submission (164 days), preventing that school from participating. The findings suggest variability in the timeliness and consistency of IRB review of medical education research across institutions that may hinder multi-institutional research and slow evidence-based medical education reform. The findings demonstrate the difficulties of having medical education research reviewed by IRBs, which are typically designed to review clinical trials, and suggest that the review process for medical education research needs reform.

Outcomes after percutaneous coronary artery revascularization procedures for cardiac allograft vasculopathy in pediatric heart transplant recipients: A multi-institutional study.

PubMed

Jeewa, Aamir; Chin, Clifford; Pahl, Elfriede; Atz, Andrew M; Carboni, Michael P; Pruitt, Elizabeth; Naftel, David C; Rodriguez, Rose; Dipchand, Anne I

2015-09-01

Cardiac allograft vasculopathy is an important cause of long-term graft loss. In adults, percutaneous revascularization procedures (PRPs) have variable success with high restenosis rates and little impact on graft survival. Limited data exist in pediatric recipients of transplants. Data from the Pediatric Heart Transplant Study (PHTS) were used to explore associations between PRPs and outcomes after heart transplant in patients listed ≤18 years old who received a first heart transplant between 1993 and 2009. Revascularization procedures were done in 28 of 3,156 (0.9%) patients; 13 patients had multiple PRPs giving a total of 51 PRPs performed across 15 centers. Mean recipient age at time of transplant was 7.7 ± 6.7 years; mean donor age was 15.9 ± 15.4 years. The mean time to first PRP was 5.7 ± 3.2 years. Vessels involved were left anterior descending artery (41%), right coronary artery (25%), circumflex artery (18%), other coronary branches/unknown (16%). PRPs consisted of 38 (75%) stent implantations and 13 (25%) balloon angioplasties with an overall procedural success rate of 73%. Freedom from graft loss after PRPs was 89%, 75%, and 61% at 1, 3, and 12 months. In addition, patients with transplants from donors >30 years old were found to have less freedom from the need for a revascularization procedure than patients with transplants from younger donors (p < 0.0001). In this large pediatric heart transplant cohort, use of PRPs for cardiac allograft vasculopathy was rare, likely related to procedural feasibility of the interventions. Despite technically successful interventions, graft loss occurred in 39% within 1 year post-procedure; relisting for heart transplant should be considered. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

The Impact of Number of Cycles of Neoadjuvant Chemotherapy on Survival of Patients Undergoing Interval Debulking Surgery for Stage IIIC-IV Unresectable Ovarian Cancer: Results From a Multi-Institutional Study.

PubMed

Bogani, Giorgio; Matteucci, Laura; Tamberi, Stefano; Arcangeli, Valentina; Ditto, Antonino; Maltese, Giuseppa; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Leone Roberti Maggiore, Umberto; Perotto, Stefania; Scaffa, Cono; Comerci, Giuseppe; Stefanetti, Marco; Raspagliesi, Francesco; Lorusso, Domenica

2017-11-01

Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95-3.22; P = 0.06). Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

Performance of a Machine Learning Classifier of Knee MRI Reports in Two Large Academic Radiology Practices: A Tool to Estimate Diagnostic Yield.

PubMed

Hassanpour, Saeed; Langlotz, Curtis P; Amrhein, Timothy J; Befera, Nicholas T; Lungren, Matthew P

2017-04-01

The purpose of this study is to evaluate the performance of a natural language processing (NLP) system in classifying a database of free-text knee MRI reports at two separate academic radiology practices. An NLP system that uses terms and patterns in manually classified narrative knee MRI reports was constructed. The NLP system was trained and tested on expert-classified knee MRI reports from two major health care organizations. Radiology reports were modeled in the training set as vectors, and a support vector machine framework was used to train the classifier. A separate test set from each organization was used to evaluate the performance of the system. We evaluated the performance of the system both within and across organizations. Standard evaluation metrics, such as accuracy, precision, recall, and F1 score (i.e., the weighted average of the precision and recall), and their respective 95% CIs were used to measure the efficacy of our classification system. The accuracy for radiology reports that belonged to the model's clinically significant concept classes after training data from the same institution was good, yielding an F1 score greater than 90% (95% CI, 84.6-97.3%). Performance of the classifier on cross-institutional application without institution-specific training data yielded F1 scores of 77.6% (95% CI, 69.5-85.7%) and 90.2% (95% CI, 84.5-95.9%) at the two organizations studied. The results show excellent accuracy by the NLP machine learning classifier in classifying free-text knee MRI reports, supporting the institution-independent reproducibility of knee MRI report classification. Furthermore, the machine learning classifier performed well on free-text knee MRI reports from another institution. These data support the feasibility of multiinstitutional classification of radiologic imaging text reports with a single machine learning classifier without requiring institution-specific training data.

Research Design Becomes Research Reality: Colorado School of Mines Implements Research Methodology for the Center for the Advancement of Engineering Education. Research Brief

ERIC Educational Resources Information Center

Loshbaugh, Heidi; Streveler, Ruth; Breaux, Kimberley

2007-01-01

The Center for the Advancement of Engineering Education was founded in 2003 with five collaborating institutions. A multi-institutional, multi-year grant offers many opportunities for the demands of reality to interfere with design goals. In particular, at Colorado School of Mines (CSM) student demographics required adjustment of the original APS…

2015 Cataloging Hidden Special Collections and Archives Unconference and Symposium: Innovation, Collaboration, and Models. Proceedings of the CLIR Cataloging Hidden Special Collections and Archives Symposium (Philadelphia, Pennsylvania, March 12-13, 2015)

ERIC Educational Resources Information Center

Oestreicher, Cheryl, Ed.

2015-01-01

The 2015 CLIR Unconference & Symposium was the capstone event to seven years of grant funding through CLIR's Cataloging Hidden Special Collections and Archives program. These proceedings group presentations by theme. Collaborations provides examples of multi-institutional projects, including one international collaboration; Student and Faculty…

A Successful Multi-Institutional Blog for Transferring Garden and Landscape Information to the Public

ERIC Educational Resources Information Center

Gillman, Jeffrey; Chalker-Scott, Linda; Scoggins, Holly; Cregg, Bert

2011-01-01

In July 2009 four faculty members from four different institutions created a blog to educate consumers and professionals about plant-related issues. Online resources were used to measure the number of times that the blog was viewed and its impacts. The blog averages about 200 views a day, and 80% of those responding to a survey could name specific…

RELIABILITY, AVAILABILITY, AND SERVICEABILITY FOR PETASCALE HIGH-END COMPUTING AND BEYOND

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chokchai "Box" Leangsuksun

2011-05-31

Our project is a multi-institutional research effort that adopts interplay of RELIABILITY, AVAILABILITY, and SERVICEABILITY (RAS) aspects for solving resilience issues in highend scientific computing in the next generation of supercomputers. results lie in the following tracks: Failure prediction in a large scale HPC; Investigate reliability issues and mitigation techniques including in GPGPU-based HPC system; HPC resilience runtime & tools.

'How Will I Know When I'm Ready?' Re-Imagining FE/HE 'Transitions' as Collaborative Identity Work

ERIC Educational Resources Information Center

Kendall, Alex; Kempson, Michelle; French, Amanda

2018-01-01

Drawing on the findings of a Quality Assurance Agency for Higher Education (QAA) funded, multi-institutional, regional project, "Transitions West Midlands", this paper works with Further Education (FE) students' transition narratives as they look forward to, and back from the move from FE to HE and explores the role of the local,…

Intra-operative peritoneal lavage for colorectal cancer

PubMed Central

Passot, Guillaume; Mohkam, Kayvan; Cotte, Eddy; Glehen, Olivier

2014-01-01

Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritoneal lavage in colorectal surgery for cancer is not used in routine, and the prognostic significance of intraperitoneal free cancer cells (IPCC) remains unclear. Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce. However, positive IPCC might be the first step of peritoneal spread in colorectal cancers, which could lead to early specific treatments. Because of the important heterogeneity of IPCC determination in reported studies, no treatment have been proposed to patients with positive IPCC. Herein, we provide an overview of IPCC detection and its impact on recurrence and survival, and we suggest further multi-institutional studies to evaluate new treatment strategies. PMID:24616569

Women and traumatic brain injury.

PubMed

Bell, K R; Pepping, M

2001-02-01

Women with TBI have been inadequately studied in relation to most aspects of pathophysiology, recovery, health and behavioral issues, and community integration. This is not entirely surprising in light of the preponderance of men with TBI but also reflects the traditional tendency of medical researchers to concentrate their efforts on men. Although most of the residual effects of TBI are gender-neutral, women may present some unique problems in relation to pain and endocrine issues, reproduction, and sexual functioning In addition, a woman's roles as wife, mother, and daughter are likely to result in a different constellation of family dynamics when TBI is introduced. Attention to enrollment of women in research studies and the increasing number of multi-institutional studies of TBI may provide enlightenment on these issues in the future.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kawai, D; Takahashi, R; Kamima, T

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), Pencilmore » 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.« less

Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society).

PubMed

Couñago, F; Rodriguez de Dios, N; Montemuiño, S; Jové-Teixidó, J; Martin, M; Calvo-Crespo, P; López-Mata, M; Samper-Ots, M P; López-Guerra, J L; García-Cañibano, T; Díaz-Díaz, V; de Ingunza-Barón, L; Murcia-Mejía, M; Alcántara, P; Corona, J; Puertas, M M; Chust, M; Couselo, M L; Del Cerro, E; Moradiellos, J; Amor, S; Varela, A; Thuissard, I J; Sanz-Rosa, D; Taboada, B

2018-04-01

The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT. The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC. Copyright © 2018 Elsevier B.V. All rights reserved.

WE-AB-BRA-08: Results of a Multi-Institutional Study for the Evaluation of Deformable Image Registration Algorithms for Structure Delineation Via Computational Phantoms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Loi, G; Fusella, M; Fiandra, C

2015-06-15

Purpose: To investigate the accuracy of various algorithms for deformable image registration (DIR), to propagate regions of interest (ROIs) in computational phantoms based on patient images using different commercial systems. This work is part of an Italian multi-institutional study to test on common datasets the accuracy, reproducibility and safety of DIR applications in Adaptive Radiotherapy. Methods: Eleven institutions with three available commercial solutions provided data to assess the agreement of DIR-propagated ROIs with automatically drown ROIs considered as ground-truth for the comparison. The DIR algorithms were tested on real patient data from three different anatomical districts: head and neck, thoraxmore » and pelvis. For every dataset two specific Deformation Vector Fields (DVFs) provided by ImSimQA software were applied to the reference data set. Three different commercial software were used in this study: RayStation, Velocity and Mirada. The DIR-mapped ROIs were then compared with the reference ROIs using the Jaccard Conformity Index (JCI). Results: More than 600 DIR-mapped ROIs were analyzed. Putting together all JCI data of all institutions for the first DVF, the mean JCI was 0.87 ± 0.7 (1 SD) while for the second DVF JCI was 0.8 ± 0.13 (1 SD). Several considerations on different structures are available from collected data: the standard deviation among different institutions on specific structure raise as the larger is the applied DVF. The higher value is 10% for bladder. Conclusion: Although the complexity of deformation of human body is very difficult to model, this work illustrates some clinical scenarios with well-known DVFs provided by specific software. CI parameter gives the inter-user variability and may put in evidence the need of improving the working protocol in order to reduce the inter-institution JCI variability.« less

Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction.

PubMed

Zielinski, Martin D; Haddad, Nadeem N; Cullinane, Daniel C; Inaba, Kenji; Yeh, Dante D; Wydo, Salina; Turay, David; Pakula, Andrea; Duane, Therese M; Watras, Jill; Widom, Kenneth A; Cull, John; Rodriguez, Carlos J; Toschlog, Eric A; Sams, Valerie G; Hazelton, Joshua P; Graybill, John Christopher; Skinner, Ruby; Yune, Ji-Ming

2017-07-01

Existing trials studying the use of Gastrografin for management of adhesive small bowel obstruction (SBO) are limited by methodological flaws and small sample sizes. We compared institutional protocols with and without Gastrografin (GG), hypothesizing that a SBO management protocol utilizing GG is associated with lesser rates of exploration, shorter length of stay, and fewer complications. A multi-institutional, prospective, observational study was performed on patients appropriate for GG with adhesive SBO. Exclusion criteria were internal/external hernia, signs of strangulation, history of abdominal/pelvic malignancy, or exploration within the past 6 weeks. Patients receiving GG were compared to patients receiving standard care without GG. Overall, 316 patients were included (58 ± 18 years; 53% male). There were 173 (55%) patients in the GG group (of whom 118 [75%] successfully passed) and 143 patients in the non-GG group. There were no differences in duration of obstipation (1.6 vs. 1.9 days, p = 0.77) or small bowel feces sign (32.9% vs. 25.0%, p = 0.14). Fewer patients in the GG protocol cohort had mesenteric edema on CT (16.3% vs. 29.9%; p = 0.009). There was a lower rate of bowel resection (6.9% vs. 21.0%, p < 0.001) and exploration rate in the GG group (20.8% vs. 44.1%, p < 0.0001). GG patients had a shorter duration of hospital stay (4 IQR 2-7 vs. 5 days IQR 2-12; p = 0.036) and a similar rate of complications (12.5% vs. 17.9%; p = 0.20). Multivariable analysis revealed that GG was independently associated with successful nonoperative management. Patients receiving Gastrografin for adhesive SBO had lower rates of exploration and shorter hospital length of stay compared to patients who did not receive GG. Adequately powered and well-designed randomized trials are required to confirm these findings and establish causality. Therapeutic, level III.

Studying a Rare Disease Using Multi-Institutional Research Collaborations vs Big Data: Where Lies the Truth?

PubMed

Johnson, Aileen C; Ethun, Cecilia G; Liu, Yuan; Lopez-Aguiar, Alexandra G; Tran, Thuy B; Poultsides, George; Grignol, Valerie; Howard, J Harrison; Bedi, Meena; Gamblin, T Clark; Tseng, Jennifer; Roggin, Kevin K; Chouliaras, Konstantinos; Votanopoulos, Konstantinos; Cullinan, Darren; Fields, Ryan C; Delman, Keith A; Wood, William C; Cardona, Kenneth; Maithel, Shishir K

2018-06-12

Multi-institutional collaborations provide granularity lacking in epidemiologic datasets to enable in-depth study of rare diseases. For pts with superficial, high-grade soft tissue sarcomas (STS) of the trunk/extremity, the value of radiation therapy (RT) is not clear. We aimed to utilize the 7-institution US-Sarcoma-Collaborative (USSC) and the National Cancer Database (NCDB) to investigate this issue. All adult pts with superficial truncal/extremity high-grade STS who underwent primary curative-intent resection from 2000-2016 at USSC institutions or were included in the NCDB from 2004-2013 were analyzed. Propensity-score matching was performed. Endpoints were locoregional recurrence-free survival(LRFS), overall-survival(OS), and disease-specific survival(DSS). Of 4,153pts in the USSC, 169pts with superficial high-grade tumors underwent primary curative-intent resection, of whom 38% received RT. On multivariable Cox-regression analysis, RT was not associated with improved LRFS(p=0.56), OS(p=0.31), or DSS(p=0.20). On analysis of 51 propensity-score matched-pairs, RT was still not associated with increased LRFS, OS, or DSS. Analysis of 631 propensity-score matched-pairs in the NCDB demonstrated improved 5-yr OS associated with RT (80%vs70%;p=0.02). LRFS and DSS were not evaluable. Granular data afforded by collaborative research enables in-depth analysis of patient outcomes. The NCDB, although powered with large numbers, cannot assess many relevant outcomes (recurrence, DSS, or complications). In this study, the approaches yielded conflicting results. USSC data suggested no value of radiation while the NCDB demonstrated improved overall survival, contradicting all randomized-controlled trials in sarcoma. The pros/cons of either approach must be considered when applying results to clinical practice, and underscore the importance of randomized-controlled trials. Copyright © 2018. Published by Elsevier Inc.

Final results of a multi-institutional phase II trial of reirradiation with concurrent weekly cisplatin and cetuximab for recurrent or second primary squamous cell carcinoma of the head and neck.

PubMed

Awan, M J; Nedzi, L; Wang, D; Tumati, V; Sumer, B; Xie, X-J; Smith, I; Truelson, J; Hughes, R; Myers, L L; Lavertu, P; Wong, S; Yao, M

2018-04-01

The optimal regimen of chemotherapy and reirradiation (re-XRT) for recurrent head and neck squamous cell carcinoma (HNSCC) is controversial. We report the final outcomes of a multicenter phase II trial evaluating cetuximab and cisplatin-based chemotherapy concurrent with re-XRT for patients with recurrent HNSCC. Patients with unresectable recurrent disease or positive margins after salvage surgery arising within a previously irradiated field with KPS ≥ 70 were eligible for this trial. Cetuximab 400 mg/m2 was delivered as a loading dose in week 1 followed by weekly cetuximab 250 mg/m2 and cisplatin 30 mg/m2 concurrent with 6 weeks of intensity-modulated radiotherapy to a dose of 60-66 Gy in 30 daily fractions. Patients who previously received both concurrent cetuximab and cisplatin with radiation or who received radiotherapy less than 6 months prior were ineligible. From 2009 to 2013, 48 patients enrolled on this trial, 2 did not receive any protocol treatment. Of the remaining 46 patients, 34 were male and 12 female, with a median age of 62 years (range 36-85). Treatment was feasible and only 1 patient did not complete the treatment course. Common grade 3 or higher acute toxicities were lymphopenia (46%), pain (22%), dysphagia (13%), radiation dermatitis (13%), mucositis (11%) and anorexia (11%). There were no grade 5 acute toxicities. Eight grade 3 late toxicities were observed, four of which were swallowing related. With a median follow-up of 1.38 years, the 1-year overall survival (OS) was 60.4% and 1-year recurrence-free survival was 34.1%. On univariate analysis, OS was significantly improved with young age (P = 0.01). OS was not associated with radiation dose, surgery before re-XRT or interval from prior XRT. Concurrent cisplatin and cetuximab with re-XRT is feasible and offers good treatment outcomes for patients with high-risk features. Younger patients had significantly improved OS. NCT00833261.

Biomarkers for Early Detection of Clinically Relvant Prostate Cancer: A Multi-Institutional Validation Trial - Genomic Health, Inc. — EDRN Public Portal

Cancer.gov

Validate a panel of tissue-based biomarkers to determine the presence of or progression to clinically relevant prostate cancer at the time of diagnosis. Utilize a novel, biopsy based multi-gene quantitative RT-PCR assay developed by Genomic Health, Oncotype DX Prostate Cancer Assay, which discriminates aggressive from indolent cancer on multivariate modeling of PCa patients.

An Interlaboratory Comparison of Dosimetry for a Multi-institutional Radiobiological

PubMed Central

Seed, TM; Xiao, S; Manley, N; Nikolich-Zugich, J; Pugh, J; van den Brink, M; Hirabayashi, Y; Yasutomo, K; Iwama, A; Koyasu, S; Shterev, I; Sempowski, G; Macchiarini, F; Nakachi, K; Kunugi, KC; Hammer, CG; DeWerd, LA

2016-01-01

Purpose An interlaboratory comparison of radiation dosimetry was conducted to determine the accuracy of doses being used experimentally for animal exposures within a large multi-institutional research project. The background and approach to this effort are described and discussed in terms of basic findings, problems and solutions. Methods Dosimetry tests were carried out utilizing optically stimulated luminescence (OSL) dosimeters embedded midline into mouse carcasses and thermal luminescence dosimeters (TLD) embedded midline into acrylic phantoms. Results The effort demonstrated that the majority (4/7) of the laboratories was able to deliver sufficiently accurate exposures having maximum dosing errors of ≤ 5%. Comparable rates of ‘dosimetric compliance’ were noted between OSL- and TLD-based tests. Data analysis showed a highly linear relationship between ‘measured’ and ‘target’ doses, with errors falling largely between 0–20%. Outliers were most notable for OSL-based tests, while multiple tests by ‘non-compliant’ laboratories using orthovoltage x-rays contributed heavily to the wide variation in dosing errors. Conclusions For the dosimetrically non-compliant laboratories, the relatively high rates of dosing errors were problematic, potentially compromising the quality of ongoing radiobiological research. This dosimetry effort proved to be instructive in establishing rigorous reviews of basic dosimetry protocols ensuring that dosing errors were minimized. PMID:26857121

An interlaboratory comparison of dosimetry for a multi-institutional radiobiological research project: Observations, problems, solutions and lessons learned.

PubMed

Seed, Thomas M; Xiao, Shiyun; Manley, Nancy; Nikolich-Zugich, Janko; Pugh, Jason; Van den Brink, Marcel; Hirabayashi, Yoko; Yasutomo, Koji; Iwama, Atsushi; Koyasu, Shigeo; Shterev, Ivo; Sempowski, Gregory; Macchiarini, Francesca; Nakachi, Kei; Kunugi, Keith C; Hammer, Clifford G; Dewerd, Lawrence A

2016-01-01

An interlaboratory comparison of radiation dosimetry was conducted to determine the accuracy of doses being used experimentally for animal exposures within a large multi-institutional research project. The background and approach to this effort are described and discussed in terms of basic findings, problems and solutions. Dosimetry tests were carried out utilizing optically stimulated luminescence (OSL) dosimeters embedded midline into mouse carcasses and thermal luminescence dosimeters (TLD) embedded midline into acrylic phantoms. The effort demonstrated that the majority (4/7) of the laboratories was able to deliver sufficiently accurate exposures having maximum dosing errors of ≤5%. Comparable rates of 'dosimetric compliance' were noted between OSL- and TLD-based tests. Data analysis showed a highly linear relationship between 'measured' and 'target' doses, with errors falling largely between 0 and 20%. Outliers were most notable for OSL-based tests, while multiple tests by 'non-compliant' laboratories using orthovoltage X-rays contributed heavily to the wide variation in dosing errors. For the dosimetrically non-compliant laboratories, the relatively high rates of dosing errors were problematic, potentially compromising the quality of ongoing radiobiological research. This dosimetry effort proved to be instructive in establishing rigorous reviews of basic dosimetry protocols ensuring that dosing errors were minimized.

Design of a national distributed health data network.

PubMed

Maro, Judith C; Platt, Richard; Holmes, John H; Strom, Brian L; Hennessy, Sean; Lazarus, Ross; Brown, Jeffrey S

2009-09-01

A distributed health data network is a system that allows secure remote analysis of separate data sets, each comprising a different medical organization's or health plan's records. Distributed health data networks are currently being planned that could cover millions of people, permitting studies of comparative clinical effectiveness, best practices, diffusion of medical technologies, and quality of care. These networks could also support assessment of medical product safety and other public health needs. Distributed network technologies allow data holders to control all uses of their data, which overcomes many practical obstacles related to confidentiality, regulation, and proprietary interests. Some of the challenges and potential methods of operation of a multipurpose, multi-institutional distributed health data network are described.

Bulky mesonephric adenocarcinoma of the uterine cervix treated with neoadjuvant chemotherapy and radical surgery: report of the first case.

PubMed

Ditto, Antonino; Martinelli, Fabio; Bogani, Giorgio; Gasparri, Maria L; Donato, Violante Di; Paolini, Biagio; Carcangiu, Maria L; Lorusso, Domenica; Raspagliesi, Francesco

2016-11-11

Malignant mesonephric adenocarcinoma of the uterine cervix is a rare occurrence with few cases described in the literature. Although surgery seems to be effective in the treatment of early-stage tumor, no cases describing outcomes of locally advanced stage are available. We report the first case of a patient with International Federation of Obstetrics and Gynecologists stage IIB mesonephric adenocarcinoma undergoing neoadjuvant chemotherapy and radical surgery. Despite the inherent limitation of a single description of a case, our experience supports the utilization of neoadjuvant chemotherapy in patients with malignant mesonephric adenocarcinoma of the uterine cervix. Further prospective multi-institutional studies are needed.

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

PubMed Central

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

Center for Extended Magnetohydrodynamics Modeling

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ramos, Jesus

This researcher participated in the DOE-funded Center for Extended Magnetohydrodynamics Modeling (CEMM), a multi-institutional collaboration led by the Princeton Plasma Physics Laboratory with Dr. Stephen Jardin as the overall Principal Investigator. This project developed advanced simulation tools to study the non-linear macroscopic dynamics of magnetically confined plasmas. The collaborative effort focused on the development of two large numerical simulation codes, M3D-C1 and NIMROD, and their application to a wide variety of problems. Dr. Ramos was responsible for theoretical aspects of the project, deriving consistent sets of model equations applicable to weakly collisional plasmas and devising test problems for verification ofmore » the numerical codes. This activity was funded for twelve years.« less

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.

PubMed

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

This pathology PILOT study aims to define the role and feasibility of centralized pathology review in a cohort of 75 patients from different centers in the United States and Europe using digital slide scanning. The pathologic material from 75 patients who had been diagnosed with mycosis fungoides/Sézary syndrome and were clinically staged as IIb or above was retrieved from 11 participating centers. Each pathology reviewer was provided with the pathologic diagnosis (by the referring pathologist), and the following list of histopathologic criteria (presence or absence) from the initial report: epidermotropism, folliculotropism (FT), large cell transformation, syringotropism, and granulomas. Patients with advance stage were selected for this study as this is a population where there is significant variability in the diagnosis of pathologic prognostic and predictive biomarkers. The slides were digitally scanned with an Aperio scanner and consensus review of cases occurred when major or minor discrepancies between the referral diagnosis and central pathology review occurred. Among the 75 cases, 70 (93.3%) had a final consensus diagnosis between the 3 central review pathologists. The overall agreement between the consensus review and the referring pathologist was 60%. The overall agreement was also higher between the reviewers and consensus review, compared with the referring pathologist and consensus. 65.3% of cases had some type of discrepancy (major or minor) between the outside and consensus review. Major discrepancies were seen in 34 of 73 cases (46.6%; 73 cases indicated a yes or no response). Minor discrepancies were seen in 32 of 75 (42.7%) of cases. Most of the major discrepancies were accounted by a difference in interpretation in the presence or absence of large cell transformation or FT. Most minor discrepancies were explained by a different interpretation in the expression of CD30. We found digital slide scanning to be a beneficial, reliable, and practical for a methodical approach to perform central pathology review in the context of a large clinical prospective study.

Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience.

PubMed

Molina, Camilo A; Ames, Christopher P; Chou, Dean; Rhines, Laurence D; Hsieh, Patrick C; Zadnik, Patricia L; Wolinsky, Jean-Paul; Gokaslan, Ziya L; Sciubba, Daniel M

2014-09-01

Chordomas involving the mobile spine are ideally managed via en bloc resection with reconstruction to optimize local control and possibly offer cure. In the cervical spine, local anatomy poses unique challenges, limiting the feasibility of aggressive resection. The authors present a multi-institutional series of 16 cases of cervical chordomas removed en bloc. Particular attention was paid to clinical outcome, complications, and recurrence. In addition, outcomes were assessed according to position of tumor at the C1-2 level versus the subaxial (SA) spine (C3-7). The authors reviewed cases involving patients who underwent en bloc resection of cervical chordoma at 4 large spine centers. Patients were included if the lesion epicenter involved the C-1 to C-7 vertebral bodies. Demographic data and details of surgery, follow-up course, exposure to adjuvant therapy, and complications were obtained. Outcome was correlated with presence of tumor in C1-2 versus subaxial spine via a Student t-test. Sixteen patients were identified (mean age at presentation 55 ± 14 years). Seven cases (44%) cases involved C1-2, and 16 involved the subaxial spine. Median survival did not differ significantly different between the C1-2 (72 months) and SA (60 months) groups (p = 0.65). A combined (staged anteroposterior) approach was used in 81% of the cases. Use of the combined approach was significantly more common in treatment of subaxial than C1-2 tumors (100% vs 57%, p = 0.04). En bloc resection was attempted via an anterior approach in 6% of cases (C1-2: 14.3%; SA: 0%; p = 0.17) and a posterior approach in 13% of cases (C1-2: 29%; SA: 0%; p = 0.09). The most commonly reported margin classification was marginal (56% of cases), followed by violated (25%) and wide (19%). En bloc excision of subaxial tumors was significantly more likely to result in marginal margins than excision of C1-2 tumors (C1-2: 29%; SA: 78%; p = 0.03). C1-2 tumors were associated with significantly higher rates of postoperative complications (C1-2: 71%; SA: 22%; p = 0.03). Both local and distant tumor recurrence was greatest for C1-2 tumors (local C1-2: 29%; local SA: 11%; distant C1-2: 14%; distant SA: 0%). Statistical analysis of tumor recurrence based on tumor location was not possible due to the small number of cases. There was no between-groups difference in exposure to postoperative adjuvant radiotherapy. There was no difference in median survival between groups receiving proton beam radiotherapy or intensity-modulated radiotherapy versus no radiation therapy (p = 0.8). Compared with en bloc resection of chordomas involving the subaxial cervical spine, en bloc resection of chordomas involving the upper cervical spine (C1-2) is associated with poorer outcomes, such as less favorable margins, higher rates of complications, and increased tumor recurrence. Data from this cohort do not support a statistically significant difference in survival for patients with C1-2 versus subaxial disease, but larger studies are needed to further study survival differences.

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

PubMed

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

2016-01-01

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.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gorovets, Daniel; Department of Radiation Oncology, Perlmutter Cancer Center, NYU School of Medicine, New York, New York; Ayala-Peacock, Diandra

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 formore » 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.« less

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

PubMed

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.

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

PubMed

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 increase research interactions among investigators.

Long-Term Cancer Outcomes From Study NRG Oncology/RTOG 9517: A Phase 2 Study of Accelerated Partial Breast Irradiation With Multicatheter Brachytherapy After Lumpectomy for Early-Stage Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

White, Julia, E-mail: Julia.White@osumc.edu; Winter, Kathryn; Kuske, Robert R.

Purpose: To examine 10-year rates of local, regional, and distant recurrences, patterns of recurrence, and survival rates for breast cancer patients enrolled on Study NRG Oncology/Radiation Therapy Oncology Group 9517, a multi-institutional prospective trial that studied one of the earliest methods of accelerated partial breast irradiation (APBI), multicatheter brachytherapy (MCT). Methods and Materials: Eligibility included stage I/II unifocal breast cancer <3 cm in size after lumpectomy with negative surgical margins and 0 to 3 positive axillary nodes without extracapsular extension. The APBI dose delivered was 34 Gy in 10 twice-daily fractions over 5 days for high-dose-rate (HDR); and 45 Gy in 3.5 to 5 days formore » low-dose-rate (LDR) brachytherapy. The primary endpoint was HDR and LDR MCT reproducibility. This analysis focuses on long-term ipsilateral breast recurrence (IBR), contralateral breast cancer events (CBE), regional recurrence (RR), and distant metastases (DM), disease-free, and overall survival. Results: The median follow-up was 12.1 years. One hundred patients were accrued from 1997 to 2000; 98 were evaluable; 65 underwent HDR and 33 LDR MCT. Median age was 62 years; 88% had T1 tumors; 81% were pN0. Seventy-seven percent were estrogen receptor and/or progesterone receptor positive; 33% received adjuvant chemotherapy and 64% antiendocrine therapy. There have been 4 isolated IBRs and 1 IBR with RR, for 5.2% 10-year IBR without DM. There was 1 isolated RR, 1 with IBR, and 1 with a CBE, for 3.1% 10-year RR without DM. The 10-year CBE rate was 4.2%, with 5 total events. Eleven patients have developed DM, 8 have died of breast cancer, and 22 have died from other causes. The 10-year DFS and OS rates are 69.8% and 78.0%, respectively. Conclusion: This multi-institutional, phase 2 trial studying MCT-APBI continues to report durable in-breast cancer control rates with long-term follow-up.« less

Long-Term Cancer Outcomes From Study NRG Oncology/RTOG 9517: A Phase 2 Study of Accelerated Partial Breast Irradiation With Multicatheter Brachytherapy After Lumpectomy for Early-Stage Breast Cancer.

PubMed

White, Julia; Winter, Kathryn; Kuske, Robert R; Bolton, John S; Arthur, Douglas W; Scroggins, Troy; Rabinovitch, Rachel A; Kelly, Tracy; Toonkel, Leonard M; Vicini, Frank A; McCormick, Beryl

2016-08-01

To examine 10-year rates of local, regional, and distant recurrences, patterns of recurrence, and survival rates for breast cancer patients enrolled on Study NRG Oncology/Radiation Therapy Oncology Group 9517, a multi-institutional prospective trial that studied one of the earliest methods of accelerated partial breast irradiation (APBI), multicatheter brachytherapy (MCT). Eligibility included stage I/II unifocal breast cancer <3 cm in size after lumpectomy with negative surgical margins and 0 to 3 positive axillary nodes without extracapsular extension. The APBI dose delivered was 34 Gy in 10 twice-daily fractions over 5 days for high-dose-rate (HDR); and 45 Gy in 3.5 to 5 days for low-dose-rate (LDR) brachytherapy. The primary endpoint was HDR and LDR MCT reproducibility. This analysis focuses on long-term ipsilateral breast recurrence (IBR), contralateral breast cancer events (CBE), regional recurrence (RR), and distant metastases (DM), disease-free, and overall survival. The median follow-up was 12.1 years. One hundred patients were accrued from 1997 to 2000; 98 were evaluable; 65 underwent HDR and 33 LDR MCT. Median age was 62 years; 88% had T1 tumors; 81% were pN0. Seventy-seven percent were estrogen receptor and/or progesterone receptor positive; 33% received adjuvant chemotherapy and 64% antiendocrine therapy. There have been 4 isolated IBRs and 1 IBR with RR, for 5.2% 10-year IBR without DM. There was 1 isolated RR, 1 with IBR, and 1 with a CBE, for 3.1% 10-year RR without DM. The 10-year CBE rate was 4.2%, with 5 total events. Eleven patients have developed DM, 8 have died of breast cancer, and 22 have died from other causes. The 10-year DFS and OS rates are 69.8% and 78.0%, respectively. This multi-institutional, phase 2 trial studying MCT-APBI continues to report durable in-breast cancer control rates with long-term follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.

Study protocol for a multi-institutional, randomised, double-blinded, placebo-controlled phase III trial investigating additive efficacy of duloxetine for neuropathic cancer pain refractory to opioids and gabapentinoids: the DIRECT study.

PubMed

Matsuoka, Hiromichi; Ishiki, Hiroto; Iwase, Satoru; Koyama, Atsuko; Kawaguchi, Takashi; Kizawa, Yoshiyuki; Morita, Tatsuya; Matsuda, Yoshinobu; Miyaji, Tempei; Ariyoshi, Keisuke; Yamaguchi, Takuhiro

2017-08-28

Management of patients with cancer suffering from neuropathic pain refractory to opioids and gabapentinoids remains an important challenge. Duloxetine is one of the choices after first-line treatment fails. The efficacy of duloxetine has been reported in patients with non-cancer disease and in chemotherapy-induced peripheral neuropathy, but no randomised clinical trials have examined its effects on neuropathic cancer pain refractory to first-line treatment. The objective of this study is to assess the analgesic efficacy of duloxetine in patients suffering from neuropathic cancer pain refractory to opioids and gabapentinoids. A multi-institutional, prospective, randomised, double-blind, placebo-controlled, two-parallel trial is planned. The inclusion criteria are adult patients with cancer suffering from neuropathic cancer pain refractory to opioids and gabapentinoids, patients with a Numerical Rating Scale (NRS) pain score of 4 or higher and patients with a total Hospital Anxiety and Depression Scale score of less than 20. Patients with chemotherapy-induced peripheral neuropathy are excluded. The study will take place at 14 sites across Japan. Participants will be randomised (1:1 allocation ratio) to a duloxetine intervention group or a placebo control group. Evaluations will be made at baseline (T0 randomisation), day 0 (T1), day 3 (T2) and day 10 (T3). The primary endpoint is defined as the difference in NRS score for pain intensity (average over the previous 24 hours) at T3 between the duloxetine and placebo groups. A sample size of 70 patients will be examined between July 2015 and March 2018. Ethics approval was obtained at all participating sites.The results of this study will be submitted for publication in international peer-reviewed journals and the key findings presented at international scientific conferences. UMIN000017647; Pre-results. 2.2, 26 April 2017. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Predicting introductory programming performance: A multi-institutional multivariate study

NASA Astrophysics Data System (ADS)

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.

Health care delivery: strength in numbers.

PubMed

DeVries, R A

1978-03-16

The number and types of multi-institutional arrangements among health care facilities are on the increase, and the days of the completely autonomous, independent hospital are coming to a close. Although by themselves hospital systems are no panacea in dealing with the challenges facing hospitals today, many such arrangements offer more opportunities than problems in coping with the rapid changes currently facing the health care industry. The pros and cons of seven arrangements are discussed in detail.

The Johns Hopkins RTR Consortium: A Collaborative Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation

DTIC Science & Technology

2014-10-01

Changes in Approach b. Problems/Delays and Plans for Resolution c. Changes that Impacted Expenditures d. Changes in use or care of vertebrate animals...the field of Restorative Transplantation matures , significant opportunities are emerging for transplant researchers and clinicians to capitalize on...that the maturing field of Restorative Transplantation will benefit the most from the establishment of a multi-institutional, multi-disciplinary

Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

DTIC Science & Technology

2015-10-01

Suzanne Kolb 12 Project Role: Project Coordinator Researcher Identifier (e.g. ORCID ID): N/A Nearest person month worked: 5 person months...Contribution to Project: Ms. Kolb works under the direction of Drs. Lin and Newcomb to fulfill daily fiscal and administrative functions of the...program. She monitors subaward budgets, provides logistical support. Ms. Kolb works closely with the PASS Deputy Director to maintain IRB files

Biomarkers for Early Detection of Clinically Relevant Prostate Cancer: A Multi-Institutional Validation Trial

DTIC Science & Technology

2015-10-01

Name: Suzanne Kolb 12 Project Role: Project Coordinator Researcher Identifier (e.g. ORCID ID): N/A Nearest person month worked: 5 person...months Contribution to Project: Ms. Kolb works under the direction of Drs. Lin and Newcomb to fulfill daily fiscal and administrative functions of the...program. She monitors subaward budgets, provides logistical support. Ms. Kolb works closely with the PASS Deputy Director to maintain IRB files

Civil-Military Relations in European Security Institutions - Challenges of Multi-Institutionality in Peace Operations

DTIC Science & Technology

2007-03-01

term “The Short Century” was used for the first time by Eric Hobsbawn, in his book The Short Century, written 1994, in which he claims that the...military implementation of the Peace Agreement.”148 147 Richard L. Layton , Command and Control...Richard L. Layton , Command and Control Structure, in Lessons from Bosnia: The IFOR Experience, Larry Wentz ed., (Washington D.C.: Institute for National

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.

PubMed

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 < 0.05). The results were validated by data obtained from the National Report of 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.

Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment.

PubMed

Goldstein, I; Newman, L; Baum, N; Brooks, M; Chaikin, L; Goldberg, K; McBride, A; Krane, R J

1997-03-01

We investigated safety and efficacy outcome pertaining to the Mentor Alpha-1, 3-piece inflatable penile prosthesis for impotence treatment. A 2-phase, multi-institutional, large scale retrospective study, with independently analyzed medical record (phase I) and questionnaire (phase II) data from consecutive eligible patients of 7 physician investigators was performed from March to October 1993. In phase I there were no morbidities of any type in 394 of the 434 patients (90.8%) (mean age 61 years, range 24 to 88) who underwent Alpha-1 implantation (mean followup 22.2 months, range 0.67 to 44.5). The risk of prosthesis malfunction (fluid leak and auto-inflation) was 2.5%. No cylinder aneurysms were reported. A total of 93.1% of Alpha-1 devices was free from explantation (4.4%) or revision surgery (2.5%) for approximately 2 years from the original implant date. Kaplan-Meier actuarial analyses revealed that cumulative survival of the Alpha-1 prostheses at 12, 24 and 36 months was 98 +/- 1%, 93 +/- 2% and 85 +/- 7% until device malfunction, and 91 +/- 2% 83 +/- 4% and 75 +/- 7% until surgical intervention (revision or explantation). In phase II 89% of the men claimed fulfilled expectations with the Alpha-1 prosthesis as impotence treatment. Satisfaction responses 80% or greater were noted with regard to intercourse ability and confidence, and device rigidity and function. Implantation did not result in greater than 80% satisfaction in partner relationships or feelings (as judged by the patient), social or work confidence, or intercourse frequency. Factors adversely affecting satisfaction included partner feelings of dissatisfaction (as judged by the patient), specific physician investigators and need for explantation/revision surgery. In 1 of the largest multi-institutional implant outcome studies thus far performed, safety and efficacy data concerning the Alpha-1 contemporary inflatable device were found markedly improved over earlier inflatable prostheses and now compare favorably with historical data from noninflatable rod type devices.

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

PubMed

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 from learning what factors their applicants value most.

Outcomes of Rehepatectomy for Colorectal Liver Metastases: A Contemporary Multi-Institutional Analysis from the French Surgical Association Database.

PubMed

Hallet, Julie; Cunha, Antonio Sa; Adam, Rene; Goéré, Diane; Azoulay, Daniel; Mabrut, Jean-Yves; Muscari, Fabrice; Laurent, Christophe; Navarro, Francis; Pessaux, Patrick

2016-12-01

Recurrence remains frequent after curative-intent hepatectomy for colorectal liver metastases (CRLM). We sought to define short- and long-term outcomes, and identify prehepatectomy factors associated with survival, following rehepatectomy (RH) for recurrence. We conducted a multi-institutional cohort study of hepatectomy for CRLM over 2006-2013. Second-stage resections were excluded. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS) assessed using Kaplan-Meier methods. Secondary outcomes included 30-day overall morbidity and mortality, and survival from recurrence. Outcomes of RH and initial hepatectomy (IH) were compared. Of 2771 hepatectomies included in the study, 447 were RH. Median operative time, 30-day morbidity, mortality, and median length of stay did not differ for RH and IH. Five-year OS did not statistically differ, i.e. 56.5 % from RH and 67.6 % from IH [adjusted hazard ratio (HR) 0.9, 95 % confidence interval (CI) 0.5-1.7], and 5-year RFS was inferior after RH (18.5 vs. 28.8 %; adjusted HR 1.3, 95 % CI 1.0-1.7). In patients who eventually recurred, 5-year survival from the time of recurrence did not differ whether it was after RH (46.5 %) or after IH (60.3 %) (adjusted HR 1.1, 95  % CI 0.8-1.8). Rectal primary tumor (HR 1.4, 95 % CI 1.0-2.1) and metastasis ≥3 cm (HR 1.3, 95 % CI 1.1-2.7) were independently associated with RFS, but not OS, after RH. Short-term outcomes of RH did not differ from IH. While recurrence was more frequent after RH than IH, it did not impact OS. Survival from the time of recurrence did not differ whether recurrence occurred after RH or after IH. CRLM recurrence can be treated with curative intent with excellent long-term outcomes.

Resource Prospector Lander: Architecture and Trade Studies

NASA Technical Reports Server (NTRS)

Moore, Josh; Calvert, Derek; Frady, Greg; Chavers, Greg; Wayne, Andrew; Hull, Patrick; Lowery, Eric; Farmer, Jeff; Trinh, Huu; Rojdev, Kristina;

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

PubMed

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 residents at risk for failure of the ABSCE. Sequential participation in mock oral examinations is associated with improved ABSCE first-time pass rate. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

PubMed

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 pilot study. NLP is an efficient method to extract information from a large collection of imaging reports to facilitate CER. ©Stephane Meystre, Ramkiran Gouripeddi, Joel Tieder, Jeffrey Simmons, Rajendu Srivastava, Samir Shah. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.05.2017.

Implementation of a nationwide health economic consultation service to assist substance use researchers: Lessons learned.

PubMed

Murphy, Sean M; Leff, Jared A; Linas, Benjamin P; Morgan, Jake R; McCollister, Kathryn; Schackman, Bruce R

2018-03-20

Health economic evaluation findings assist stakeholders in improving the quality, availability, scalability, and sustainability of evidence-based services, and in maximizing the efficiency of service delivery. The Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV, and HIV (CHERISH) is a NIDA-funded multi-institutional center of excellence whose mission is to develop and disseminate health-economic research on healthcare utilization, health outcomes, and health-related behaviors that informs substance use disorder treatment policy, and HCV and HIV care of people who use substances. We designed a consultation service that is free to researchers whose work aligns with CHERISH's mission. The service includes up to six hours of consulting time. After prospective consultees submit their request online, they receive a screening call from the consultation service director, who connects them with a consultant with relevant expertise. Consultees and consultants complete web-based evaluations following the consultation; consultees also complete a six-month follow-up. We report on the status of the service from its inception in July 2015 through June 2017. We have received 28 consultation requests (54% Early Stage Investigators, 57% MD or equivalent, 28% PhD, 61% women) on projects typically related to planning a study or grant application (93%); 71% were HIV/AIDS-related. Leading topics included cost-effectiveness (43%), statistical-analysis/econometrics (36%), cost (32%), cost-benefit (21%), and quality-of-life (18%). All consultees were satisfied with their overall experience, and felt that consultation expectations and objectives were clearly defined and the consultant's expertise was matched appropriately with their needs. Results were similar for consultants, who spent a median of 3 hours on consultations. There is a need for health-economic methodological guidance among substance use, HCV, and HIV researchers. Lessons learned pertain to the feasibility of service provision, the need to implement systems to measure and improve service value, and strategies for service promotion.

The Risk and Clinical/Molecular Characteristics of Breast Cancer in Women with Neurofibromatosis Type 1

DTIC Science & Technology

2014-10-01

Neurofibromatosis Type 1 PRINCIPAL INVESTIGATOR: Xia Wang, M.D., Ph.D. CONTRACTING ORGANIZATION: Henry Ford Health System Detroit... Neurofibromatosis Type 1” 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Betty Diamond 5d. PROJECT NUMBER Xia Wang, MD, PhD; Renee... Neurofibromatosis type 1 (NF1) in a multi-institutional setting. Aim 1 assessed the incidence of breast cancer in this cohort and the clinical

Collaborative Project: Improving the Representation of Coastal and Estuarine Processes in Earth System Models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bryan, Frank; Dennis, John; MacCready, Parker

This project aimed to improve long term global climate simulations by resolving and enhancing the representation of the processes involved in the cycling of freshwater through estuaries and coastal regions. This was a collaborative multi-institution project consisting of physical oceanographers, climate model developers, and computational scientists. It specifically targeted the DOE objectives of advancing simulation and predictive capability of climate models through improvements in resolution and physical process representation.

Final Report Collaborative Project: Improving the Representation of Coastal and Estuarine Processes in Earth System Models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bryan, Frank; Dennis, John; MacCready, Parker

This project aimed to improve long term global climate simulations by resolving and enhancing the representation of the processes involved in the cycling of freshwater through estuaries and coastal regions. This was a collaborative multi-institution project consisting of physical oceanographers, climate model developers, and computational scientists. It specifically targeted the DOE objectives of advancing simulation and predictive capability of climate models through improvements in resolution and physical process representation.

Diagnosing Diagnosis Errors: Lessons From A Multi-Institutional Collaborative Project

DTIC Science & Technology

2005-01-01

Breast Cancer Inappropriately reassured to have benign lesions - 21/435 (5%); 14 (3%) misread mammogram, 4 (1%) misread pathologic finding, 5 (1...diagnostic tests they are using. It is well known that a normal mammogram in a woman with a breast lump does not rule out the diagnosis of breast cancer ...physician delay in the diagnosis of breast cancer . Arch Intern Med 2002;162:1343–8. 27. Clark S. Spinal infections go undetected. Lancet 1998;351

Multi-institutional external validation of seminal vesicle invasion nomograms: head-to-head comparison of Gallina nomogram versus 2007 Partin tables.

PubMed

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

2009-04-01

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. 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. 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. 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.

Impact of hypoxia and the metabolic microenvironment on radiotherapy of solid tumors. Introduction of a multi-institutional research project.

PubMed

Zips, Daniel; Adam, Markus; Flentje, Michael; Haase, Axel; Molls, Michael; Mueller-Klieser, Wolfgang; Petersen, Cordula; Philbrook, Christine; Schmitt, Peter; Thews, Oliver; Walenta, Stefan; Baumann, Michael

2004-10-01

Recent developments in imaging technology and tumor biology have led to new techniques to detect hypoxia and related alterations of the metabolic microenvironment in tumors. However, whether these new methods can predict radiobiological hypoxia and outcome after fractionated radiotherapy still awaits experimental evaluation. The present article will introduce a multi-institutional research project addressing the impact of hypoxia and the metabolic microenvironment on radiotherapy of solid tumors. The four laboratories involved are situated at the universities of Dresden, Mainz, Munich and Würzburg, Germany. The joint scientific project started to collect data obtained on a set of ten different human tumor xenografts growing in nude mice by applying various imaging techniques to detect tumor hypoxia and related parameters of the metabolic microenvironment. These techniques include magnetic resonance imaging and spectroscopy, metabolic mapping with quantitative bioluminescence and single-photon imaging, histological multiparameter analysis of biochemical hypoxia, perfusion and vasculature, and immunohistochemistry of factors related to angiogenesis, invasion and metastasis. To evaluate the different methods, baseline functional radiobiological data including radiobiological hypoxic fraction and outcome after fractionated irradiation will be determined. Besides increasing our understanding of tumor biology, the project will focus on new, clinically applicable strategies for microenvironment profiling and will help to identify those patients that might benefit from targeted interventions to improve tumor oxygenation.

Science education: A meta-analysis of major questions

NASA Astrophysics Data System (ADS)

Anderson, Ronald D.; Kahl, Stuart R.; Glass, Gene V.; Smith, Mary Lee

A multi-institutional endeavor was initiated to integrate the findings of extant research studies directed toward the major science education research questions. The research questions were selected by a largely empirical process of identifiying the most frequently researched questions in the literature. These questions were assigned to various researchers who developed coding sheets and procedures with many features in common. This article describes the overall operation of the project, the research questions identified, and some rudiments of meta-analysis. The results of the several meta-analysis are reported in the other articles of this issue of the Journal. The final article in this issue deals with research topics for which data are drawn from one or more of the separate meta-analyses.

ACCESS: The Arizona-CfA-Catolica Exoplanet Spectroscopy Survey

NASA Astrophysics Data System (ADS)

Lopez-Morales, Mercedes; Apai, Daniel; Jordan, Andres; Espinoza, Nestor; Rackham, Benjamin; Fraine, Jonathan D.; Rodler, Florian; Lewis, Nikole; Fortney, Jonathan J.; Osip, David J.

2014-06-01

The Arizona-CfA-Catolica Exoplanet Spectroscopy Survey (ACCESS) is an international, multi-institutional consortium with members from the Harvard-Smithsonian CfA, the University of Arizona, Pontificia Universidad Catolica in Chile, MIT and UC Santa Cruz and the Carnegie Institution. ACCESS' goal is to observe about two dozen planets covering a wide range of mass, radius, atmospheric temperatures and energy irradiation levels, with two main scientific goals: 1) to obtain, for the first time, a uniform sample of visible transmission spectra of exoplanets, allowing the study of their atmospheric characteristics as a statistically significant sample, and 2) to mature the technique of ground-based observations of exoplanetary atmospheres for future observations of small planets. Here we describe ACCESS and its first science results.

The LCLS Project

NASA Astrophysics Data System (ADS)

Paterson, James M.

2000-04-01

The Linac Coherent Light Source (LCLS) is a linac driven FEL which uses a 1km electron linac (the last third of the SLAC linac) and a 100m long undulator to produce 1.5 angstrom X-rays of extremely high peak brightness. This radiation is fully tranversely coherent and is in sub-picosecond long pulses. The LCLS Project is a four year R&D program to solidify the design, to develop required technologies, to optimize the cost and performance and to study the potential experimental programs using these unique beam characteristics. The program is conducted by a multi-institutional collaboration consisting of SLAC as the lead laboratory, along with ANL, BNL, LLNL, LANL and UCLA.The LCLS design and the R&D programs are described.

Perceived Safety and Value of Inpatient "Very Important Person" Services.

PubMed

Allen-Dicker, Joshua; Auerbach, Andrew; Herzig, Shoshana J

2017-03-01

Providing care to "very important person" (VIP) patients can pose unique moral and value-based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi-institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self-reported perceptions, as well as case-based questions, we also found that the VIP status of a patient may impact physician clinical decision-making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient-specific outcomes are needed. Journal of Hospital Medicine 2017;12:177-179. © 2017 Society of Hospital Medicine.

Promoting Knowledge to Action through the Study of Environmental Arctic Change (SEARCH) Program

NASA Astrophysics Data System (ADS)

Myers, B.; Wiggins, H. V.

2016-12-01

The Study of Environmental Arctic Change (SEARCH) is a multi-institutional collaborative U.S. program that advances scientific knowledge to inform societal responses to Arctic change. Currently, SEARCH focuses on how diminishing Arctic sea ice, thawing permafrost, and shrinking land ice impact both Arctic and global systems. Emphasizing "knowledge to action", SEARCH promotes collaborative research, synthesizes research findings, and broadly communicates the resulting knowledge to Arctic researchers, stakeholders, policy-makers, and the public. This poster presentation will highlight recent program products and findings; best practices and challenges for managing a distributed, interdisciplinary program; and plans for cross-disciplinary working groups focused on Arctic coastal erosion, synthesis of methane budgets, and development of Arctic scenarios. A specific focus will include how members of the broader research community can participate in SEARCH activities. http://www.arcus.org/search

Initial Technology Assessment for the Large-Aperture UV-Optical-Infrared (LUVOIR) Mission Concept Study

NASA Technical Reports Server (NTRS)

Bolcar, Matthew R.; Feinberg, Lee; France, Kevin; Rauscher, Bernard J.; Redding, David; Schiminovich, David

2016-01-01

The NASA Astrophysics Division's 30-Year Roadmap prioritized a future large-aperture space telescope operating in the ultra-violet/optical/infrared wavelength regime. The Association of Universities for Research in Astronomy envisioned a similar observatory, the High Definition Space Telescope. And a multi-institution group also studied the Advanced Technology Large Aperture Space Telescope. In all three cases, a broad science case is outlined, combining general astrophysics with the search for biosignatures via direct-imaging and spectroscopic characterization of habitable exoplanets. We present an initial technology assessment that enables such an observatory that is currently being studied for the 2020 Decadal Survey by the Large UV/Optical/Infrared (LUVOIR) surveyor Science and Technology Definition Team. We present here the technology prioritization for the 2016 technology cycle and define the required technology capabilities and current state-of-the-art performance. Current, planned, and recommended technology development efforts are also reported.

The Value of Student-Run Clinics for Premedical Students: A Multi-Institutional Study.

PubMed

Pennington, Kaylin; Tong, Ian L; Lai, Cindy J; O'Sullivan, Patricia S; Sheu, Leslie

2016-01-01

Research has shown that student-run clinics (SRCs) are ideal experiential learning arenas for medical students, but no studies have characterized the impact of SRC participation on premedical students. We conducted a retrospective cohort study with newly matriculated first-year medical students at five California medical schools to determine the impact of premedical involvement in SRCs. Participants completed an anonymous one-time online survey that included demographic information and questions regarding SRC involvement prior to medical school. Two-hundred eighty-seven out of 588 (48.2%) newly matriculated first-year medical students responded, with 17.4% of respondents reporting that they had volunteered in SRCs prior to medical school. These students identified SRCs as meaningful venues for developing patient interaction skills and finding medical student and physician mentors. Prior to medical school matriculation, SRC experiences may be important experiential learning arenas, providing premedical students with an authentic clinical setting and access to mentors.

Initial Technology Assessment for the Large UV-Optical-Infrared (LUVOIR) Mission Concept Study

NASA Technical Reports Server (NTRS)

Bolcar, Matthew R.; Feinberg, Lee D.; France, Kevin; Rauscher, Bernard J.; Redding, David; Schiminovich, David

2016-01-01

The NASA Astrophysics Divisions 30-Year Roadmap prioritized a future large-aperture space telescope operating in the ultra-violet-optical-infrared wavelength regime. The Association of Universities for Research in Astronomy envisioned a similar observatory, the High Definition Space Telescope. And a multi-institution group also studied the Advanced Technology Large Aperture Space Telescope. In all three cases, a broad science case is outlined, combining general astrophysics with the search for bio-signatures via direct-imaging and spectroscopic characterization of habitable exo-planets. We present an initial technology assessment that enables such an observatory that is currently being studied for the 2020 Decadal Survey by the Large UV-Optical Infrared (LUVOIR) surveyor Science and Technology Definition Team. We present here the technology prioritization for the 2016 technology cycle and define the required technology capabilities and current state-of-the-art performance. Current, planned, and recommended technology development efforts are also reported.

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

PubMed

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 and exclusions, and reporting guidelines. III, prognostic study.

Myeloproliferative neoplasms with concurrent BCR-ABL1 translocation and JAK2 V617F mutation: a multi-institutional study from the bone marrow pathology group.

PubMed

Soderquist, Craig R; Ewalt, Mark D; Czuchlewski, David R; Geyer, Julia T; Rogers, Heesun J; Hsi, Eric D; Wang, Sa A; Bueso-Ramos, Carlos E; Orazi, Attilio; Arber, Daniel A; Hexner, Elizabeth O; Babushok, Daria V; Bagg, Adam

2018-05-01

Myeloproliferative neoplasms arise from hematopoietic stem cells with somatically altered tyrosine kinase signaling. Classification of myeloproliferative neoplasms is based on hematologic, histopathologic and molecular characteristics including the presence of the BCR-ABL1 and JAK2 V617F. Although thought to be mutually exclusive, a number of cases with co-occurring BCR-ABL1 and JAK2 V617F have been identified. To characterize the clinicopathologic features of myeloproliferative neoplasms with concomitant BCR-ABL1 and JAK2 V617F, and define the frequency of co-occurrence, we conducted a retrospective multi-institutional study. Cases were identified using a search of electronic databases over a decade at six major institutions. Of 1570 patients who were tested for both BCR-ABL1 and JAK2 V617F, six were positive for both. An additional five patients were identified via clinical records providing a total of 11 cases for detailed evaluation. For each case, clinical variables, hematologic and genetic data, and bone marrow histomorphologic features were analyzed. The sequence of identification of the genetic abnormalities varied: five patients were initially diagnosed with a JAK2 V617F+ myeloproliferative neoplasm, one patient initially had BCR-ABL1+ chronic myeloid leukemia, while both alterations were identified simultaneously in five patients. Classification of the BCR-ABL1-negative myeloproliferative neoplasms varied, and in some cases, features only became apparent following tyrosine kinase inhibitor therapy. Seven of the 11 patients showed myelofibrosis, in some cases before identification of the second genetic alteration. Our data, reflecting the largest reported study comprehensively detailing clinicopathologic features and response to therapy, show that the co-occurrence of BCR-ABL1 and JAK2 V617F is rare, with an estimated frequency of 0.4%, and most often reflects two distinct ('composite') myeloproliferative neoplasms. Although uncommon, it is important to be aware of this potentially confounding genetic combination, lest these features be misinterpreted to reflect resistance to therapy or disease progression, considerations that could lead to inappropriate management.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ohashi, Toshio, E-mail: ohashi@rad.med.keio.ac.jp; Yorozu, Atsunori; Saito, Shiro

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 radiationmore » 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 studies.« less

Current Research Activities of the Department of Oceanography.

DTIC Science & Technology

1981-04-01

being analyzed in terms of the structure of the East Pacific A multi-institutional investi- Rise at 12* N and the change in crus- gation on the abundance...seismic experiment at the axis of the East Pacific Rise . Marine Geology 35: 147-169. No. 1090 McDaniel, N . and K. Banse (1979) A novel method of...proceeded eastward from Tahiti ducted off the Oregon and Washington to the East Pacific Rise area, then coasts. In late August a return back to Tahiti. On

Final Report for the Center for Momentum Transport and Flow Organization (CMTFO)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tynan, George R.

The Center for Momentum Transport and Flow Organization (CMTFO) was established in 2009 as a multi-institutional U.S. DOE Plasma Science Center, with a focus on the fundamental physics mechanisms that lead to the transport of momentum within fusion and astrophysical plasma systems, and the subsequent formation of ordered behavior in such systems. It was funded in two tranches; this report covers the activities supported by the second period of funding which ran from May 2012 through May 2016.

Successful linking of the Society of Thoracic Surgeons database to social security data to examine survival after cardiac operations.

PubMed

Jacobs, Jeffrey Phillip; Edwards, Fred H; Shahian, David M; Prager, Richard L; Wright, Cameron D; Puskas, John D; Morales, David L S; Gammie, James S; Sanchez, Juan A; Haan, Constance K; Badhwar, Vinay; George, Kristopher M; O'Brien, Sean M; Dokholyan, Rachel S; Sheng, Shubin; Peterson, Eric D; Shewan, Cynthia M; Feehan, Kelly M; Han, Jane M; Jacobs, Marshall Lewis; Williams, William G; Mayer, John E; Chitwood, W Randolph; Murray, Gordon F; Grover, Frederick L

2011-07-01

Long-term evaluation of cardiothoracic surgical outcomes is a major goal of The Society of Thoracic Surgeons (STS). Linking the STS Database to the Social Security Death Master File (SSDMF) allows for the verification of "life status." This study demonstrates the feasibility of linking the STS Database to the SSDMF and examines longitudinal survival after cardiac operations. For all operations in the STS Adult Cardiac Surgery Database performed in 2008 in patients with an available Social Security Number, the SSDMF was searched for a matching Social Security Number. Survival probabilities at 30 days and 1 year were estimated for nine common operations. A Social Security Number was available for 101,188 patients undergoing isolated coronary artery bypass grafting, 12,336 patients undergoing isolated aortic valve replacement, and 6,085 patients undergoing isolated mitral valve operations. One-year survival for isolated coronary artery bypass grafting was 88.9% (6,529 of 7,344) with all vein grafts, 95.2% (84,696 of 88,966) with a single mammary artery graft, 97.4% (4,422 of 4,540) with bilateral mammary artery grafts, and 95.6% (7,543 of 7,890) with all arterial grafts. One-year survival was 92.4% (11,398 of 12,336) for isolated aortic valve replacement (95.6% [2,109 of 2,206] with mechanical prosthesis and 91.7% [9,289 of 10,130] with biologic prosthesis), 86.5% (2,312 of 2,674) for isolated mitral valve replacement (91.7% [923 of 1,006] with mechanical prosthesis and 83.3% [1,389 of 1,668] with biologic prosthesis), and 96.0% (3,275 of 3,411) for isolated mitral valve repair. Successful linkage to the SSDMF has substantially increased the power of the STS Database. These longitudinal survival data from this large multi-institutional study provide reassurance about the durability and long-term benefits of cardiac operations and constitute a contemporary benchmark for survival after cardiac operations. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Robot-assisted simple prostatectomy: multi-institutional outcomes for glands larger than 100 grams.

PubMed

Vora, Anup; Mittal, Sameer; Hwang, Jonathan; Bandi, Gaurav

2012-05-01

To present our experience with robot-assisted simple prostatectomy in patients with large gland adenoma (>100 g) that would not be amenable to transurethral treatments. From August 2009 to May 2011, 13 robot-assisted simple suprapubic prostatectomies were performed in patients with symptomatic large gland (>100 g) prostatomegaly on transrectal ultrasonography (mean 163 cc). Essential aspects of our technique include a transverse cystotomy just proximal to the prostatovesical junction and use of a robotic tenotomy grasper to aid in adenoma dissection. Mean operative time was 179 minutes (range 90-270 min), and mean estimated blood loss was 219 mL (range 50-500 mL). Mean hospital stay was 2.7 days (range 1-8 d), and the mean urethral catheterization time was 8.8 days (range 5-14 d). None of the patients needed blood transfusion. One patient had an intraoperative urinary leak after bladder closure that was managed with prolonged urethral catheterization (14 d). Histopathologic analysis confirmed benign prostatic hyperplasia (BPH) in all patients, and mean specimen weight on pathologic examination was 127 g (range 100-165 g). Mean follow-up duration was 7.2 months with all patients having a minimum of a 4-month follow-up. Significant improvements were noted in the International Prostate Symptom Score (preoperative vs postoperative 18.1 vs 5.3, p<0.001) and the maximum urine flow rate (preoperative vs postoperative 4.3 vs 19.1 mL/min, P<0.001). Minimally invasive robot-assisted simple prostatectomy is technically feasible in patients with large volume (>100 g) BPH and is associated with significant improvements in obstructive urinary symptoms. Surgeons with robotic expertise may consider using this approach for treatment of their patients with large volume BPH.

Research as a standard of care in PICU

PubMed Central

Zimmerman, Jerry J.; Anand, Kanwaljeet J. S.; Meert, Kathleen L.; Willson, Douglas F.; Newth, Christopher J. L.; Harrison, Rick; Carcillo, Joseph A.; Berger, John; Jenkins, Tammara L.; Nicholson, Carol; Dean, J. Michael

2016-01-01

Background Excellence in clinical care coupled with basic and applied research reflects the maturation of a medical subspecialty, advances that field, and provides objective data for identifying best practices. Pediatric intensive care units (PICU) are uniquely suited for conducting translational and clinical research. Moreover, multiple investigations have reported that a majority of parents are interested in their children’s participation in clinical research, even when the research offers no direct benefit to their child. However, such activity may generate ethical conflict with bedside care providers trying to acutely identify the best approach for an individual critically ill child. Ultimately, this conflict may diminish enthusiasm for the generation of scientific evidence that supports application of evidence-based medicine into PICU clinical standard work. Objective Provide an overview of current state PICU clinical research strengths, liabilities, opportunities, and barriers, and contrast this with an established pediatric hematology-oncology iterative research model that constitutes a learning healthcare system. Design Narrative review of medical literature published in English. Conclusions Currently most PICU therapy is not evidence-based. Developing a learning healthcare system in the PICU integrates clinical research into usual practice and fosters a culture of evidence-based learning and continual care improvement. As PICU mortality has significantly decreased, identification and validation of patient-centered, clinically relevant research outcome measures other than mortality is essential for future clinical trial design. Because most pediatric critical illness may be classified as rare diseases, participation in research networks will facilitate iterative, collaborative, multi-institutional investigations that over time identify best practices to improve PICU outcomes. Despite real ethical challenges, critically ill children and their families should have the opportunity to participate in translational/clinical research whenever feasible. PMID:26513203

Evolution of Precipitation Particle Size Distributions within MC3E Systems and its Impact on Aerosol-Cloud-Precipitation Interactions: Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kollias, Pavlos

2017-08-08

This is a multi-institutional, collaborative project using observations and modeling to study the evolution (e.g. formation and growth) of hydrometeors in continental convective clouds. Our contribution was in data analysis for the generation of high-value cloud and precipitation products and derive cloud statistics for model validation. There are two areas in data analysis that we contributed: i) the development of novel, state-of-the-art dual-wavelength radar algorithms for the retrieval of cloud microphysical properties and ii) the evaluation of large domain, high-resolution models using comprehensive multi-sensor observations. Our research group developed statistical summaries from numerous sensors and developed retrievals of vertical airmore » motion in deep convection.« less

ARM Airborne Carbon Measurements (ARM-ACME) and ARM-ACME 2.5 Final Campaign Reports

DOE Office of Scientific and Technical Information (OSTI.GOV)

Biraud, S. C.; Tom, M. S.; Sweeney, C.

2016-01-01

We report on a 5-year multi-institution and multi-agency airborne study of atmospheric composition and carbon cycling at the Atmospheric Radiation Measurement (ARM) Climate Research Facility’s Southern Great Plains (SGP) site, with scientific objectives that are central to the carbon-cycle and radiative-forcing goals of the U.S. Global Change Research Program and the North American Carbon Program (NACP). The goal of these measurements is to improve understanding of 1) the carbon exchange of the Atmospheric Radiation Measurement (ARM) SGP region; 2) how CO 2 and associated water and energy fluxes influence radiative-forcing, convective processes, and CO 2 concentrations over the ARM SGPmore » region, and 3) how greenhouse gases are transported on continental scales.« less

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zorn, Kevin C.; Capitanio, Umberto; Jeldres, Claudio

2009-04-01

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 Northmore » 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.« less

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

PubMed

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 < 0.0001). Similar associations between smoking and the early diagnosis of upper tract urothelial carcinoma were shown in the sex subgroups and in subgroups stratified by pathological T stages. Among the current smokers, the age at diagnosis for the smoking ≥ 20 cigarettes per day group was 6.5 years lower than that of the < 20 cigarettes per day group, which was significantly different (P < 0.0001). Current smoking is a significant risk factor for the earlier diagnosis of upper tract urothelial carcinoma. The finding is important from the perspective of both healthcare and medical economies. © 2015 The Japanese Urological Association.

Biallelic Alteration and Dysregulation of the Hippo Pathway in Mucinous Tubular and Spindle Cell Carcinoma of the Kidney.

PubMed

Mehra, Rohit; Vats, Pankaj; Cieslik, Marcin; Cao, Xuhong; Su, Fengyun; Shukla, Sudhanshu; Udager, Aaron M; Wang, Rui; Pan, Jincheng; Kasaian, Katayoon; Lonigro, Robert; Siddiqui, Javed; Premkumar, Kumpati; Palapattu, Ganesh; Weizer, Alon; Hafez, Khaled S; Wolf, J Stuart; Sangoi, Ankur R; Trpkov, Kiril; Osunkoya, Adeboye O; Zhou, Ming; Giannico, Giovanna; McKenney, Jesse K; Dhanasekaran, Saravana M; Chinnaiyan, Arul M

2016-11-01

Mucinous tubular and spindle cell carcinoma (MTSCC) is a relatively rare subtype of renal cell carcinoma (RCC) with distinctive morphologic and cytogenetic features. Here, we carry out whole-exome and transcriptome sequencing of a multi-institutional cohort of MTSCC (n = 22). We demonstrate the presence of either biallelic loss of Hippo pathway tumor suppressor genes (TSG) and/or evidence of alteration of Hippo pathway genes in 85% of samples. PTPN14 (31%) and NF2 (22%) were the most commonly implicated Hippo pathway genes, whereas other genes such as SAV1 and HIPK2 were also involved in a mutually exclusive fashion. Mutations in the context of recurrent chromosomal losses amounted to biallelic alterations in these TSGs. As a readout of Hippo pathway inactivation, a majority of cases (90%) exhibited increased nuclear YAP1 protein expression. Taken together, nearly all cases of MTSCC exhibit some evidence of Hippo pathway dysregulation. MTSCC is a rare and relatively recently described subtype of RCC. Next-generation sequencing of a multi-institutional MTSCC cohort revealed recurrent chromosomal losses and somatic mutations in the Hippo signaling pathway genes leading to potential YAP1 activation. In virtually all cases of MTSCC, there was evidence of Hippo pathway dysregulation, suggesting a common mechanistic basis for this disease. Cancer Discov; 6(11); 1258-66. ©2016 AACR.This article is highlighted in the In This Issue feature, p. 1197. ©2016 American Association for Cancer Research.

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

NASA Astrophysics Data System (ADS)

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.

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

PubMed

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.

Is Hypospadias Associated with Prenatal Exposure to Endocrine Disruptors? A French Collaborative Controlled Study of a Cohort of 300 Consecutive Children Without Genetic Defect.

PubMed

Kalfa, Nicolas; Paris, Françoise; Philibert, Pascal; Orsini, Mattea; Broussous, Sylvie; Fauconnet-Servant, Nadège; Audran, Françoise; Gaspari, Laura; Lehors, Hélène; Haddad, Myriam; Guys, Jean-Michel; Reynaud, Rachel; Alessandrini, Pierre; Merrot, Thierry; Wagner, Kathy; Kurzenne, Jean-Yves; Bastiani, Florence; Bréaud, Jean; Valla, Jean-Stéphane; Lacombe, Gérard Morisson; Dobremez, Eric; Zahhaf, Amel; Daures, Jean-Pierre; Sultan, Charles

2015-12-01

Numerous studies have focused on the association between endocrine-disrupting chemicals (EDCs) and hypospadias. Phenotype variability, the absence of representative comparison groups and concomitant genetic testing prevent any definitive conclusions. To identify the role of occupational and environmental exposures to EDCs in nongenetic isolated hypospadias. A total of 408 consecutive children with isolated hypospadias and 302 normal boys were prospectively included (2009-2014) in a multi-institutional study in the south of France, the area of the country with the highest prevalence of hypospadias surgery. In patients without AR, SRD5A2, and MAMLD1 mutations, parental occupational and professional exposures to EDCs were evaluated based on European questionnaire QLK4-1999-01422 and a validated job-exposure matrix for EDCs. Environmental exposure was estimated using the zip code, the type of surrounding hazards, and distance from these hazards. Multivariate analysis was performed. Fetal exposure to EDCs around the window of genital differentiation was more frequent in the case of hypospadias (40.00% vs 17.55%, odds ratio 3.13, 95% confidence interval 2.11-4.65). The substances were paints/solvents/adhesives (16.0%), detergents (11.0%), pesticides (9.0%), cosmetics (5.6%), and industrial chemicals (4.0%). Jobs with exposure were more frequent in mothers of hypospadiac boys (19.73% vs 10.26%, p=0.0019), especially cleaners, hairdressers, beauticians, and laboratory workers. Paternal job exposure was more frequent in the cases of hypospadias (40.13% vs 27.48%, p=0.02). Industrial areas, incinerators, and waste areas were more frequent within a 3-km radius for mothers of hypospadiac boys (13.29% vs. 6.64%, p<0.00005). Association of occupational and environmental exposures increases this risk. This multicenter prospective controlled study with a homogeneous cohort of hypospadiac boys without genetic defects strongly suggests that EDCs are a risk factor for hypospadias through occupational and environmental exposure during fetal life. The association of various types of exposures may increase this risk. Our multi-institutional study showed that parental professional, occupational, and environmental exposures to chemical products increase the risk of hypospadias in children. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Is Ki67 prognostic for aggressive prostate cancer? A multicenter real-world study.

PubMed

Fantony, Joseph J; Howard, Lauren E; Csizmadi, Ilona; Armstrong, Andrew J; Lark, Amy L; Galet, Colette; Aronson, William J; Freedland, Stephen J

2018-06-15

To test if Ki67 expression is prognostic for biochemical recurrence (BCR) after radical prostatectomy (RP). Ki67 immunohistochemistry was performed on tissue microarrays constructed from specimens obtained from 464 men undergoing RP at the Durham and West LA Veterans Affairs Hospitals. Hazard ratios (HR) for Ki67 expression and time to BCR were estimated using Cox regression. Ki67 was associated with more recent surgery year (p < 0.001), positive margins (p = 0.001) and extracapsular extension (p < 0.001). In center-stratified analyses, the adjusted HR for Ki67 expression and BCR approached statistical significance for west LA (HR: 1.54; p = 0.06), but not Durham (HR: 1.10; p = 0.74). This multi-institutional 'real-world' study provides limited evidence for the prognostic role of Ki67 in predicting outcome after RP.

Tissue microarrays and digital image analysis.

PubMed

Ryan, Denise; Mulrane, Laoighse; Rexhepaj, Elton; Gallagher, William M

2011-01-01

Tissue microarrays (TMAs) have recently emerged as very valuable tools for high-throughput pathological assessment, especially in the cancer research arena. This important technology, however, has yet to fully penetrate into the area of toxicology. Here, we describe the creation of TMAs representative of samples produced from conventional toxicology studies within a large-scale, multi-institutional pan-European project, PredTox. PredTox, short for Predictive Toxicology, formed part of an EU FP6 Integrated Project, Innovative Medicines for Europe (InnoMed), and aimed to study pre-clinically 16 compounds of known liver and/or kidney toxicity. In more detail, TMAs were constructed from materials corresponding to the full face sections of liver and kidney from rats treated with different drug candidates by members of the consortium. We also describe the process of digital slide scanning of kidney and liver sections, in the context of creating an online resource of histopathological data.

A prospective investigation of fluorescence imaging to detect sentinel lymph nodes at robotic-assisted endometrial cancer staging.

PubMed

Paley, Pamela J; Veljovich, Dan S; Press, Joshua Z; Isacson, Christina; Pizer, Ellen; Shah, Chirag

2016-07-01

The accuracy of sentinel lymph node mapping has been shown in endometrial cancer, but studies to date have primarily focused on cohorts at low risk for nodal involvement. In our practice, we acknowledge the lack of benefit of lymphadenectomy in the low-risk subgroup and omit lymph node removal in these patients. Thus, our aim was to evaluate the feasibility and accuracy of sentinel node mapping in women at sufficient risk for nodal metastasis warranting lymphadenectomy and in whom the potential benefit of avoiding nodal procurement could be realized. To evaluate the detection rate and accuracy of fluorescence-guided sentinel lymph node mapping in endometrial cancer patients undergoing robotic-assisted staging. One hundred twenty-three endometrial cancer patients undergoing sentinel lymph node sentinel node mapping using indocyanine green were prospectively evaluated. Two mL (1.0 mg/mL) of dye were injected into the cervical stroma divided between the 2-3 and 9-10 o'clock positions at the time of uterine manipulator placement. Before hysterectomy, the retroperitoneal spaces were developed and fluorescence imaging was used for sentinel node detection. Identified sentinel nodes were removed and submitted for touch prep intraoperatively, followed by permanent assessment with routine hematoxylin and eosin levels. Patients then underwent hysterectomy, bilateral salpingo-oophorectomy, and completion bilateral pelvic and periaortic lymphadenectomy based on intrauterine risk factors determined intraoperatively (tumor size >2 cm, >50% myometrial invasion, and grade 3 histology). Of 123 patients enrolled, at least 1 sentinel node was detected in 119 (96.7%). Ninety-nine patients (80%) had bilateral pelvic or periaortic sentinel nodes detected. A total of 85 patients met criteria warranting completion lymphadenectomy. In 14 patients (16%) periaortic lymphadenectomy was not feasible, and the mean number of pelvic nodes procured was 13 (6-22). Of the 71 patients undergoing pelvic and periaortic lymphadenectomy, the mean nodal count was 23.2 (8-51). Of patients undergoing lymphadenectomy, 10.6% had lymph node metastasis on final hematoxylin and eosin evaluation. Notably, the sentinel node was the only positive node in 44% of cases. There were no cases in which final pathology of the sentinel node was negative and metastatic disease was detected upon completion lymphadenectomy in the non-sentinel nodes (no false negatives), yielding a sensitivity of 100%. Of the 14 sentinel nodes ultimately found to harbor metastases, 3 were negative on touch prep, yielding a sensitivity of 78.6% for intraoperative detection of sentinel node involvement. In all 3 of the false-negative touch preps, final pathology detected a single micrometastasis (0.24 mm, 1.4 mm, 1.5 mm). As expected, there were no false-positive results, yielding a specificity of 100%. No complications related to sentinel node mapping or allergic reactions to the dye were encountered. Intraoperative sentinel node mapping using fluorescence imaging with indocyanine green in endometrial cancer patients is feasible and yields high detection rates. In our pilot study, sentinel node mapping identified all women with Stage IIIC disease. Low false-negative rates are encouraging, and if confirmed in multi-institutional trials, this approach would be anticipated to reduce the morbidity, operative times, and costs associated with complete pelvic and periaortic lymphadenectomy. Copyright © 2015 Elsevier Inc. All rights reserved.

Achievement of trifecta in minimally invasive partial nephrectomy correlates with functional preservation of operated kidney: a multi-institutional assessment using MAG3 renal scan.

PubMed

Zargar, Homayoun; Porpiglia, Francesco; Porter, James; Quarto, Giuseppe; Perdona, Sisto; Bertolo, Riccardo; Autorino, Riccardo; Kaouk, Jihad H

2016-07-01

To validate and compare the values of "MIC" and "trifecta" as predictors of operated kidney functional preservation in a multi-institutional cohort of patients undergoing minimally invasive PN. We retrospectively reviewed records of consecutive cases of minimally invasive PN performed for cT1 renal masses in 4 centers from 2009 to 2013. Inclusion criteria consisted of availability of a renal scan obtained within 2 weeks prior to surgery and follow-up renal scan 3-6 months after the surgery. The primary endpoint of the study was to compare the degree of ipsilateral renal function preservation assessed by MAG3 renal scan in relation to achievement of MIC and trifecta. Total of 351 patients met our inclusion criteria. The rates of trifecta achievement for cT1a and cT1b tumors were 78.9 and 60.6 %, respectively. The rate of MIC achievement for cT1a tumors and cT1b tumors was 60.3 and 31.7 %, respectively. On multivariable linear regression model, only the degree of tumor complexity assessed by R.E.N.A.L nephrometry score [coefficient B -1.8 (-2.7, -0.9); p < 0.0001] and the achievement of trifecta [coefficient B 6.1 (2.4,9.8); p = 0.014] or MIC (coefficient B 7.2 (3.8,0.6); p < 0.0001) were significant clinical factors predicting ipsilateral split function preservation. Achievement of both MIC and "trifecta" is associated with higher proportion of split renal function preservation for cT1 tumors after minimally invasive PN. Thus, these outcome measures can be regarded not only as markers of surgical quality, but also as reliable surrogates for predicting functional outcome in the operated kidney.

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.

PubMed

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.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Merchant, Thomas E.; Kun, Larry E.; Krasin, Matthew J.

2008-03-01

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). Themore » 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.« less

A multi-institutional outcome analysis of patients undergoing left ventricular assist device implantation stratified by sex and race.

PubMed

Meeteren, Justin van; Maltais, Simon; Dunlay, Shannon M; Haglund, Nicholas A; Beth Davis, Mary; Cowger, Jennifer; Shah, Palak; Aaronson, Keith D; Pagani, Francis D; Stulak, John M

2017-01-01

Earlier studies have demonstrated disparities in patients undergoing left ventricular assist device (LVAD) implantation when stratified according to sex and race. Because very few data exist from large investigations, we reviewed data from the registry of the Mechanical Circulatory Support Research Network. Between May 2004 and September 2014, 734 patients underwent primary LVAD implantation at our institutions. Median age at implant was 57 (range 18 to 82) years and there were 577 males (80%). Race included Caucasian (C) in 586 patients (82%), African-American (AA) in 112 (16%), and other (O) in 21 (3%). Between sexes, significant pre-operative differences most commonly included median age at implant (males 60 years, females 57 years), ischemic etiology (53% vs 35%) and mean INTERMACS profile (2.9 vs 2.5). Between races, significant pre-operative differences most commonly included median age at implant (C = 61 vs AA = 51 vs O = 51), New York Heart Association functional class (85% vs 100% vs 92%) and ischemic etiology (55% vs 24% vs 40%). There were no significant differences in survival at 1, 3 or 5 years by sex or race. Similarly, there were no differences in time-related freedom from stroke, drive-line infection, gastrointestinal bleeding or pump thrombus by sex or race. After controlling for differences, neither sex nor race was associated with survival (p = 0.09 and p = 0.18, respectively), stroke (p = 0.28 and p = 0.21), drive-line infection (p = 0.9 and p = 0.92), gastrointestinal bleed (p = 0.48 and p = 0.45) or pump thrombus (p = 0.99 and p = 0.8). In this large, multi-institutional analysis, although some pre-operative clinical characteristics varied, they did not translate into any significant differences in late survival or complications while on LVAD support. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers.

PubMed

Tobert, Conrad M; Mott, Sarah L; Nepple, Kenneth G

2018-01-01

Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis. The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations. The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis. All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated. Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code. Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition. A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01). Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which suggests that institutional culture influences malnutrition diagnosis. Quality improvement efforts aimed at improved structure and process appear to be needed to improve the identification of malnutrition. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Developing effective chronic disease interventions in Africa: insights from Ghana and Cameroon

PubMed Central

2010-01-01

Background Africa faces an urgent but 'neglected epidemic' of chronic disease. In some countries stroke, hypertension, diabetes and cancers cause a greater number of adult medical admissions and deaths compared to communicable diseases such as HIV/AIDS or tuberculosis. Experts propose a three-pronged solution consisting of epidemiological surveillance, primary prevention and secondary prevention. In addition, interventions must be implemented through 'multifaceted multi-institutional' strategies that make efficient use of limited economic and human resources. Epidemiological surveillance has been prioritised over primary and secondary prevention. We discuss the challenge of developing effective primary and secondary prevention to tackle Africa's chronic disease epidemic through in-depth case studies of Ghanaian and Cameroonian responses. Methods A review of chronic disease research, interventions and policy in Ghana and Cameroon instructed by an applied psychology conceptual framework. Data included published research and grey literature, health policy initiatives and reports, and available information on lay community responses to chronic diseases. Results There are fundamental differences between Ghana and Cameroon in terms of 'multi-institutional and multi-faceted responses' to chronic diseases. Ghana does not have a chronic disease policy but has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. Cameroon has a policy on diabetes and hypertension, has established diabetes clinics across the country and provided training to health workers to improve treatment and education, but lacks community and media engagement. In both countries churches provide public education on major chronic diseases. Neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness. Conclusions Both Ghana and Cameroon require a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. We outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions. PMID:20403170

Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line?

PubMed

Lawrence, Yaacov Richard; Blumenthal, Deborah T; Matceyevsky, Diana; Kanner, Andrew A; Bokstein, Felix; Corn, Benjamin W

2011-10-01

Glioblastoma is a malignant tumor characterized by a rapid proliferation rate. Contemporary multi-modality treatment consists of maximal surgical resection followed by radiation therapy (RT) combined with cytotoxic chemotherapy. The optimal timing of these different steps is not known. Four studies from the pre-temozolomide era, encompassing a total of 4,584 subjects, have examined the consequences of a delay between resection and starting RT. Whereas the two small single-institution studies found this delay to be detrimental, two large multi-institutional studies found delay to be either slightly beneficial or at least not harmful. Here, we critically compare the methodologies and results presented in these studies, and include a novel analysis of the combined datasets. We conclude that moderate wait periods (up to 4-6 weeks post-operatively) are safe and may be modestly beneficial. Conversely, there is no evidence to justify waiting longer than 6 weeks. Underlying radiobiological principles are discussed.

Authorship, collaboration, and predictors of extramural funding in the emergency medicine literature.

PubMed

Rosenzweig, Jaime S; Van Deusen, Shawn K; Okpara, Okemefuna; Datillo, Paris A; Briggs, William M; Birkhahn, Robert H

2008-01-01

The objectives of the study were to examine the last decade of general emergency medicine (EM) literature published in the United States for trends with regard to authorship and multidisciplinary collaboration and to estimate the effect on extramural funding. Print articles published in the Academic Emergency Medicine, Annals of Emergency Medicine, Journal of Emergency Medicine, and American Journal of Emergency Medicine between 1994 and 2003 were reviewed. Original research, case reports/series, and others (consensus/educational) were considered; abstracts, book reviews, and editorials were not. The author byline was reviewed for number, specialty, nationality, collaboration, and presence of extramural funding. Multidisciplinary collaboration was defined as authors from 2 or more specialties, whereas multi-institutional collaboration was defined as EM authors from more than one institution. Logistic regression was used to identify predictors of extramural funding from the variables collected. Of 5728 articles identified, there were 3278 (57%) original research, 1437 (25%) case reports/series, and 975 (17%) classified as others. The percentage funded was 22% for all articles (32% for original research). The literature had at least one EM investigator as coauthor 84% of the time. Article location of origin was the United States (63%), foreign (15%), and combined (22%). Multidisciplinary collaboration increased overall from 33% in 1994 to a high of 43% in 2003. Multi-institutional collaboration also increased from 16% in 1994 to 26% in 2003. The percentage of articles having 6 or more authors increased from 12% to 18% over the decade. Of all variables studied, only article type (original research: odds ratio, 4.8; 95% confidence interval, 4.0-5.6) and foreign source (non-United States: odds ratio, 1.3; 95% confidence interval, 1.1-1.5) predicted extramural funding. The number of authors per article in the EM literature has steadily increased over the last decade, as has evidence of collaboration with other specialties. This increase in collaboration and author number has not been associated with increased extramural funding in the general EM literature published in the United States.

Defibrotide, a polydisperse mixture of single-stranded phosphodiester oligonucleotides with lifesaving activity in severe hepatic veno-occlusive disease: clinical outcomes and potential mechanisms of action.

PubMed

Kornblum, Noah; Ayyanar, Kanyalakshmi; Benimetskaya, Luba; Richardson, Paul; Iacobelli, Massimo; Stein, C A

2006-01-01

Veno-occlusive disease of the liver (VOD) remains a troubling and potentially fatal complication of high-dose chemotherapy and hematopoietic stem cell transplantation conditioning regimens. No effective therapy has been available for these patients to date, and the best supportive care measures remain woefully inadequate. Defibrotide (DF) (Gentium, S.p.A., Como, Italy), a polydisperse mixture of all the single-stranded phosphodiester oligodeoxyribonucleotides that can be obtained from the controlled depolymerization of porcine intestinal mucosal genomic DNA, seems to offer a safe and effective treatment for some patients suffering from severe VOD, a condition for which no accepted standard therapy currently exists. Early clinical studies evaluating the efficacy of DF for the treatment of severe VOD in patients undergoing hematopoietic stem cell transplantation have been very encouraging. Approximately 45% of the patients treated in multiple initial phase II clinical trials achieved a complete response at day +100, demonstrating normalization of serum bilirubin and resolution of the clinical syndrome. However, although multi-institutional, these represented single arm studies. A large, FDA-approved, pivotal, prospective, multi-institutional, global phase III trial of DF vs. historical controls (best available therapy) commenced in the first quarter of 2006 and should provide further validation of DF's efficacy. The drug seems to have few significant side effects, and almost all test subjects who have received this treatment have tolerated it well. Although the mechanism of action remains unclear, the drug exerts minimal systemic anticoagulant effects yet appears to induce numerous antithrombotic and profibrinolytic effects both in vitro and in vivo. It may function as an adenosine receptor agonist and causes increased concentrations of endogenous prostaglandins, which modulate thrombomodulin, platelets, and fibrinolysis. It also appears to block lipopolysaccharide (LPS)-induced tissue factor (TF) expression. However, despite the fact the DF is composed of oligonucleotides, its mechanism of action, which at the present time is unclear, is not related to Watson-Crick base pair-dependent downregulation of gene expression but is rather likely a result of its polyanionic nature.

Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study.

PubMed

Smith, Timothy L; Kern, Robert C; Palmer, James N; Schlosser, Rodney J; Chandra, Rakesh K; Chiu, Alexander G; Conley, David; Mace, Jess C; Fu, Rongwei F; Stankiewicz, James A

2011-01-01

Evidence evaluating the comparative effectiveness of various treatments for chronic rhinosinusitis (CRS) is insufficient. This study evaluates outcomes in patients who failed initial medical management and elect a subsequent treatment option, either continued medical management or endoscopic sinus surgery (ESS) coupled with continued medical management. Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort. Baseline characteristics and objective clinical findings were collected. Primary outcome measures included 2 disease-specific quality-of-life (QOL) instruments: the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Bivariate and multivariate analyses compared QOL improvement by treatment type, as well as differences in antibiotic and oral steroid utilization and work/school productivity. Subjects (n = 180) were enrolled between March 2009 and April 2010. Patients electing medical management (n = 55) reported significantly better baseline QOL on 1 instrument relative to surgery patients (CSS symptom [p = 0.019] and total scores [p = 0.010]). Surgical patients (n = 75) reported significantly more improvement than medically managed patients (RSDI, p = 0.015; CSS, p < 0.001). Surgical patients reported significantly fewer oral antibiotics (p = 0.002), oral steroids (p = 0.042), and missed days of work/school (p < 0.001) following ESS. After adjustment, more frequent improvement was found within the surgical cohort as measured by the RSDI physical (78.7% vs 56.4%; odds ratio [OR], 3.36; 95% confidence interval [CI], 1.15-9.87; p = 0.027), CSS symptom (80.6% vs 57.4%; OR, 2.65; 95% CI, 1.06-6.66; p = 0.038), medication (49.3% vs 29.6%; OR, 2.33; 95% CI, 0.96-5.64; p = 0.060), and total scores (76.4% vs 53.7%; OR, 2.20; 95% CI, 0.86-5.59; p = 0.099). Patients electing ESS experienced significantly higher levels of improvement in several outcomes. Further investigation with a larger cohort is warranted as treatment selection bias may confound the magnitude of improvement experienced with each treatment. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis.

PubMed

Hashmi, Ahmed; Guckenberger, Matthias; Kersh, Ron; Gerszten, Peter C; Mantel, Frederick; Grills, Inga S; Flickinger, John C; Shin, John H; Fahim, Daniel K; Winey, Brian; Oh, Kevin; John Cho, B C; Létourneau, Daniel; Sheehan, Jason; Sahgal, Arjun

2016-11-01

OBJECTIVE This study is a multi-institutional pooled analysis specific to imaging-based local control of spinal metastases in patients previously treated with conventional external beam radiation therapy (cEBRT) and then treated with re-irradiation stereotactic body radiotherapy (SBRT) to the spine as salvage therapy, the largest such study to date. METHODS The authors reviewed cases involving 215 patients with 247 spinal target volumes treated at 7 institutions. Overall survival was calculated on a patient basis, while local control was calculated based on the spinal target volume treated, both using the Kaplan-Meier method. Local control was defined as imaging-based progression within the SBRT target volume. Equivalent dose in 2-Gy fractions (EQD2) was calculated for the cEBRT and SBRT course using an α/β of 10 for tumor and 2 for both spinal cord and cauda equina. RESULTS The median total dose/number of fractions of the initial cEBRT was 30 Gy/10. The median SBRT total dose and number of fractions were 18 Gy and 1, respectively. Sixty percent of spinal target volumes were treated with single-fraction SBRT (median, 16.6 Gy and EQD2/10 = 36.8 Gy), and 40% with multiple-fraction SBRT (median 24 Gy in 3 fractions, EQD2/10 = 36 Gy). The median time interval from cEBRT to re-irradiation SBRT was 13.5 months, and the median duration of patient follow-up was 8.1 months. Kaplan-Meier estimates of 6- and 12-month overall survival rates were 64% and 48%, respectively; 13% of patients suffered a local failure, and the 6- and 12-month local control rates were 93% and 83%, respectively. Multivariate analysis identified Karnofsky Performance Status (KPS) < 70 as a significant prognostic factor for worse overall survival, and single-fraction SBRT as a significant predictive factor for better local control. There were no cases of radiation myelopathy, and the vertebral compression fracture rate was 4.5%. CONCLUSIONS Re-irradiation spine SBRT is effective in yielding imaging-based local control with a clinically acceptable safety profile. A randomized trial would be required to determine the optimal fractionation.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Catterall, Simon

This final report summarizes the work carried out by the Syracuse component of a multi-institutional SciDAC grant led by USQCD. This grant supported software development for theoretical high energy physics. The Syracuse component specifically targeted the development of code for the numerical simulation of N=4 super Yang-Mills theory. The work described in the final report includes this and a summary of results achieve in exploring the structure of this theory. It also describes the personnel - students and a postdoc who were directly or indirectly involved in this project. A list of publication is also described.

7 CFR 4279.150 - Feasibility studies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Feasibility studies. 4279.150 Section 4279.150... § 4279.150 Feasibility studies. A feasibility study by a qualified independent consultant may be required... affect the borrower's operations. An acceptable feasibility study should include, but not be limited to...

7 CFR 4279.150 - Feasibility studies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Feasibility studies. 4279.150 Section 4279.150... § 4279.150 Feasibility studies. A feasibility study by a qualified independent consultant may be required... affect the borrower's operations. An acceptable feasibility study should include, but not be limited to...

Robot-assisted partial nephrectomy for large renal masses: a multi-institutional series.

PubMed

Delto, Joan C; Paulucci, David; Helbig, Michael W; Badani, Ketan K; Eun, Daniel; Porter, James; Abaza, Ronney; Hemal, Ashok K; Bhandari, Akshay

2018-06-01

To compare peri-operative outcomes after robot-assisted partial nephrectomy (RAPN) for cT2a (7 to <10 cm) to cT1 tumours. Patients with a cT1a (n = 1 358, 76.4%), cT1b (n = 379, 21.3%) or cT2a (n = 41, 2.3%) renal mass were identified from a multi-institutional RAPN database. Intra- and postoperative outcomes were compared for cT2a masses vs cT1a and cT1b masses using multivariable regression models (linear, logistic, Poisson etc.), adjusting for operating surgeon and a modified R.E.N.A.L. nephrometry score that excluded the radius component. The median sizes for cT1a, cT1b and cT2a tumours were 2.5, 5.0 and 8.0 cm, respectively (P < 0.001) with modified R.E.N.A.L. nephrometry scores being 6.0, 6.5 and 7.0, respectively (cT1a, P < 0.001; cT1b, P = 0.105). RAPN for cT2a vs cT1a masses was associated with a 12% increase in operating time (P < 0.001), a 32% increase in estimated blood loss (P < 0.001), a 7% increase in ischaemia time (P = 0.008), a 3.93 higher odds of acute kidney injury at discharge (95% confidence interval [CI] 1.33, 8.76; P = 0.009) and a higher risk of recurrence (hazard ratio [HR] 10.9, 95% CI 1.31, 92.2; P = 0.027). RAPN for cT2a vs cT1b masses was associated with a 12% increase in blood loss (P = 0.036), a 5% increase in operating time (P = 0.062) and a marginally higher risk of recurrence (HR 11.2, 95% CI 0.77, 11.5; P = 0.059). RAPN for cT2a tumours was not associated with differences in complications (cT1a, P = 0.535; cT1b, P = 0.382), positive margins (cT1a, P = 0.972; cT1b, P = 0.681), length of stay (cT1a, P = 0.507; cT1b, P = 0.513) or renal function decline up to 24 months post-RAPN (cT1a, P = 0.124; cT1b, P = 0.467). For T2a tumours RAPN is a feasible treatment option in a select patient population when performed by experienced surgeons in institutions equipped to manage postoperative complications. Although RAPN was associated with greater blood loss and longer operating and ischaemia time in T2a tumours, it was not associated with greater complication or positive surgical margin rates compared with T1 tumours. Renal function preservation rates were equivalent for up to 24 months postoperatively; however, 12-month recurrence-free survival was significantly lower in the T2a group. Extended follow-up is required to further evaluate long-term survival. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Conducting Molecular Epidemiological Research in the Age of HIPAA: A Multi-Institutional Case-Control Study of Breast Cancer in African-American and European-American Women

PubMed Central

Ambrosone, Christine B.; Ciupak, Gregory L.; Bandera, Elisa V.; Jandorf, Lina; Bovbjerg, Dana H.; Zirpoli, Gary; Pawlish, Karen; Godbold, James; Furberg, Helena; Fatone, Anne; Valdimarsdottir, Heiddis; Yao, Song; Li, Yulin; Hwang, Helena; Davis, Warren; Roberts, Michelle; Sucheston, Lara; Demissie, Kitaw; Amend, Kandace L.; Tartter, Paul; Reilly, James; Pace, Benjamin W.; Rohan, Thomas; Sparano, Joseph; Raptis, George; Castaldi, Maria; Estabrook, Alison; Feldman, Sheldon; Weltz, Christina; Kemeny, Margaret

2009-01-01

Breast cancer in African-American (AA) women occurs at an earlier age than in European-American (EA) women and is more likely to have aggressive features associated with poorer prognosis, such as high-grade and negative estrogen receptor (ER) status. The mechanisms underlying these differences are unknown. To address this, we conducted a case-control study to evaluate risk factors for high-grade ER- disease in both AA and EA women. With the onset of the Health Insurance Portability and Accountability Act of 1996, creative measures were needed to adapt case ascertainment and contact procedures to this new environment of patient privacy. In this paper, we report on our approach to establishing a multicenter study of breast cancer in New York and New Jersey, provide preliminary distributions of demographic and pathologic characteristics among case and control participants by race, and contrast participation rates by approaches to case ascertainment, with discussion of strengths and weaknesses. PMID:19865486

Treatment of dilated cardiomyopathy with carvedilol in children.

PubMed

Erdoğan, Ilkay; Ozer, Sema; Karagöz, Tevfik; Celiker, Alpay; Ozkutlu, Süheyla; Alehan, Dursun

2009-01-01

We performed a study to examine the clinical use of carvedilol, its dosage and its effects on systolic functions in children. Twenty-one patients with dilated cardiomyopathy who were treated with carvedilol adjacent to standard heart failure therapy were enrolled in the study. Echocardiographic assessment was obtained before and during carvedilol therapy, and left ventricular fractional shortening and left ventricular ejection fraction were determined in order to estimate left ventricular function. At a follow-up of six months, left ventricular ejection fraction and fractional shortening significantly improved from 38 +/- 10% to 53 +/- 13% and from 19 +/- 6 % to 27 +/- 8%, respectively, following carvedilol treatment. The results of the present study indicate that carvedilol is well tolerated in children with dilated cardiomyopathy and there is a significant improvement in the clinical status and left ventricular ejection fraction in patients not responding to conventional therapy. Patient selection criteria, optimal timing of carvedilol therapy, its dosage and its long-term effects need to be investigated with multi-institutional trials and large numbers of patients.

Nursing as a Career Choice by Hispanic/Latino College Students: A Multi-Institutional Study.

PubMed

Stroup, Linda M; Kuk, Linda

2015-09-01

Despite rapid growth in the Hispanic/Latino population, there is significant underrepresentation of Hispanic/Latino individuals in the nursing workforce and nursing programs. This study investigated college students' interest in and self-efficacy for nursing as a career choice, and factors that students believe will impact their success in a nursing program. A nonexperimental, associational research study using a survey instrument was conducted at three comprehensive, public state universities and one community college in the western United States in an area with a significant Hispanic/Latino population. Descriptive and multivariable correlation statistical analysis suggested that college students' interest in and self-efficacy for nursing as a career choice was similar for both Hispanic/Latino and non-Hispanic/Latino students in the sample. Perceived facilitators for success in a nursing program were identified. Findings can be used to develop strategies and programs to enhance the success of Hispanic/Latino students interested in nursing as a career choice. Copyright 2015, SLACK Incorporated.

Upgrading Reference Set — EDRN Public Portal

Cancer.gov

We are proposing a multi-institutional study to identify molecular biomarkers and clinical measures that will predict presence of Gleason 7 or higher cancer (as evidence in the radical prostatectomy specimen) among patients with a biopsy diagnosis of Gleason score ≤ 6 prostate cancer. This proposal will be conducted in two phases. The first phase will assemble an “Upgrading Reference Set” that will include clinical information as well as biologics on a cohort of 600 men. The first phase will also assess the clinical parameters associated with upgrading, as well as, perform a central pathology review of both biopsies and prostatectomy specimens to confirm tumor grade. The second phase will use the biologics collected in phase 1 to evaluate a series of biomarkers to further refine the prediction of Gleason 7-10 cancer at radical prostatectomy.

43 CFR 404.47 - How will a feasibility study be conducted under this program?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false How will a feasibility study be conducted... Studies § 404.47 How will a feasibility study be conducted under this program? Feasibility studies will be... feasibility study, including the Principles and Guidelines (incorporated by reference at § 404.4). You can...

7 CFR 1737.70 - Description of feasibility study

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 11 2011-01-01 2011-01-01 false Description of feasibility study 1737.70 Section 1737... TELECOMMUNICATIONS LOANS Feasibility Determination Procedures § 1737.70 Description of feasibility study (a) In connection with each loan RUS shall prepare a feasibility study that includes sections on consolidated loan...

7 CFR 1737.70 - Description of feasibility study

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Description of feasibility study 1737.70 Section 1737... TELECOMMUNICATIONS LOANS Feasibility Determination Procedures § 1737.70 Description of feasibility study (a) In connection with each loan RUS shall prepare a feasibility study that includes sections on consolidated loan...

Addressing Health Disparities through Multi-institutional, Multidisciplinary Collaboratories

PubMed Central

Fleming, Erik S.; Perkins, James; Easa, David; Conde, José G.; Baker, Richard S.; Southerland, William M.; Dottin, Robert; Benabe, Julio E.; Ofili, Elizabeth O.; Bond, Vincent C.; McClure, Shelia A.; Sayre, Michael H.; Beanan, Maureen J.; Norris, Keith C.

2009-01-01

The national research leadership has recently become aware of the tremendous potential of translational research as an approach to address health disparities. The Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) is a research network that supports multi-institutional, multidisciplinary collaboration with a focus on key diseases and conditions for which disproportionately adverse racial and ethnic health disparities exist. The RTRN is designed to facilitate the movement of scientific advances across the translational research spectrum by providing researchers at different institutions with the infrastructure and tools necessary to collaborate on interdisciplinary and transdisciplinary research projects relating to specific health outcomes for which major racial/ethnic disparities exist. In the past, the difficulty of overcoming the restrictions imposed by time and space have made it difficult to carry out this type of large-scale, multilevel collaboration efficiently. To address this formidable challenge, the RTRN will deploy a translational research cluster system that uses “cyber workspaces” to bring researchers with similar interests together by using online collaboratory technology. These virtual meeting environments will provide a number of tools, including videoconferences (seminars, works in progress, meetings); project management tools (WebCT, Microsoft Share Point); and posting areas for projects, concepts, and other research and educational activities. This technology will help enhance access to resources across institutions with a common mission, minimize many of the logistical hurdles that impede intellectual exchange, streamline the planning and implementation of innovative interdisciplinary research, and assess the use of protocols and practices to assist researchers in interacting across and within cyber workspaces. PMID:18646341

Addressing health disparities through multi-institutional, multidisciplinary collaboratories.

PubMed

Fleming, Erik S; Perkins, James; Easa, David; Conde, José G; Baker, Richard S; Southerland, William M; Dottin, Robert; Benabe, Julio E; Ofili, Elizabeth O; Bond, Vincent C; McClure, Shelia A; Sayre, Michael H; Beanan, Maureen J; Norris, Keith C

2008-01-01

The national research leadership has recently become aware of the tremendous potential of translational research as an approach to address health disparities. The Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) is a research network that supports multi-institutional, multidisciplinary collaboration with a focus on key diseases and conditions for which disproportionately adverse racial and ethnic health disparities exist. The RTRN is designed to facilitate the movement of scientific advances across the translational research spectrum by providing researchers at different institutions with the infrastructure and tools necessary to collaborate on interdisciplinary and transdisciplinary research projects relating to specific health outcomes for which major racial/ethnic disparities exist. In the past, the difficulty of overcoming the restrictions imposed by time and space have made it difficult to carry out this type of large-scale, multilevel collaboration efficiently. To address this formidable challenge, the RTRN will deploy a translational research cluster system that uses "cyber workspaces" to bring researchers with similar interests together by using online collaboratory technology. These virtual meeting environments will provide a number of tools, including videoconferences (seminars, works in progress, meetings); project management tools (WebCT, Microsoft Share Point); and posting areas for projects, concepts, and other research and educational activities. This technology will help enhance access to resources across institutions with a common mission, minimize many of the logistical hurdles that impede intellectual exchange, streamline the planning and implementation of innovative interdisciplinary research, and assess the use of protocols and practices to assist researchers in interacting across and within cyber workspaces.

Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology.

PubMed

Gor, Ronak A; Long, Christopher J; Shukla, Aseem R; Kirsch, Andrew J; Perez-Brayfield, Marcos; Srinivasan, Arun K

2016-02-01

To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures. Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification. Hasson technique was used for peritoneal entry, GelPOINT advanced access platform was inserted, and standard 5mm laparoscopic instruments were used. Fifty-nine patients (median age 5 years, 4 months-17 years) met inclusion criteria: 29 nephrectomies, 9 nephroureterectomies, 3 bilateral nephrectomies, 5 heminephrectomies, 5 renal cyst decortications, 3 bilateral gonadectomies, 2 Malone antegrade continence enema, 2 calyceal diverticulectomy, and 1 ovarian detorsion with cystectomy. Median operative times for each case type were comparable to published experiences with traditional laparoscopy. Overall mean and median length of stay was 36.2 hours and 1 day, respectively. There were two complications: port site hernia requiring surgical repair (Clavien IIIb) and a superficial port site infection that resolved with antibiotics (Clavien II). Cosmetic outcomes were subjectively well received by patients and their parents. Operative time was significantly shorter between the first half of the experience and the second half (102 vs 70 minutes, P  <  .05). LESS approach can be broadly applied across many major extirpative and reconstructive procedures within pediatric urology. Our series advances our field's utilization of this technique and its safety. Copyright © 2016 Elsevier Inc. All rights reserved.

Double KRAS and BRAF Mutations in Surgically Treated Colorectal Cancer Liver Metastases: An International, Multi-institutional Case Series.

PubMed

Deshwar, Amar; Margonis, Georgios Antonios; Andreatos, Nikolaos; Barbon, Carlotta; Wang, Jaeyun; Buettner, Stefan; Wagner, Doris; Sasaki, Kazunari; Beer, Andrea; Løes, Inger Marie; Pikoulis, Emmanouil; Damaskos, Christos; Garmpis, Nikolaos; Kamphues, Karsten; He, Jin; Kaczirek, Klaus; Poultsides, George; Lønning, Per Eystein; Mischinger, Hans Joerg; Aucejo, Federico N; Kreis, Martin E; Wolfgang, Christopher L; Weiss, Matthew J

2018-05-01

While previously believed to be mutually exclusive, concomitant mutation of Kirsten rat sarcoma viral oncogene homolog (KRAS)- and V-raf murine sarcoma b-viral oncogene homolog B1 (BRAF)-mutated colorectal carcinoma (CRC), has been described in rare instances and been associated with advanced-stage disease. The present case series is the first to report on the implications of concurrent KRAS/BRAF mutations among surgically treated patients, and the largest set of patients with surgically treated colorectal liver metastasis (CRLM) and data on KRAS/BRAF mutational status thus far described. We present cases from an international, multi-institutional cohort of patients that underwent hepatic resection for CRLM between 2000-2015 at seven tertiary centers. The incidence of KRAS/BRAF mutation in patients with CRLM was 0.5% (4/820). Of these cases, patient 1 (T2N1 primary, G13D/V600E), patient 2 (T3N1 primary, G12V/V600E) and patient 3 (T4N2 primary, G13D/D594N) succumbed to their disease within 485, 236 and 79 days respectively, post-hepatic resection. Patient 4 (T4 primary, G12S/G469S) was alive 416 days after hepatic resection. The present case series suggests that the incidence of concomitant KRAS/BRAF mutations in surgical cohorts may be higher than previously hypothesized, and associated with more variable survival outcomes than expected. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Domain Specific Language Support for Exascale

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mellor-Crummey, John

A multi-institutional project known as D-TEC (short for “Domain- specific Technology for Exascale Computing”) set out to explore technologies to support the construction of Domain Specific Languages (DSLs) to map application programs to exascale architectures. DSLs employ automated code transformation to shift the burden of delivering portable performance from application programmers to compilers. Two chief properties contribute: DSLs permit expression at a high level of abstraction so that a programmer’s intent is clear to a compiler and DSL implementations encapsulate human domain-specific optimization knowledge so that a compiler can be smart enough to achieve good results on specific hardware. Domainmore » specificity is what makes these properties possible in a programming language. If leveraging domain specificity is the key to keep exascale software tractable, a corollary is that many different DSLs will be needed to encompass the full range of exascale computing applications; moreover, a single application may well need to use several different DSLs in conjunction. As a result, developing a general toolkit for building domain-specific languages was a key goal for the D-TEC project. Different aspects of the D-TEC research portfolio were the focus of work at each of the partner institutions in the multi-institutional project. D-TEC research and development work at Rice University focused on on three principal topics: understanding how to automate the tuning of code for complex architectures, research and development of the Rosebud DSL engine, and compiler technology to support complex execution platforms. This report provides a summary of the research and development work on the D-TEC project at Rice University.« less

The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: a multi-institutional analysis.

PubMed

Margonis, Georgios A; Buettner, Stefan; Sasaki, Kazunari; Kim, Yuhree; Ratti, Francesca; Russolillo, Nadia; Ferrero, Alessandro; Berger, Nickolas; Gamblin, T Clark; Poultsides, George; Tran, Thuy; Postlewait, Lauren M; Maithel, Shishir; Michaels, Alex D; Bauer, Todd W; Marques, Hugo; Barroso, Eduardo; Aldrighetti, Luca; Pawlik, Timothy M

2016-08-01

Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

43 CFR 404.48 - What process will Reclamation follow to determine if a feasibility study is ready for review?

Code of Federal Regulations, 2011 CFR

2011-10-01

... determine if a feasibility study is ready for review? 404.48 Section 404.48 Public Lands: Interior... SUPPLY PROGRAM Feasibility Studies § 404.48 What process will Reclamation follow to determine if a feasibility study is ready for review? (a) Reclamation will evaluate whether the feasibility study adequately...

Evidence regarding the utility of multiple mini-interview (MMI) for selection to undergraduate health programs: A BEME systematic review: BEME Guide No. 37.

PubMed

Rees, Eliot L; Hawarden, Ashley W; Dent, Gordon; Hays, Richard; Bates, Joanna; Hassell, Andrew B

2016-05-01

In the 11 years since its development at McMaster University Medical School, the multiple mini-interview (MMI) has become a popular selection tool. We aimed to systematically explore, analyze and synthesize the evidence regarding MMIs for selection to undergraduate health programs. The review protocol was peer-reviewed and prospectively registered with the Best Evidence Medical Education (BEME) collaboration. Thirteen databases were searched through 34 terms and their Boolean combinations. Seven key journals were hand-searched since 2004. The reference sections of all included studies were screened. Studies meeting the inclusion criteria were coded independently by two reviewers using a modified BEME coding sheet. Extracted data were synthesized through narrative synthesis. A total of 4338 citations were identified and screened, resulting in 41 papers that met inclusion criteria. Thirty-two studies report data for selection to medicine, six for dentistry, three for veterinary medicine, one for pharmacy, one for nursing, one for rehabilitation, and one for health science. Five studies investigated selection to more than one profession. MMIs used for selection to undergraduate health programs appear to have reasonable feasibility, acceptability, validity, and reliability. Reliability is optimized by including 7-12 stations, each with one examiner. The evidence is stronger for face validity, with more research needed to explore content validity and predictive validity. In published studies, MMIs do not appear biased against applicants on the basis of age, gender, or socio-economic status. However, applicants of certain ethnic and social backgrounds did less well in a very small number of published studies. Performance on MMIs does not correlate strongly with other measures of noncognitive attributes, such as personality inventories and measures of emotional intelligence. MMI does not automatically mean a more reliable selection process but it can do, if carefully designed. Effective MMIs require careful identification of the noncognitive attributes sought by the program and institution. Attention needs to be given to the number of stations, the blueprint and examiner training. More work is required on MMIs as they may disadvantage groups of certain ethnic or social backgrounds. There is a compelling argument for multi-institutional studies to investigate areas such as the relationship of MMI content to curriculum domains, graduate outcomes, and social missions; relationships of applicants' performance on different MMIs; bias in selecting applicants of minority groups; and the long-term outcomes appropriate for studies of predictive validity.

The Learning Preferences of Applicants Who Interview for General Surgery Residency: A Multiinstitutional Study.

PubMed

Kim, Roger H; Kurtzman, Scott H; Collier, Ashley N; Shabahang, Mohsen M

Learning styles theory posits that learners have distinct preferences for how they assimilate new information. The VARK model categorizes learners based on combinations of 4 learning preferences: visual (V), aural (A), read/write (R), and kinesthetic (K). A previous single institution study demonstrated that the VARK preferences of applicants who interview for general surgery residency are different from that of the general population and that learning preferences were associated with performance on standardized tests. This multiinstitutional study was conducted to determine the distribution of VARK preferences among interviewees for general surgery residency and the effect of those preferences on United States Medical Licensing Examination (USMLE) scores. The VARK learning inventory was administered to applicants who interviewed at 3 general surgery programs during the 2014 to 2015 academic year. The distribution of VARK learning preferences among interviewees was compared with that of the general population of VARK respondents. Performance on USMLE Step 1 and Step 2 Clinical Knowledge was analyzed for associations with VARK learning preferences. Chi-square, analysis of variance, and Dunnett's test were used for statistical analysis, with p < 0.05 considered statistically significant. The VARK inventory was completed by a total of 140 residency interviewees. Sixty-four percent of participants were male, and 41% were unimodal, having a preference for a single learning modality. The distribution of VARK preferences of interviewees was different than that of the general population (p = 0.02). By analysis of variance, there were no overall differences in USMLE Step 1 and Step 2 Clinical Knowledge scores by VARK preference (p = 0.06 and 0.21, respectively). However, multiple comparison analysis using Dunnett's test revealed that interviewees with R preferences had significantly higher scores than those with multimodal preferences on USMLE Step 1 (239 vs. 222, p = 0.02). Applicants who interview for general surgery residency have a different pattern of VARK preferences than that of the general population. Interviewees with preferences for read/write learning modalities have higher scores on the USMLE Step 1 than those with multimodal preferences. Learning preferences may have impact on residency applicant selection and represents a topic that warrants further investigation. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tokumaru, Sunao, E-mail: tokumaru@cc.saga-u.ac.jp; Toita, Takafumi; Oguchi, Masahiko

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 therapymore » 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.« less

Do feasibility studies contribute to, or avoid, waste in research?

PubMed Central

Hejdenberg, Jennie; Hinrichs-Krapels, Saba; Armstrong, David

2018-01-01

In the context of avoiding research waste, the conduct of a feasibility study before a clinical trial should reduce the risk that further resources will be committed to a trial that is likely to ‘fail’. However, there is little evidence indicating whether feasibility studies add to or reduce waste in research. Feasibility studies funded by the National Institute for Health Research’s (NIHR) Research for Patient Benefit (RfPB) programme were examined to determine how many had published their findings, how many had applied for further funding for a full trial and the timeframe in which both of these occurred. A total of 120 feasibility studies which had closed by May 2016 were identified and each Principal Investigator (PI) was sent a questionnaire of which 89 responses were received and deemed suitable for analysis. Based on self reported answers from the PIs a total of 57 feasibility studies were judged as feasible, 20 were judged not feasible and for 12 it was judged as uncertain whether a full trial was feasible. The RfPB programme had spent approximately £19.5m on the 89 feasibility studies of which 16 further studies had been subsequently funded to a total of £16.8m. The 20 feasibility studies which were judged as not feasible potentially saved up to approximately £20m of further research funding which would likely to have not completed successfully. The average RfPB feasibility study took 31 months (range 18 to 48) to complete and cost £219,048 (range £72,031 to £326,830) and the average full trial funded from an RfPB feasibility study took 42 months (range 26 to 55) to complete and cost £1,163,996 (range £321,403 to £2,099,813). The average timeframe of feasibility study and full trial was 72 months (range 56 to 91), however in addition to this time an average of 10 months (range -7 to 29) was taken between the end of the feasibility study and the application for the full trial, and a further average of 18 months (range 13 to 28) between the application for the full trial and the start of the full trial. Approximately 58% of the 89 feasibility studies had published their findings with the majority of the remaining studies still planning to publish. Due to the long time frames involved a number of studies were still in the process of publishing the feasibility findings and/or applying for a full trial. Feasibility studies are potentially useful at avoiding waste and de-risking funding investments of more expensive full trials, however there is a clear time delay and therefore some potential waste in the existing research pathway. PMID:29684043

Do feasibility studies contribute to, or avoid, waste in research?

PubMed

Morgan, Ben; Hejdenberg, Jennie; Hinrichs-Krapels, Saba; Armstrong, David

2018-01-01

In the context of avoiding research waste, the conduct of a feasibility study before a clinical trial should reduce the risk that further resources will be committed to a trial that is likely to 'fail'. However, there is little evidence indicating whether feasibility studies add to or reduce waste in research. Feasibility studies funded by the National Institute for Health Research's (NIHR) Research for Patient Benefit (RfPB) programme were examined to determine how many had published their findings, how many had applied for further funding for a full trial and the timeframe in which both of these occurred. A total of 120 feasibility studies which had closed by May 2016 were identified and each Principal Investigator (PI) was sent a questionnaire of which 89 responses were received and deemed suitable for analysis. Based on self reported answers from the PIs a total of 57 feasibility studies were judged as feasible, 20 were judged not feasible and for 12 it was judged as uncertain whether a full trial was feasible. The RfPB programme had spent approximately £19.5m on the 89 feasibility studies of which 16 further studies had been subsequently funded to a total of £16.8m. The 20 feasibility studies which were judged as not feasible potentially saved up to approximately £20m of further research funding which would likely to have not completed successfully. The average RfPB feasibility study took 31 months (range 18 to 48) to complete and cost £219,048 (range £72,031 to £326,830) and the average full trial funded from an RfPB feasibility study took 42 months (range 26 to 55) to complete and cost £1,163,996 (range £321,403 to £2,099,813). The average timeframe of feasibility study and full trial was 72 months (range 56 to 91), however in addition to this time an average of 10 months (range -7 to 29) was taken between the end of the feasibility study and the application for the full trial, and a further average of 18 months (range 13 to 28) between the application for the full trial and the start of the full trial. Approximately 58% of the 89 feasibility studies had published their findings with the majority of the remaining studies still planning to publish. Due to the long time frames involved a number of studies were still in the process of publishing the feasibility findings and/or applying for a full trial. Feasibility studies are potentially useful at avoiding waste and de-risking funding investments of more expensive full trials, however there is a clear time delay and therefore some potential waste in the existing research pathway.

Important considerations for feasibility studies in physical activity research involving persons with multiple sclerosis: a scoping systematic review and case study.

PubMed

Learmonth, Yvonne C; Motl, Robert W

2018-01-01

Much research has been undertaken to establish the important benefits of physical activity in persons with multiple sclerosis (MS). There is disagreement regarding the strength of this research, perhaps because the majority of studies on physical activity and its benefits have not undergone initial and systematic feasibility testing. We aim to address the feasibility processes that have been examined within the context of physical activity interventions in MS. A systematic scoping review was conducted based on a literature search of five databases to identify feasibility processes described in preliminary studies of physical activity in MS. We read and extracted methodology from each study based on the following feasibility metrics: process (e.g. recruitment), resource (e.g. monetary costs), management (e.g. personnel time requirements) and scientific outcomes (e.g. clinical/participant reported outcome measures). We illustrate the use of the four feasibility metrics within a randomised controlled trial of a home-based exercise intervention in persons with MS. Twenty-five studies were identified. Resource feasibility (e.g. time and resources) and scientific outcomes feasibility (e.g. clinical outcomes) methodologies were applied and described in many studies; however, these metrics have not been systematically addressed. Metrics related to process feasibility (e.g. recruitment) and management feasibility (e.g. human and data management) are not well described within the literature. Our case study successfully enabled us to address the four feasibility metrics, and we provide new information on management feasibility (i.e. estimate data completeness and estimate data entry) and scientific outcomes feasibility (i.e. determining data collection materials appropriateness). Our review highlights the existing research and provides a case study which assesses important metrics of study feasibility. This review serves as a clarion call for feasibility trials that will substantially strengthen the foundation of research on exercise in MS.

Plasmapheresis in immune hematology: review of clinical outcome data with respect to evidence-based medicine and clinical experience.

PubMed

von Baeyer, Hans

2003-02-01

The objective of this paper is to assess the role of plasmapheresis in immune hematology by reviewing published clinical outcome data and narrative review articles. This information will be used to define evidence levels for appraisal of the efficacy and rank of plasmapheresis among other management options. This evidence-based strategy conforms to the concepts of the American Society of Hematology (ASH). as put forward in 1996 in the context of immune thrombocytopenia (ITP) treatment. The term 'experimental' is used to describe indications where the only scientific evidence of the efficacy of plasmapheresis consists of pathophysiological reasoning and empiric clinical findings. We reviewed the available literature on the use of plasmapheresis in autoimmune hemolytic anemia (AIHA), hemolytic disease of the newborn (HDN), autoimmune thrombocytopenic purpura (AITP), heparin-induced thrombocytopenia type II (HIT II), post-transfusion purpura (PTP), refractoriness to platelet transfusion (RPT), coagulation factor inhibitor (CFI) and catastrophic antiphospholipid syndrome (CAS). Plasmapheresis completes the spectrum of management options as it eliminates physically circulating free antibodies involved in the pathogenesis of these immune hematological syndromes. Because of the paucity of data, evidence levels had to be defined based on the findings of uncontrolled case series and the opinions of independent experts. In many cases, randomized clinical trials were not feasible because the syndromes are so rare. When defined as an 'experimental indication', plasmapheresis has a firm scientific basis, but larger scale clinical experience with the method is still lacking. In these cases, the detection and monitoring of symptomatic disease-related circulating free antibodies or immune complexes is a mandatory prerequisite for the use of plasmapheresis. The therapeutic benefit of plasmapheresis is substantiated by the level V of evidence of its efficacy in treatment of HDN, HIV-associated AITP, induction of tolerance in CFI and in CAS. The goal of future studies should be to establish a firmer base of scientific evidence for indications classified as experimental by setting up case series large enough for proper assessment of plasmapheresis alone or combination with other treatment measures. This goal can only be achieved through multiinstitutional cooperation.

Expanding the scope of quality measurement in surgery to include nonoperative care: Results from the American College of Surgeons National Surgical Quality Improvement Program emergency general surgery pilot.

PubMed

Wandling, Michael W; Ko, Clifford Y; Bankey, Paul E; Cribari, Chris; Cryer, H Gill; Diaz, Jose J; Duane, Therese M; Hameed, S Morad; Hutter, Matthew M; Metzler, Michael H; Regner, Justin L; Reilly, Patrick M; Reines, H David; Sperry, Jason L; Staudenmayer, Kristan L; Utter, Garth H; Crandall, Marie L; Bilimoria, Karl Y; Nathens, Avery B

2017-11-01

Patients managed nonoperatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where nonoperative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed nonoperatively to evaluate variability in nonoperative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered. Using ACS NSQIP infrastructure and methodology, surgical consultations for acute appendicitis, acute cholecystitis, and small bowel obstruction (SBO) were sampled at 13 hospitals that volunteered to participate in the EGS clinical data registry. Standard NSQIP variables and 16 EGS-specific variables were abstracted with 30-day follow-up. To determine the influence of complications in nonoperative patients, rates of adverse outcomes were identified, and hospitals were ranked by performance with and then without including nonoperative cases. Two thousand ninety-one patients with EGS diagnoses were included, 46.6% with appendicitis, 24.3% with cholecystitis, and 29.1% with SBO. The overall rate of nonoperative management was 27.4%, 6.6% for appendicitis, 16.5% for cholecystitis, and 69.9% for SBO. Despite comprising only 27.4% of patients in the EGS pilot, nonoperative management accounted for 67.7% of deaths, 34.3% of serious morbidities, and 41.8% of hospital readmissions. After adjusting for patient characteristics and hospital diagnosis mix, addition of nonoperative management to hospital performance assessment resulted in 12 of 13 hospitals changing performance rank, with four hospitals changing by three or more positions. This study identifies a gap in performance evaluation when nonoperative patients are excluded from surgical quality assessment and demonstrates the feasibility of incorporating nonoperative care into existing surgical quality initiatives. Broadening the scope of hospital performance assessment to include nonoperative management creates an opportunity to improve the care of all surgical patients, not just those who have an operation. Care management, level IV; Epidemiologic, level III.

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

PubMed

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 experienced robotic surgeons. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Augmented-reality-based skills training for robot-assisted urethrovesical anastomosis: a multi-institutional randomised controlled trial.

PubMed

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.

43 CFR 404.20 - What information must I include in my full proposal to conduct an appraisal or a feasibility study?

Code of Federal Regulations, 2011 CFR

2011-10-01

... proposal to conduct an appraisal or a feasibility study? 404.20 Section 404.20 Public Lands: Interior... appraisal or a feasibility study? A full proposal to conduct an appraisal investigation or a feasibility... feasibility study and a plan for addressing those issues. The information provided must also address each of...

Feasibility of multi-sector policy measures that create activity-friendly environments for children: results of a Delphi study.

PubMed

Aarts, Marie-Jeanne; Schuit, Albertine J; van de Goor, Ien Am; van Oers, Hans Am

2011-12-15

Although multi-sector policy is a promising strategy to create environments that stimulate physical activity among children, little is known about the feasibility of such a multi-sector policy approach. The aims of this study were: to identify a set of tangible (multi-sector) policy measures at the local level that address environmental characteristics related to physical activity among children; and to assess the feasibility of these measures, as perceived by local policy makers. In four Dutch municipalities, a Delphi study was conducted among local policy makers of different policy sectors (public health, sports, youth and education, spatial planning/public space, traffic and transportation, and safety). In the first Delphi round, respondents generated a list of possible policy measures addressing three environmental correlates of physical activity among children (social cohesion, accessibility of facilities, and traffic safety). In the second Delphi round, policy makers weighted different feasibility aspects (political feasibility, cultural/community acceptability, technical feasibility, cost feasibility, and legal feasibility) and assessed the feasibility of the policy measures derived from the first round. The third Delphi round was aimed at reaching consensus by feedback of group results. Finally, one overall feasibility score was calculated for each policy measure. Cultural/community acceptability, political feasibility, and cost feasibility were considered most important feasibility aspects. The Delphi studies yielded 16 feasible policy measures aimed at physical and social environmental correlates of physical activity among children. Less drastic policy measures were considered more feasible, whereas environmental policy measures were considered less feasible. This study showed that the Delphi technique can be a useful tool in reaching consensus about feasible multi-sector policy measures. The study yielded several feasible policy measures aimed at physical and social environmental correlates of physical activity among children and can assist local policy makers in designing multi-sector policies aimed at an activity-friendly environment for children.

The Longevity Consortium: Harnessing diverse approaches to understand the genetic basis of human longevity and healthy aging. An introduction to a series of articles.

PubMed

Kahn, Arnold

2011-04-01

The Longevity Consortium is a multi-investigator, multi-institutional research group focused on identifying the genetic variants that regulate human lifespan and healthy aging. The text that follows is an introduction to a series of seven articles prepared by Consortium investigators that represent a profile of planned and ongoing research and up-to-date reviews of topics of major interest to biogerontologists and others scientists and clinicians interested in ageing research. Copyright © 2010 Elsevier B.V. All rights reserved.

76 FR 70152 - Pilot Program for Early Feasibility Study Investigational Device Exemption Applications

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-10

...] Pilot Program for Early Feasibility Study Investigational Device Exemption Applications AGENCY: Food and... feasibility study investigational device exemption (IDE) applications. The pilot program will conform to the... Feasibility Medical Device Clinical Studies, Including Certain First in Human (FIH) Studies.'' Under the pilot...

Feasibility and Pilot Studies in Palliative Care Research: A Systematic Review.

PubMed

Jones, Terry A; Olds, Timothy S; Currow, David C; Williams, Marie T

2017-07-01

Feasibility and pilot study designs are common in palliative care research. Finding standard guidelines on the structure and reporting of these study types is difficult. In feasibility and pilot studies in palliative care research, to determine 1) how commonly a priori feasibility are criteria reported and whether results are subsequently reported against these criteria? and 2) how commonly are participants' views on acceptability of burden of the study protocol assessed? Four databases (OVID Medline, EMBASE, CINAHL, and PubMed via caresearch.com.au.) were searched. Search terms included palliative care, terminal care, advance care planning, hospice, pilot, feasibility, with a publication date between January 1, 2012 and December 31, 2013. Articles were selected and appraised by two independent reviewers. Fifty-six feasibility and/or pilot studies were included in this review. Only three studies had clear a priori criteria to measure success. Sixteen studies reported participant acceptability or burden with measures. Forty-eight studies concluded feasibility. The terms "feasibility" and "pilot" are used synonymously in palliative care research when describing studies that test for feasibility. Few studies in palliative care research outline clear criteria for success. The assessment of participant acceptability and burden is uncommon. A gold standard for feasibility study design in palliative care research that includes both clear criteria for success and testing of the study protocol for participant acceptability and burden is needed. Such a standard would assist with consistency in the design, conduct and reporting of feasibility and pilot studies. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

A phase II study of 5-fluorouracil, leucovorin, adriamycin, and cisplatin (FLAP) for metastatic gastric and gastroesophageal junction adenocarcinoma. A Penn Cancer Clinical Trial Group and Roswell Park Cancer Institute Community Oncology Research Program Trial.

PubMed

Vaughn, D J; Meropol, N J; Holroyde, C; Mintzer, D; Nuamah, I; Armstead, B; Douglass, H O; Haller, D G

1997-06-01

A Phase II study was performed to evaluate the activity and toxicity of 5-fluorouracil, leucovorin, Adriamycin, and cisplatin combination chemotherapy (FLAP) in patients with previously untreated advanced gastric and gastroesophageal (GE) junction adenocarcinoma. Forty-two consecutive patients were enrolled to received FLAP in this multi-institutional trial. Response, toxicity, and survival data were noted. Fifteen of 42 (36%) patients demonstrated objective responses, with two complete responses (5%) and 13 partial responses (31%). The median time to disease progression was 17 weeks, and the overall survival duration was 30 weeks. Myelosuppression was significant, requiring dose modifications, but there were no treatment-related deaths. FLAP is an active regimen in the treatment of advanced gastric and GE junction adenocarcinoma. We are presently using this regimen in the neoadjuvant setting in patients with gastric and GE junction cancers.

Treatment outcomes and prognostic factors of feline splenic mast cell tumors: A multi-institutional retrospective study of 64 cases.

PubMed

Evans, B J; O'Brien, D; Allstadt, S D; Gregor, T P; Sorenmo, K U

2018-03-01

Mast cell tumors (MCT) are common splenic tumors in cats, but there is limited information on treatment outcomes of cats with this disease. This retrospective study evaluated treatment outcomes in 64 cats with splenic MCT. Cats were categorized into the following treatment groups: splenectomy (A, n = 20); splenectomy with chemotherapy (B, n = 20); chemotherapy alone (C, n = 15); or supportive care (D, n = 9). Median tumor specific survival (MTSS) was: 856, 853, 244, 365 days for groups A, B, C, and D, respectively. The MTSS was not significantly different between the 4 groups. However, comparing cats that had splenectomy (A and B) versus those that did not (C and D), the MTSS was 856 and 342 days, respectively (p=0.008). None of the prognostic factors analyzed significantly influenced survival. Splenectomy (+/- chemotherapy) significantly prolongs survival in cats with mast cell tumors. The role of chemotherapy remains unknown. © 2017 John Wiley & Sons Ltd.

NEWS Climatology Project: The State of the Water Cycle at Continental to Global Scales

NASA Technical Reports Server (NTRS)

Rodell, Matthew; LEcuyer, Tristan; Beaudoing, Hiroko Kato; Olson, Bill

2011-01-01

NASA's Energy and Water Cycle Study (NEWS) program fosters collaborative research towards improved quantification and prediction of water and energy cycle consequences of climate change. In order to measure change, it is first necessary to describe current conditions. The goal of the NEWS Water and Energy Cycle Climatology project is to develop "state of the global water cycle" and "state of the global energy cycle" assessments based on data from modern ground and space based observing systems and data integrating models. The project is a multiinstitutional collaboration with more than 20 active contributors. This presentation will describe results of the first stage of the water budget analysis, whose goal was to characterize the current state of the water cycle on mean monthly, continental scales. We examine our success in closing the water budget within the expected uncertainty range and the effects of forcing budget closure as a method for refining individual flux estimates.

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

NASA Astrophysics Data System (ADS)

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.

Education as an intergenerational process of human learning, teaching, and development.

PubMed

Cole, Michael

2010-11-01

In this article I argue that the future of psychological research on educational processes would benefit from an interdisciplinary approach that enables psychologists to locate their objects of study within the cultural, social, and historical contexts of their research. To make this argument, I begin by examining anthropological accounts of the characteristics of education in small, face-to-face, preindustrial societies. I then turn to a sample of contemporary psychoeducational research that seeks to implement major, qualitative changes in modern educational practices by transforming them to have the properties of education in those self-same face-to-face societies. Next I examine the challenges faced by these modern approaches and briefly describe a multi-institutional, multidisciplinary system of education that responds to these challenges while offering a model for educating psychology students in a multigenerational system of activities with potential widespread benefits. PsycINFO Database Record (c) 2010 APA, all rights reserved.

E-learning and blended learning in textile engineering education: a closed feedback loop approach

NASA Astrophysics Data System (ADS)

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.

Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework.

PubMed

Eldridge, Sandra M; Lancaster, Gillian A; Campbell, Michael J; Thabane, Lehana; Hopewell, Sally; Coleman, Claire L; Bond, Christine M

2016-01-01

We describe a framework for defining pilot and feasibility studies focusing on studies conducted in preparation for a randomised controlled trial. To develop the framework, we undertook a Delphi survey; ran an open meeting at a trial methodology conference; conducted a review of definitions outside the health research context; consulted experts at an international consensus meeting; and reviewed 27 empirical pilot or feasibility studies. We initially adopted mutually exclusive definitions of pilot and feasibility studies. However, some Delphi survey respondents and the majority of open meeting attendees disagreed with the idea of mutually exclusive definitions. Their viewpoint was supported by definitions outside the health research context, the use of the terms 'pilot' and 'feasibility' in the literature, and participants at the international consensus meeting. In our framework, pilot studies are a subset of feasibility studies, rather than the two being mutually exclusive. A feasibility study asks whether something can be done, should we proceed with it, and if so, how. A pilot study asks the same questions but also has a specific design feature: in a pilot study a future study, or part of a future study, is conducted on a smaller scale. We suggest that to facilitate their identification, these studies should be clearly identified using the terms 'feasibility' or 'pilot' as appropriate. This should include feasibility studies that are largely qualitative; we found these difficult to identify in electronic searches because researchers rarely used the term 'feasibility' in the title or abstract of such studies. Investigators should also report appropriate objectives and methods related to feasibility; and give clear confirmation that their study is in preparation for a future randomised controlled trial designed to assess the effect of an intervention.

77 FR 13343 - Pilot Program for Early Feasibility Study Investigational Device Exemption Applications...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

...] Pilot Program for Early Feasibility Study Investigational Device Exemption Applications; Termination of... acceptance of nominations for the Early Feasibility Study Investigational Device Exemption (IDE) Applications... technologies to participate in a pilot program for early feasibility study IDE applications. FDA is also...

25 CFR 41.7 - Feasibility studies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Feasibility studies. 41.7 Section 41.7 Indians BUREAU OF... NAVAJO COMMUNITY COLLEGE Tribally Controlled Community Colleges § 41.7 Feasibility studies. (a) Grants... initiate a feasibility study to determine whether there is justification to encourage and maintain a...

25 CFR 41.7 - Feasibility studies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Feasibility studies. 41.7 Section 41.7 Indians BUREAU OF... NAVAJO COMMUNITY COLLEGE Tribally Controlled Community Colleges § 41.7 Feasibility studies. (a) Grants... initiate a feasibility study to determine whether there is justification to encourage and maintain a...

Acquired EGFR T790M Mutation After Relapse Following EGFR-TKI Therapy: A Population-based Multi-institutional Study.

PubMed

Kaburagi, Takayuki; Kiyoshima, Moriyuki; Nawa, Takeshi; Ichimura, Hideo; Saito, Takefumi; Hayashihara, Kenji; Yamada, Hideyasu; Satoh, Hiroaki; Endo, Takeo; Inage, Yoshihisa; Saito, Kazuhito; Inagaki, Masaharu; Hizawa, Nobuyuki; Sato, Yukio; Ishikawa, Hiroichi; Sakai, Mitsuaki; Kamiyama, Koichi; Kikuchi, Norihiro; Nakamura, Hiroyuki; Furukawa, Kinya; Kodama, Takahide; Yamashita, Takaaki; Nomura, Akihiro; Yoshida, Susumu

2018-05-01

To describe the prevalence and determinants of acquired epidermal growth factor receptor (EGFR) T790M gene mutation in a clinical practice setting. We performed a retrospective chart review study between January 2013 and November 2017 across multiple institutes, covering a population of 3 million people. We reviewed the charts of 233 patients non-small cell lung cancer with EGFR mutations. Of them, 99 (42.5%) patients had acquired T790M mutations in EGFR. Patients ≥75 years old and patients with an exon 19 deletion had higher rates of acquired T790M mutation than did younger patients and those with an exon 21 L858R mutation. In 75 patients treated with afatinib, 34 (45.3%) patients had acquired T790M mutation. The sensitivity of T790M mutation detection was lower in plasma specimens than in biopsy specimens. This population-based study confirms previous studies and highlights potential determinants of acquired T790M mutation to be considered in clinical practice. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT

PubMed Central

Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

Objective: To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. Methods: 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius® phantom and seven29® 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. Results: For Varian® linear accelerators (Varian® Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = −0.84, p < 0.01). Conclusion: MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Advances in knowledge: Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery. PMID:26511276

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kachnic, Lisa A., E-mail: lisa.kachnic@bmc.org; Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Tsai, Henry K.

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 themore » 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.« less

WHOI and SIO (I): Next Steps toward Multi-Institution Archiving of Shipboard and Deep Submergence Vehicle Data

NASA Astrophysics Data System (ADS)

Detrick, R. S.; Clark, D.; Gaylord, A.; Goldsmith, R.; Helly, J.; Lemmond, P.; Lerner, S.; Maffei, A.; Miller, S. P.; Norton, C.; Walden, B.

2005-12-01

The Scripps Institution of Oceanography (SIO) and the Woods Hole Oceanographic Institution (WHOI) have joined forces with the San Diego Supercomputer Center to build a testbed for multi-institutional archiving of shipboard and deep submergence vehicle data. Support has been provided by the Digital Archiving and Preservation program funded by NSF/CISE and the Library of Congress. In addition to the more than 92,000 objects stored in the SIOExplorer Digital Library, the testbed will provide access to data, photographs, video images and documents from WHOI ships, Alvin submersible and Jason ROV dives, and deep-towed vehicle surveys. An interactive digital library interface will allow combinations of distributed collections to be browsed, metadata inspected, and objects displayed or selected for download. The digital library architecture, and the search and display tools of the SIOExplorer project, are being combined with WHOI tools, such as the Alvin Framegrabber and the Jason Virtual Control Van, that have been designed using WHOI's GeoBrowser to handle the vast volumes of digital video and camera data generated by Alvin, Jason and other deep submergence vehicles. Notions of scalability will be tested, as data volumes range from 3 CDs per cruise to 200 DVDs per cruise. Much of the scalability of this proposal comes from an ability to attach digital library data and metadata acquisition processes to diverse sensor systems. We are able to run an entire digital library from a laptop computer as well as from supercomputer-center-size resources. It can be used, in the field, laboratory or classroom, covering data from acquisition-to-archive using a single coherent methodology. The design is an open architecture, supporting applications through well-defined external interfaces maintained as an open-source effort for community inclusion and enhancement.

A Gene Signature to Determine Metastatic Behavior in Thymomas

PubMed Central

Gökmen-Polar, Yesim; Wilkinson, Jeff; Maetzold, Derek; Stone, John F.; Oelschlager, Kristen M.; Vladislav, Ioan Tudor; Shirar, Kristen L.; Kesler, Kenneth A.; Loehrer, Patrick J.; Badve, Sunil

2013-01-01

Purpose Thymoma represents one of the rarest of all malignancies. Stage and completeness of resection have been used to ascertain postoperative therapeutic strategies albeit with limited prognostic accuracy. A molecular classifier would be useful to improve the assessment of metastatic behaviour and optimize patient management. Methods qRT-PCR assay for 23 genes (19 test and four reference genes) was performed on multi-institutional archival primary thymomas (n = 36). Gene expression levels were used to compute a signature, classifying tumors into classes 1 and 2, corresponding to low or high likelihood for metastases. The signature was validated in an independent multi-institutional cohort of patients (n = 75). Results A nine-gene signature that can predict metastatic behavior of thymomas was developed and validated. Using radial basis machine modeling in the training set, 5-year and 10-year metastasis-free survival rates were 77% and 26% for predicted low (class 1) and high (class 2) risk of metastasis (P = 0.0047, log-rank), respectively. For the validation set, 5-year metastasis-free survival rates were 97% and 30% for predicted low- and high-risk patients (P = 0.0004, log-rank), respectively. The 5-year metastasis-free survival rates for the validation set were 49% and 41% for Masaoka stages I/II and III/IV (P = 0.0537, log-rank), respectively. In univariate and multivariate Cox models evaluating common prognostic factors for thymoma metastasis, the nine-gene signature was the only independent indicator of metastases (P = 0.036). Conclusion A nine-gene signature was established and validated which predicts the likelihood of metastasis more accurately than traditional staging. This further underscores the biologic determinants of the clinical course of thymoma and may improve patient management. PMID:23894276

Coronary artery calcium: a multi-institutional, multimanufacturer international standard for quantification at cardiac CT.

PubMed

McCollough, Cynthia H; Ulzheimer, Stefan; Halliburton, Sandra S; Shanneik, Kaiss; White, Richard D; Kalender, Willi A

2007-05-01

To develop a consensus standard for quantification of coronary artery calcium (CAC). A standard for CAC quantification was developed by a multi-institutional, multimanufacturer international consortium of cardiac radiologists, medical physicists, and industry representatives. This report specifically describes the standardization of scan acquisition and reconstruction parameters, the use of patient size-specific tube current values to achieve a prescribed image noise, and the use of the calcium mass score to eliminate scanner- and patient size-based variations. An anthropomorphic phantom containing calibration inserts and additional phantom rings were used to simulate small, medium-size, and large patients. The three phantoms were scanned by using the recommended protocols for various computed tomography (CT) systems to determine the calibration factors that relate measured CT numbers to calcium hydroxyapatite density and to determine the tube current values that yield comparable noise values. Calculation of the calcium mass score was standardized, and the variance in Agatston, volume, and mass scores was compared among CT systems. Use of the recommended scanning parameters resulted in similar noise for small, medium-size, and large phantoms with all multi-detector row CT scanners. Volume scores had greater interscanner variance than did Agatston and calcium mass scores. Use of a fixed calcium hydroxyapatite density threshold (100 mg/cm(3)), as compared with use of a fixed CT number threshold (130 HU), reduced interscanner variability in Agatston and calcium mass scores. With use of a density segmentation threshold, the calcium mass score had the smallest variance as a function of patient size. Standardized quantification of CAC yielded comparable image noise, spatial resolution, and mass scores among different patient sizes and different CT systems and facilitated reduced radiation dose for small and medium-size patients.

Development and reproducibility evaluation of a Monte Carlo-based standard LINAC model for quality assurance of multi-institutional clinical trials.

PubMed

Usmani, Muhammad Nauman; Takegawa, Hideki; Takashina, Masaaki; Numasaki, Hodaka; Suga, Masaki; Anetai, Yusuke; Kurosu, Keita; Koizumi, Masahiko; Teshima, Teruki

2014-11-01

Technical developments in radiotherapy (RT) have created a need for systematic quality assurance (QA) to ensure that clinical institutions deliver prescribed radiation doses consistent with the requirements of clinical protocols. For QA, an ideal dose verification system should be independent of the treatment-planning system (TPS). This paper describes the development and reproducibility evaluation of a Monte Carlo (MC)-based standard LINAC model as a preliminary requirement for independent verification of dose distributions. The BEAMnrc MC code is used for characterization of the 6-, 10- and 15-MV photon beams for a wide range of field sizes. The modeling of the LINAC head components is based on the specifications provided by the manufacturer. MC dose distributions are tuned to match Varian Golden Beam Data (GBD). For reproducibility evaluation, calculated beam data is compared with beam data measured at individual institutions. For all energies and field sizes, the MC and GBD agreed to within 1.0% for percentage depth doses (PDDs), 1.5% for beam profiles and 1.2% for total scatter factors (Scps.). Reproducibility evaluation showed that the maximum average local differences were 1.3% and 2.5% for PDDs and beam profiles, respectively. MC and institutions' mean Scps agreed to within 2.0%. An MC-based standard LINAC model developed to independently verify dose distributions for QA of multi-institutional clinical trials and routine clinical practice has proven to be highly accurate and reproducible and can thus help ensure that prescribed doses delivered are consistent with the requirements of clinical protocols. © The Author 2014. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

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

PubMed

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.

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

PubMed

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 Education.

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

PubMed

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.

Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements.

PubMed

Hu, Eric M; Zhang, Andrew; Silverman, Stuart G; Pedrosa, Ivan; Wang, Zhen J; Smith, Andrew D; Chandarana, Hersh; Doshi, Ankur; Shinagare, Atul B; Remer, Erick M; Kaffenberger, Samuel D; Miller, David C; Davenport, Matthew S

2018-04-17

To determine the need for a standardized renal mass reporting template by analyzing reports of indeterminate renal masses and comparing their contents to stated preferences of radiologists and urologists. The host IRB waived regulatory oversight for this multi-institutional HIPAA-compliant quality improvement effort. CT and MRI reports created to characterize an indeterminate renal mass were analyzed from 6 community (median: 17 reports/site) and 6 academic (median: 23 reports/site) United States practices. Report contents were compared to a published national survey of stated preferences by academic radiologists and urologists from 9 institutions. Descriptive statistics and Chi-square tests were calculated. Of 319 reports, 85% (271; 192 CT, 79 MRI) reported a possibly malignant mass (236 solid, 35 cystic). Some essential elements were commonly described: size (99% [269/271]), mass type (solid vs. cystic; 99% [268/271]), enhancement (presence vs. absence; 92% [248/271]). Other essential elements had incomplete penetrance: the presence or absence of fat in solid masses (14% [34/236]), size comparisons when available (79% [111/140]), Bosniak classification for cystic masses (54% [19/35]). Preferred but non-essential elements generally were described in less than half of reports. Nephrometry scores usually were not included for local therapy candidates (12% [30/257]). Academic practices were significantly more likely than community practices to include mass characterization details, probability of malignancy, and staging. Community practices were significantly more likely to include management recommendations. Renal mass reporting elements considered essential or preferred often are omitted in radiology reports. Variation exists across radiologists and practice settings. A standardized template may mitigate these inconsistencies.

Comparison of Re-irradiation Outcomes for Charged Particle Radiotherapy and Robotic Stereotactic Radiotherapy Using CyberKnife for Recurrent Head and Neck Cancers: A Multi-institutional Matched-cohort Analysis.

PubMed

Yamazaki, Hideya; Demizu, Yusuke; Okimoto, Tomoaki; Ogita, Mikio; Himei, Kengo; Nakamura, Satoaki; Suzuki, Gen; Yoshida, Ken; Kotsuma, Tadayuki; Yoshioka, Yasuo

2016-10-01

To compare survival outcomes for charged particle radiotherapy (CP) and stereotactic body radiotherapy using CyberKnife (CK) in patients who had undergone re-irradiation for head and neck cancers. We conducted a retrospective multi-institutional matched-cohort analysis on 25 patients treated with CP and 25 matched patients treated with CK according to three prognostic factors (nasopharyngeal cancer or not, interval between initial radiotherapy and re-irradiation, and planning target volume). CP was used more often to treat non-squamous cell cancer ((non-SCC): 52% vs. 0%) with a higher prescribed dose (median=57.6 Gy(RBE)/16 fractions) than CK (32 Gy/5 fractions). The local control rate (LC) for patients treated with CP was 71.2% at 1 year and that for patients treated with CK was 63.8% (p=0.24). The 1-year overall survival (OS) rates were 67.1% for CP and 36.3% for CK (p=0.0002), respectively. Non-SCC patients showed better OS rates at 1 year than SCC patients. In the SCC sub-group analysis, the 1-year LC, OS rates were 65%, 58.3% in the CP group and 64%, 36.3% in the CK group (p=0.81, p=0.02), respectively. A total of 16 patients (32%) experienced grade 3 or worse toxicities (24% in CK and 40% in CP, p=0.36), including six grade 5 toxicities. CP produced higher survival rates than CK, treated more non-SCC patients and used a higher prescribed dose. On the other hand, severe toxicities occurred in both groups, which, however, require further investigation. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT.

PubMed

McGarry, Conor K; Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01). MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.

43 CFR 404.18 - How can I request assistance to conduct a feasibility study?

Code of Federal Regulations, 2011 CFR

2011-10-01

... feasibility study? 404.18 Section 404.18 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF... request assistance to conduct a feasibility study? To request assistance to conduct a feasibility study under § 404.11(a) or (b), consistent with Reclamation's recommendation in an appraisal report, you must...

41 CFR 101-5.104-3 - Data requirements for feasibility studies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... feasibility studies. 101-5.104-3 Section 101-5.104-3 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-3 Data requirements for feasibility studies. (a) The data requirements for feasibility studies may vary from program to program, but shall be standard...

41 CFR 101-5.104-3 - Data requirements for feasibility studies.

Code of Federal Regulations, 2013 CFR

2013-07-01

... feasibility studies. 101-5.104-3 Section 101-5.104-3 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-3 Data requirements for feasibility studies. (a) The data requirements for feasibility studies may vary from program to program, but shall be standard...

41 CFR 101-5.104-3 - Data requirements for feasibility studies.

Code of Federal Regulations, 2012 CFR

2012-07-01

... feasibility studies. 101-5.104-3 Section 101-5.104-3 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-3 Data requirements for feasibility studies. (a) The data requirements for feasibility studies may vary from program to program, but shall be standard...

41 CFR 101-5.104-3 - Data requirements for feasibility studies.

Code of Federal Regulations, 2014 CFR

2014-07-01

... feasibility studies. 101-5.104-3 Section 101-5.104-3 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-3 Data requirements for feasibility studies. (a) The data requirements for feasibility studies may vary from program to program, but shall be standard...

41 CFR 101-5.104-3 - Data requirements for feasibility studies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... feasibility studies. 101-5.104-3 Section 101-5.104-3 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-3 Data requirements for feasibility studies. (a) The data requirements for feasibility studies may vary from program to program, but shall be standard...

Outcomes in a multi-institutional cohort of patients treated with intraoperative radiation therapy for advanced or recurrent renal cell carcinoma.

PubMed

Paly, Jonathan J; Hallemeier, Christopher L; Biggs, Peter J; Niemierko, Andrzej; Roeder, Falk; Martínez-Monge, Rafael; Whitson, Jared; Calvo, Felipe A; Fastner, Gerd; Sedlmayer, Felix; Wong, William W; Ellis, Rodney J; Haddock, Michael G; Choo, Richard; Shipley, William U; Zietman, Anthony L; Efstathiou, Jason A

2014-03-01

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). 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. 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. 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 similar cohorts treated by local resection alone suggesting the potential for improved DFS with IORT. Copyright © 2014 Elsevier Inc. All rights reserved.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paly, Jonathan J.; Hallemeier, Christopher L.; Biggs, Peter J.

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 duringmore » 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 similar cohorts treated by local resection alone suggesting the potential for improved DFS with IORT.« less

Comparison of x ray computed tomography number to proton relative linear stopping power conversion functions using a standard phantom.

PubMed

Moyers, M F

2014-06-01

Adequate evaluation of the results from multi-institutional trials involving light ion beam treatments requires consideration of the planning margins applied to both targets and organs at risk. A major uncertainty that affects the size of these margins is the conversion of x ray computed tomography numbers (XCTNs) to relative linear stopping powers (RLSPs). Various facilities engaged in multi-institutional clinical trials involving proton beams have been applying significantly different margins in their patient planning. This study was performed to determine the variance in the conversion functions used at proton facilities in the U.S.A. wishing to participate in National Cancer Institute sponsored clinical trials. A simplified method of determining the conversion function was developed using a standard phantom containing only water and aluminum. The new method was based on the premise that all scanners have their XCTNs for air and water calibrated daily to constant values but that the XCTNs for high density/high atomic number materials are variable with different scanning conditions. The standard phantom was taken to 10 different proton facilities and scanned with the local protocols resulting in 14 derived conversion functions which were compared to the conversion functions used at the local facilities. For tissues within ±300 XCTN of water, all facility functions produced converted RLSP values within ±6% of the values produced by the standard function and within 8% of the values from any other facility's function. For XCTNs corresponding to lung tissue, converted RLSP values differed by as great as ±8% from the standard and up to 16% from the values of other facilities. For XCTNs corresponding to low-density immobilization foam, the maximum to minimum values differed by as much as 40%. The new method greatly simplifies determination of the conversion function, reduces ambiguity, and in the future could promote standardization between facilities. Although it was not possible from these experiments to determine which conversion function is most appropriate, the variation between facilities suggests that the margins used in some facilities to account for the uncertainty in converting XCTNs to RLSPs may be too small.

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

PubMed

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 < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional 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 radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article.

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

PubMed Central

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 < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional 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 radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article. PMID:27439324

43 CFR 404.34 - Can Reclamation reduce the amount of non-Federal cost-share required for a feasibility study?

Code of Federal Regulations, 2011 CFR

2011-10-01

...-Federal cost-share required for a feasibility study? 404.34 Section 404.34 Public Lands: Interior... for a feasibility study? Yes. Reclamation may reduce the non-Federal cost-share required for a feasibility study to an amount less than 50 percent of the study costs if: (a) Reclamation determines that...

43 CFR 404.27 - How will Reclamation evaluate my request to review an appraisal investigation or feasibility...

Code of Federal Regulations, 2010 CFR

2010-10-01

... to review an appraisal investigation or feasibility study completed without the support of... Reclamation evaluate my request to review an appraisal investigation or feasibility study completed without... appraisal investigation or feasibility study is eligible to be reviewed under the program. Reclamation will...

43 CFR 404.27 - How will Reclamation evaluate my request to review an appraisal investigation or feasibility...

Code of Federal Regulations, 2011 CFR

2011-10-01

... to review an appraisal investigation or feasibility study completed without the support of... Reclamation evaluate my request to review an appraisal investigation or feasibility study completed without... appraisal investigation or feasibility study is eligible to be reviewed under the program. Reclamation will...

43 CFR 404.35 - Is there a different non-Federal cost-share requirement for feasibility studies that involve a...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-share requirement for feasibility studies that involve a community greater than 50,000 inhabitants? 404... non-Federal cost-share requirement for feasibility studies that involve a community greater than 50,000 inhabitants? Yes. If the feasibility study involves a rural water supply system that will serve a...

43 CFR 404.19 - What requirements must be met before I can request assistance to conduct a feasibility study?

Code of Federal Regulations, 2011 CFR

2011-10-01

... request assistance to conduct a feasibility study? 404.19 Section 404.19 Public Lands: Interior... a feasibility study? All of the following requirements must be met before you can request assistance to conduct a feasibility study: (a) An appraisal investigation must be completed, with or without...

History of the Congenital Heart Surgeons' Society.

PubMed

Mavroudis, Constantine; Williams, William G

2015-10-01

The Congenital Heart Surgeons' Society is a group of over 100 pediatric heart surgeons representing 72 institutions that specialize in the treatment of patients with congenital heart defects. The Society began in 1972 and incorporated as a not-for-profit charitable organization in 2004. It has become the face and voice of congenital heart surgery in North America. In 1985, the Society established a data center for multicenter clinical research studies to encourage congenital heart professionals to participate in improving outcomes for our patients. The goals of the Congenital Heart Surgeons' Society are to stimulate the study of congenital cardiac physiology, pathology, and management options which are instantiated in data collection, multi-institutional studies, and scientific meetings. Honest and open discussion of problems with possible solutions to the challenges facing congenital heart professionals have been the strength of the Congenital Heart Surgeons' Society. It is imperative for the growth of an organization to know from where it came in order to know to where it is going. The purpose of this article is to review the history of the Congenital Heart Surgeons' Society. © The Author(s) 2015.

43 CFR 404.28 - Is it possible to expedite the completion of an appraisal investigation or feasibility study?

Code of Federal Regulations, 2011 CFR

2011-10-01

... of an appraisal investigation or feasibility study? 404.28 Section 404.28 Public Lands: Interior... or feasibility study? Yes. If Reclamation determines that a community or groups of communities to be..., to the maximum extent practicable, expedite appraisal investigations and reports and feasibility...

Artificial Retina Project: Final Report for CRADA ORNL 01-0625

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenbaum, E; Little, J

The U.S. Department of Energy’s Artificial Retina Project is a collaborative, multi-institutional effort to develop an implantable microelectronic retinal prosthesis that restores useful vision to people blinded by retinal diseases. The ultimate goal of the project is to restore reading ability, facial recognition, and unaided mobility in people with retinitis pigmentosa and age-related macular degeneration. The project taps into the unique research technologies and resources developed at DOE national laboratories to surmount the many technical challenges involved with developing a safe, effective, and durable product. The research team includes six DOE national laboratories, four universities, and private industry.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

PubMed

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed.

UMCS feasibility study for Fort George G. Meade volume 1. Feasibility study

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-12-01

Fort George G. Meade selected 83 buildings, from the approximately 1,500 buildings on the base to be included in the UMCS Feasibility Study. The purpose of the study is to evaluate the feasibility of replacing the existing analog based Energy Monitoring and Control System (EMCS) with a new distributed process Monitoring and Control System (UMCS).

RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Carcinoma of the Anal Canal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kachnic, Lisa A., E-mail: lisa.kachnic@bmc.org; Winter, Kathryn; Myerson, Robert J.

2013-05-01

Purpose: A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811. Methods and Materials: T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.4 Gy ≤3 cm or 54more » Gy >3 cm metastatic nodal and 54 Gy anal tumor PTVs in 30 fractions. The primary endpoint is described above. Planned secondary endpoints assessed all AEs and the investigator’s ability to perform DP-IMRT. Results: Of 63 accrued patients, 52 were evaluable. Tumor stage included 54% II, 25% IIIA, and 21% IIIB. In primary endpoint analysis, 77% experienced grade 2+ gastrointestinal/genitourinary acute AEs (9811 77%). There was, however, a significant reduction in acute grade 2+ hematologic, 73% (9811 85%, P=.032), grade 3+ gastrointestinal, 21% (9811 36%, P=.0082), and grade 3+ dermatologic AEs 23% (9811 49%, P<.0001) with DP-IMRT. On initial pretreatment review, 81% required DP-IMRT replanning, and final review revealed only 3 cases with normal tissue major deviations. Conclusions: Although the primary endpoint was not met, DP-IMRT was associated with significant sparing of acute grade 2+ hematologic and grade 3+ dermatologic and gastrointestinal toxicity. Although DP-IMRT proved feasible, the high pretreatment planning revision rate emphasizes the importance of real-time radiation quality assurance for IMRT trials.« less

Development of a Core Clinical Dataset to Characterize Serious Illness, Injuries, and Resource Requirements for Acute Medical Responses to Public Health Emergencies.

PubMed

Murphy, David J; Rubinson, Lewis; Blum, James; Isakov, Alexander; Bhagwanjee, Statish; Cairns, Charles B; Cobb, J Perren; Sevransky, Jonathan E

2015-11-01

In developed countries, public health systems have become adept at rapidly identifying the etiology and impact of public health emergencies. However, within the time course of clinical responses, shortfalls in readily analyzable patient-level data limit capabilities to understand clinical course, predict outcomes, ensure resource availability, and evaluate the effectiveness of diagnostic and therapeutic strategies for seriously ill and injured patients. To be useful in the timeline of a public health emergency, multi-institutional clinical investigation systems must be in place to rapidly collect, analyze, and disseminate detailed clinical information regarding patients across prehospital, emergency department, and acute care hospital settings, including ICUs. As an initial step to near real-time clinical learning during public health emergencies, we sought to develop an "all-hazards" core dataset to characterize serious illness and injuries and the resource requirements for acute medical response across the care continuum. A multidisciplinary panel of clinicians, public health professionals, and researchers with expertise in public health emergencies. Group consensus process. The consensus process included regularly scheduled conference calls, electronic communications, and an in-person meeting to generate candidate variables. Candidate variables were then reviewed by the group to meet the competing criteria of utility and feasibility resulting in the core dataset. The 40-member panel generated 215 candidate variables for potential dataset inclusion. The final dataset includes 140 patient-level variables in the domains of demographics and anthropometrics (7), prehospital (11), emergency department (13), diagnosis (8), severity of illness (54), medications and interventions (38), and outcomes (9). The resulting all-hazard core dataset for seriously ill and injured persons provides a foundation to facilitate rapid collection, analyses, and dissemination of information necessary for clinicians, public health officials, and policymakers to optimize public health emergency response. Further work is needed to validate the effectiveness of the dataset in a variety of emergency settings.

Restoring the biological crust cover of soils across biomes in arid North America

NASA Astrophysics Data System (ADS)

Garcia-Pichel, Ferran; Antoninka, Anita; Bowker, Matthew; Giraldo Silva, Ana; Nelson, Corey; Velasco Ayuso, Sergio; Barger, Nichole; Belnap, Jayne; Reed, Sasha; Duniway, Michael

2015-04-01

Biological soil crust communities provide important ecosystem services to arid lands, particularly regarding soil fertility and stability against erosion. In North America, and in many other areas of the globe, increasingly intense human activities, ranging from cattle grazing to military training, have resulted in the significant deterioration of biological soil surface cover of soils. With the intent of attaining sustainable land use practices, we are conducting a 5-year, multi-institutional research effort to develop feasible soil crusts restoration strategies for US military lands. We are including field sites of varying climatic regions (warm and cold deserts, in the Chihuahuan Desert and in the Great Basin, respectively) and varying edaphic characteristics (sandy and silty soils in each). We have multiple aims. First, we aim to establishing effective "biocrust nurseries" that produce viable and pedigreed inoculum, as a supply center for biocrust restoration and for research and development. Second, we aim to develop optimal field application methods of biocrust inoculum in a series of field trials. Currently in our second year of research, we will be reporting on significant advances made on optimizing methodologies for the large-scale supply of inoculum based on a) pedigreed laboratory cultures that match the microbial community structure of the original sites, and b) "in soil" biomass enhancement, whereby small amounts of local crusts are nursed under greenhouse conditions to yield hundred-fold increases in biomass without altering significantly community structure. We will also report on field trials for methodologies in field application, which included shading, watering, application of chemical polymers, and soil surface roughening. In a soon-to-be-initiated effort we also aim to evaluate soil and plant responses to biocrust restoration with respect to plant community structure, soil fertility, and soil stability, in multi-factorial field experiments. An important part of the plan will be to construct effective channels for sharing challenges and solutions in biocrust restoration with military and federal land managers.

43 CFR 404.36 - Will Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study...

Code of Federal Regulations, 2011 CFR

2011-10-01

... of an appraisal investigation or a feasibility study that was not completed under § 404.11(a) or (b... Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study that was not... appraisal investigations and feasibility studies that are completed under the program pursuant to § 404.11(a...

43 CFR 404.36 - Will Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study...

Code of Federal Regulations, 2010 CFR

2010-10-01

... of an appraisal investigation or a feasibility study that was not completed under § 404.11(a) or (b... Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study that was not... appraisal investigations and feasibility studies that are completed under the program pursuant to § 404.11(a...

43 CFR 404.33 - How much Federal funding can Reclamation provide for the completion of a feasibility study?

Code of Federal Regulations, 2011 CFR

2011-10-01

... provide for the completion of a feasibility study? 404.33 Section 404.33 Public Lands: Interior... of a feasibility study? In general, Reclamation will be responsible for 50 percent of the cost of a feasibility study conducted under § 404.11(a) or (b). You will be responsible to pay for the remaining 50...

43 CFR 404.29 - Can the level of effort needed to complete an appraisal investigation or feasibility study be...

Code of Federal Regulations, 2011 CFR

2011-10-01

... feasibility study must not diminish the quality of the data, the analysis, or the overall completeness of the... an appraisal investigation or feasibility study be scaled to be proportional to the size and cost of... § 404.29 Can the level of effort needed to complete an appraisal investigation or feasibility study be...

How to Train an Injured Brain? A Pilot Feasibility Study of Home-Based Computerized Cognitive Training.

PubMed

Verhelst, Helena; Vander Linden, Catharine; Vingerhoets, Guy; Caeyenberghs, Karen

2017-02-01

Computerized cognitive training programs have previously shown to be effective in improving cognitive abilities in patients suffering from traumatic brain injury (TBI). These studies often focused on a single cognitive function or required expensive hardware, making it difficult to be used in a home-based environment. This pilot feasibility study aimed to evaluate the feasibility of a newly developed, home-based, computerized cognitive training program for adolescents who suffered from TBI. Additionally, feasibility of study design, procedures, and measurements were examined. Case series, longitudinal, pilot, feasibility intervention study with one baseline and two follow-up assessments. Nine feasibility outcome measures and criteria for success were defined, including accessibility, training motivation/user experience, technical smoothness, training compliance, participation willingness, participation rates, loss to follow-up, assessment timescale, and assessment procedures. Five adolescent patients (four boys, mean age = 16 years 7 months, standard deviation = 9 months) with moderate to severe TBI in the chronic stage were recruited and received 8 weeks of cognitive training with BrainGames. Effect sizes (Cohen's d) were calculated to determine possible training-related effects. The new cognitive training intervention, BrainGames, and study design and procedures proved to be feasible; all nine feasibility outcome criteria were met during this pilot feasibility study. Estimates of effect sizes showed small to very large effects on cognitive measures and questionnaires, which were retained after 6 months. Our pilot study shows that a longitudinal intervention study comprising our novel, computerized cognitive training program and two follow-up assessments is feasible in adolescents suffering from TBI in the chronic stage. Future studies with larger sample sizes will evaluate training-related effects on cognitive functions and underlying brain structures.

Longitudinal study of the feasibility of using ecological momentary assessment to study teacher stress: Objective and self-reported measures.

PubMed

McIntyre, Teresa M; McIntyre, Scott E; Barr, Christopher D; Woodward, Phillip S; Francis, David J; Durand, Angelia C; Mehta, Paras; Kamarck, Thomas W

2016-10-01

There is a lack of comprehensive research on Ecological Momentary Assessment (EMA) feasibility to study occupational stress, especially its long-term sustainability. EMA application in education contexts has also been sparse. This study investigated the feasibility of using EMA to study teacher stress over 2 years using both objective compliance data and a self-reported feasibility survey. It also examined the influence of individual and school factors on EMA feasibility. Participants were 202 sixth through eighth grade teachers from 22 urban middle schools in the southern United States. EMA was implemented via an iPod-based Teacher Stress Diary (TSD). Teachers recorded demands, stress responses, and resources during 12 days (6 waves) over 2 years. Feasibility was assessed via compliance data generated by the TSD (e.g., entry completion) and an EMA Feasibility Survey of self-reported user-friendliness and EMA interference. The results showed high compliance regarding entry and item completion, and completion time, which was sustained over time. User-friendliness was appraised as very high and EMA interference as low. Initial difficulties regarding timing and length of assessments were addressed via EMA method refinement, resulting in improved feasibility. Teachers' ethnicity, age, marital status, grade/course taught, class size, class load, and daily workload impacted feasibility. The results supported the feasibility of using EMA to study work stress longitudinally and the value of continued feasibility monitoring. They also support EMA use to study teacher stress and inform EMA implementation in schools. Some teacher and school factors need to be taken into consideration when deciding on EMA implementation in education contexts. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

7 CFR 1737.71 - Interest rate to be considered for the purpose of assessing feasibility for loans.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-year Treasury rate will be used in all feasibility studies for loans with a final maturity of at least... rate used in feasibility studies for loans with final maturities of less than 30 years. (c) The... “date of determination” means the date of the feasibility study used in support of the loan...

Ecological Feasibility Studies in Restoration Decision Making

NASA Astrophysics Data System (ADS)

Hopfensperger, Kristine N.; Engelhardt, Katharina A. M.; Seagle, Steven W.

2007-06-01

The restoration of degraded systems is essential for maintaining the provision of valuable ecosystem services, including the maintenance of aesthetic values. However, restoration projects often fail to reach desired goals for a variety of ecologic, financial, and social reasons. Feasibility studies that evaluate whether a restoration effort should even be attempted can enhance restoration success by highlighting potential pitfalls and gaps in knowledge before the design phase of a restoration. Feasibility studies also can bring stakeholders together before a restoration project is designed to discuss potential disagreements. For these reasons, a feasibility study was conducted to evaluate the efficacy of restoring a tidal freshwater marsh in the Potomac River near Alexandria, Virginia. The study focused on science rather than engineering questions, and thus differed in approach from other feasibility studies that are mostly engineering driven. The authors report the framework they used to conduct a feasibility study to inform other potential restoration projects with similar goals. The seven steps of the framework encompass (1) initiation of a feasibility study, (2) compilation of existing data, (3) collection of current site information, (4) examination of case studies, (5) synthesis of information in a handbook, (6) meeting with selected stakeholders, and (7) evaluation of meeting outcomes. By conducting a feasibility study using the seven-step framework, the authors set the stage for conducting future compliance studies and enhancing the chance of a successful restoration.

Supporting Regularized Logistic Regression Privately and Efficiently.

PubMed

Li, Wenfa; Liu, Hongzhe; Yang, Peng; Xie, Wei

2016-01-01

As one of the most popular statistical and machine learning models, logistic regression with regularization has found wide adoption in biomedicine, social sciences, information technology, and so on. These domains often involve data of human subjects that are contingent upon strict privacy regulations. Concerns over data privacy make it increasingly difficult to coordinate and conduct large-scale collaborative studies, which typically rely on cross-institution data sharing and joint analysis. Our work here focuses on safeguarding regularized logistic regression, a widely-used statistical model while at the same time has not been investigated from a data security and privacy perspective. We consider a common use scenario of multi-institution collaborative studies, such as in the form of research consortia or networks as widely seen in genetics, epidemiology, social sciences, etc. To make our privacy-enhancing solution practical, we demonstrate a non-conventional and computationally efficient method leveraging distributing computing and strong cryptography to provide comprehensive protection over individual-level and summary data. Extensive empirical evaluations on several studies validate the privacy guarantee, efficiency and scalability of our proposal. We also discuss the practical implications of our solution for large-scale studies and applications from various disciplines, including genetic and biomedical studies, smart grid, network analysis, etc.

Supporting Regularized Logistic Regression Privately and Efficiently

PubMed Central

Li, Wenfa; Liu, Hongzhe; Yang, Peng; Xie, Wei

2016-01-01

As one of the most popular statistical and machine learning models, logistic regression with regularization has found wide adoption in biomedicine, social sciences, information technology, and so on. These domains often involve data of human subjects that are contingent upon strict privacy regulations. Concerns over data privacy make it increasingly difficult to coordinate and conduct large-scale collaborative studies, which typically rely on cross-institution data sharing and joint analysis. Our work here focuses on safeguarding regularized logistic regression, a widely-used statistical model while at the same time has not been investigated from a data security and privacy perspective. We consider a common use scenario of multi-institution collaborative studies, such as in the form of research consortia or networks as widely seen in genetics, epidemiology, social sciences, etc. To make our privacy-enhancing solution practical, we demonstrate a non-conventional and computationally efficient method leveraging distributing computing and strong cryptography to provide comprehensive protection over individual-level and summary data. Extensive empirical evaluations on several studies validate the privacy guarantee, efficiency and scalability of our proposal. We also discuss the practical implications of our solution for large-scale studies and applications from various disciplines, including genetic and biomedical studies, smart grid, network analysis, etc. PMID:27271738

78 FR 60291 - Investigational Device Exemptions for Early Feasibility Medical Device Clinical Studies...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-01

...] Investigational Device Exemptions for Early Feasibility Medical Device Clinical Studies, Including Certain First in Human Studies; Guidance for Industry and Food and Drug Administration Staff; Availability AGENCY... Feasibility Medical Device Clinical Studies, Including Certain First in Human (FIH) Studies.'' Through the...

The rationale and design of the Beta-blocker to LOwer CArdiovascular Dialysis Events (BLOCADE) Feasibility Study.

PubMed

Roberts, Matthew A; Pilmore, Helen L; Ierino, Francesco L; Badve, Sunil V; Cass, Alan; Garg, Amit X; Hawley, Carmel M; Isbel, Nicole M; Krum, Henry; Pascoe, Elaine M; Tonkin, Andrew M; Vergara, Liza A; Perkovic, Vlado

2015-03-01

The Beta-blocker to LOwer CArdiovascular Dialysis Events (BLOCADE) Feasibility Study aims to determine the feasibility of a large-scale randomized controlled trial with clinical endpoints comparing the beta-blocking agent carvedilol with placebo in patients receiving dialysis. The BLOCADE Feasibility Study is a randomized, double-blind, placebo-controlled, parallel group feasibility study comparing the beta-blocking agent carvedilol with placebo. Patients receiving dialysis for ≥3 months and who are aged ≥50 years, or who are ≥18 years and have diabetes or cardiovascular disease, were eligible. The primary outcome was the proportion of participants who complete a 6-week run-in phase in which all participants received carvedilol titrated from 3.125 mg twice daily to 6.25 mg twice daily. Other measures included how many patients are screened, the proportion recruited, the overall recruitment rate, the proportion of participants who remain on study drug for 12 months and the incidence of intra-dialytic hypotension while on randomized treatment. The BLOCADE Feasibility Study commenced recruiting in May 2011 and involves 11 sites in Australia and New Zealand. The BLOCADE Feasibility Study will inform the design of a larger clinical endpoint study to determine whether beta-blocking agents provide benefit to patients receiving dialysis, and define whether such a study is feasible. © 2014 Asian Pacific Society of Nephrology.

Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klopp, Ann H., E-mail: aklopp@mdanderson.org; Moughan, Jennifer; Portelance, Lorraine

2013-05-01

Purpose: Intensity modulated radiation therapy (IMRT), compared with conventional 4-field treatment, can reduce the volume of bone marrow irradiated. Pelvic bone marrow sparing has produced a clinically significant reduction in hematologic toxicity (HT). This analysis investigated HT in Radiation Therapy Oncology Group (RTOG) 0418, a prospective study to test the feasibility of delivering postoperative IMRT for cervical and endometrial cancer in a multiinstitutional setting. Methods and Materials: Patients in the RTOG 0418 study were treated with postoperative IMRT to 50.4 Gy to the pelvic lymphatics and vagina. Endometrial cancer patients received IMRT alone, whereas patients with cervical cancer received IMRTmore » and weekly cisplatin (40 mg/m{sup 2}). Pelvic bone marrow was defined within the treatment field by using a computed tomography density-based autocontouring algorithm. The volume of bone marrow receiving 10, 20, 30, and 40 Gy and the median dose to bone marrow were correlated with HT, graded by Common Terminology Criteria for Adverse Events, version 3.0, criteria. Results: Eighty-three patients were eligible for analysis (43 with endometrial cancer and 40 with cervical cancer). Patients with cervical cancer treated with weekly cisplatin and pelvic IMRT had grades 1-5 HT (23%, 33%, 25%, 0%, and 0% of patients, respectively). Among patients with cervical cancer, 83% received 5 or more cycles of cisplatin, and 90% received at least 4 cycles of cisplatin. The median percentage volume of bone marrow receiving 10, 20, 30, and 40 Gy in all 83 patients, respectively, was 96%, 84%, 61%, and 37%. Among cervical cancer patients with a V40 >37%, 75% had grade 2 or higher HT compared with 40% of patients with a V40 less than or equal to 37% (P =.025). Cervical cancer patients with a median bone marrow dose of >34.2 Gy also had higher rates of grade ≥2 HT than did those with a dose of ≤34.2 Gy (74% vs 43%, P=.049). Conclusions: Pelvic IMRT with weekly cisplatin is associated with low rates of HT and high rates of weekly cisplatin use. The volume of bone marrow receiving 40 Gy and the median dose to bone marrow correlated with higher rates of grade ≥2 toxicity among patients receiving weekly cisplatin (cervical cancer patients). Evaluation and limitation of the volume of bone marrow treated with pelvic IMRT is warranted in patients receiving concurrent chemotherapy.« less

7 CFR 1980.442 - Feasibility studies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 14 2011-01-01 2011-01-01 false Feasibility studies. 1980.442 Section 1980.442... studies. A feasibility study by a recognized independent consultant will be required for all loans, except as provided in this paragraph. The cost of the study will be borne by the borrower and may be paid...

40 CFR 35.1605-8 - Diagnostic-feasibility study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Diagnostic-feasibility study. 35.1605-8... Freshwater Lakes § 35.1605-8 Diagnostic-feasibility study. A two-part study to determine a lake's current... the study includes gathering information and data to determine the limnological, morphological...

40 CFR 35.1605-8 - Diagnostic-feasibility study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Diagnostic-feasibility study. 35.1605-8... Freshwater Lakes § 35.1605-8 Diagnostic-feasibility study. A two-part study to determine a lake's current... the study includes gathering information and data to determine the limnological, morphological...

Inventory of the carabid beetle fauna of the Gaoligong Mountains, western Yunnan Province, China: species of the tribe Zabrini (Coleoptera, Carabidae)

PubMed Central

Kavanaugh, David H.; Hieke, Fritz; Liang, Hongbin; Dong, Dazhi

2014-01-01

Abstract A ten-year multidisciplinary, multi-national and multi-institutional biodiversity inventory project in the Gaoligong Shan region of western Yunnan Province, China generated more than 35,000 specimens of the beetle (Coleoptera) family Carabidae. In this report, first of a planned series, we focus on diversity in tribe Zabrini. Our study of just over 1300 specimens of zabrine carabids from the project, all in genus Amara Bonelli, found a total of 13 species, all previously described, to occur in the study area, with none of them strictly endemic. We present a key for identification of adults of these species, as well as nomenclatural data, diagnoses, illustrations of dorsal habitus and male genitalia, and information about geographical, altitudinal and habitat distributions within the study area and overall geographical distribution for each species. Distributions of the species within the study area are compared, and broader geographical range patterns are characterized. We also discuss a possible role of the Gaoligong Shan region as one source area for the present-day fauna of the Himalaya and southern edge of the Qinghai-Xizang (Tibetan) Plateau. PMID:24899831

Findings from a mixed-methods study of an interprofessional faculty development program.

PubMed

Abu-Rish Blakeney, Erin; Pfeifle, Andrea; Jones, Mandy; Hall, Leslie Walter; Zierler, Brenda K

2016-01-01

Forty faculty members from eight schools participated in a year-long National Faculty Development Program (NFDP) conducted in 2012-2013, aimed at developing faculty knowledge and skills for interprofessional education (IPE). The NFDP included two live conferences. Between conferences, faculty teams implemented self-selected IPE projects at their home institutions and participated in coaching and peer-support conference calls. This paper describes program outcomes. A mixed methods approach was adopted. Data were gathered through online surveys and semi-structured interviews. The study explored whether faculty were satisfied with the program, believed the program was effective in developing knowledge and skills in designing, implementing, and evaluating IPE, and planned to continue newly-implemented IPE and faculty development (FD). Peer support and networking were two of the greatest perceived benefits. Further, this multi-institutional program appears to have facilitated early organizational change by bringing greater contextual understanding to assumptions made at the local level that in turn could influence hidden curricula and networking. These findings may guide program planning for future FD to support IPE.

Design of a decentralized reusable research database architecture to support data acquisition in large research projects.

PubMed

Iavindrasana, Jimison; Depeursinge, Adrien; Ruch, Patrick; Spahni, Stéphane; Geissbuhler, Antoine; Müller, Henning

2007-01-01

The diagnostic and therapeutic processes, as well as the development of new treatments, are hindered by the fragmentation of information which underlies them. In a multi-institutional research study database, the clinical information system (CIS) contains the primary data input. An important part of the money of large scale clinical studies is often paid for data creation and maintenance. The objective of this work is to design a decentralized, scalable, reusable database architecture with lower maintenance costs for managing and integrating distributed heterogeneous data required as basis for a large-scale research project. Technical and legal aspects are taken into account based on various use case scenarios. The architecture contains 4 layers: data storage and access are decentralized at their production source, a connector as a proxy between the CIS and the external world, an information mediator as a data access point and the client side. The proposed design will be implemented inside six clinical centers participating in the @neurIST project as part of a larger system on data integration and reuse for aneurism treatment.

Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multi-institutional trial.

PubMed

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.

An epidemiological approach to welfare research in zoos: the Elephant Welfare Project.

PubMed

Carlstead, Kathy; Mench, Joy A; Meehan, Cheryl; Brown, Janine L

2013-01-01

Multi-institutional studies of welfare have proven to be valuable in zoos but are hampered by limited sample sizes and difficulty in evaluating more than just a few welfare indicators. To more clearly understand how interactions of husbandry factors influence the interrelationships among welfare outcomes, epidemiological approaches are needed as well as multifactorial assessments of welfare. Many questions have been raised about the housing and care of elephants in zoos and whether their environmental and social needs are being met in a manner that promotes good welfare. This article describes the background and rationale for a large-scale study of elephant welfare in North American zoos funded by the (U.S.) Institute of Museum and Library Services. The goals of this project are to document the prevalence of positive and negative welfare states in 291 elephants exhibited in 72 Association of Zoos and Aquariums zoos and then determine the environmental, management, and husbandry factors that impact elephant welfare. This research is the largest scale nonhuman animal welfare project ever undertaken by the zoo community, and the scope of environmental variables and welfare outcomes measured is unprecedented.

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

NASA Astrophysics Data System (ADS)

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.

Ventricular assist devices: a review of psychosocial risk factors and their impact on outcomes.

PubMed

Bruce, Courtenay R; Delgado, Estevan; Kostick, Kristin; Grogan, Sherry; Ashrith, Guha; Trachtenberg, Barry; Estep, Jerry D; Bhimaraj, Arvind; Pham, Linda; Blumenthal-Barby, Jennifer S

2014-12-01

Psychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices. Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices. We identified 5 studies that examined psychosocial factors and their relationship to postoperative VAD-related outcomes. Our results suggest that 3 psychosocial variables are possibly associated with VAD-related outcomes: depression, functional status, and self-care. Of the few studies that exist, the generalizability of findings is constrained by a lack of methodologic rigor, inconsistent terminology, and a lack of conceptual clarity. This review should serve as a call for research. Efforts to minimize psychosocial risk before device placement can only be successful insofar as VAD programs can clearly identify who is at risk for suboptimal outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Non-intubated video-assisted thoracic surgery: where does evidence stand?

PubMed Central

Tacconi, Federico

2016-01-01

In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients’ management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients’ well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet. PMID:27195134

Emotional intelligence and the relationship to resident performance: a multi-institutional study.

PubMed

Talarico, Joseph F; Varon, Albert J; Banks, Shawn E; Berger, Jeffrey S; Pivalizza, Evan G; Medina-Rivera, Glorimar; Rimal, Jyotsna; Davidson, Melissa; Dai, Feng; Qin, Li; Ball, Ryan D; Loudd, Cheryl; Schoenberg, Catherine; Wetmore, Amy L; Metro, David G

2013-05-01

To test the hypothesis that emotional intelligence, as measured by a BarOn Emotional Quotient Inventory (EQ-i), the 125-item version personal inventory (EQ-i:125), correlates with resident performance. Survey (personal inventory) instrument. Five U.S. academic anesthesiology residency programs. Postgraduate year (PGY) 2, 3, and 4 residents enrolled in university-based anesthesiology residency programs. Residents confidentially completed the BarOn EQ-i:125 personal inventory. The deidentified resident evaluations were sent to the principal investigator of a separate data collection study for data analysis. Data collected from the inventory were correlated with daily evaluations of the residents by residency program faculty. Results of the individual BarOn EQ-i:125 and daily faculty evaluations of the residents were compiled and analyzed. Univariate correlation analysis and multivariate canonical analysis showed that some aspects of the BarOn EQ-i:125 were significantly correlated with, and likely to be predictors of, resident performance. Emotional intelligence, as measured by the BarOn EQ-i personal inventory, has considerable promise as an independent indicator of performance as an anesthesiology resident. Copyright © 2013 Elsevier Inc. All rights reserved.

Knee ultrasound from research to real practice: a systematic literature review of adult knee ultrasound assessment feasibility studies.

PubMed

Peltea, Alexandra; Berghea, Florian; Gudu, Tania; Ionescu, Ruxandra

2016-12-05

To identify and analyse existing data regarding knee ultrasound (US) feasibility in clinical practice. Material and methods: A systematic literature review was performed using the terms: ("knee") AND ("ultrasound" OR "ultrasonography") AND ("feasibility" OR "pilot" OR "proof of concept"). Feasibility studies regarding knee US or US aided maneuver involving knee joint, published during 2005-2015, were selected and evaluated against a complex framework constructed around mandatory key areas for feasibility studies: acceptability, demand, implementation, practicality, adaptation, integration and expansion. One hundred and fifty-nine publications were identified, of which 9 were included in the final analysis: 6 dealt with the development and implementation of novel US scores, while the rest focused on implementing MSUS in clinical practice, evaluating the usefulness of articular cartilage US assessment and the feasibility of sonography for intra-articular knee injections, respectively. Six studies quantified feasibility as time spent for the evaluation, with only two addressing areassuch as acceptability, implementation and practicality, although none of these systematically assessed all feasibility domains. Knee US feasibility is still poorly addressed; the time required for US assessment is the main area addressed. This information gap should be properly addressed in future works, in order to ensure the right place for this technique.

7 CFR 4280.173 - Grant funding for feasibility studies.

Code of Federal Regulations, 2013 CFR

2013-01-01

... costs will be considered eligible. Eligible project costs for renewable energy system feasibility... America Program General Renewable Energy System Feasibility Study Grants § 4280.173 Grant funding for...; and (3) Environmental study. (c) Ineligible project costs. Ineligible project costs for renewable...

7 CFR 4280.173 - Grant funding for feasibility studies.

Code of Federal Regulations, 2014 CFR

2014-01-01

... costs will be considered eligible. Eligible project costs for renewable energy system feasibility... America Program General Renewable Energy System Feasibility Study Grants § 4280.173 Grant funding for...; and (3) Environmental study. (c) Ineligible project costs. Ineligible project costs for renewable...

7 CFR 4280.173 - Grant funding for feasibility studies.

Code of Federal Regulations, 2012 CFR

2012-01-01

... costs will be considered eligible. Eligible project costs for renewable energy system feasibility... America Program General Renewable Energy System Feasibility Study Grants § 4280.173 Grant funding for...; and (3) Environmental study. (c) Ineligible project costs. Ineligible project costs for renewable...

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability—An Emerging Framework

PubMed Central

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four “pillars” of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two “foundational considerations,” adaptive capacity and policy levers, are also discussed. PMID:25848557

76 FR 80947 - Draft Guidance for Industry and Food and Drug Administration Staff; Investigational Device...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... for Early Feasibility Medical Device Clinical Studies, Including Certain First in Human Studies... feasibility studies of medical devices, using appropriate risk mitigation strategies, under the... comments on the key principles unique to the justification for, and design of, early feasibility studies...

41 CFR 101-5.104-4 - Scheduling feasibility studies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... studies. 101-5.104-4 Section 101-5.104-4 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-4 Scheduling feasibility studies. The schedule of feasibility studies will be coordinated by GSA with its construction, space management, and buildings...

41 CFR 101-5.104-4 - Scheduling feasibility studies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... studies. 101-5.104-4 Section 101-5.104-4 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.1-General § 101-5.104-4 Scheduling feasibility studies. The schedule of feasibility studies will be coordinated by GSA with its construction, space management, and buildings...

Laparoscopic esophagomyotomy for achalasia in children: A review

PubMed Central

Pandian, T Kumar; Naik, Nimesh D; Fahy, Aodhnait S; Arghami, Arman; Farley, David R; Ishitani, Michael B; Moir, Christopher R

2016-01-01

Esophageal achalasia in children is rare but ultimately requires endoscopic or surgical treatment. Historically, Heller esophagomyotomy has been recommended as the treatment of choice. The refinement of minimally invasive techniques has shifted the trend of treatment toward laparoscopic Heller myotomy (LHM) in adults and children with achalasia. A review of the available literature on LHM performed in patients < 18 years of age was conducted. The pediatric LHM experience is limited to one multi-institutional and several single-institutional retrospective studies. Available data suggest that LHM is safe and effective. There is a paucity of evidence on the need for and superiority of concurrent antireflux procedures. In addition, a more complete portrayal of complications and long-term (> 5 years) outcomes is needed. Due to the infrequency of achalasia in children, these characteristics are unlikely to be defined without collaboration between multiple pediatric surgery centers. The introduction of peroral endoscopic myotomy and single-incision techniques, continue the trend of innovative approaches that may eventually become the standard of care. PMID:26839646

Emotional intelligence and its correlation to performance as a resident: a preliminary study.

PubMed

Talarico, Joseph F; Metro, David G; Patel, Rita M; Carney, Patricia; Wetmore, Amy L

2008-03-01

To test the hypothesis that emotional intelligence, as measured by the Bar-On Emotional Quotient Inventory (EQ-I) 125 (Multi Health Systems, Toronto, Ontario, Canada) personal inventory, would correlate with resident performance. Prospective survey. University-affiliated, multiinstitutional anesthesiology residency program. Current clinical anesthesiology years one to three (PGY 2-4) anesthesiology residents enrolled in the University of Pittsburgh Anesthesiology Residency Program. Participants confidentially completed the Bar-On EQ-I 125 survey. Results of the individual EQ-I 125 and daily evaluations by the faculty of the residency program were compiled and analyzed. There was no positive correlation between any facet of emotional intelligence and resident performance. There was statistically significant negative correlation (-0.40; P < 0.05) between assertiveness and the "American Board of Anesthesiology essential attributes" component of the resident evaluation. Emotional intelligence, as measured by the Bar-On EQ-I personal inventory, does not strongly correlate to resident performance as defined at the University of Pittsburgh.

OpenSim: open-source software to create and analyze dynamic simulations of movement.

PubMed

Delp, Scott L; Anderson, Frank C; Arnold, Allison S; Loan, Peter; Habib, Ayman; John, Chand T; Guendelman, Eran; Thelen, Darryl G

2007-11-01

Dynamic simulations of movement allow one to study neuromuscular coordination, analyze athletic performance, and estimate internal loading of the musculoskeletal system. Simulations can also be used to identify the sources of pathological movement and establish a scientific basis for treatment planning. We have developed a freely available, open-source software system (OpenSim) that lets users develop models of musculoskeletal structures and create dynamic simulations of a wide variety of movements. We are using this system to simulate the dynamics of individuals with pathological gait and to explore the biomechanical effects of treatments. OpenSim provides a platform on which the biomechanics community can build a library of simulations that can be exchanged, tested, analyzed, and improved through a multi-institutional collaboration. Developing software that enables a concerted effort from many investigators poses technical and sociological challenges. Meeting those challenges will accelerate the discovery of principles that govern movement control and improve treatments for individuals with movement pathologies.

Settler colonial power and the American Indian sovereignty movement: forms of domination, strategies of transformation.

PubMed

Steinman, Erich

2012-01-01

The article extends the multi-institutional model of power and change through an analysis of the American Indian Sovereignty Movement. Drawing upon cultural models of the state, and articulating institutionalist conceptions of political opportunities and resources, the analysis demonstrates that this framework can be applied to challenges addressing the state as well as nonstate fields. The rational-legal diminishment of tribal rights, bureaucratic paternalism, commonsense views of tribes as racial/ethnic minorities, and the binary construction of American and Indian as oppositional identities diminished the appeal of "contentious" political action. Instead, to establish tribes' status as sovereign nations, tribal leaders aggressively enacted infrastructural power, transposed favorable legal rulings across social fields to legitimize sovereignty discourses, and promoted a pragmatic coexistence with state and local governments. Identifying the United States as a settler colonial society, the study suggests that a decolonizing framework is more apt than racial/ethnicity approaches in conceptualizing the struggle of American Indians.

A consensus prognostic gene expression classifier for ER positive breast cancer

PubMed Central

Teschendorff, Andrew E; Naderi, Ali; Barbosa-Morais, Nuno L; Pinder, Sarah E; Ellis, Ian O; Aparicio, Sam; Brenton, James D; Caldas, Carlos

2006-01-01

Background A consensus prognostic gene expression classifier is still elusive in heterogeneous diseases such as breast cancer. Results Here we perform a combined analysis of three major breast cancer microarray data sets to hone in on a universally valid prognostic molecular classifier in estrogen receptor (ER) positive tumors. Using a recently developed robust measure of prognostic separation, we further validate the prognostic classifier in three external independent cohorts, confirming the validity of our molecular classifier in a total of 877 ER positive samples. Furthermore, we find that molecular classifiers may not outperform classical prognostic indices but that they can be used in hybrid molecular-pathological classification schemes to improve prognostic separation. Conclusion The prognostic molecular classifier presented here is the first to be valid in over 877 ER positive breast cancer samples and across three different microarray platforms. Larger multi-institutional studies will be needed to fully determine the added prognostic value of molecular classifiers when combined with standard prognostic factors. PMID:17076897