Computerised Diagnostic Decision Support System for the Classification of Pre-Invasive Cervical Squamous Lesions.

Previous studies have revealed considerable interobserver and intraobserver variation in the histological classification of preinvasive cervical squamous lesions. The aim of the present study was to develop a decision support system (DSS) for the histological interpretation of these lesions. Knowledge and uncertainty were represented in the form of a Bayesian belief network that permitted the storage of diagnostic knowledge and, for a given case, the collection of evidence in a cumulative manner that provided a final probability for the possible diagnostic outcomes. The network comprised 8 diagnostic histological features (evidence nodes) that were each independently linked to the diagnosis (decision node) by a conditional probability matrix. Diagnostic outcomes comprised normal; koilocytosis; and cervical intraepithelial neoplasia (CIN) 1, CIN II, and CIN M. For each evidence feature, a set of images was recorded that represented the full spectrum of change for that feature. The system was designed to be interactive in that the histopathologist was prompted to enter evidence into the network via a specifically designed graphical user interface (i-Path Diagnostics, Belfast, Northern Ireland). Membership functions were used to derive the relative likelihoods for the alternative feature outcomes, the likelihood vector was entered into the network, and the updated diagnostic belief was computed for the diagnostic outcomes and displayed. A cumulative probability graph was generated throughout the diagnostic process and presented on screen. The network was tested on 50 cervical colposcopic biopsy specimens, comprising 10 cases each of normal, koilocytosis, CIN 1, CIN H, and CIN III. These had been preselected by a consultant gynecological pathologist. Using conventional morphological assessment, the cases were classified on 2 separate occasions by 2 consultant and 2 junior pathologists. The cases were also then classified using the DSS on 2 occasions by the 4 pathologists and by 2 medical students with no experience in cervical histology. Interobserver and intraobserver agreement using morphology and using the DSS was calculated with K statistics. Intraobserver reproducibility using conventional unaided diagnosis was reasonably good (kappa range, 0.688 to 0.861), but interobserver agreement was poor (kappa range, 0.347 to 0.747). Using the DSS improved overall reproducibility between individuals. Using the DSS, however, did not enhance the diagnostic performance of junior pathologists when comparing their DSS-based diagnosis against an experienced consultant. However, the generation of a cumulative probability graph also allowed a comparison of individual performance, how individual features were assessed in the same case, and how this contributed to diagnostic disagreement between individuals. Diagnostic features such as nuclear pleomorphism were shown to be particularly problematic and poorly reproducible. DSSs such as this therefore not only have a role to play in enhancing decision making but also in the study of diagnostic protocol, education, self-assessment, and quality control. (C) 2003 Elsevier Inc. All rights reserved.

The University Incubator: Insights in the Entrepreneurial Process from a Network Perspective

Research to date has identified incubator units as an effective mechanism for supporting the growth and development of small entrepreneurial firms. Advantages are gained not only from the provision of appropriate facilities and external managerial expertise on site, but also from the opportunity to develop entrepreneurial networks facilitated by the spatial proximity of incubator firms. Therefore, the research question upon which the paper is based investigates the impact of context, in other words the degree to which the networking opportunities provided by the university incubator support the small firm in its pursuit of sustainability and growth

Improved Nonlinear PCA for Process Monitoring Using Support Vector Data Description

Nonlinear principal component analysis (PCA) based on neural networks has drawn significant attention as a monitoring tool for complex nonlinear processes, but there remains a difficulty with determining the optimal network topology. This paper exploits the advantages of the Fast Recursive Algorithm, where the number of nodes, the location of centres, and the weights between the hidden layer and the output layer can be identified simultaneously for the radial basis function (RBF) networks. The topology problem for the nonlinear PCA based on neural networks can thus be solved. Another problem with nonlinear PCA is that the derived nonlinear scores may not be statistically independent or follow a simple parametric distribution. This hinders its applications in process monitoring since the simplicity of applying predetermined probability distribution functions is lost. This paper proposes the use of a support vector data description and shows that transforming the nonlinear principal components into a feature space allows a simple statistical inference. Results from both simulated and industrial data confirm the efficacy of the proposed method for solving nonlinear principal component problems, compared with linear PCA and kernel PCA.

Guideline on the design and conduct of cystic fibrosis clinical trials: The European Cystic Fibrosis Society–Clinical Trials Network (ECFS-CTN)

We describe the rationale for disease specific research networks in general as well as the aims and function of the European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN) specifically. The ECFS-CTN was founded in 2009 with the aim of improving the quality and quantity of clinical research in the area of cystic fibrosis (CF) in Europe. A network of 18 clinical trial sites in 8 European countries was established according to uniform state-of-the-art quality criteria. To support the ECFS-CTN in the acquisition, planning and conduct of clinical trials, the network is equipped with a coordinating centre, steering and executive committees, and committees for protocol review, standardization, training and networking as well as a data safety monitoring board. A strong partnership with European CF patient parent organizations aims to increase awareness of the need for efficient clinical research and the participation of patients in clinical trials.

PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN) - PERFORMANCE OF BAYESIAN BELIEF NETWORK FOR DIAGNOSIS AND GRADING

Prostatic intraepithelial neoplasia (PIN) diagnosis and grading are affected by uncertainties which arise from the fact that almost all knowledge of PIN histopathology is expressed in concepts, descriptive linguistic terms, and words. A Bayesian belief network (BBN) was therefore used to reduce the problem of uncertainty in diagnostic clue assessment, while still considering the dependences between elements in the reasoning sequence. A shallow network was used with an open-tree topology, with eight first-level descendant nodes for the diagnostic clues (evidence nodes), each independently linked by a conditional probability matrix to a root node containing the diagnostic alternatives (decision node). One of the evidence nodes was based on the tissue architecture and the others were based on cell features. The system was designed to be interactive, in that the histopathologist entered evidence into the network in the form of likelihood ratios for outcomes at each evidence node. The efficiency of the network was tested on a series of 110 prostate specimens, subdivided as follows: 22 cases of non-neoplastic prostate or benign prostatic tissue (NP), 22 PINs of low grade (PINlow), 22 PINs of high grade (PINhigh), 22 prostatic adenocarcinomas with cribriform pattern (PACcri), and 22 prostatic adenocarcinomas with large acinar pattern (PAClgac). The results obtained in the benign and malignant categories showed that the belief for the diagnostic alternatives is very high, the values being in general more than 0.8 and often close to 1.0. When considering the PIN lesions, the network classified and graded most of the cases with high certainty. However, there were some cases which showed values less than 0.8 (13 cases out of 44), thus indicating that there are situations in which the feature changes are intermediate between contiguous categories or grades. Discrepancy between morphological grading and the BBN results was observed in four out of 44 PIN cases: one PINlow was classified as PINhigh and three PINhigh were classified as PINlow. In conclusion, the network can grade PlN lesions and differentiate them from other prostate lesions with certainty. In particular, it offers a descriptive classifier which is readily implemented and which allows the use of linguistic, fuzzy variables.

EXPERT-SYSTEM SUPPORT USING BAYESIAN BELIEF NETWORKS IN THE DIAGNOSIS OF FINE-NEEDLE ASPIRATION BIOPSY SPECIMENS OF THE BREAST

Aim-To develop an expert system model for the diagnosis of fine needle aspiration cytology (FNAC) of the breast.

Methods-Knowledge and uncertainty were represented in the form of a Bayesian belief network which permitted the combination of diagnostic evidence in a cumulative manner and provided a final probability for the possible diagnostic outcomes. The network comprised 10 cytological features (evidence nodes), each independently linked to the diagnosis (decision node) by a conditional probability matrix. The system was designed to be interactive in that the cytopathologist entered evidence into the network in the form of likelihood ratios for the outcomes at each evidence node.

Results-The efficiency of the network was tested on a series of 40 breast FNAC specimens. The highest diagnostic probability provided by the network agreed with the cytopathologists' diagnosis in 100% of cases for the assessment of discrete, benign, and malignant aspirates. A typical probably benign cases were given probabilities in favour of a benign diagnosis. Suspicious cases tended to have similar probabilities for both diagnostic outcomes and so, correctly, could not be assigned as benign or malignant. A closer examination of cumulative belief graphs for the diagnostic sequence of each case provided insight into the diagnostic process, and quantitative data which improved the identification of suspicious cases.

Conclusion-The further development of such a system will have three important roles in breast cytodiagnosis: (1) to aid the cytologist in making a more consistent and objective diagnosis; (2) to provide a teaching tool on breast cytological diagnosis for the non-expert; and (3) it is the first stage in the development of a system capable of automated diagnosis through the use of expert system machine vision.

Capability Curve Based Enhanced Reactive Power Control Strategy for Stability Enhancement and Network Voltage Management

Reactive power has become a vital resource in modern electricity networks due to increased penetration of distributed generation. This paper examines the extended reactive power capability of DFIGs to improve network stability and capability to manage network voltage profile during transient faults and dynamic operating conditions. A coordinated reactive power controller is designed by considering the reactive power capabilities of the rotor-side converter (RSC) and the grid-side converter (GSC) of the DFIG in order to maximise the reactive power support from DFIGs. The study has illustrated that, a significant reactive power contribution can be obtained from partially loaded DFIG wind farms for stability enhancement by using the proposed capability curve based reactive power controller; hence DFIG wind farms can function as vital dynamic reactive power resources for power utilities without commissioning additional dynamic reactive power devices. Several network adaptive droop control schemes are also proposed for network voltage management and their performance has been investigated during variable wind conditions. Furthermore, the influence of reactive power capability on network adaptive droop control strategies has been investigated and it has also been shown that enhanced reactive power capability of DFIGs can substantially improve the voltage control performance.

On-off based charging strategies for EVs connected to a Low Voltage distributon network

The development of appropriate Electric Vehicle (EV) charging strategies has been identified as an effective way to accommodate an increasing number of EVs on Low Voltage (LV) distribution networks. Most research studies to date assume that future charging facilities will be capable of regulating charge rates continuously, while very few papers consider the more realistic situation of EV chargers that support only on-off charging functionality. In this work, a distributed charging algorithm applicable to on-off based charging systems is presented. Then, a modified version of the algorithm is proposed to incorporate real power system constraints. Both algorithms are compared with uncontrolled and centralized charging strategies from the perspective of both utilities and customers. © 2013 IEEE.

Measuring horizontal integration among health care providers in the community: An examination of a collaborative process within a palliative care network

In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.

Dose-response relationship in phase 1 clinical trials: a European Drug Development Network (EDDN) Collaboration Study

Introduction: Because a dose–response relationship is characteristic of conventional chemotherapy, this concept is widely used for the development of novel cytotoxic (CTX) drugs. However, the need to reach the MTD to obtain optimal benefit with molecularly targeted agents (MTA) is controversial. In this study, we evaluated the relationship between dose and efficacy in a large cohort of phase I patients with solid tumors.

Experimental Design: We collected data on 1,182 consecutive patients treated in phase I trials in 14 European institutions in 2005–2007. Inclusion criteria were: (i) patients treated within completed single-agent studies in which a maximum-administered dose was defined and (ii) RECIST/survival data available.

Results: Seventy-two percent of patients were included in trials with MTA (N = 854) and 28% in trials with CTX (N = 328). The objective response (OR) rate was 3% and disease control at 6 months was 11%. OR for CTX was associated with higher doses (median 92% of MTD); this was not the case for MTA, where patients achieving OR received a median of 50% of MTD. For trials with MTA, patients treated at intermediate doses (40%–80%) had better survival compared with those receiving low or high doses (P = 0.038). On the contrary, there was a direct association between higher dose and better OS for CTX agents (P = 0.003).

Conclusion: Although these results support the development of novel CTX based on MTD, we found no direct relationship between higher doses and response with MTA in unselected patients. However, the longest OS was seen in patients treated with MTA at intermediate doses (40%–80% of MTD)

Mathematics Learning Support in Ireland in 2015

The provision of mathematics learning support in higher-level institutions on the island of Ireland has developed rapidly in recent times with the number of institutions providing some form of support doubling in the past seven years. The Irish Mathematics Learning Support Network aims to inform all mathematics support practitioners in Ireland on relevant issues. Consequently it was decided that a detailed picture of current provision was necessary. A comprehensive online survey was conducted to amass the necessary data. The ultimate aim of the survey is to benefit all mathematics support practitioners in Ireland, in particular those in third-level institutions who require further support to enhance the mathematical learning experience of their students. The survey reveals that the majority of Irish higher-level institutions provide mathematics learning support to some extent, with 65% doing so through a support centre. Learners of service mathematics are the primary users: first-year science, engineering and business undergraduates, with non-traditional students being a sizeable element. Despite the growing recognition for the need to offer mathematics learning support almost half of the centres are subject to annual review. Further, less than half the support offerings have a dedicated full-time manager, while 60% operate with a staff of five or fewer. The elevation of mathematics support as a viable and worthwhile career in order to attract and retain high quality staff is seen by many respondents as the crucial next phase of development.

An Evaluation of the Drug and Alcohol Service User Network in NI

Objectives:
The process evaluation will consider the views of the appointed SUN workers and representatives from selected service user groups as regards the setting up and maintenance of the SUN network. This component of the evaluation will also examine the perceptions of stakeholders from a number of relevant organisations.

The outcome evaluation will assess the effectiveness of the SUN project in achieving the intended outcomes as outlined in the original Action Plans.
The following outcomes will be evaluated:
To ascertain the level to which the SUN has provided support, information and advice to existing service user groups.
To examine the SUN co-ordination of Trust and regional networks of service user groups.
To consider how the SUN assists organisations to establish and maintain service user groups.
To examine the level of current and future membership of service users on relevant groups, with a particular focus on engagement of hard to reach populations.
To gauge service user perceptions of the Service User Network.
To examine the levels of training provided and consider the efficacy of training.

A governance approach to integrated rural tourism: factors influencing organisational performance and tourism support of local development organisations

Ao longo das últimas três décadas, o envolvimento das comunidades na formulação de políticas locais tem vindo a ganhar cada vez mais atenção como uma abordagem sustentável para o desenvolvimento rural na União Europeia (UE) e no mundo. Emergendo da globalização, novas estruturas de governação têm desafiado a base territorial restricta da autoridade do Estado soberano através do envolvimento de uma rede complexa e de autoorganização de atores governamentais e não-governamentais na tomada de decisões coletivas. A reestruturação territorial e institucional das zonas rurais, associada à expansão da governança rural, ganhou atenção considerável na literatura. No entanto, o potencial de empregar princípios de governança como fatores que determinam as direções de desenvolvimento rural através de desempenho organizacional e apoio no turismo não tem sido amplamente explorado na literatura. Deste modo, o principal objetivo desta tese consiste no emprego de ‘integração’, ‘participação’ e ‘empowerment’ como fatores críticos que influenciam os rumos do desenvolvimento rural (1) através do desempenho organizacional das organizações de governança rural e (2) apoio no turismo de organizações de desenvolvimento rural tendo em vista a validação da abordagem de governança para o turismo integrado. Ao longo deste duplo objectivo geral, a tese é dividida numa componente qualitativa de ‘desempenho’ e numa componente quantitativa de ‘apoio’. Seguindo uma abordagem sistemática baseada num sistema conceptual, foram realizadas 38 entrevistas em profundidade com pessoas chave envolvendo gestores do programa LEADER da UE na Hungria (34% do número total de Grupos de Ação Local [GAL]), seguido por um levantamento de campo transversal realizado através de um sistema de recolha de dados na Internet, tendo resultado em 662 questionários válidos para uma taxa de resposta de 63.6%. Os resultados da componente “desempenho” revelaram padrões na implementação dos princípios de governança, que por sua vez permitiram a identificação de fatores que permitem e restringem o desempenho organizacional. Os resultados da componente “apoio” permitiram destacar que o ponto de vista de redes de desenvolvimento local nos princípios de governança não é homogéneo. Diferenças significativas foram encontradas entre organizações responsáveis pelo planeamento e os grupos de aconselhamento. Contudo, os resultados sugeriram que a dimensão sustentável de turismo rural integrado é um prognosticador da contribuição do turismo para o desenvolvimento global da comunicade e para o apoio do turismo ao longo das redes de desenvolvimento local. Este estudo responde a uma necessidade crescente de investigação, que resulta da proliferação à escala mundial de formações de governança em sistemas de administração pública, tanto no lado dos investigadores como no lado dos praticantes.