Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process

Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA.

Vocal rate as an assessment process during fallow deer contests

Two types of model propose that strategic decisions during contests are determined either by (i) a mutual-assessment process or (ii) a self-assessment process. Vocal signals are thought to convey information about the competitive abilities of individuals, the ultimate function of which is a reduction in costs associated with fighting consistent with the principle of mutual assessment. Nevertheless, the limited evidence that male ungulates engage in mutual assessment of vocal rates during dyadic contests has been questioned. Therefore, we examined the vocal rates of winners and losers during escalated dyadic contests between male fallow deer in order to further inform on this issue. Our results showed that winners and losers did not differ in vocal rate. The best model fit that accounted for individual vocal rates included a preponderance of factors related to the opponent indicating that contestants were attending to their opponent during fights. Vocal rate was, therefore, dependent on estimates of opponent quality without reference to self, supporting an 'opponent-only' rather than a mutual assessment process. © 2012 Elsevier B.V.

Perceptions of the process of care among caregivers and care recipients in Dementia Care Networks

The Dementia Care Networks Study investigated 4 community-based, not-for-profit dementia care networks in Ontario, Canada. Investigators examined whether sociodemographic and health characteristics, type of support network, and amount of service use among care recipients and caregivers (n = 267 dyads) were associated with experiences with care processes. The process-of-care constructs were: family physicians' awareness of services; experiences with health care workers, and assessment and placement activities. The findings highlighted that family physicians' understanding of dementia and their ability to work with the dyad to become aware of and accept services, was an important component in the dyad's satisfaction. If caregivers received home support and the care recipients received emotional support from their social support network, they were more likely to be satisfied with their experiences with health care workers. In summary, increased awareness and provision of services were associated with more positive perceptions of network effectiveness. © 2007 Sage Publications.

Numerical modelling of laboratory tests for TBM cutter indentation process analysis

Considering that TBMs are nowadays used for long Trans-Alpine tunnels, the
understanding of rock breaking and chipping due to TBM cutter disks mechanism, for deep tunnelling operations, becomes very interesting. In this paper, the results from carried out laboratory tests that simulate the disk cutter action at the rock tunnel face by means of an indentation tool, acting on a rock
specimen with proper size, and the related three-dimensional and two-dimensional numerical modelling are proposed. The developed numerical models simulate the different test conditions (applied load, boundary conditions) allowing the analysis of the stresses distributions along possible breaking planes.
The influence of a confinement-free area on one side of the specimen, simulating the formation of a groove near the tool, is pointed out.
The obtained results from numerical modelling put in evidence a satisfactory agreement with the experimental observations.

The prediction of process-induced deformation in a thermoplastic composite in support of manufacturing simulation

Digital manufacturing techniques can simulate complex assembly sequences using computer-aided design-based, as-designed' part forms, and their utility has been proven across several manufacturing sectors including the ship building, automotive and aerospace industries. However, the reality of working with actual parts and composite components, in particular, is that geometric variability arising from part forming or processing conditions can cause problems during assembly as the as-manufactured' form differs from the geometry used for any simulated build validation. In this work, a simulation strategy is presented for the study of the process-induced deformation behaviour of a 90 degrees, V-shaped angle. Test samples were thermoformed using pre-consolidated carbon fibre-reinforced polyphenylene sulphide, and the processing conditions were re-created in a virtual environment using the finite element method to determine finished component angles. A procedure was then developed for transferring predicted part forms from the finite element outputs to a digital manufacturing platform for the purpose of virtual assembly validation using more realistic part geometry. Ultimately, the outcomes from this work can be used to inform process condition choices, material configuration and tool design, so that the dimensional gap between as-designed' and as-manufactured' part forms can be reduced in the virtual environment.

The impact of peer review on the radiotherapy treatment planning process in the treatment of lung cancer

Background:
Advanced radiotherapy techniques permit accurate delivery of radiotherapy to lung tumours. Improved accuracy increases the possibility of radiotherapy field geographic miss of the tumour. One source of error is the accuracy of target volume (TV) delineation by the clinical oncologist. Colleague peer review of all curative intent lung cancer plans has been mandatory in our institution since May 2013. At least 2 clinical oncologists review plans checking treatment paradigm, TV delineated, dose to tumour and dose to critical organs. We report the impact of peer review on the radiotherapy planning process for lung cancer.

Methods:
The radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly peer review meetings after their TVs volumes were provisionally signed off by the treating consultant or post-fellowship registrar. All cases and any resultant change to the treatment plan were recorded in our prospective peer review database. We present the summary of changes agreed following the peer review process for a 6 month period.

Results:
Fifteen peer review sessions, including 46 patients (36 NSCLC, 10 SCLC) were analysed. An average of 3 cases were discussed per meeting (range 1 5). 24% of treatment courses were changed. In 4% there was a complete change in paradigm
of treatment (1 patient proceeded to induction chemotherapy, 1 patient had high dose palliative radiotherapy). In 16% there was a change in TV delineated and in 9% a change in dose (2 dose reductions and 2 alterations to post-operative dose fractionations).

Conclusions:
Consultant led peer review resulted in a change in a component of the treatment plan for 28% of patients that would not otherwise have taken place. Given this impact, consultant led peer review should be considered as an essential component in the radiotherapy planning process for all patients treated with curative radiotherapy.

Optimized process for the inclusion of carbon nanotubes in elastomers with improved thermal and mechanical properties

The effects of addition of reinforcing carbon nanotubes (CNTs) into hydrogenated nitrile-butadiene rubber (HNBR) matrix on the mechanical, dynamic viscoelastic, and permeability properties were studied in this investigation. Different techniques of incorporating nanotubes in HNBR were investigated in this research. The techniques considered were more suitable for industrial preparation of rubber composites. The nanotubes were modified with different surfactants and dispersion agents to improve the compatibility and adhesion of nanotubes on the HNBR matrix. The effects of the surface modification of the nanotubes on various properties were examined in detail. The amount of CNTs was varied from 2.5 to 10 phr in different formulations prepared to identify the optimum CNT levels. A detailed analysis was made to investigate the morphological structure and mechanical behavior at room temperature. The viscoelastic behavior of the nanotube filler elastomer was studied by dynamic mechanical thermal analysis (DMTA). Morphological analysis indicated a very good dispersion of the CNTs for a low nanotube loading of 3.5 phr. A significant improvement in the mechanical properties was observed with the addition of nanotubes. DMTA studies revealed an increase in the storage modulus and a reduction in the glass-transition temperature after the incorporation of the nanotubes. Further, the HNBR/CNT nanocomposites were subjected to permeability studies. The studies showed a significant reduction in the permeability of nitrogen gas. Copyright © 2011 Wiley Periodicals, Inc.

Towards an automated evaluation process for software architectures

Optimizing and editing enterprise software systems, after the implementation process has started, is widely recognized to be an expensive process. This has led to increasing emphasis on locating mistakes within software systems at the design stage, to help minimize development costs. There is increasing interest in the field of architecture evaluation techniques that can identify problems at the design stage, either within complete, or partially complete architectures. Most current techniques rely on manual review-based evaluation methods that require advanced skills from architects and evaluators. We are currently considering what a formal Architecture Description Language (ADL) can contribute to the process of architecture evaluation and validation. Our investigation is considering the inter-relationships between the activities performed during the architecture evaluation process, the characteristics an ADL should possess to support these activities, and the tools needed to provide convenient access to, and presentation of architectural information.