Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids.

BACKGROUND Pulmonary carcinoids (PCs) are rare tumors. As there is a paucity of randomized studies, this expert consensus document represents an initiative by the European Neuroendocrine Tumor Society to provide guidance on their management. PATIENTS AND METHODS Bibliographical searches were carried out in PubMed for the terms 'pulmonary neuroendocrine tumors', 'bronchial neuroendocrine tumors', 'bronchial carcinoid tumors', 'pulmonary carcinoid', 'pulmonary typical/atypical carcinoid', and 'pulmonary carcinoid and diagnosis/treatment/epidemiology/prognosis'. A systematic review of the relevant literature was carried out, followed by expert review. RESULTS PCs are well-differentiated neuroendocrine tumors and include low- and intermediate-grade malignant tumors, i.e. typical (TC) and atypical carcinoid (AC), respectively. Contrast CT scan is the diagnostic gold standard for PCs, but pathology examination is mandatory for their correct classification. Somatostatin receptor imaging may visualize nearly 80% of the primary tumors and is most sensitive for metastatic disease. Plasma chromogranin A can be increased in PCs. Surgery is the treatment of choice for PCs with the aim of removing the tumor and preserving as much lung tissue as possible. Resection of metastases should be considered whenever possible with curative intent. Somatostatin analogs are the first-line treatment of carcinoid syndrome and may be considered as first-line systemic antiproliferative treatment in unresectable PCs, particularly of low-grade TC and AC. Locoregional or radiotargeted therapies should be considered for metastatic disease. Systemic chemotherapy is used for progressive PCs, although cytotoxic regimens have demonstrated limited effects with etoposide and platinum combination the most commonly used, however, temozolomide has shown most clinical benefit. CONCLUSIONS PCs are complex tumors which require a multidisciplinary approach and long-term follow-up.

Modelling the system behaviour of wet snow avalanches using an expert system approach for risk management on high alpine traffic roads

The presented approach describes a model for a rule-based expert system calculating the temporal variability of the release of wet snow avalanches, using the assumption of avalanche triggering without the loading of new snow. The knowledge base of the model is created by using investigations on the system behaviour of wet snow avalanches in the Italian Ortles Alps, and is represented by a fuzzy logic rule-base. Input parameters of the expert system are numerical and linguistic variables, measurable meteorological and topographical factors and observable characteristics of the snow cover. Output of the inference method is the quantified release disposition for wet snow avalanches. Combining topographical parameters and the spatial interpolation of the calculated release disposition a hazard index map is dynamically generated. Furthermore, the spatial and temporal variability of damage potential on roads exposed to wet snow avalanches can be quantified, expressed by the number of persons at risk. The application of the rule base to the available data in the study area generated plausible results. The study demonstrates the potential for the application of expert systems and fuzzy logic in the field of natural hazard monitoring and risk management.

Identifying observable criteria defining a critical situation involving football fans: an expert focus group study

Critical situations (CSs) involving football fans is a well-researched phenomenon with most studies examining factors leading to an escalation of violence (e.g. Braun & Vliegenthart, 2008). However, research so far has fallen short of analysing CSs that do not escalate (e.g. Hylander & Guvå, 2010) as well as establishing observable criteria that constitute such CSs. Granström et al. (2009), for instance, put forward a definition of a CS describing such situations as characterised by a discrepancy between peace and war-making behaviours between police and demonstrators. Still, this definition remains vague and does not provide concrete, defining criteria that can be identified on site. The present study looks beyond fans’ violent acts per se and focuses on these situations with a potentially – but not necessarily - violent outcome. The aim of this preliminary study is to identify observable criteria defining such a CS involving football fans. This focus group comprised of five experts working with football fans in the German-speaking area of Switzerland who discussed observable characteristics of a CS. Inductive content analysis led to the identification of specific criteria such as, “arrest of a fan”, “insufficient distance (<30m) between fans and police” and “fans mask themselves”. These criteria were then assigned to four phases of a CS highlighting the dynamic aspect of this phenomenon: Antecedents, Causes, Reactions, Consequence. Specifically, Causes, Reactions and Consequences are observable on site, while Antecedents include relevant, background information directly influencing a CS. This study puts forward a working definition of a CS that can facilitate the assessment of actual situations in the football context as well as for further research on fan violence prevention and control. These results also highlight similarities with studies investigating fan violence in other European countries while acknowledging unique characteristics of the Swiss German fan culture.

European expert consensus on rotational atherectomy

The interest in rotational atherectomy (RA) has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with percutaneous coronary interventions. Yet adoption of RA is hampered by several factors: amongst others, by the lack of a standardised protocol. This European expert consensus document stems from the awareness of the large heterogeneity in the protocols adopted to perform rotational atherectomy. The objective of the present document is to provide some points of consensus among highly experienced operators on the most controversial steps of RA in an attempt to build the basis of a standardised and universally accepted protocol.

EACTS expert consensus statement for surgical management of pleural empyema

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference.

Expert Opinion on the Perceived Effectiveness and Importance of On-Farm Biosecurity Measures for Cattle and Swine Farms in Switzerland.

Biosecurity is crucial for safeguarding livestock from infectious diseases. Despite the plethora of biosecurity recommendations, published scientific evidence on the effectiveness of individual biosecurity measures is limited. The objective of this study was to assess the perception of Swiss experts about the effectiveness and importance of individual on-farm biosecurity measures for cattle and swine farms (31 and 30 measures, respectively). Using a modified Delphi method, 16 Swiss livestock disease specialists (8 for each species) were interviewed. The experts were asked to rank biosecurity measures that were written on cards, by allocating a score from 0 (lowest) to 5 (highest). Experts ranked biosecurity measures based on their importance related to Swiss legislation, feasibility, as well as the effort required for implementation and the benefit of each biosecurity measure. The experts also ranked biosecurity measures based on their effectiveness in preventing an infectious agent from entering and spreading on a farm, solely based on transmission characteristics of specific pathogens. The pathogens considered by cattle experts were those causing Bluetongue (BT), Bovine Viral Diarrhea (BVD), Foot and Mouth Disease (FMD) and Infectious Bovine Rhinotracheitis (IBR). Swine experts expressed their opinion on the pathogens causing African Swine Fever (ASF), Enzootic Pneumonia (EP), Porcine Reproductive and Respiratory Syndrome (PRRS), as well as FMD. For cattle farms, biosecurity measures that improve disease awareness of farmers were ranked as both most important and most effective. For swine farms, the most important and effective measures identified were those related to animal movements. Among all single measures evaluated, education of farmers was perceived by the experts to be the most important and effective for protecting both Swiss cattle and swine farms from disease. The findings of this study provide an important basis for recommendation to farmers and policy makers.

A study of factors influencing high school students' attitudes and opinions about violence

Tenth grade students in a lower income neighborhood Houston school were surveyed on violence related beliefs, attitudes, and coping ability. Self-administered questionnaires were used to collect information for scale scores for statistical analysis.^ One hundred twenty six students participated of which 60% were Hispanic, 18% Black, 18% White, 2 American Indians, and 3 Asian/Pacific persons. There were 60 males, mean age 16.03, and 66 females, mean age 15.49. One-half of the sample reported repeating a grade, 53.4% of males, and 47% of females. Females' self-reported grades were slightly higher than males.^ Measures of student acceptance of violence and ability to handle conflict peacefully were studied in relation to student responses to questions about five areas: parental monitoring of the student, parent type of punishment, optimism about future prospects, frustration tolerance, and perceived peer group attitudes and practices.^ Significant gender differences included males having higher violence acceptance scores and females higher on coping with conflict peacefully. No significant race differences or gender interactions were found.^ Females' scores on future orientation were inversely related to their scores on the measure of acceptance of violence. For males, parents' punishment and perceived peer attitudes were positively related to their acceptance of violence, p $<$.0083.^ Female handling of conflict was significantly related to frustration tolerance and optimism; not significant were perceived peer attitudes, parent monitoring or punishment method. For males significantly related to handling conflict were perceived peer attitudes, parental monitoring, and severity of punishment, with the last two terms having a significant interaction effect, and inversely correlated (less monitoring, harsher punishment explained lower ability to handle conflict). ^

Family Preservation Conference Participants and the Internet: Opinions about On-Line Continuing Education

Development of distance and distributed learning continuing education (CE) opportunities for human services workers requires existence of such CE offerings, participant access to the Internet, knowledge of the Internet's use, and willingness to enroll in such programs. A survey of human services professionals who attended the Family Preservation Annual Conferences in 2000 (N = 230) and 2002 (N - 197) revealed that 92% (n = 206) of 2000 survey participants and 98% (192) of 2002 survey participants have used the Internet, while 76% of 2000 and 56% of 2002 respondents reported no formal training in the use of the Internet and its features. Findings are reported that reveal substantial interest among subjects in the Internet as a medium for continuing education programs for professional development.

Health care providers' opinions on abortion: a study for the implementation of the legal abortion public policy in the Province of Santa Fe, Argentina

Background: In Argentina, abortion has been decriminalized under certain circumstances since the enactment of the Penal Code in 1922. Nevertheless, access to abortion under this regulatory framework has been extremely limited in spite of some recent changes. This article reports the findings of the first phase of an operations research study conducted in the Province of Santa Fe, Argentina, regarding the implementation of the local legal and safe abortion access policy. Methods: The project combined research and training to generate a virtuous circle of knowledge production, decision-making, and the fostering of an informed healthcare policy. The project used a pre-post design of three phases: baseline, intervention, and evaluation. It was conducted in two public hospitals. An anonymous self-administered questionnaire (n = 157) and semi-structured interviews (n = 27) were applied to gather information about tacit knowledge about the regulatory framework; personal opinions regarding abortion and its decriminalization; opinions on the requirements needed to carry out legal abortions; and service’s responses to women in need of an abortion. Results: Firstly, a fairly high percentage of health care providers lack accurate information on current legal framework. This deficit goes side by side with a restrictive understanding of both health and rape indications. Secondly, while a great majority of health care providers support abortion under the circumstances consider in the Penal Code, most of them are reluctant towards unrestricted access to abortion. Thirdly, health care providers’ willingness to perform abortions is noticeably low given that only half of them are ready to perform an abortion when a woman’s life is at risk. Willingness is even lower for each of the other current legal indications. Conclusions: Findings suggest that there are important challenges for the implementation of a legal abortion policy. Results of the study call for specific strategies targeting health care providers in order to better inform about current legal abortion regulations and to sensitize them about abortion social determinants. The interpretation of the current legal framework needs to be broadened in order to reflect a comprehensive view of the health indication, and stereotypes regarding women’s sexuality and abortion decisions need to be dismantled.

Bird species recorded in an untrained observer survey (UOS) and an expert observer survey (EOS) in 2011 in SE Peru

To evaluate the potential of community-based bird surveys in the tropics, we compared the species richness and abundances of bird functional groups that would be detected by a basic untrained observer (untrained observer survey, UOS) to a comprehensive bird species list compiled by a professional bird guide, in a coffee agroforestry landscape in the Peruvian East Andean foothills and compared functional signatures to global functional signatures of tropical bird assemblages. The submitted data comprises the transect counts of the UOS, the comprehensive bird list, ecological data of the recorded birds and information regarding the conservation status of the recorded birds from the IUCN Red List.

Professional Liability of the Construction Professional as an Expert Witness in the Spanish Legal Framework

Inside COBRA 2011 RICS International Research Conference, the present paper is linked to analyze the liability of the construction professional in his practice as a expert witness in the Spanish legal framework. In a large number of legal procedures related to the building it is necessary the intervention of the expert witness to report on the subject of litigation, and to give an opinion about possible causes and solutions. This field is increasingly importantly for the practice of construction professional that requires an important specialization. The expert provides his knowledge to the judge in the matter he is dealing with (construction, planning, assessment, legal, ...), providing arguments or reasons as the base for his case and acting as part of the evidence. Although the importance of expert intervention in the judicial process, the responsibilities arising from their activity is a slightly studied field. Therefore, the study has as purpose to think about the regulation of professional activities raising different aims. The first is to define the action of the construction professional-expert witness and the need for expert evidence, establishing the legal implications of this professional activity. The different types of responsibilities (the civil, criminal and administrative) have been established as well as the economic, penal or disciplinary damages that can be derived from the expert report

Linked Opinions: Describing Sentiments on the Structured Web of Data

In the paper we report on the results of our experiments on the construction of the opinion ontology. Our aim is to show the benefits of publishing in the open, on the Web, the results of the opinion mining process in a structured form. On the road to achieving this, we attempt to answer the research question to what extent opinion information can be formalized in a unified way. Furthermore, as part of the evaluation, we experiment with the usage of Semantic Web technologies and show particular use cases that support our claims.

Hybrid Approach Combining Machine Learning and a Rule-Based Expert System for Text Categorization

This paper discusses a novel hybrid approach for text categorization that combines a machine learning algorithm, which provides a base model trained with a labeled corpus, with a rule-based expert system, which is used to improve the results provided by the previous classifier, by filtering false positives and dealing with false negatives. The main advantage is that the system can be easily fine-tuned by adding specific rules for those noisy or conflicting categories that have not been successfully trained. We also describe an implementation based on k-Nearest Neighbor and a simple rule language to express lists of positive, negative and relevant (multiword) terms appearing in the input text. The system is evaluated in several scenarios, including the popular Reuters-21578 news corpus for comparison to other approaches, and categorization using IPTC metadata, EUROVOC thesaurus and others. Results show that this approach achieves a precision that is comparable to top ranked methods, with the added value that it does not require a demanding human expert workload to train

Diseño de un modelo de riesgo integral de incendios forestales mediante técnicas multicriterio y su automatización en sistemas de información geográfica : una aplicación en la Comunidad Valenciana

Los incendios forestales son la principal causa de mortalidad de árboles en la Europa mediterránea y constituyen la amenaza más seria para los ecosistemas forestales españoles. En la Comunidad Valenciana, diariamente se despliega cerca de un centenar de vehículos de vigilancia, cuya distribución se apoya, fundamentalmente, en un índice de riesgo de incendios calculado en función de las condiciones meteorológicas. La tesis se centra en el diseño y validación de un nuevo índice de riesgo integrado de incendios, especialmente adaptado a la región mediterránea y que facilite el proceso de toma de decisiones en la distribución diaria de los medios de vigilancia contra incendios forestales. El índice adopta el enfoque de riesgo integrado introducido en la última década y que incluye dos componentes de riesgo: el peligro de ignición y la vulnerabilidad. El primero representa la probabilidad de que se inicie un fuego y el peligro potencial para que se propague, mientras que la vulnerabilidad tiene en cuenta las características del territorio y los efectos potenciales del fuego sobre el mismo. Para el cálculo del peligro potencial se han identificado indicadores relativos a los agentes naturales y humanos causantes de incendios, la ocurrencia histórica y el estado de los combustibles, extremo muy relacionado con la meteorología y las especies. En cuanto a la vulnerabilidad se han empleado indicadores representativos de los efectos potenciales del incendio (comportamiento del fuego, infraestructuras de defensa), como de las características del terreno (valor, capacidad de regeneración…). Todos estos indicadores constituyen una estructura jerárquica en la que, siguiendo las recomendaciones de la Comisión europea para índices de riesgo de incendios, se han incluido indicadores representativos del riesgo a corto plazo y a largo plazo. El cálculo del valor final del índice se ha llevado a cabo mediante la progresiva agregación de los componentes que forman cada uno de los niveles de la estructura jerárquica del índice y su integración final. Puesto que las técnicas de decisión multicriterio están especialmente orientadas a tratar con problemas basados en estructuras jerárquicas, se ha aplicado el método TOPSIS para obtener la integración final del modelo. Se ha introducido en el modelo la opinión de los expertos, mediante la ponderación de cada uno de los componentes del índice. Se ha utilizado el método AHP, para obtener las ponderaciones de cada experto y su integración en un único peso por cada indicador. Para la validación del índice se han empleado los modelos de Ecuaciones de Estimación Generalizadas, que tienen en cuenta posibles respuestas correlacionadas. Para llevarla a cabo se emplearon los datos de oficiales de incendios ocurridos durante el período 1994 al 2003, referenciados a una cuadrícula de 10x10 km empleando la ocurrencia de incendios y su superficie, como variables dependientes. Los resultados de la validación muestran un buen funcionamiento del subíndice de peligro de ocurrencia con un alto grado de correlación entre el subíndice y la ocurrencia, un buen ajuste del modelo logístico y un buen poder discriminante. Por su parte, el subíndice de vulnerabilidad no ha presentado una correlación significativa entre sus valores y la superficie de los incendios, lo que no descarta su validez, ya que algunos de sus componentes tienen un carácter subjetivo, independiente de la superficie incendiada. En general el índice presenta un buen funcionamiento para la distribución de los medios de vigilancia en función del peligro de inicio. No obstante, se identifican y discuten nuevas líneas de investigación que podrían conducir a una mejora del ajuste global del índice. En concreto se plantea la necesidad de estudiar más profundamente la aparente correlación que existe en la provincia de Valencia entre la superficie forestal que ocupa cada cuadrícula de 10 km del territorio y su riesgo de incendios y que parece que a menor superficie forestal, mayor riesgo de incendio. Otros aspectos a investigar son la sensibilidad de los pesos de cada componente o la introducción de factores relativos a los medios potenciales de extinción en el subíndice de vulnerabilidad. Summary Forest fires are the main cause of tree mortality in Mediterranean Europe and the most serious threat to the Spanisf forest. In the Spanish autonomous region of Valencia, forest administration deploys a mobile fleet of 100 surveillance vehicles in forest land whose allocation is based on meteorological index of wildlandfire risk. This thesis is focused on the design and validation of a new Integrated Wildland Fire Risk Index proposed to efficient allocation of vehicles and specially adapted to the Mediterranean conditions. Following the approaches of integrated risk developed last decade, the index includes two risk components: Wildland Fire Danger and Vulnerability. The former represents the probability a fire ignites and the potential hazard of fire propagation or spread danger, while vulnerability accounts for characteristics of the land and potential effects of fire. To calculate the Wildland Fire Danger, indicators of ignition and spread danger have been identified, including human and natural occurrence agents, fuel conditions, historical occurrence and spread rate. Regarding vulnerability se han empleado indicadores representativos de los efectos potenciales del incendio (comportamiento del fuego, infraestructurasd de defensa), como de las características del terreno (valor, capacidad de regeneración…). These indicators make up the hierarchical structure for the index, which, following the criteria of the European Commission both short and long-term indicators have been included. Integration consists of the progressive aggregation of the components that make up every level in risk the index and, after that, the integration of these levels to obtain a unique value for the index. As Munticriteria methods are oriented to deal with hierarchically structured problems and with situations in which conflicting goals prevail, TOPSIS method is used in the integration of components. Multicriteria methods were also used to incorporate expert opinion in weighting of indicators and to carry out the aggregation process into the final index. The Analytic Hierarchy Process method was used to aggregate experts' opinions on each component into a single value. Generalized Estimation Equations, which account for possible correlated responses, were used to validate the index. Historical records of daily occurrence for the period from 1994 to 2003, referred to a 10x10-km-grid cell, as well as the extent of the fires were the dependant variables. The results of validation showed good Wildland Fire Danger component performance, with high correlation degree between Danger and occurrence, a good fit of the logistic model used and a good discrimination power. The vulnerability component has not showed a significant correlation between their values and surface fires, which does not mean the index is not valid, because of the subjective character of some of its components, independent of the surface of the fires. Overall, the index could be used to optimize the preventing resources allocation. Nevertheless, new researching lines are identified and discussed to improve the overall performance of the index. More specifically the need of study the inverse relationship between the value of the wildfire Fire Danger component and the forested surface of each 10 - km cell is set out. Other points to be researched are the sensitivity of the index component´s weight and the possibility of taking into account indicators related to fire fighting resources to make up the vulnerability component.

QL-CONST1: an expert system for quality level prediction in concrete structures

Current trends in the fields of artifical intelligence and expert systems are moving towards the exciting possibility of reproducing and simulating human expertise and expert behaviour into a knowledge base, coupled with an appropriate, partially ‘intelligent’, computer code. This paper deals with the quality level prediction in concrete structures using the helpful assistance of an expert system, QL-CONST1, which is able to reason about this specific field of structural engineering. Evidence, hypotheses and factors related to this human knowledge field have been codified into a knowledge base. This knowledge base has been prepared in terms of probabilities of the presence of either hypotheses or evidence and the conditional presence of both. Human experts in the fields of structural engineering and the safety of structures gave their invaluable knowledge and assistance to the construction of the knowledge base. Some illustrative examples for, the validation of the expert system behaviour are included.