Predicting necrosis in residual mass analysis after retroperitoneal lymph node dissection: a retrospective study

Background: Recent studies have demonstrated that pathological analysis of retroperitoneal residual masses of patients with testicular germ cell tumors revealed findings of necrotic debris or fibrosis in up to 50% of patients. We aimed at pursuing a clinical and pathological review of patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in order to identify variables that may help predict necrosis in the retroperitoneum. Methods: We performed a retrospective analysis of all patients who underwent PC-RPLND at the University Hospital of the University of Sao Paulo and Cancer Institute of Sao Paulo between January 2005 and September 2011. Clinical and pathological data were obtained and consisted basically of: measures of retroperitoneal masses, histology of the orchiectomy specimen, serum tumor marker and retroperitoneal nodal size before and after chemotherapy. Results: We gathered a total of 32 patients with a mean age of 29.7; pathological analysis in our series demonstrated that 15 (47%) had necrosis in residual retroperitoneal masses, 15 had teratoma (47%) and 2 (6.4%) had viable germ cell tumors (GCT). The mean size of the retroperitoneal mass was 4.94 cm in our sample, without a difference between the groups (P = 0.176). From all studied variables, relative changes in retroperitoneal lymph node size (P = 0.04), the absence of teratoma in the orchiectomy specimen (P = 0.03) and the presence of choriocarcinoma in the testicular analysis after orchiectomy (P = 0.03) were statistically significant predictors of the presence of necrosis. A reduction level of 35% was therefore suggested to be the best cutoff for predicting the absence of tumor in the retroperitoneum with a sensitivity of 73.3% and specificity of 82.4%. Conclusions: Even though retroperitoneal lymph node dissection remains the gold standard for patients with residual masses, those without teratoma in the primary tumor and a shrinkage of 35% or more in retroperitoneal mass have a considerably smaller chance of having viable GCT or teratoma in the retroperitoneum and a surveillance program could be considered.

Hospitalized children with respiratory syncytial virus infection and neuromuscular impairment face an increased risk of a complicated course

BACKGROUND: Respiratory syncytial virus (RSV) infection is an important cause of viral respiratory tract infection in children. In contrast to other confirmed risk factors that predispose to a higher morbidity and mortality, the particular risk of a preexisting neuromuscular impairment (NMI) in hospitalized children with RSV infection has not been prospectively studied in a multicenter trial. METHODS: The DMS RSV Paed database was designed for the prospective multicenter documentation and analysis of all clinically relevant aspects of the management of inpatients with RSV infection. Patients with clinically relevant NMI were identified according to the specific comments of the attending physicians and compared with those without NMI. RESULTS: This study covers 6 consecutive seasons; the surveillance took place in 14 pediatric hospitals in Germany from 1999 to 2005. In total, 1568 RSV infections were prospectively documented in 1541 pediatric patients. Of these, 73 (4.7%) patients displayed a clinically relevant NMI; 41 (56%) NMI patients had at least 1 additional risk factor for a severe course of the infection (multiple risk factors in some patients; prematurity in 30, congenital heart disease in 19, chronic lung disease 6 and immunodeficiency in 8). Median age at diagnosis was higher in NMI patients (14 vs. 5 months); NMI patients had a greater risk of seizures (15.1% vs. 1.6%), and a higher proportion in the NMI group had to be mechanically ventilated (9.6% vs. 1.9%). Eventually, the attributable mortality was significantly higher in the NMI group (5.5% vs. 0.2%; P < 0.001 for all). Multivariate logistic regression confirmed that NMI was independently associated with pediatric intensive care unit (PICU) admission (OR, 4.94; 95% CI, 2.69-8.94; P < 0.001] and mechanical ventilation (OR, 3.85; 95% CI, 1.28-10.22; P = 0.017). CONCLUSION: This is the first prospective multicenter study confirming the hypothesis that children with clinically relevant NMI face an increased risk for severe RSV-disease. It seems reasonable to include NMI as a cofactor into the decision algorithm of passive immunization.

Adaptive Rückmeldungen im intelligenten Tutorensystem LARGO

Das intelligente Tutorensystem LARGO für die Rechtswissenschaften soll Jurastudenten helfen, Argumentationsstrategien zu lernen. Im verwendeten Ansatz werden Gerichtsprotokolle als Lernmaterialien verwendet: Studenten annotieren diese und erstellen graphische Repräsentationen des Argumentationsverlaufs. Das System kann dabei zur Reflexion über die von Anwälten vorgebrachten Argumente anregen und Lernende auf mögliche Schwächen in ihrer Analyse des Disputs hinweisen. Zur Erkennung von Schwächen verwendet das System Graphgrammatiken und kollaborative Filtermechanismen. Dieser Artikel stellt dar, wie in LARGO auf Basis der Bestimmung eines „Benutzungskontextes“ die Rückmeldungen im System benutzungsadaptiv gestaltet werden. Weiterhin diskutieren wir auf Basis der Ergebnisse einer kontrollierten Studie mit dem System, welche mit Jurastudierenden an der University of Pittsburgh stattfand, in wie weit der automatisch bestimmte Benutzungskontext zur Vorhersage von Lernerfolgen bei Studenten verwendbar ist.

A Socioeconomic Approach to the Development of E-Learning

A multitude of products, systems, approaches, views and notions characterize the field of e-learning. This article attempts to disentangle the field by using economic and sociological theories, theories of marketing management and strategy as well as practical experience gained by the author while working with leading edge suppliers of e-learning. On this basis, a distinction between knowledge creation e-learning and knowledge transfer e-learning is made. The various views are divided into four different ideal-typical paradigms, each with its own characteristics and limitations. Selecting the right paradigm to use in the development of an e-learning strategy may prove crucial to success. Implications for the development of an e-learning strategy in businesses and educational institutions are outlined.

Leveraging Informality Within eLearning

The next generation of learners expect more informality in learning. Formal learning systems such as traditional LMS systems no longer meet the needs of a generation of learners used to Twitter and Facebook, social networking and user-generated content. Regardless of this, however, formal content and learning models are still important and play a major role in educating learners, particularly in enterprise. The eLite project at DERI addressed this emerging dichotomy of learning styles, reconciling the traditional with the avant garde by using innovative technology to add informal learning capabilities to formal learning architectures.

The use of learning management systems: A Longitudinal Case Study

In this article the use of Learning Management Systems (LMS) at the School of Engineering, University of Borås, in the year 2004 and the academic year 2009-2010 is investigated. The tools in the LMS were classified into four groups (tools for distribution, tools for communication, tools for interaction and tools for course administration) and the pattern of use was analyzed. The preliminary interpretation of the results was discussed with a group of teachers from the School of Engineering with long experience of using LMS. High expectations about LMS as a tool to facilitate flexible education, student centered methods and the creation of an effective learning environment is abundant in the literature. This study, however, shows that in most of the surveyed courses the available LMS is predominantly used to distribute documents to students. The authors argue that a more elaborate use of LMS and a transformation of pedagogical practices towards social constructivist, learner centered procedures should be treated as an integrated process of professional development.

Using Moodle as a support tool for teaching in Higher Education in Portugal: an exploratory study

The use of virtual learning environments in Higher Education (HE) has been growing in Portugal, driven by the Bologna Process. An example is the use of Learning Management Systems (LMS) that translates an opportunity to leverage the use of technological advances in the educational process. The progress of information and communication technologies (ICT) coupled with the great development of Internet has brought significant challenges to educators that require a thorough knowledge of their implementation process. These field notes present the results of a survey among teachers of a private HE institution in its use of Moodle as a tool to support face-to-face teaching. A research methodology essentially of exploratory nature based on a questionnaire survey, supported by statistical treatment allowed to detect motivations, type of use and perceptions of teachers in relation to this kind of tool. The results showed that most teachers, by a narrow margin (58%), had not changed their pedagogical practice as a consequence of using Moodle. Among those that did 67% attended institutional internal training. Some of the results obtained suggest further investigation and provide guidelines to plan future internal training.

Language Learning in 3D Virtual World

Second Life (SL) is an ideal platform for language learning. It is called a Multi-User Virtual Environment, where users can have varieties of learning experiences in life-like environments. Numerous attempts have been made to use SL as a platform for language teaching and the possibility of SL as a means to promote conversational interactions has been reported. However, the research so far has largely focused on simply using SL without further augmentations for communication between learners or between teachers and learners in a school-like environment. Conversely, not enough attention has been paid to its controllability which builds on the embedded functions in SL. This study, based on the latest theories of second language acquisition, especially on the Task Based Language Teaching and the Interaction Hypothesis, proposes to design and implement an automatized interactive task space (AITS) where robotic agents work as interlocutors of learners. This paper presents a design that incorporates the SLA theories into SL and the implementation method of the design to construct AITS, fulfilling the controllability of SL. It also presents the result of the evaluation experiment conducted on the constructed AITS.