Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation–rationale and design of the European CGA-TAVI registry

Abstract Purpose Aortic stenosis (AS) is the most common valvular abnormality in the elderly population. For inoperable patients or those at high-risk for surgery, transcatheter aortic valve implantation (TAVI) has become an alternative therapeutic option. The aim of the “Comprehensive geriatric assessment for transcatheter aortic valve implantation” (CGA-TAVI) registry is to evaluate the effectiveness of TAVI from the perspective of the geriatrician and to identify patient characteristics and indicators related to complications and clinical benefits for patients with symptomatic severe calcified degenerative AS undergoing TAVI. Materials and methods The CGA-TAVI registry is an international, multi-center, prospective, observational registry across Europe with consecutive patient enrolment. The registry will enrol up to 200 patients with AS undergoing TAVI, starting August 2013. CGA-TAVI has two co-primary objectives: (1) Establish predictive value of Comprehensive geriatric assessment (CGA) for mortality and/or hospitalization in TAVI patients. (2) Demonstrate CGA changes within 3 months after TAVI. Secondary objectives are: (1) Establish predictive value of CGA in TAVI patients for all-cause hospitalization, TAVI-related hospitalization, and nursing home admission. (2) Develop a comprehensive score for the assessment of TAVI patient prognosis. Conclusions The data obtained from the CGA-TAVI registry will supplement previous results to document the potential value of the effectiveness of TAVI from the perspective of geriatricians and will allow the assessment of the predictive value of CGA for mortality and/or hospitalization in elderly TAVI patients. Keywords Aortic stenosis; Transcatheter aortic valve implantation (TAVI); Comprehensive geriatric assessment (CGA); Registry; Predictor

Xenotransplantation of cryopreserved human ovarian tissue--a systematic review of MII oocyte maturation and discussion of it as a realistic option for restoring fertility after cancer treatment.

OBJECTIVE To systematically review the reporting of MII (MII) oocyte development after xenotransplantation of human ovarian tissue. DESIGN Systematic review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). SETTING Not applicable. PATIENT(S) Not applicable. INTERVENTION(S) Formation of MII oocytes after xenotransplantation of human ovarian tissue. MAIN OUTCOME MEASURE(S) Any outcome reported in Pubmed. RESULT(S) Six publications were identified that report on formation of MII oocytes after xenotransplantation of human ovarian tissue. CONCLUSION(S) Xenografting of human ovarian tissue has proved to be a useful model for examining ovarian function and follicle development in vivo. With human follicles that have matured through xenografting, the possibility of cancer transmission and relapse can also be eliminated, because cancer cells are not able to penetrate the zona pellucida. The reported studies have demonstrated that xenografted ovarian tissue from a range of species, including humans, can produce antral follicles that contain mature (MII) oocytes, and it has been shown that mice oocytes have the potential to give rise to live young. Although some ethical questions remain unresolved, xenotransplantation may be a promising method for restoring fertility. This review furthermore describes the value of xenotransplantation as a tool in reproductive biology and discusses the ethical and potential safety issues regarding ovarian tissue xenotransplantation as a means of recovering fertility.

Differentiating the Multipoint Expected Improvement for Optimal Batch Design

This work deals with parallel optimization of expensive objective functions which are modelled as sample realizations of Gaussian processes. The study is formalized as a Bayesian optimization problem, or continuous multi-armed bandit problem, where a batch of q > 0 arms is pulled in parallel at each iteration. Several algorithms have been developed for choosing batches by trading off exploitation and exploration. As of today, the maximum Expected Improvement (EI) and Upper Confidence Bound (UCB) selection rules appear as the most prominent approaches for batch selection. Here, we build upon recent work on the multipoint Expected Improvement criterion, for which an analytic expansion relying on Tallis’ formula was recently established. The computational burden of this selection rule being still an issue in application, we derive a closed-form expression for the gradient of the multipoint Expected Improvement, which aims at facilitating its maximization using gradient-based ascent algorithms. Substantial computational savings are shown in application. In addition, our algorithms are tested numerically and compared to state-of-the-art UCB-based batchsequential algorithms. Combining starting designs relying on UCB with gradient-based EI local optimization finally appears as a sound option for batch design in distributed Gaussian Process optimization.

Optimal and Long-Term Dynamic Transport Policy Design: Seeking Maximum Social Welfare through a Pricing Scheme.

This article presents an alternative approach to the decision-making process in transport strategy design. The study explores the possibility of integrating forecasting, assessment and optimization procedures in support of a decision-making process designed to reach the best achievable scenario through mobility policies. Long-term evaluation, as required by a dynamic system such as a city, is provided by a strategic Land-Use and Transport Interaction (LUTI) model. The social welfare achieved by implementing mobility LUTI model policies is measured through a cost-benefit analysis and maximized through an optimization process throughout the evaluation period. The method is tested by optimizing a pricing policy scheme in Madrid on a cordon toll in a context requiring system efficiency, social equity and environmental quality. The optimized scheme yields an appreciable increase in social surplus through a relatively low rate compared to other similar pricing toll schemes. The results highlight the different considerations regarding mobility impacts on the case study area, as well as the major contributors to social welfare surplus. This leads the authors to reconsider the cost-analysis approach, as defined in the study, as the best option for formulating sustainability measures.

Optimal and Long-Term Dynamic Transport Policy Design: Seeking Maximum Social Welfare through a Pricing Scheme

This article presents an alternative approach to the decision-making process in transport strategy design. The study explores the possibility of integrating forecasting, assessment and optimization procedures in support of a decision-making process designed to reach the best achievable scenario through mobility policies. Long-term evaluation, as required by a dynamic system such as a city, is provided by a strategic Land-Use and Transport Interaction (LUTI) model. The social welfare achieved by implementing mobility LUTI model policies is measured through a cost-benefit analysis and maximized through an optimization process throughout the evaluation period. The method is tested by optimizing a pricing policy scheme in Madrid on a cordon toll in a context requiring system efficiency, social equity and environmental quality. The optimized scheme yields an appreciable increase in social surplus through a relatively low rate compared to other similar pricing toll schemes. The results highlight the different considerations regarding mobility impacts on the case study area, as well as the major contributors to social welfare surplus. This leads the authors to reconsider the cost-analysis approach, as defined in the study, as the best option for formulating sustainability measures.

The differentiated effects of CSR actions in the service industry

Purpose – The purpose of this study is to attempt to explain why the impact of Corporate Social Responsibility (CSR) initiatives may be different and/or more important in service firms compared to manufacturing firms. CSR is becoming a common strategy, hence its extensive research. Central to it is the analysis of the effect of CSR on a firm’s performance, whose outcome depends on firm-specific and industry-related factors. Design/methodology/approach – The event study methodology is applied to all the 248 companies that have ever traded on the Spanish Stock Market between 1990 and 2007. A regression analysis examines potential different effects of CSR on service and goods firms. Findings – The results show that CSR activities have a positive impact on firm performance that is higher for service firms than for manufacturing firms. Actions related to the environment, responsible labor relationships and good corporate governance are especially important in the service context. Research limitations/implications – This research is focused on shareholders’ performance, but it does not consider other stakeholders, such as real consumer behavior or employees’ commitment and productivity. Practical implications – Service firms are likely to gain from focusing on some CSR activities (environment, employees and good corporate governance) and should use their responsible behavior as a valuable tool for public relations and differentiation in the market. Originality/value – This article is the first attempt to empirically test and explain why the relationship between CSR and firm performance may be different (more positive) for service vs manufacturing firms.

Controversy between curriculum design and curriculum development of online "highly specialized" education in the field of construction

Nowadays, on a global level, the Higher Education System has a complex and broad horizon of curricular tools to use in the teaching and learning process. In addition to these new educational instruments, full of possibilities, we face specific socio-economic conditions that affect in a significantly way the Curriculum Development in certain knowledge areas (areas traditionally built on a methodology based on a physical presence of students in the classroom). Some areas such as Restoration, Rehabilitation or Construction Pathologies, and the construction sector in general, require very defined and particular knowledge that only a small number of experts claim as specialized training. All these aspects condition the teaching methodology performed in a physical classroom at a university campus (the only option used until recent years) and made us consider the integration of online teaching in these areas too. The present work shows the teaching methodology used for the development of two online courses, where we offer distance learning for "highly specialized" formation in the Edification area (an area where traditionally there was only classroom training). At the beginning, both courses were designed by classroom training, but got a really small number of applications due to the specialized topic proposed. Later, we proposed a "Curriculum Redesign" of the contents, offering an online modality, which implied a significant demand both within and outside the university area. A notable feature of this educational experience is the great spectrum opened for attendees of both courses in the online version. This situation improved significantly the "Curriculum Development" for the student and implied an interesting new proposal on the offered contents and materials (what would have been really difficult to get in a face to face classroom). In conclusion, the absence of certain types of specialized contents in the academic university curricula makes essential to raise new methodologies to save the gap in this area through additional training courses as those analyzed in this paper. Thus, our experience opens a debate on the appropriateness of implementing online training in relation to the face to face training in constructive content subjects and, especially, presents a new scheme, not without controversy, for the curriculum design.

Design of Activated Carbon/Activated Carbon Asymmetric Capacitors

Supercapacitors are energy storage devices that offer a high power density and a low energy density in comparison with batteries. Their limited energy density can be overcome by using asymmetric configuration in mass electrodes, where each electrode works within their maximum available potential window, rendering the maximum voltage output of the system. Such asymmetric capacitors are optimized using the capacitance and the potential stability limits of the electrodes, with the reliability of the design largely depending on the accuracy and the approach taken for the electrochemical characterization. Therefore, the performance could be lower than expected and even the system could break down, if a well thought out procedure is not followed. In this work, a procedure for the development of asymmetric supercapacitors based on activated carbons is detailed. Three activated carbon materials with different textural properties and surface chemistry have been systematically characterized in neutral aqueous electrolyte. The asymmetric configuration of the masses of both electrodes in the supercapacitor has allowed to cover a higher potential window, resulting in an increase of the energy density of the three devices studied when compared with the symmetric systems, and an improved cycle life.

The Virtual Interactive Relationship Between BIM Project Teams: Effective Communication to aid Collaboration in the Design Process

Building Information Modelling (BIM) provides a shared source of information about a built asset, which creates a collaborative virtual environment for project teams. Literature suggests that to collaborate efficiently, the relationship between the project team is based on sympathy, obligation, trust and rapport. Communication increases in importance when working collaboratively but effective communication can only be achieved when the stakeholders are willing to act, react, listen and share information. Case study research and interviews with Architecture, Engineering and Construction (AEC) industry experts suggest that synchronous face-to-face communication is project teams’ preferred method, allowing teams to socialise and build rapport, accelerating the creation of trust between the stakeholders. However, virtual unified communication platforms are a close second-preferred option for communication between the teams. Effective methods for virtual communication in professional practice, such as virtual collaboration environments (CVE), that build trust and achieve similar spontaneous responses as face-to-face communication, are necessary to face the global challenges and can be achieved with the right people, processes and technology. This research paper investigates current industry methods for virtual communication within BIM projects and explores the suitability of avatar interaction in a collaborative virtual environment as an alternative to face-to-face communication to enhance collaboration between design teams’ professional practice on a project. Hence, this paper presents comparisons between the effectiveness of these communication methods within construction design teams with results of further experiments conducted to test recommendations for more efficient methods for virtual communication to add value in the workplace between design teams.

Building from building waste: The development of an instrument to determine the circularity of materials from the existing building stock in order to maximise high quality reuse

On a global level the population growth and increase of the middle class lead to a growing demand on material resources. The built environment has an enormous impact on this scarcity. In addition, a surplus of construction and demolition waste is a common problem. The construction industry claims to recycle 95% of this waste but this is in fact mainly downcycling. Towards the circular economy, the quality of reuse becomes of increasing importance. Buildings are material warehouses that can contribute to this high quality reuse. However, several aspects to achieve this are unknown and a need for more insight into the potential for high quality reuse of building materials exists. Therefore an instrument has been developed that determines the circularity of construction waste in order to maximise high quality reuse. The instrument is based on three principles: ‘product and material flows in the end of life phase’, ‘future value of secondary materials and products’ and ‘the success of repetition in a new life cycle’. These principles are further divided into a number of criteria to which values and weighting factors are assigned. A degree of circularity can then be determined as a percentage. A case study for a typical 70s building is carried out. For concrete, the circularity is increased from 25% to 50% by mapping out the potential for high quality reuse. During the development of the instrument it was clarified that some criteria are difficult to measure. Accurate and reliable data are limited and assumptions had to be made. To increase the reliability of the instrument, experts have reviewed the instrument several times. In the long-term, the instrument can be used as a tool for quantitative research to reduce the amount of construction and demolition waste and contribute to the reduction of raw material scarcity.

Advanced recorder design and development. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Improved commercial vehicle conspicuity and signalling systems. Task II: analyses, experiments and design recommendations. Interim report.

National Highway Traffic Safety Administration, Washington, D.C.

National Accident Sampling System sample design - phases 2 and 3 - executive summary. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

National Accident Sampling System sample design - phases 2 and 3. Volume II: exhibits. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

National Accident Sampling System sample design - phases 2 and 3. Volume I: final technical report.

National Highway Traffic Safety Administration, Washington, D.C.