Guideline Adherence and Implementation of Tumor Board Therapy Recommendations for Patients With Gastrointestinal Cancer

Purpose: Although participation in multidisciplinary tumor boards (MTBs) is an obligatory quality criterion for certification, there is scarce evidence, whether MTB recommendations are consistent with consensus guidelines and whether they are followed in clinical practice. Reasons of guideline and tumor board deviations are poorly understood so far. Methods: MTBs recommendations from the weekly MTB for gastrointestinal cancers at the University Cancer Center Leipzig/Germany (UCCL) in 2020 were analyzed for their adherence to therapy recommendations as stated in National German guidelines and implementation within an observation period of 3 months. To assess adherence, an objective classification system was developed assigning a degree of guideline and tumor board adherence to each MTB case. For cases with deviations, underlying causes and influencing factors were investigated and categorized. Results: 76% of MTBs were fully adherent to guidelines, with 16% showing deviations, mainly due to study inclusions and patient comorbidities. Guideline adherence in 8% of case discussions could not be determined, especially because there was no underlying guideline recommendation for the specific topic. Full implementation of the MTBs treatment recommendation occurred in 64% of all cases, while 21% showed deviations with primarily reasons of comorbidities and differing patient wishes. Significantly lower guideline and tumor board adherences were demonstrated in patients with reduced performance status (ECOG-PS ≥ 2) and for palliative intended therapy (p=.002/.007). Conclusion: The assessment of guideline deviations and adherence to MTB decisions by a systematic and objective quality assessment tool could become a meaningful quality criterion for cancer centers in Germany.

Identification of time series models using sparse Takagi–Sugeno fuzzy systems with reduced structure

Simplifying fuzzy models, including those for predicting time series, is an important issue in terms of their interpretation and implementation. This simplification can involve both the number of inference rules (i.e., structure) and the number of parameters. This paper proposes novel hybrid methods for time series prediction that utilize Takagi–Sugeno fuzzy systems with reduced structure. The fuzzy sets are obtained using a global optimization algorithm (particle swarm optimization, simulated annealing, genetic algorithm, or pattern search). The polynomials are determined by elastic net regression, which is a sparse regression. The simplification is based on reducing the number of polynomial parameters in the then-part by using sparse regression and removing unnecessary rules by using labels. A new quality criterion is proposed to express a compromise between the model accuracy and its simplification. The experimental results show that the proposed methods can improve a fuzzy model while simplifying its structure.

Validation and Application of Predictive Models for Inadequate Bowel Preparation in Colonoscopies in a Tertiary Hospital Population

<b><i>Background:</i></b> Bowel preparation is a major quality criterion for colonoscopies. Models developed to identify patients with inadequate preparation have not been validated in external cohorts. We aim to validate these models and determine their applicability. <b><i>Methods:</i></b> Colonoscopies between April and November 2019 were retrospectively included. Boston Bowel Preparation Scale ≥2 per segment was considered adequate. Insufficient data, incomplete colonoscopies, and total colectomies were excluded. Two models were tested: model 1 (tricyclic antidepressants, opioids, diabetes, constipation, abdominal surgery, previous inadequate preparation, inpatient status, and American Society of Anesthesiology [ASA] score ≥3); model 2 (co-morbidities, tricyclic antidepressants, constipation, and abdominal surgery). <b><i>Results:</i></b> We included 514 patients (63% males; age 61.7 ± 15.6 years), 441 with adequate preparation. The main indications were inflammatory bowel disease (26.1%) and endoscopic treatment (24.9%). Previous surgery (36.2%) and ASA score ≥3 (23.7%) were the most common comorbidities. An ASA score ≥3 was the only identified predictor for inadequate preparation in this study (<i>p</i> &#x3c; 0.001, OR 3.28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of model 1 were 60.3, 64.2, 21.8, and 90.7%, respectively. Model 2 had a sensitivity, specificity, PPV, and NPV of 57.5, 67.4, 22.6, and 90.5%, respectively. The AUC for the ROC curves was 0.62 for model 1, 0.62 for model 2, and 0.65 for the ASA score. <b><i>Conclusions:</i></b> Although both models accurately predict adequate bowel preparation, they are still unreliable in predicting inadequate preparation and, as such, new models, or further optimization of current ones, are needed. Utilizing the ASA score might be an appropriate approximation of the risk for inadequate bowel preparation in tertiary hospital populations.

Model of the quantitative criterion calculation for security assessment of the information and telecommunications systems in the critical infrastructure of the state

The subject of the article is methods and models for assessing the criticality of industry information and telecommunications systems (ITS). The purpose of this article is to analyze the existing methods and models of criticality assessment and use its results to propose a functional model for calculating the quantitative criterion for assessing the security of ITS. Results. Based on the known method of hierarchy analysis, a functional model for calculating the quantitative criterion for assessing ITS security is proposed, which, through the processing of expert assessments, allows to obtain a quantitative indicator of ITS security. This makes it possible to simplify the procedure for selecting experts, to avoid the specifics of processing expert data, as well as to assess ITS in a limited amount of statistics. Conclusions. The study showed that the developed model for calculating the quantitative criterion for assessing the security of ITS, using pairwise comparisons, allows experts to focus on the problem. In addition, the proposed model has a built-in quality criterion of the expert and allows to move from a qualitative assessment in the form of an ordered series of alphanumeric combinations, to a quantitative assessment in the form of the ratio of the basic security profile to the security profile defined by the expert.

Puree and Juice of Thai Mango and Pineapple Analyzed by High-Performance Thin-Layer Chromatography Hyphenated with Effect-Directed Assays

The requirements for analytical tools are changing due to the global production chain, the increasing cases of adulteration, and the growing trend towards consumption of plant-based food products worldwide. The assessment of bioactivity of natural foods is currently not a quality criterion, and a paradigm shift is postulated. A non-targeted effect-directed profiling by high-performance thin-layer chromatography hyphenated with five different effect-directed assays was developed exemplarily for the puree and juice products of mango Mangifera indica L. (Anacardiaceae) and pineapple Ananas comosus (L.) Merr. (Bromeliaceae). Several bioactive compounds were detected in each sample. The additional bioactivity information obtained through effect-directed profiles improves, expands and modernizes product control. Non-target effect-directed profiling adds a new perspective to previous target analysis results that can be used not only to ensure health claims based on bioactive compounds, but also to detect unknown bioactive compounds coming from contamination or residues or changes caused by food processing.

Appealing to Tacit Knowledge and Axiology to Enhance Medical Practice in the COVID-19 Pandemic: A Systematic Review and Hermeneutic Bioethical Analysis

Background: The pressure of coronavirus disease 2019 (COVID-19) pandemic, epidemiological and demographic changes, personnel-patient relationship in healthcare, and the development of biotechnologies do not go unnoticed by the healthcare professional. Changes are so wide and at a high rate that guidelines and mere scientific knowledge, which are represented by evidence-based medicine, are not sufficient to lead actions, thus the experiential aspects in the configuration of an ethos present as a fundamental part of the resources to deal with critical scenarios, such as a pandemic. In this regard, the recognition of tacit knowledge as a way of teaching and learning skills related to ethical aspects such as principles, virtues, and values, revealed as a fundamental part of the clinical field. The challenge is to strengthen binomial evidence-based medicine and values-based in order to achieve excellence in the health care of the patients and the well-being of the clinical personnel.Method: A 2-fold analysis was conducted taking pediatric endocrinology as an example. First, a systematic review was carried out in electronic databases BIREME, PubMed, and PhilPapers following PEO and PRISMA approaches. A total of 132 articles were garnered. After reading their title and abstract, 30 articles were obtained. Quantitative information was arranged in an Excel database according to three themes: ethics, axiology, and tacit knowledge. A quality criterion that meets our research question was assigned to each article and those which had a quality criterion of 3 (9) were taken to carry out the hermeneutic bioethical analysis, which consisted of three stages, namely naïve reading, codification, and interpretation. The results were analyzed in Atlas.ti. to elucidate the relations between the three main themes in accordance with the objective.Results: Although there was no difference in the frequency of tacit knowledge skills, including cognitive, social, and technical, for medical practice, there is an intrinsic relationship between epistemic and ethical values with cognitive skills, this means that professionals who practice honesty, authenticity and self-control are capable of seeing patients as persons and thus respect their dignity. This suggested that there is a strong partnership between evidence-based medicine and value-based medicine, which reinforced this binomial as the two feet on which medical practice decisions rested. With regard to tacit knowledge in terms of the context of the COVID-19 pandemic, the challenges refer to (1) adapting and learning a new way of establishing trust with the patient and (2) how to capitalize on the new knowledge that new experiences have posed.Discussion: The analysis of ethical-tacit knowledge in medicine is a recent phenomenon and is in full development. Although no references were found that dealt with any of the main topics in pediatric endocrinology, there is an interest in pediatrics to explore and discuss educational strategies in ethics related to its tacit dimension as a vector of enhancement in the clinical practice. Educational strategies ought to take into consideration the development of skills that promote reflection and discussion of experiences, even more vigorously in the context of the COVID-19 pandemic.

A Study on the Effect of Soil and Sediment Types on the Fugacity Based Multimedia Partitioning of a Contact Fungicide Fluopyram: An Equilibrium Quality Criterion (EQC) Level 1 Approach

Equilibrium Quality Criterion (EQC) Level I calculations have been performed with Standard Equilibrium Quality Criterion (EQC) environment to study the environmental partitioning of a fungicide Fluopyram. Equilibrium Quality Criterion (EQC) Level I calculation assumes no degradation of the chemical, steady-state, and equilibrium conditions between the environmental compartments. The results reveal that the concentration of Fluopyram is expected to be maximum in the sediment compartment, followed by soil and water compartments. The effect of soil and sediment types on partitioning has been studied by systematically varying the densities of these two compartments. In the sediment compartment, the Fluopyram concentration is predicted to be highest if the sediment type is ‘sandy’ and the soil type is ‘clay’.

Information technology for time series forecasting by the method of the forecast scheme synthesis

The study is devoted to the development of information technology for forecasting based on time series. It has been found that it is important to develop new models and forecasting methods to improve the quality of the forecast. Information technology is based on the evolutionary method of synthesis of the forecast scheme grounded on basic forecast models. The selected method allows you to consider any number of predictive models that may belong to different classes. For a given time series, the weight coefficients with which the models are included in the resulting forecast scheme are calculated by finding the solution to the optimization problem. The method of constructing the objective function for the optimization problem in the form of a linear combination of forecasting results by basic forecasting models is shown. It is proposed to find the solution to the optimization problem using a genetic algorithm. The result of the method is the forecast scheme, which is a linear combination of basic forecast models. To assess the quality of the forecast, it is suggested to use forecasting errors or forecast volatility calculated as the standard deviation. Forecast quality criteria are selected depending on the context of the task. The use of forecast volatility as a quality criterion, with repeated use of technology, will reduce the deviation of forecast values from real data. The structural scheme of information technology is developed. Structurally, information technology consists of two blocks: data processing and interpretation of the obtained values. The result of the application of the developed information technology is the production rules for determining the predicted value of the studied quantity. Experimental verification of the obtained results was performed. The problem of forecasting the number of religious organizations in Ukraine based on statistical data from 1997 to 2000 has been solved. The autoregression method and the linear regression model were chosen as the basic forecast models. Based on the results of using the developed information technology, the weights of the basic models were calculated. It is demonstrated that the obtained forecast scheme allowed to improve the average absolute percentage error and forecast volatility in comparison with the selected models. Keywords: information technology; time series; forecasting; evolutionary technologies; forecast volatility; synthesis of the forecast scheme.

Hygienic Assessment of Disposable Baby Diapers Made with Innovative Materials

Background: It is of current importance to develop an algorithm for assessing chemical and physical safety of products for children and adolescents made with such innovative materials as organic cotton, bamboo, fibers and threads containing silver ions used for children’s underwear, materials impregnated with marigold extract for insoles of children’s footwear, and diapers from plant raw materials. The institute conducts testing and scientific substantiation of children’s goods made using innovative technologies. Objective: To assess safety of diapers made with innovative materials (ECO-diapers). Materials and methods: We conducted physicochemical, toxicological and organoleptic testing of 200 samples of medium size disposable baby ECO-diapers made with innovative materials. Results: The results of chemical and toxicological tests of ECO-diapers in a model aqueous environment showed that the formaldehyde concentration in aqueous extracts of the diaper samples ranged from 0.08 ± 0.020 to 0.1 mg/dm3; toxicity index values – from 74.1 to 89.1 %; pH – from 0.35 to 0.5 units, and the total phenolic content – from < 0.005 to 0.024 ± 0.002 mg/dm3, thus being within permissible limits. Measured concentrations of acetaldehyde, acrylonitrile, acetone, benzene, hexane, methyl and propyl alcohols, toluene, ethyl acetate, lead, arsenic, zinc, chromium were also below threshold values. Chemical testing of the samples of baby diapers in a model air environment with exposure duration of 4, 12, and 24 hours detected migration of chemicals already after four hours of exposure, which did not change following 12 and 24 hours. The value of water absorption capacity, which is one of the main indicators of functional benefit of diapers, ranged from 307.6 ± 30.8 g to 355.5 ± 35.5 g and significantly exceeded the established standard (not less than 240.0 g for medium size diapers) owing to the use of innovative materials in the production of ECO-diapers. Conclusions: Our findings demonstrate the necessity to develop special methodological approaches to measuring breathability of ECO- and traditional diapers, to regulate smell by including this organoleptic quality criterion in the list of safety requirements, and to limit exposure duration in a model air environment to four hours.