Assessment of Preoperative Condition and Postoperative Outcome in Nonsmall Cell Lung Cancer Surgery

Complete surgical resection still represents the main curative treatment modality for patients with early-stage nonsmall cell lung cancer. Despite tremendous advances in perioperative and postoperative care, postoperative outcome is still disappointing. Although pathological tumor stage is the most important prognostic parameter in nonsmall cell lung cancer, additional parameters are required to explain the large variability in postoperative outcome. Therefore, assessment of preoperative condition and postoperative outcome in patients undergoing surgery is a challenging area. The research summarized in this thesis describes preoperative risk assessment, including preoperative staging, and early and late postoperative outcome. This may help the clinician in clinical decision-making and treatment tailoring

Treatment selection of early stage non-small cell lung cancer: The role of the patient in clinical decision making

Background: The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Methods: Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. Results: In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Conclusions: Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow

Background Despite advances in pump technology, thromboembolic events/acute pump thrombosis remain potentially life-threatening complications in patients with continuous-flow left ventricular assist devices (CF-LVAD). We sought to determine early signs of thromboembolic event/ pump thrombosis in patients with CF-LVAD, which could lead to earlier intervention. Methods We analysed all HeartMate II recipients (n = 40) in our centre between December 2006 and July 2013. Thromboembolic event/pump thrombosis was defined as a transient ischaemic attack (TIA), ischaemic cerebrovascular accident (CVA), or pump thrombosis. Results During median LVAD support of 336 days [IQR: 182–808], 8 (20%) patients developed a thromboembolic event/pump thrombosis (six TIA/CVA, two pump thromboses). At the time of the thromboembolic event/pump thrombosis, significantly higher pump power was seen compared with the no-thrombosis group (8.2 ± 3.0 vs. 6.4 ± 1.4 W, p = 0.02), as well as a trend towards a lower pulse index (4.1 ± 1.5 vs. 5.0 ± 1.0, p = 0.05) and a trend towards higher pump flow (5.7 ± 1.0 vs. 4.9 ± 1.9 L m, p = 0.06). The thrombosis group had a more than fourfold higher lactate dehydrogenase (LDH) median 1548 [IQR: 754– 2379] vs. 363 [IQR: 325–443] U/L, p = 0.0001). Bacterial (n = 4) or viral (n = 1) infection was present in 5 out of 8 patients. LDH > 735 U/L predicted thromboembolic events/ pump thrombosis with a positive predictive value of 88%. Conclusions In patients with a CF-LVAD (HeartMate II), thromboembolic events and/or pump thrombosis are associated with symptoms and signs of acute haemolysis as manifested by a high LDH, elevated pump power and decreased pulse index, especially in the context of an infection

Matched‐pair and propensity score comparisons of outcomes of patients with clinical stage I non–small cell lung cancer treated with resection or stereotactic radiosurgery

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98996/1/cncr28100.pd

An investigation about communication and cooperation between local governments and the NGOs in the case of Ankara Metropolitan Municipality and Chamber of City Planners in Turkey

Throughout this thesis research, communication and cooperation between local governments and a specific NGO called Chamber of City Planners (CCP) were investigated. Further, Ankara Metropolitan Municipality (AMM) was taken as a specific example of the local governments in Turkey, Ankara. Therefore the research and the qualitative investigation were based on those particular stakeholders, Ankara Metropolitan Municipality and Chamber of City Planners. The study includes not only different views of different stakeholders but also during qualitative investigations every interviewee had a chance to be explicit so that the results show us the level of the cooperation and communication between those two stakeholders in a much realistic way. During this degree project, the relationship between those two actors was analyzed by using both environmental communication and stakeholder management aspects. Since reaching a consensus or compromising between those two institutions, definitely, is required the application of stakeholder management principles and facilitation processes. Moreover, the effects of the results of communication and cooperation between those stakeholders were investigated and analyzed in this study. Consequently, miscommunication and lack of cooperation between the two significant actors, which has caused numerous controversies and conflicts regarding urban planning issues, were explored. Some of those deficiencies might be solved or facilitate by designing an environmental communication strategy, however it is crucial to reiterate that juridical precautions and law enforcements should introduce those strategies in order to reach participatory planning process and decline the controversies and conflicts

ArBanking77: Intent Detection Neural Model and a New Dataset in Modern and Dialectical Arabic

This paper presents the ArBanking77, a large Arabic dataset for intent detection in the banking domain. Our dataset was arabized and localized from the original English Banking77 dataset, which consists of 13,083 queries to ArBanking77 dataset with 31,404 queries in both Modern Standard Arabic (MSA) and Palestinian dialect, with each query classified into one of the 77 classes (intents). Furthermore, we present a neural model, based on AraBERT, fine-tuned on ArBanking77, which achieved an F1-score of 0.9209 and 0.8995 on MSA and Palestinian dialect, respectively. We performed extensive experimentation in which we simulated low-resource settings, where the model is trained on a subset of the data and augmented with noisy queries to simulate colloquial terms, mistakes and misspellings found in real NLP systems, especially live chat queries. The data and the models are publicly available at https://sina.birzeit.edu/arbanking77

Evaluating vendor managed inventory systems: how incentives can benefit supply chain partners

In a vendor managed inventory (VMI) system, the effects of financial incentives on the entire supply chain (SC) and on the individual firms are investigated in this study. To this end, order management, order replenishment and inventory control activities of a two-echelon SC are examined via modeling using discrete event simulation. By determining the appropriate parameters for the incentives with scenario analysis, balanced profit distribution between buyers and a supplier in VMI is established. Simulation outputs of the traditional model, VMI only and VMI with incentives models are compared based on profits with paired comparisons. In VMI with incentives, both buyers, and the supplier experience higher benefits than the traditional system. This study provides a new method which eliminates the unbalanced benefit distribution due to VMI and offers almost equal benefits to the participating firms. With financial incentives, firms are encouraged to share information with each other to work in a coordinated SC