Project description:ImportanceAdvance care planning (ACP) may prevent end-of-life (EOL) care that is nonbeneficial and discordant with patient wishes. Despite long-standing recognition of the merits of ACP in oncology, it is unclear whether participation in ACP by patients with cancer has increased over time.ObjectivesTo characterize trends in durable power of attorney (DPOA) assignment, living will creation, and participation in discussions of EOL care preferences and to explore associations between ACP subtypes and EOL treatment intensity as reflected in EOL care decisions and terminal hospitalizations.Design, setting, and participantsWe analyzed prospectively collected survey data from 1985 next-of-kin surrogates of Health and Retirement Study (HRS) participants with cancer who died between 2000 and 2012, including data from in-depth "exit" interviews conducted with the surrogates after the participant's death. The HRS is a nationally representative, biennial, longitudinal panel study of US residents older than 50 years. Trends in ACP subtypes were tested, and multivariable logistic regression models examined for associations between ACP subtypes and measures of treatment intensity.Main outcomes and measuresTrends in the surrogate-reported frequency of DPOA assignment, living will creation, and participation in discussions of EOL care preferences; associations between ACP subtypes and both surrogate-reported EOL care decisions and terminal hospitalizations.ResultsFrom 2000 to 2012, there was an increase in DPOA assignment (52% to 74%, P = .03), without significant change in use of living wills (49% to 40%, P = .63) or EOL discussions (68% to 60%, P = .62). Surrogate reports that patients received "all care possible" at EOL increased during the period (7% to 58%, P = .004), and rates of terminal hospitalizations were unchanged (29% to 27%, P = .70). Limiting or withholding treatment was associated with living wills (adjusted odds ratio [AOR], 2.51; 95% CI, 1.53-4.11; P < .001) and EOL discussions (AOR, 1.93; 95% CI, 1.53-3.14; P = .002) but not with DPOA assignment.Conclusions and relevanceUse of DPOA increased significantly between 2000 and 2012 but was not associated with EOL care decisions. Importantly, there was no growth in key ACP domains such as discussions of care preferences. Efforts that bolster communication of EOL care preferences and also incorporate surrogate decision makers are critically needed to ensure receipt of goal-concordant care.

Project description:BackgroundAcetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual reality-style environment.Methods7 patients (5 male and 2 female; median age 53 y (25 to 92 y)) with an acetabular fracture were prospectively included. Exclusion criterions were simple wall fractures, cases with anticipated surgical dislocation of the femoral head for joint debridement and accurate fracture reduction. According to the Letournel classification 4 cases had two column fractures, 2 cases had anterior column fractures and 1 case had a T-shaped fracture including a posterior wall fracture.The workflow included following steps: (1) Formation of a patient-specific bone model from preoperative computed tomography scans, (2) interactive virtual fracture reduction with visuo-haptic feedback, (3) virtual fracture fixation using common osteosynthesis implants and (4) measurement of implant position relative to landmarks. The surgeon manually contoured osteosynthesis plates preoperatively according to the virtually defined deformation. Screenshots including all measurements for the OR were available.The tool was validated comparing the preoperative planning and postoperative results by 3D-superimposition.ResultsPreoperative planning was feasible in all cases. In 6 of 7 cases superimposition of preoperative planning and postoperative follow-up CT showed a good to excellent correlation. In one case part of the procedure had to be changed due to impossibility of fracture reduction from an ilioinguinal approach. In 3 cases with osteopenic bone patient-specific prebent fixation plates were helpful in guiding fracture reduction. Additionally, anatomical landmark based measurements were helpful for intraoperative navigation.ConclusionThe presented prototype planning tool for pelvic surgery was successfully integrated in a clinical workflow to improve patient-specific preoperative planning, giving visual and haptic information about the injury and allowing a patient-specific adaptation of osteosynthesis implants to the virtually reduced pelvis.

Project description:Dynamic and flexible systems offer huge advantages for businesses in addressing dynamic uncertain factors and implementing dynamic business processes (DBP). However, DBP remains a challenge from the perspectives of modeling, simulation, and implementation because of a nontrivial understanding of "What is a dynamic business process?" A variety of approaches for DBP modeling and implementation have been proposed over the past years, yet few comprehensive studies analyzing DBP from different particular perspectives (e.g., business process (BP) variability, aspect oriented BP, service compositions, etc.) and research questions that lay the foundation for the development of a meaning of a DBP have been reported. The motivation behind this review is to examine DBP meaning from a global perspective and, consequently, answer the previously presented research question. Therefore, in this paper, we present a systematic literature review (SLR) comprised of 67 papers from five respective digital libraries, which index Computer Science (CS), Information Systems (IS), and Software Engineering (SE) journals and conference proceedings. Two points of view are analyzed in the selected papers. First, we observe the similarities and differences between the proposed approaches to DBP modeling and implementation. From these observations, we define six main requirements for DBP (DBPR). In addition, the comparison of the selected papers according to DBPR shows that most of the approaches analyzed limit BP dynamicity, since they use partially predefined BP models. Secondly, we analyze the papers based on a visualization perspective that shows the less explored areas as follows: more flexible process modeling approach and its implementation in IS should be developed; usage of historic data should be extended; domain knowledge usage, like goal-orientation, multi-criteria optimization, domain knowledge, artificial intelligence, etc., should be included and extended to ensure BP dynamicity. As such, this study makes important contributions and serves as a useful resource for future DBP studies and practice. Moreover, we expect that our results could inspire researchers and practitioners towards further work aimed at bringing forward the field of DBP modeling and implementation.

Project description:Background: This systematic literature review (SLR) study is on Islamic financial technology (FinTech) business trends and challenges. It follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. This research identifies the gaps in Islamic FinTech, which require further studies. Moreover, it highlights the issues raised during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study is based on the FinTech business model (BM) classifications by Lee & Shin and Imerman & Fabozzi. Furthermore, the set of challenges used in this study are adopted from research by Lee & Shin and Li & Xu. The Scopus database was used to collect data using nine keywords. Articles and review papers published between 2016 and 2022 were included. Studies that were not published in English, and those with no ranking journals were excluded. The results were presented using bibliometric analysis. Results: The results showed 36 articles discussing Islamic FinTech business trends and challenges, and most of these studies are conducted on FinTech crowdfunding vertical BM. By contrast, the most dominant horizontal BMs are FinTech regulation and FinTech funding BMs. The top challenge found in this study is the regulation management challenges. Moreover, there are remarkable dominating articles and reviews published in 2020 and 2021 discussing COVID-19. Conclusions: This study concluded that many horizontal BMs were not covered in Islamic FinTech, especially horizontal technology BMs. Investment, property and insurance BMs are examples of unavailable articles. Islamic FinTech is considered a promising field due to the size of the opportunities it presents, the available capital, and the great demand for banking and financial products that comply with the Sharia. This study will help the Islamic FinTech industry grow and predict the demand, and provide an alternative to conventional banking FinTech and further boost the technology progress in the financial industry.

Project description:Even with advanced inverse-planning techniques, radiation treatment plan opti-mization remains a very time-consuming task with great output variability, which prompted the development of more automated approaches. One commercially available technique mimics the actions of experienced human operators to pro-gressively guide the traditional optimization process with automatically created regions of interest and associated dose-volume objectives. We report on the initial evaluation of this algorithm on 10 challenging cases of locoreginally advanced head and neck cancer. All patients were treated with VMAT to 70 Gy to the gross disease and 56 Gy to the elective bilateral nodes. The results of post-treatment autoplanning (AP) were compared to the original human-driven plans (HDP). We used an objective scoring system based on defining a collection of specific dosimetric metrics and corresponding numeric score functions for each. Five AP techniques with different input dose goals were applied to all patients. The best of them averaged the composite score 8% lower than the HDP, across the patient population. The difference in median values was statistically significant at the 95% confidence level (Wilcoxon paired signed-rank test p = 0.027). This result reflects the premium the institution places on dose homogeneity, which was consistently higher with the HDPs. The OAR sparing was consistently better with the APs, the differences reaching statistical significance for the mean doses to the parotid glands (p < 0.001) and the inferior pharyngeal constrictor (p = 0.016), as well as for the maximum doses to the spinal cord (p = 0.018) and brainstem (p = 0.040). If one is prepared to accept less stringent dose homogeneity criteria from the RTOG 1016 protocol, nine APs would comply with the protocol, while providing lower OAR doses than the HDPs. Overall, AP is a promising clinical tool, but it could benefit from a better process for shifting the balance between the target dose coverage/homogeneity and OAR sparing.

Dataset Information

Trends in Biobanking Business Planning: Initial Results of a Survey of Biobankers.

Publications

Trends in Biobanking Business Planning: Initial Results of a Survey of Biobankers.

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