The feasibility of a Bayesian network model to assess the probability of simultaneous symptoms in patients with advanced cancer.

Although patients with advanced cancer often experience multiple symptoms simultaneously, clinicians usually focus on symptoms that are volunteered by patients during regular history-taking. We aimed to evaluate the feasibility of a Bayesian network (BN) model to predict the presence of simultaneous symptoms, based on the presence of other symptoms. Our goal is to help clinicians prioritize which symptoms to assess. Patient-reported severity of 11 symptoms (scale 0-10) was measured using an adapted Edmonton Symptom Assessment Scale (ESAS) in a national cross-sectional survey among advanced cancer patients. Scores were dichotomized (< 4 and ≥ 4). Using fourfold cross validation, the prediction error of 9 BN algorithms was estimated (Akaike information criterion (AIC). The model with the highest AIC was evaluated. Model predictive performance was assessed per symptom; an area under curve (AUC) of ≥ 0.65 was considered satisfactory. Model calibration compared predicted and observed probabilities; > 10% difference was considered inaccurate. Symptom scores of 532 patients were collected. A symptom score ≥ 4 was most prevalent for fatigue (64.7%). AUCs varied between 0.60 and 0.78, with satisfactory AUCs for 8/11 symptoms. Calibration was accurate for 101/110 predicted conditional probabilities. Whether a patient experienced fatigue was directly associated with experiencing 7 other symptoms. For example, in the absence or presence of fatigue, the model predicted a 8.6% and 33.1% probability of experiencing anxiety, respectively. It is feasible to use BN development for prioritizing symptom assessment. Fatigue seems most eligble to serve as a starting symptom for predicting the probability of experiencing simultaneous symptoms.

Predicting Lung Cancer Survival Using Probabilistic Reclassification of TNM Editions With a Bayesian Network.

PURPOSE: The TNM classification system is used for prognosis, treatment, and research. Regular updates potentially break backward compatibility. Reclassification is not always possible, is labor intensive, or requires additional data. We developed a Bayesian network (BN) for reclassifying the 5th, 6th, and 7th editions of the TNM and predicting survival for non-small-cell lung cancer (NSCLC) without training data with known classifications in multiple editions. METHODS: Data were obtained from the Netherlands Cancer Registry (n = 146,084). A BN was designed with nodes for TNM edition and survival, and a group of nodes was designed for all TNM editions, with a group for edition 7 only. Before learning conditional probabilities, priors for relations between the groups were manually specified after analysis of changes between editions. For performance evaluation only, part of the 7th edition test data were manually reclassified. Performance was evaluated using sensitivity, specificity, and accuracy. Two-year survival was evaluated with the receiver operating characteristic area under the curve (AUC), and model calibration was visualized. RESULTS: Manual reclassification of 7th to 6th edition stage group as ground truth for testing was impossible in 5.6% of the patients. Predicting 6th edition stage grouping using 7th edition data and vice versa resulted in average accuracies, sensitivities, and specificities between 0.85 and 0.99. The AUC for 2-year survival was 0.81. CONCLUSION: We have successfully created a BN for reclassifying TNM stage grouping across TNM editions and predicting survival in NSCLC without knowing the true TNM classification in various editions in the training set. We suggest binary prediction of survival is less relevant than predicted probability and model calibration. For research, probabilities can be used for weighted reclassification.

Impact on Quality of Documentation and Workload of the Introduction of a National Information Standard for Tumor Board Reporting.

PURPOSE: Tumor boards, clinical practice guidelines, and cancer registries are intertwined cancer care quality instruments. Standardized structured reporting has been proposed as a solution to improve clinical documentation, while facilitating data reuse for secondary purposes. This study describes the implementation and evaluation of a national standard for tumor board reporting for breast cancer on the basis of the clinical practice guideline and the potential for reusing clinical data for the Netherlands Cancer Registry (NCR). METHODS: Previously, a national information standard for breast cancer was derived from the corresponding Dutch clinical practice guideline. Using data items from the information standard, we developed three different tumor board forms: preoperative, postoperative, and postneoadjuvant-postoperative. The forms were implemented in Amphia Hospital's electronic health record. Quality of clinical documentation and workload before and after implementation were compared. RESULTS: Both draft and final tumor board reports were collected from 27 and 31 patients in baseline and effect measurements, respectively. Completeness of final reports increased from 39.5% to 45.4% (P = .04). The workload for tumor board preparation and discussion did not change significantly. Standardized tumor board reports included 50% (61/122) of the data items carried in the NCR. An automated process was developed to upload information captured in tumor board reports to the NCR database. CONCLUSION: This study shows implementation of a national standard for tumor board reports improves quality of clinical documentation, without increasing clinical workload. Simultaneously, our work enables data reuse for secondary purposes like cancer registration.

Alkylindium subhalides derived from the tetrahedral indium(I) cluster compound [In4[C(SiMe3)3]4].

Partial oxidation of the tetraalkyltetraindium(I) compound In4[C(SiMe3)3]4] 1 with halogen donors such as 1,2-dibromoethane and hexachloroethane or with mixtures of bromine and aluminum tribromide afforded novel alkylindium halides in which the indium atoms still possess unusually low oxidation states. Indium-indium single bonds between bivalent indium atoms were found in the compounds In2X2R2 (R = C(SiMe3)3, X = Cl (2) or Br (4)), which gave dimers in the solid state with all four halogen atoms in a bridging position. The tetrahedral arrangement of four indium atoms in a cluster was retained in the compound In4Br2R4 (3), in which one bromine atom occupied a mu3-bridging position above one triangular face of the In4 tetrahedron. One edge of that triangle was bridged by the second bromine atom. Mixed-valent indium atoms resulted with an average oxidation state of + 1.5.

Time scaling regimes in aggregation of magnetic dipolar particles: scattering dichroism results.

We report experimental results on the aggregation kinetics in magnetorheological fluids subject to a constant uniaxial magnetic field using the technique of scattering dichroism. We show that the number of aggregated particles displays a long-time power-law dependence with exponents that correspond to two different aggregation regimes. These regimes coincide with 3D and 1D-like aggregation. We also derive the values of both time exponents for the number of aggregated particles.

Reaction of Ni2Cp2(mu-CO)2 with the alkylgallium(I) and alkylindium(I) compounds E4[C(SiMe3)3]4 (E = Ga, In). Insertion of E-R groups into the Ni-Ni bond versus replacement of CO by the isolobal E-R ligands.

The monomeric fragment In-C(SiMe3)3 was inserted into the Ni-Ni bond of Ni2Cp2(mu-CO)2 upon treatment of the carbonyl complex with the tetraindium(I) compound In4[C(SiMe3)3]4, 1, in a molar ratio of 4 to 1. The product (3) contains an indium atom coordinated to one alkyl substituent and two Ni(Cp)CO groups in a planar coordination sphere. Reaction of the starting compounds in a molar ratio of 2 to 1 led to the replacement of both CO ligands by two InR groups. A compound (4) was formed that is isostructural to the carbonyl nickel complex and has a Ni2 couple bridged by two InR ligands and two terminally coordinated cyclopentadienyl groups. The insertion product was not observed with the gallium derivative Ga4[C(SiMe3)3]4 (2); instead, a nickel gallium complex (5) analogous to 4 containing two bridging GaR ligands was isolated as the only product regardless of the ratio of the starting compounds. On the basis of quantum chemical calculations, we conclude that there is no evidence for an In-In or Ga-Ga bond in complexes 4 or 5, respectively. This, however, supports a butterfly geometry, which is isostructural to the starting carbonyl complex Ni2Cp2(mu-CO)2.

Structure and dynamics of magnetorheological fluids in rotating magnetic fields

We report on the orientation dynamics and aggregation processes of magnetorheological fluids subject to rotating magnetic fields using the technique of scattering dichroism. In the presence of stationary fields we find that the mean length of the field-induced aggregates reaches a saturation value due to finite-size effects. When a rotating field is imposed, we see the chains rotate with the magnetic field frequency (synchronous regime) but with a retarded phase angle for all the rotational frequencies applied. However, two different behaviors are found below or above a critical frequency f(c). Within the first regime (low frequency values) the size of the aggregates remains almost constant, while at high frequencies this size becomes shorter due to hydrodynamic drag. Experimental results have been reproduced by a simple model considering a torque balance on the chainlike aggregates.

Practical fiber-optic Bragg grating strain gauge system.

A fiber-optic strain gauge system for use in structural monitoring and smart-structure applications is described. The strain gauge uses a fiber-optic Bragg grating sensor to measure strain and a passive, wavelength demodulation system to determine the wavelength of the narrow-band, backreflected spectrum from the grating sensor. The fiber-optic strain gauge system permits the measurement of both static and dynamic strains with a noise-limited resolution of 0.44 microstrain/√Hz, a measurement dynamic range of 27.8 dB, and a bandwidth of 250 Hz.