Definite Decision Research Articles

Distinctive Remarks On The Prophet’s Parents: Edition and Analysis of an Epistle Attributed to Ibrāhīm al-Ḥalabī (d. 956/1549)

Hz. Peygamber’in anne ve babasının (ebeveyn-i Resûl) iman bakımından dünyadaki durumları ile ahirette Cennet’e gidip gitmeyecekleri meselesi İslam düşünce tarihi boyunca Müslüman âlimler tarafından çeşitli bağlamlarda tartışılmış ve konu hakkında farklı görüşler ortaya çıkmıştır. Mesele üzerine özellikle Osmanlı döneminde müstakil risaleler kaleme alan birçok âlim bulunmaktadır. Bunlardan biri de gerek yazdığı eserlerle gerekse de görüşleriyle Osmanlı dinî düşüncesinde önemli izler bırakan İbrahim el-Halebî’dir (ö. 956/1549). Halebî’nin yazma eser kütüphanelerinde nüshaları bulunan ve Risâle fi hakkı ebeveyi’r-Resûl adıyla neşredilen bir ebeveyn-i Resûl risalesi bulunmaktadır. Ancak bu çalışmanın konu edindiği ve neşrini gerçekleştirdiği risale henüz tek nüshasını tespit edebildiğimiz ve metnin baş kısmında “el-Fakîr İbrahim el-Halebî der ki” ibaresiyle Halebî’ye ait olabileceğini düşündüğümüz aynı konuya (ebeveyn-i Resûl) dair bir başka eserdir. Osmanlı dinî düşüncesi açısından önemli bir şahsiyete nispet edilmesi ve henüz tek nüshasının tespit edilebilmiş olması bir yana risalede ebeveyn-i Resûl konusuna dair özgün yaklaşım ve görüşler ortaya konulması eserin neşrini ve muhteva analizini içeren bu makalenin yazılış gerekçesidir.İbrahim el-Halebî’ye nispet edilen bu risaleyi özgün kılan hususların başında, meseleyi fer’î/amelî değil, usulî/itikadî bir konu olarak gören müellifin, ulema tarafından ebeveyn-i Resûl konusunda serdedilen görüşleri, “fetret ehlinin durumu” zemininde verilen cevaplar bağlamında gruplandırması gelmektedir. Buna göre fetret ehlinin iman etmekle mükellef olup iman etmedikleri takdirde azap göreceğini söyleyenler, iman ile mükellef olmadığını söyleyenler ve bu konuda susanlar olmak üzere üç ana grup bulunmaktadır. Fetret ehlini iman ile mükellef görenler ise ebeveyn-i Resûl konusunda dört farklı görüşe sahip olmuşlardır. Böylece toplamda altı farklı görüş ortaya çıkmıştır.

1788. The Utility of Next-Generation Sequencing for Detection of Candidate Pathogens in Bronchoalveolar Lavage Fluid from Pediatric Patients with Respiratory Failure

BackgroundIn the field of infectious diseases, identification of etiologic pathogen is essential for definitive diagnosis and decisions regarding appropriate management. Bronchoalveolar lavage fluid (BALF) is considered a sterile type of specimen that is suitable for detecting pathogens of respiratory infections. Recently, next-generation sequencing (NGS) has been applied in the field of infectious diseases and has enabled us to identify pathogenic microorganisms comprehensively. The aim of this study was to comprehensively identify pathogens using NGS in BALF samples from immunocompetent pediatric patients with respiratory failure.MethodsTen patients hospitalized in the pediatric intensive care unit with respiratory failure were included. BALF samples obtained in the acute phase were used to prepare DNA- and RNA-sequencing libraries. The libraries were sequenced on MiSeq, and the sequence data were analyzed using metagenome analysis tools.ResultsA mean of 2,041,216 total reads were sequenced for each library. A significant number of four types of bacterial reads was detected in three BALF samples with DNA-sequencing, whereas pathogenic respiratory viruses were detected in seven of 10 patients with RNA-sequencing.Candidate pathogens were detected in three patients in whom etiologic agents were not identified by conventional methods. A summary of the detected pathogens is listed in Table 1. Sequence coverage and depth of each reference bacterial and viral genome are shown in Figures 1 and 2, respectively. The complete genome of enterovirus D68 was identified in two patients without underlying diseases, and phylogenetic analysis suggested that both strains belong to subclade B3, which is an epidemic strain that has spread worldwide in recent years.ConclusionWe demonstrated the utility of the NGS-based approach for detection of candidate pathogens in BALF from pediatric patients with severe respiratory failure. Our results suggest that NGS can be applied for comprehensive molecular diagnostics as well as surveillance of pathogens in the field of infectious diseases. Disclosures All authors: No reported disclosures.

Understanding the decision to screen for lung cancer or not: A qualitative analysis.

BackgroundAlthough new screening programmes with low‐dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening‐eligible persons' decisions to screen or not remain poorly understood.ObjectiveTo describe how current and former long‐term smokers explain their decisions regarding participation in lung cancer screening.DesignPhone interviews using a semi‐structured interview guide were conducted to ask screening‐eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques.Setting and participantsA subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements.ResultsThe sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening‐eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x‐ray. A physician recommendation was a key influence on decisions to screen.Discussion and conclusionsEducation initiatives aimed at providers and long‐term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates.

Penerapan Metode Multi Attribute Utility Theory (MAUT) Dalam Pemilihan Rumah Kost

The development of information technology is currently developing rapidly. The use of information technology is very broad in various fields of life. The choice of boarding house is one of the things that is not easy to do. The problem often faced when choosing a boarding house is that boarders find it difficult to get information about boarding houses. Decision support system is a method that helps in making decisions on a particular problem, where no one can make a definite decision. Multi Attribute Utility Theory (MAUT) is a method of decision making. MAUT is a method where looking for weighted sums of the same values in each utility in each attribute. By applying the MAUT method in the selection of boarding houses, it can give good suggestions or recommendations on boarding houses.

Exploring the experiences of individuals with an insertable cardiac monitor: Making the decision for device insertion

BackgroundLittle is known about the decision-making process for insertable cardiac monitors (ICM) in those with suspected arrhythmias. ObjectiveThe purpose of this qualitative study was to describe how individuals make a decision to insert an ICM. MethodsA qualitative descriptive design was used. Data were analyzed using content analysis and constant comparison. NVivo 10 was used for data grouping and patterns. ResultsParticipants (N = 12) ranged in age from 41to 95. Most (n = 7) had the device inserted because of syncope or atrial fibrillation (AF), and others (n = 5) for cryptogenic stroke. Three categories emerged: pre-decision, definitive decision, and deliberated decision. Event symptoms, including physical, cognitive and emotional, and trust emerged as factors in decision-making. ConclusionsThose who perceived their experience as life-threatening, trusted the healthcare provider and assented to the ICM insertion. Conversely, those who perceived symptoms as episodic, used other strategies to resolve symptoms prior to making the decision for insertion.

Tenurial conflict between parties in the technical implementation unit of the Banjar Regency Forest Management Unit in the Province of South Kalimantan

The main issues in the management of forest resources at present, include: legal uncertainty over forests, high tenure conflicts over forest areas and uncertainty over community management areas over forest areas. One of the root causes of legal uncertainty over forests is overlapping policies governing forest management. The purpose of this study was to find a solution in handling tenurial conflicts at UPT KPH Banjar Regency. In the implementation of tenure conflict research the methodology used was interviews. The results of this study found different perceptions about forest, where the community considers the forest when there is still physical forest, on the other hand forestry based on law 41 of 1999 is not so and there are different perceptions between BPN and Forestry relating to the status of the region. BPN together with the Regional Government are the parties that strengthen the position of the community with the certificate issued and the definitive village decision issued. The existence of FMUs is expected to be streamlined to build synergies between institutions in forest utilization and management as outlined in a work program, therefore integrated coordination of the Forestry Planning Agency, Director General of Forestry Production Development, Directorate General of Forest and Land Rehabilitation, BPHP, BPKH and BPDAS.

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture.

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

The pathology of epstein-barr virus lymphoproliferations.

The pathology of epstein-barr virus lymphoproliferations.

Therapy discontinuation processes in a gynecologic oncology population.

11611 Background: The decision to discontinue anti-cancer therapies in oncology patients is a complex one and may occur in several unique ways. We sought to understand the processes of therapy discontinuation in a gynecologic oncology population and to discern possible changes in the distribution of these processes after implementation of a palliative care (PC) quality improvement project. Methods: Women with incurable gynecologic malignancies seen in the outpatient setting at an academic center were identified with the recommendation for ‘goals of care’ discussion within 3 visits following identification. Processes of discontinuing chemotherapy for this population were assessed and categorized into 1 of 4 categories: definitive outpatient decision, definitive inpatient decision, interruption by hospitalization, treatment holiday, and “no decision.” Retrospective chart review identified a similar cohort of women prior to the implementation of our PC intervention. Univariate analyses were conducted to determine associations between characteristics and binary outcome of definitive outpatient decision versus all other decision processes. Results: 90/102 (88%) pre-intervention subjects and 83/157 (53%) post-intervention subjects had died at time of analysis. Of the total deceased cohort, 59/173 (34%) made a definitive decision to stop therapy in the outpatient setting. After implementation of the PC initiative, there was a trend towards fewer women identified as having made “no decision” (18.1% vs 30%). Those who made a definitive outpatient decision were less likely to die within 30 days of hospitalization than those who did not (OR 0.16 [95% CI 0.07,0.390], p < 0.0001). Conclusions: Discontinuation of therapy is a nuanced concept in gynecologic oncology patients that can be stratified into several processes. While our data demonstrates a possible increase in active decision-making with the PC initiative, a majority of patients near the end of life still did not make definitive therapy cessation decisions. This reveals an urgent need for the development of initiatives to enhance patient engagement and shared decision making for women near the end of life.

Abstract P5-02-02: Improving efficiency of breast MRI utilization by coordinating primary care, breast imaging and surgeons

Abstract Introduction: Breast MRI in the workup of a new breast cancer diagnosis is both a valuable and costly imaging study. The decision to obtain a breast MRI is often made by the surgeon who is referred the newly diagnosed breast cancer patient. That is followed by a delay in their management due to scheduling the MRI. Our breast center program leadership developed a protocol to move the time of MRI prior to the surgeon's evaluation while avoiding unnecessary breast MRIs ordered by some well-intentioned primary care providers. Coordinating a breast MRI protocol can optimize timely performance of breast MRI, guiding primary care to become the ordering clinician while avoiding unnecessary breast MRIs. Methods: Recognizing a delay in the journey of newly diagnosed breast cancer patients that have their breast MRI ordered only after the multidisciplinary conference or surgical consultation, we developed a protocol to improve timeliness of care. Guidelines were identified by our breast program leadership when a newly diagnosed breast cancer patient would warrant a breast MRI. Agreed upon indicators included dense breast tissue, invasive lobular breast cancer, patients typically under 50 years old, and vague imaging of primary lesions. When these findings were identified, the radiologist included a statement with the core needle biopsy report. It stated that our breast program leadership identified this patient as benefiting from a breast MRI ordered soon after the positive biopsy. This avoided the issue of self-referral since our breast leadership created the guidelines. The message went to the primary care provider who now ordered the breast MRI prior to conference or surgical consultation. We examined sixty consecutive patients from two time periods, half before and half after institution of the MRI protocol. Results: Prior to this policy, patients who needed breast MRI would obtain the study on average 12 days after our multidisciplinary breast conference (MDC), while after institution of the policy breast MRI was obtained 3 days PRIOR to conference. Before only 43% of necessary breast MRIs were ordered prior to surgical consultation while after the protocol 100% of breast MRIs were ordered PRIOR to surgical consultation. Before the protocol rarely did primary care order breast MRIs. After the protocol primary care providers ordered 80% of all breast MRIs. While ordering more breast MRIs, primary care ordered less unnecessary studies. After the protocol was instituted, inappropriate studies as determined by the MDC decreased from 21% deemed unnecessary to only 10%. Conclusions: Institution of a breast MRI ordering guideline by the breast program leadership with participation of primary care had the benefits of obtaining the breast MRI before the multidisciplinary conference and/or surgical consultation while avoiding unnecessary breast MRI orders. Institution of a breast MRI protocol enhances patient care, eliminates delays in treatment, avoids unnecessary tests, shifts appropriate care to primary care providers and allows initial surgical consultation to have all the data necessary to make definitive decisions. This quality improvement effort via program leadership improved comprehensive care. Citation Format: Kaufman CS, Behrndt VS, Hall W, Moses K, Wolgamot GM, Crabo L, Backer L, Carpenter K, Smits S. Improving efficiency of breast MRI utilization by coordinating primary care, breast imaging and surgeons [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-02-02.

Lactate and NEWS-L are fair predictors of mortality in critically ill geriatric emergency department patients

IntroductionIn this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. MethodsThis retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study. The predictive performances of lactate, NEWS, and NEWS-L in terms of in-hospital mortality were compared. ResultsA total of 455 patients were included in the statistical analyses. The in-hospital mortality rate was 22.9%. The mean lactate, NEWS, and NEWS-L of non-survivors was significantly higher than those of survivors (2.9 ± 2.2 vs. 1.9 ± 1.5 mmol/L, 8.9 ± 4.1 vs. 6.1 ± 3.7, and 11.8 ± 5.0 vs. 8.1 ± 4.4, respectively, for all p < 0.001). The AUCs of the lactate, NEWS, and NEWS-L were respectively 0.654 (95% CI 0.594–0.713), 0.686 (95% CI 0.628–0.744), and 0.714 (95% CI 0.658–0.770) in predicting in-hospital mortality. ConclusionsAccording to the results of this study, we conclude that ED admission lactate level and NEWS are low-accuracy predictors of in-hospital mortality in critically ill geriatric patients. Although the combination of lactate level with physiological parameters increases the predictive performances of both parameters, NEWS-L is still not a powerful predictor to make definitive clinical decisions for critically ill geriatric ED patients.

Sistem Pendukung Keputusan Dalam Menentukan Pengguna Listrik Subsidi Dan Nonsubsidi Menggunakan Metode Fuzzy Mamdani (Studi Kasus : PT. PLN Tanjung Balai)

Abstract - The electricity subsidy program is one of the poverty reduction programs by providing electricity subsidies to poor and disadvantaged households paid by the Government of Indonesia to PT. PLN (Persero). At PT. PLN (Persero) Area Rantau Prapat Rayon Tanjung Balai which is located on Jl. General Sudirman has a problem that is faced, namely regarding the subsidy budget, it turns out that there have been many wrong targets, most of the subsidy funds have fallen to economically capable people. The government applies the electricity subsidy policy on target, subsidies must be really enjoyed by poor people. To provide electricity subsidies to poor households and poor households, both humans and agencies cannot be separated from information technology systems. This system is usually called a decision support system that is designed to assist in making a decision where no one knows exactly how the decision should be made. The problem of decision-making systems using fuzzy logic systems is very suitable for definite reasoning or estimation, especially for systems with difficult mathematical models and inappropriate data to get a definite decision. Keywords - Decision Support System, Electricity Subsidies, Fuzzy Logic.

The impact of the 21-gene recurrence score (Oncotype DX) on concordance of adjuvant therapy decision making as measured by the Liverpool Systemic Therapy Adjuvant Decision Tool

PurposeThe 21-gene recurrence score (Oncotype DX) (RS) informs systemic therapy decision making in ER-positive HER2-negative early breast cancer (BC). To date no study has described the more nuanced discussions that take place regarding systemic therapy or the impact of the RS on concordance in such decision making. Here we utilized a novel decision making tool to assess the impact of the RS on decision making as well as concordance of treatment recommendations. Patients and methodsThe clinicopathological information (CPI) of 50 BCs without and with the RS were presented to a panel of breast oncologists in a simulated MDT. The Liverpool Adjuvant Systemic Therapy Decision Tool (LASTDT) was developed and used to categorize treatment recommendations. Outcome measures included the impact of the RS on decisiveness and concordance in decision making and its impact on treatment recommendations. ResultsAvailability of the RS increased definitive decision making from 8% (4/50) to 56% (28/50) [χ2 = 79.35, p < 0.001] and altered the LASTDT category in 68% (34/50) of cases (p < 0.001), 74% of which were to forgo chemotherapy. With knowledge of RS, universal concordance rose from 14% to 64% [K = 0.328: K = 0.729]. ConclusionsThe RS improves certainty of decision making as well as concordance amongst oncologists. This provides evidence that the availability of the RS can improve consistency of decision making amongst oncologists and thus helps to ensure patients are managed consistently. This is particularly important when patients are managed in a loco-regional, multidisciplinary team manner where heterogeneous decisions can lead to disparity in care.

A sensitive label-free immunosensor for alpha fetoprotein detection using platinum nanodendrites loaded on functional MoS2 hybridized polypyrrole nanotubes as signal amplifier

Sensitive detection of alpha fetoprotein (AFP) in serum is an important prerequisite to prompt definitive treatment decisions for reducing mortality rate of hepatocellular carcinoma. In this study, a label-free amperometric immunosensor was developed to detect AFP sensitively. It was based on platinum nanodendrites loaded on poly(diallyldimethylammonium chloride) functionalized molybdenum disulfide nanosheet hybridized polypyrrole nanotubes (Pt NDs/PDDA/MoS2@PPy NTs). The Pt NDs and MoS2 nanosheet improved the catalytic activity, PPy NTs and PDDA increased electron transfer and enhanced the stability. The Pt NDs/PDDA/MoS2@PPy NTs nanocomposite also had large active surface area and immobilized antibodies effectively. Therefore, the nanocomposite showed high catalytic activity, enhancing the electron transfer and immobilizing antibodies effectively, which amplified the current signal. Based on above advantages, the immunosensor had low detection limit of 17fgmL−1, wide linear concentration range from 50fgmL−1 to 50ngmL−1 for AFP (signal-to-noise ratio of 3), good reproducibility, selectivity and stability. The good analysis results of human serum samples implied that the immunosensor had bright potential application in clinical monitoring biomarkers.

A Trajetória de Adoção de Uma Criança por um Casal de Lésbicas

RESUMO Este estudo de caso objetivou conhecer o modo de acesso à parentalidade e analisar a trajetória de adoção na perspectiva de um casal de lésbicas. A entrevista semiestruturada e o questionário foram aplicados a um casal de mulheres, e os dados foram submetidos à análise temática. Os resultados mostram o percurso da adoção marcado por dois momentos: a luta do casal para afirmar a legitimidade do desejo e direito de se tornarem mães, e a surpresa com os rumos tomados pelo processo. A guarda foi concedida desde o início como definitiva, fato incomum nos casos de adoção, mas não em situações de crianças com deficiências. As cônjuges enfrentaram preconceito e discriminação da parte de alguns profissionais e o superaram graças à obstinação, somada ao fortalecimento do enlace afetivo estabelecido com a criança fragilizada.

Does plastic incise drape prevent recolonization of endogenous skin flora during lumbar spine procedures?

Background:The aim of this study was to compare the PID with bare skin (without PID) regarding bacterial recolonization and bacterial regrowth of the adjacent skin of surgical incision in lumbar spine surgery patients.Methods:This quasi-experimental study was conducted from February to May 2018 on 88 patients who were candidate for lumbar spine surgery. Patients were assigned to one of two groups, treatment (with PID) and control (without PID). Skin sampling (adjacent of surgical incision) for bacterial culture was done in two steps, immediately after surgical skin prep (IASSP) and immediately after surgical wound closure (IASWC) by researcher. Finally, samples were sent to the laboratory.Results:The mean total bacterial count of patient's skin in stage IASSP was not significantly different between treatment and control groups (0.34 vs 0.27, P = 0.68). However, mean total bacterial count in stage IASWC in treatment group was significantly higher than control group (2.2 vs 0.93, P = 0.03). The frequency distribution of S. aureus (P = 0.04) and S. epidermidis (P = 0.02) was significantly higher in treatment group compared with control group in stage IASWC.Conclusions:The results showed that using PID is unable to reduce recolonization and regrowth of bacteria on patients’ skin adjacent to surgical wound in clean lumbar spine surgeries. However, making a definite decision about using or not using of PID requires further studies.

The Effect of Implementing Professional and Intelligence Ethics Emotional on Decision Making for Auditors

The auditor in making a definite decision to use more than one rational considerations, based on the implementation of ethics policies are understood and made a fair decision. In addition, education and experience may also improve them competence in decision making. This research is used to analyze the effect of the research implementation of professional ethics and emotional intelligence to the auditor making decisions. This study stores a sample of the independent auditors who are in public accounting in Semarang and BPK-RI branches of Central Java. The types of data used are primary data by collecting data that is an indirect interview or questionnaire. The analysis tool used is multiple linear regression. The results of this study suggest that professional ethics are measured from indepence, integrity and objectivity; general standards and accounting principles; responsibility to clients 'significant influence auditors' decision making, while the responsibility to colleagues and other responsibilities and practices have no significant effect auditors in the decision-making. Emotional intelligence as measure from the self regulation, motivation and social skills have a significant effect on the auditor's in decision making, while the self-awareness and empathy no significant effect on the auditor decision making.

Distract yourself: prediction of salient distractors by own actions and external cues

Distracting sensory events can capture attention, interfering with the performance of the task at hand. We asked: is our attention captured by such events if we cause them ourselves? To examine this, we employed a visual search task with an additional salient singleton distractor, where the distractor was predictable either by the participant’s own (motor) action or by an endogenous cue; accordingly, the task was designed to isolate the influence of motor and non-motor predictive processes. We found both types of prediction, cue- and action-based, to attenuate the interference of the distractor—which is at odds with the “attentional white bear” hypothesis, which states that prediction of distracting stimuli mandatorily directs attention towards them. Further, there was no difference between the two types of prediction. We suggest this pattern of results may be better explained by theories postulating general predictive mechanisms, such as the framework of predictive processing, as compared to accounts proposing a special role of action–effect prediction, such as theories based on optimal motor control. However, rather than permitting a definitive decision between competing theories, our study highlights a number of open questions, to be answered by these theories, with regard to how exogenous attention is influenced by predictions deriving from the environment versus our own actions.

Undescended Testes and Laparoscopy: Experience from the Developing World

Background Cryptorchidism or undescended testes is the most common disorder of the male endocrine glands in children. With the advancements in laparoscopic techniques and instruments, laparoscopic orchidopexy has become the standard procedure in the management of nonpalpable undescended testes. Aim To evaluate and determine the therapeutic role, sensitivity, and specificity of laparoscopy in localizing nonpalpable testes and the mean operative time, the conversion rate (and reasons thereof), postoperative wound infection, postoperative stay, and time taken for return to daily activities following laparoscopic orchidopexy or orchidectomy. Materials and Methods This was a prospective study carried out in the Postgraduate Department of Surgery, Government Medical College, Srinagar, J&K, India, from May 2008 to August 2011. All patients who presented to the outpatient department with complaints of absent testes were examined, and the ones with nonpalpable testes were included in the study. Results The mean operative time for bilateral and unilateral nonpalpable testis was 102.76 and 53.67 minutes, respectively. Minor postoperative wound infections were noted in 4 of our patients. Mean duration of hospital stay was 14.23 hrs for unilateral cases and 16.27 hrs for bilateral cases. Patients who underwent laparoscopic orchidopexy resumed their normal activities within 4 ± 1 days. Conclusion Laparoscopy clearly demonstrates the anatomy and provides visual information upon which a definitive decision can be made for further management of the undescended nonpalpable testis.

Sequential, Multiple-Assignment, Randomized Trials for COMparing Personalized Antibiotic StrategieS (SMART-COMPASS).

Patient management is not based on a single decision. Rather, it is dynamic: based on a sequence of decisions, with therapeutic adjustments made over time. Adjustments are personalized: tailored to individual patients as new information becomes available. However, strategies allowing for such adjustments are infrequently studied. Traditional antibiotic trials are often nonpragmatic, comparing drugs for definitive therapy when drug susceptibilities are known. COMparing Personalized Antibiotic StrategieS (COMPASS) is a trial design that compares strategies consistent with clinical practice. Strategies are decision rules that guide empiric and definitive therapy decisions. Sequential, multiple-assignment, randomized (SMART) COMPASS allows evaluation when there are multiple, definitive therapy options. SMART COMPASS is pragmatic, mirroring clinical, antibiotic-treatment decision-making and addressing the most relevant issue for treating patients: identification of the patient-management strategy that optimizes the ultimate patient outcomes. SMART COMPASS is valuable in the setting of antibiotic resistance, when therapeutic adjustments may be necessary due to resistance.