Final Classification System Research Articles

Complications and adverse events in lymphadenectomy of the inguinal area: worldwide expert consensus.

Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group. A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer. The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer.

International Classification System for Ocular Complications of Anti-VEGF Agents in Clinical Trials

Complications associated with intravitreal anti-VEGF therapies are reported inconsistently in the literature, thus limiting an accurate evaluation and comparison of safety between studies. This study aimed to develop a standardized classification system for anti-VEGF ocular complications using the Delphi consensus process. Systematic review and Delphi consensus process. Twenty-five international retinal specialists participated in the Delphi consensus survey. A systematic literature search was conducted to identify complications of intravitreal anti-VEGF agent administration based on randomized controlled trials (RCTs) of anti-VEGF therapy. A comprehensive list of complications was derived from these studies, and this list was subjected to iterative Delphi consensus surveys involving international retinal specialists who voted on inclusion, exclusion, rephrasing, and addition of complications. Furthermore, surveys determined specifiers for the selected complications. This iterative process helped to refine the final classification system. The proportion of retinal specialists who choose to include or exclude complications associated with anti-VEGF administration. After screening 18 229 articles, 130 complications were categorized from 145 included RCTs. Participant consensus via the Delphi method resulted in the inclusion of 91 complications (70%) after 3 rounds. After incorporating further modifications made based on participant suggestions, such as rewording certain phrases and combining similar terms, 24 redundant complications were removed, leaving a total of 67 complications (52%) in the final list. A total of 14 complications (11%) met exclusion thresholds and were eliminated by participants across both rounds. All other remaining complications not meeting inclusion or exclusion thresholds also were excluded from the final classification system after the Delphi process terminated. In addition, 47 of 75 proposed complication specifiers (63%) were included based on participant agreement. Using the Delphi consensus process, a comprehensive, standardized classification system consisting of 67 ocular complications and 47 unique specifiers was established for intravitreal anti-VEGF agents in clinical trials. The adoption of this system in future trials could improve consistency and quality of adverse event reporting, potentially facilitating more accurate risk-benefit analyses. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Classification system for primary care provider eConsults about medications for older adults with frailty

BackgroundProviding primary care for people with frailty can be challenging due to an increased risk of adverse outcomes and use of potentially inappropriate medications which may exacerbate characteristics of frailty. eConsult is a service where primary care providers can receive timely specialist advice for their patients through a secure web-based application. We aimed to develop a classification system to characterize medication-focused eConsult questions for older adults with frailty and assess its usability.MethodsA classification system was developed and refined over three cycles of improvement through a cross-sectional study of 35 cases categorized as medication-focused from cases submitted in 2019 for patients aged 65 or older with frailty through the Champlain BASE eConsult service (Ontario, Canada). The final classification system was then applied to each case.ResultsThe classification system contains 5 sections: (1) case descriptives; (2) intent and type of question; (3) medication recommendations and additional information in the response; (4) medication classification; and (5) potentially inappropriate medications. Among the 35 medication-focused cases, the most common specialties consulted were endocrinology (9 cases, 26%) and cardiology (5 cases, 14%). Medication histories were available for 29 cases (83%). Many patients were prescribed potentially inappropriate medications based on explicit tools (AGS Beers Criteria®, STOPPFall, Anticholinergic Cognitive Burden Scale, ThinkCascades) yet few consults inquired about these medications.ConclusionA classification system to describe medication-related eConsult cases for patients experiencing frailty was developed and applied to 35 eConsult cases. It can be applied to more cases to identify professional development opportunities and enhancements for eConsult services.

MP42-02 PROPOSAL AND VALIDATION OF A URETERAL STRICTURE CLASSIFICATION SYSTEM

You have accessJournal of UrologyCME1 Apr 2023MP42-02 PROPOSAL AND VALIDATION OF A URETERAL STRICTURE CLASSIFICATION SYSTEM Eric Cho, Lee Zhao, Michael Witthaus, Ameen Chaudry, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Sean Elliott, Bradley Erickson, Shawn Grove, Jeremy Myers, Andrew Peterson, Keith Rourke, Thomas Smith, Alex Vanni, Bryan Voelzke, and Jill Buckley Eric ChoEric Cho More articles by this author , Lee ZhaoLee Zhao More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Ameen ChaudryAmeen Chaudry More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Sean ElliottSean Elliott More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Shawn GroveShawn Grove More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Alex VanniAlex Vanni More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , and Jill BuckleyJill Buckley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The surgical management of ureteral stricture disease is contingent upon multiple factors such as stricture length, location, and etiology. Ureteral strictures are conventionally characterized descriptively. Unlike urethral stricture disease, there is currently no widely adopted classification system. Herein, we aim to propose a ureteral stricture classification system for the purpose of creating a standard nomenclature with the goal of validating classification with reconstructive surgical techniques. METHODS: Consensus was obtained from 14 reconstructive urologists. All reviewers had completed a Society of Genitourinary Reconstructive Surgeons (GURS) fellowship and were in clinical practice. Consensus was formulated regarding three primary elements: length of ureteral stricture (L); stricture segment (S); and modifiers (M). These constituted the cLSM classification system (Table 1). Each reviewer was presented with an image(s) of fluoroscopic studies for 24 various ureteral strictures with no additional clinical history and were tasked with assigning a cLSM grade for each individual clinical vignette. These results were tabulated and interrater reliability was determined by a Fleiss Kappa analysis. Etiology of stricture was included in the final version of the cLSM classification system but was not designed to be included in this analysis (Table 1). RESULTS: Of the 24 ureteral strictures, 11 (45.8%) were proximal, 10 (41.7%) were distal, 2 (8.3%) were mid-ureter and 1 (4.2%) was of overlapping sites. Distal ureteral injuries were assessed with only an antegrade pyelogram hindering a precise length measurement. There was substantial agreement across experts demonstrated by an overall Fleiss Kappa score of 0.677 (0.667 – 0.686) for the 24 clinical vignettes for ureteral length, segment and modifiers. CONCLUSIONS: The cLSM ureteral classification system shows a strong interrater reliability by experienced reconstructive urologists. Consistent nomenclature and application of the classification system will standardize discussion of types of ureteral injuries as well as allow for assessment of outcomes. The final ureteral classification system will include etiology (cLSE) to further characterize ureteral injuries and compare reconstructive operative techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e566 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Cho More articles by this author Lee Zhao More articles by this author Michael Witthaus More articles by this author Ameen Chaudry More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Sean Elliott More articles by this author Bradley Erickson More articles by this author Shawn Grove More articles by this author Jeremy Myers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Bryan Voelzke More articles by this author Jill Buckley More articles by this author Expand All Advertisement PDF downloadLoading ...

Modification of an extended total temporomandibular joint replacement (eTMJR) classification system

The aims of this paper were to validate a modification of an extended total temporomandibular joint replacement (eTMJR) classification system and develop a classification schematic for ease of reference. High-volume TMJ surgeons were asked to score 20 separate eTMJR devices using the updated classification system, and inter-rater variability was calculated. Using the modified classification system developed, a Conger’s kappa (κ) coefficient of 0.53 was returned, suggesting moderate to good levels of agreement. The final classification system was then developed in a series of standardised graphic illustrations as visual representations of the different subcategories of eTMJR devices.

데이터 표준화를 위한 패션 감성 분류 체계

Accumulation of high-quality data is crucial for AI learning. The goal of using AI in fashion service is to propose of a creative, personalized solution that is close to the know-how of a human operator. These customized solutions require an understanding of fashion products and emotions. Therefore, it is necessary to accumulate data on the attributes of fashion products and fashion emotion. The first step for accumulating fashion data is to standardize the attribute with coherent system. The purpose of this study is to propose a fashion emotional classification system. For this, images of fashion products were collected, and metadata was obtained by allowing consumers to describe their emotions about fashion images freely. An emotional classification system with a hierarchical structure, was then constructed by performing frequency and CONCOR analyses on metadata. A final classification system was proposed by supplementing attribute values with reference to findings from previous studies and SNS data.

Development of a preference-based heart disease-specific health state classification system using MacNew heart disease-related quality of life instrument.

The MacNew Heart Disease Health-Related Quality of Life Instrument (MacNew) is a validated, clinically sensitive, 27-item disease-specific questionnaire. This study aimed to develop a new heart disease-specific classification system for the MacNew amenable for use in health state valuation. Patients with heart disease attending outpatient clinics and inpatient wards in Brisbane, Australia, completed MacNew. The development of the new disease-specific classification system included three stages. First, a principal component analysis (PCA) established dimensionality. Second, Rasch analysis was used to select items for each dimension. Third, Rasch analysis was used to explore response-level reduction. In addition, clinician and patient judgement informed item selection. Participants included 685 patients (acute coronary 6%, stable coronary 41%, chronic heart failure 20%). The PCA identified 4 dimensions (restriction, emotion, perception of others, and symptoms). The restriction dimension was divided into physical and social dimensions. One item was selected from each to be included in the classification system. Three items from the emotional dimension and two symptom items were also selected. The final classification system had seven dimensions with four severity levels in each: physical restriction; excluded from doing things with other people; worn out or low in energy; frustrated, impatient or angry; unsure and lacking in self-confidence; shortness of breath; and chest pain. This study generated a brief heart disease-specific classification system, consisting of seven dimensions with four severity levels in each. The classification system is amenable to valuation to enable the generation of utility value sets to be developed for use in economic evaluation.

Classification of psychotherapy interventions for people with schizophrenia: development of the Nottingham Classification of Psychotherapies

BackgroundCurrently, there is no accepted system for the classification of psychotherapies for application within systematic reviews. The creation of anuncomplicated, understandable and practical classification system is neccessary for conducting reliable...

Developing an early childhood oral health impact-specific health-state classification system for a new preference-based instrument, the ECOHIS-4D.

Most of the paediatric quality-of-life instruments in oral health research are not preference-based measures, thus cannot be used in economic evaluations. The Early Childhood Oral Health Impact Scale (ECOHIS) is one such instrument which assesses oral health impact on children's quality of life among three- to five-year-olds. With increasing demands for more resource allocation in oral health care, there is a need for an outcome metric which can be used as the outcome in economic evaluations. The aim of this study was to develop a preference-based, health-state classification system from the existing ECOHIS instrument. The 13-item ECOHIS instrument was applied to the carers of 280 preschoolers who participated in a clinical trial in metropolitan Perth, Western Australia. Exploratory factor analysis was conducted to assess the dimensionality of the ECOHIS. Rasch analysis was used to eliminate and select items per determined dimensions and to reduce the number of response options for each item, because six levels were not amenable to valuation. The final classification system was determined through a combination of psychometric and expert advice. Items loaded on to four dimensions with the factor analysis. Using Rasch analysis, three items were selected from the first dimension (child functional and psychological impact) and one item from the second dimension (child social interaction impact). None were selected from the third dimension (parental distress and family function impact) as it is not an appropriate proxy method of measuring the level of impact on a child. The final classification system has four dimensions with three levels in each, and so it has been named the ECOHIS-4D. The ECOHIS-4D classification system is a new preference-based instrument derived from the existing ECOHIS instrument. Future valuation studies will develop a utility value set for the health states defined by this classification system, and this will guide economic evaluations related to oral health interventions.

Development and Validation of A Male Anterior Urethral Stricture Classification System

To develop and validate a clinical classification system for urethral stricture disease (USD) based on the retrograde urethrogram (RUG), physical exam, and stricture-specific patient history. Three elements were chosen to be included in the classification system: 1) Length of urethral stricture (L); 2) Stricture segment/location (S); 3) Stricture Etiology (E) (LSE classification system). Each element was divided into clinically relevant sub-categories. A three-step development and validation process then ensued, culminating in an in-person Trauma and Urologic Reconstruction Network of Surgeons (TURNS) meeting, at which the final classification system was unanimously agreed upon by attendees based on interrater reliability data obtained from the classifying of 22 clinical vignettes. A final validation step involved retrospectively classifying cases in the TURNS database to determine if classification influenced surgical technique and was associated with presumed stricture etiology. The final LSE classification system was found to have an interrater reliability of 0.79 (individual components 0.76, 0.70 and 0.93 respectfully). Retrospective classification of the 2162 TURNS strictures revealed the segment (S) to be strongly associated with urethroplasty type (p = 0.0005) and stricture etiology (E) (p = 0.0005). We developed and validated a novel, easy to use, urethral stricture classification system. The system's ability to aid in directing treatments, predict treatment outcomes, and facilitate collaborative research efforts will require further study.

A Blended Artificial Intelligence Approach for Spectral Classification of Stars in Massive Astronomical Surveys.

This paper analyzes and compares the sensitivity and suitability of several artificial intelligence techniques applied to the Morgan–Keenan (MK) system for the classification of stars. The MK system is based on a sequence of spectral prototypes that allows classifying stars according to their effective temperature and luminosity through the study of their optical stellar spectra. Here, we include the method description and the results achieved by the different intelligent models developed thus far in our ongoing stellar classification project: fuzzy knowledge-based systems, backpropagation, radial basis function (RBF) and Kohonen artificial neural networks. Since one of today’s major challenges in this area of astrophysics is the exploitation of large terrestrial and space databases, we propose a final hybrid system that integrates the best intelligent techniques, automatically collects the most important spectral features, and determines the spectral type and luminosity level of the stars according to the MK standard system. This hybrid approach truly emulates the behavior of human experts in this area, resulting in higher success rates than any of the individual implemented techniques. In the final classification system, the most suitable methods are selected for each individual spectrum, which implies a remarkable contribution to the automatic classification process.

Abstract P6-15-03: Inflammatory breast cancer (IBC) defined: Proposed common diagnostic criteria and scoring - Moving beyond the subjective ‘clinical diagnosis’ of IBC to advance research

Abstract Spurred by the lack of progress in improving outcomes in patients with inflammatory breast cancer (IBC), a deadly and aggressive type of breast cancer, Susan G. Komen, the Inflammatory Breast Cancer Research Foundation, and the Milburn Foundation convened patient advocates, breast cancer researchers, and clinicians to review the state of IBC care and research globally, and propose specific initiatives to move the field forward. The outcome of the discussions was abundantly clear: the field needs a formal definition of IBC. Without a clear definition, both patient care and research suffer. Diagnosis remains subjective and treatment variable. Clinical trials become inherently underpowered by inclusion of subjects with locally advanced, but not inflammatory, breast cancer. Similarly, the search for a molecular sine qua non or unifying pathway aberration is hindered by inclusion of bio-specimens from subjects with a different disease. The goal is to move beyond the subjective ‘clinical diagnosis’ to a set of specific diagnostic criteria and scoring system that will advance IBC research and facilitate the discoveries that will improve care of IBC patients. Here we propose a definition of IBC, based on a review of clinical, and pathologic features. Table 1. Proposed Scoring System for inflammatory breast cancer diagnosisPriority FactorCharacteristicScore3213Timing of signs/symptoms≤ 3 months3-6 months> 6 months3Skin changesPeau d’orangeSkin edema/thickening (≥ 1/3 of the breast)Focal skin edema/thickening (< 1/3 of the breast)3Swelling/engorgement of the breastClinically apparent enlargement of the breast or new asymmetry in breast sizeBreast edema identified on imaging but not clinically detectable2Erythema or other skin discoloration: pink, red, darkened, bruising/purplish or serpiginous in characterNearly complete involvement of the breastPartial involvement of the breastMinimal involvement or ambiguous color change2Nipple abnormalitiesNew nipple inversionNew nipple flattening or other asymmetryCrusting of the nipple/areola without other nipple changes2Lymphatic emboliDermal lymphatic emboli present without evidence of direct involvement of the dermis or epidermisNon-dermal lymphatic embolic present in breast parenchyma or stroma1Breast imagingDiffuse involvement of breast parenchyma, with or without dominant massEnlargement of non-axillary nodes (internal mammary, supraclavicular, subpectoral etc.) With increased awareness of IBC, patients are coming to medical attention earlier when clinical characteristics may not be as profound as historically depicted. Not all criterion are required for a diagnosis. To determine the total score, multiply the priority factor by the score for each criteria, then add the subtotals for each criteria. A priority factor is used to weigh criterion more heavily that are key to a consistent diagnosis of IBC to better define breast cancers that are ambiguous. While we cannot currently recommend a molecular-genetic profile that unambiguously identifies IBC, we will also provide a panel of prioritized biomarkers that are strongly associated with IBC and deserve further study in cohorts meeting our diagnostic criteria. We acknowledge that our proposed scoring system requires validation and refinement. If accurate, we expect patients with IBC based on these criteria to have a different clinical course and outcome compared to patients with “non-inflammatory” locally advanced breast cancer (LABC). Ultimately, we envision using the final disease classification and scoring system to develop a staging system specific to IBC. The discovery and validation of a distinct molecular or genetic profile that identifies IBC is of utmost importance to advancing research in this disease and cannot be accomplished without a clear and validated definition of IBC. Citation Format: Ginny Mason, Beth A Overmoyer, Wendy A. Woodward, Sunil Badve, Robert J. Schneider, Reshma Jagsi, Julie E. Lang, Mary Alpaugh, Krissa Smith, Kathy Miller. Inflammatory breast cancer (IBC) defined: Proposed common diagnostic criteria and scoring - Moving beyond the subjective ‘clinical diagnosis’ of IBC to advance research [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-15-03.

Who Benefits from National Estuaries? Applying the FEGS Classification System to Identify Ecosystem Services and their Beneficiaries.

In spite of their perceived value, the widespread implementation of ecosystem services assessments has been limited because of perceptions of being too technical, too expensive, or requiring special expertise. For example, federal estuary management programs have widely used ecosystem services concepts to frame management issues and communicate with stakeholders. Yet, indicators assessed, monitored, and reported in estuarine management still have traditionally focused on ecological conditions, with weak connections, if any, to social or economic outcomes. Approaches are needed which expand the range of ecosystem services that can be considered, link ecosystem services explicitly to different stakeholder groups, facilitate effective communication with economists and other social scientists, and expand the array of available valuation techniques. We applied the concept of final ecosystem goods and services to review the broad suite of ecosystem services and their beneficiaries relevant to the management of two federal programs for estuary management, the National Estuary Program (NEP) and the National Estuarine Research Reserve System (NERRS). The Final Ecosystem Goods and Services Classification System provided a structured framework for connecting ecosystem services to their beneficiaries and the environments providing them. Document analysis of management plans assessed the degree to which these programs consider ecosystem services, their beneficiaries, and habitats within the estuarine watershed. The hierarchical list of final ecosystem goods and services generated from document analysis serves as a tool for defining management goals, identifying stakeholders, developing meaningful indicators, and conducting valuation studies in estuarine management planning efforts. Though developed here for estuarine management, the keyword hierarchy and final ecosystem goods and services approach have broad applicability and transferability to other environmental management scenarios.

Mammographic Image Classification System via Active Learning

Training an accurate prediction model for mammographic image classification is usually necessary to require a large number of labeled images. However, the manually acquiring rich and reliable annotations is known to be tedious and time-consuming process, especially for medical image. The advances in machine learning yielded a branch of technique, termed active learning (AL), which has been proposed for solving the problem of the limited training samples and expensive labeling cost, and has resulted in highly successful applications in many pattern recognition tasks such as image processing and speech recognition. In this article, a comparison is provided among the mammographic image classification systems, relying on traditional supervised learning, un-supervised learning and AL, aiming to obtain a system with low labeling cost. The experiments based on digital database for screening mammography demonstrate that the AL is able to minimize the labeling cost of mammographic image without sacrificing the accuracy of final classification system. In addition, some specific characteristics of mammographic image: file information and spatial feature, which are not available to the traditional AL methods, have been found to further decrease the labeling cost. In conclusion, we suggest that the AL is a reasonable alternative to supervised learning for the researchers in the field of medical image classification with limited experimental conditions.

Rationality of N3 classification and its sub-classification in TNM classification system for advanced gastric cancer

To investigate the rationality of N3 classification and its sub-classification in the 7th UICC/AJCC TNM classification system. Clinicopathological data of 610 patients with stage N3 advanced gastric cancer who underwent standard D2 and D2+ radical surgery at the Department of Surgical Oncology, The First Hospital of China Medical University, from January 1980 to March 2010 were analyzed retrospectively. Patients were divided into N3a and N3b groups, and clinicopathological characteristics and prognosis were compared between N3a and N3b patients. Overall survival rate was determined using the Kaplan-Meier estimator. The log-rank test was used to identify differences between the survival curves of different groups. In multivariate analysis, Cox proportional hazard model was used to identify independent factors associated with prognosis. Among 610 patients, 426 were men and 184 were women, 394 were N3a and 216 were N3b, with a mean age of(57±11) years old (range 23 to 83). A total of 19 842 lymph nodes were examined, in which 9 575 nodes were positive, with the metastatic ratio of 48.3%. The 5-year overall survival rate was 20.0%. Univariate analysis of prognostic factors suggested that tumor location (P=0.000), tumor size (P=0.003), Borrmann type (P=0.000), pathologic type (P=0.043), lymphatic vessel invasion (P=0.000), growth pattern (P=0.019), invasion depth (P=0.000), resection extent (P=0.000) and N3 sub-classification (P=0.000) were significantly associated with the prognosis of N3 patients. Further analysis showed that tumor size (P=0.028), invasion depth (P=0.000) and gastric resection extent (P=0.002) were significantly associated with the prognosis of N3a patients, while Borrmann type (P=0.034), lymphatic vessel invasion (P=0.002), invasion depth (P=0.008) and resection extent (P=0.003) were significantly associated with the prognosis of N3b patients. Multivariate analysis revealed that lymphatic vessel invasion (P=0.009), resection extent (P=0.001), invasion depth (P=0.000) and N3 sub-classification (P=0.000) were independent prognostic factors of N3 patients; resection extent (P=0.004) and invasion depth (P=0.001) were independent prognostic factors of N3a patients; lymphatic vessel invasion (P=0.006) and invasion depth (P=0.009) were independent prognostic factors of N3b patients. Comparison of 5-year survival rate revealed that there was significant difference between T2-4N3a and T2-4N3b patients (P=0.000), while there was no significant difference between T2N3a and T2N3b patients (P=0.140). On the contrary, there were significant differences between T3N3a and T3N3b patients, T4aN3a and T4aN3b patients, T4bN3a and T4bN3b patients, respectively (all P<0.05). Further comparison demonstrated that there were significant differences between T4aN3a and T4bN3a patients, T4aN3b and T4bN3b patients, respectively (P=0.000, P=0.041). Besides, there were no significant differences in 5-year survival rate between T2N3 (at present, staged as III(A), T3N3a (III(B) and T4aN3a (III(C) patients(P=0.506), and T3N3b (III(B), T4aN3b (III(C) and T4bN3a (III(C) patients(P=0.283), respectively. N3 sub-classification should be included in the final TNM classification system. It is suggested that T2N3, T3N3a and T4aN3a may be categorized into III(A stage, T3N3b, T4aN3b and T4bN3a may be categorized into III(B stage,T4bN3b may be categorized into III(C stage or IIII( stage.

Automated detection of unusual events on stairs

This paper presents a method for automatically detecting unusual human events on stairs from video data. The motivation is to provide a tool for biomedical researchers to rapidly find the events of interest within large quantities of video data. Our system identifies potential sequences containing anomalies, and reduces the amount of data that needs to be searched by a human. We compute two sets of features from a video of a person descending a stairwell. The first set of features are the foot positions and velocities. We track both feet using a mixed state particle filter with an appearance model based on histograms of oriented gradients. We compute expected (most likely) foot positions given the state of the filter at each frame. The second set of features are the parameters of the mean optical flow over a foreground region. Our final classification system inputs these two sets of features into a hidden Markov model (HMM) to analyse the spatio-temporal progression of the stair descent. A single HMM is trained on sequences of normal stair use, and a threshold on sequence likelihoods is used to detect unusual events in new data. We demonstrate our system on a data set with five people descending a set of stairs in a laboratory environment. We show how our system can successfully detect nearly all anomalous events, with a low false positive rate. We discuss limitations and suggest improvements to the system.

How to provide insomnia interventions to people with cancer: insights from patients

Chronic insomnia affects approximately one quarter of cancer patients. Non-pharmacologic interventions are the treatment of choice for chronic insomnia, yet they are rarely offered to people with cancer. The study question was how to make these interventions available to cancer patients. Twenty-six cancer patients who had sleep difficulty participated in focus groups or one-to-one interviews. The key questions included: What would be the best way for you to find out about a service for insomnia treatment? What would make it easy/difficult for you to participate? Transcripts were examined independently by three readers who identified participants' answers to the questions, as well as themes that emerged from participants' reflections on their experience with cancer and sleep difficulty. The readers then worked together to reach consensus on a final classification system for describing the content of patients' responses. Participants provided many practical answers to our specific questions. In addition, the following themes emerged: sleep difficulty needs greater recognition by health professionals; patients wish to receive more information about sleep and sleep difficulty; and that although patients perceive sleep as being important, they are reluctant to report sleep problems to doctors. Furthermore, participants recommended that the assessment and treatment of sleep difficulty be integrated into the health care system while considering the cancer-treatment status and energy level of patients.

Crop and land cover classification in Iran using Landsat 7 imagery

Remote sensing provides one way of obtaining more accurate information on total cropped area and crop types in irrigated areas. The technique is particularly well suited to arid and semi‐arid areas where almost all vegetative growth is associated with irrigation. In order to obtain more information with regard to crop patterns in the irrigated areas in the Zayandeh Rud basin, a classification analysis was made of the Landsat 7 image of 2 July 2000. The target of the classification was to primarily focus on the agricultural land use. The date of the image fell in the transition period where the first crops were harvested and many fields were being prepared for the second crop. The image has therefore captured an instantaneous picture of a system generally in transition from the first to the second crop, but with significant differences from system to system, both with respect to crop types and agricultural cycles. The overall accuracy of image registration was about 30 m (one pixel). Fieldwork was conducted on various occasions in August–October 2000 and May–October 2001. Farmers were interviewed to determine the situation on 2 July 2000. Fields were mapped in detail with the GPS instruments, and data compiled for 112 fields. Using a supervised classification system, training areas were selected and initial classifications were made to determine the validity of the classes. After merging several classes and testing several new classes a final classification system was made. All seven Landsat bands were used in the determination of the feature statistics. The final classification was made with the minimum distance algorithm. The statistics with respect to areas and crop type for the districts was obtained by crossing the raster map with the irrigation district raster map. The results with respect to crop type and total irrigated area per district were compared with those of previous studies. This included both NOAA/AVHRR and conventional agricultural district statistics.

The identification of homogeneous groups of cattle farms in the mountains of León, Spain

The aim of this work was to establish homogenous groups of cattle farms in the mountains of León, Spain, using the variables selected in a sister paper (this issue). Principal components analysis (PCA) was used to characterise and compare the different farms studied. Two classifications were established, the first taking into account the first seven axes selected by PCA, and the second by taking into account only the first two. A comparison of these systems led to the latter being selected. The final classification system involves eight groups based mainly on the orientation of production, size, productivity per breeding cow, and productivity per work unit.

A severity classification system for AIDS hospitalizations.

The authors describe a new model for classifying hospitalized patients with acquired immunodeficiency syndrome (AIDS) according to their severity of illness. In the first phase of the project, a clinical model indicating the relative severity of AIDS complications was formulated, based on the clinical literature and expert opinion. In the second phase, the model was tested empirically using data on in-patient mortality of over 6,000 adult AIDS hospitalizations in New York State during 1985. The ordering of AIDS-related complications in the clinical model was revised to reflect a continuum of increasing likelihood of death in the hospital. The final classification system for AIDS hospitalizations has 20 substages, grouped into three stages, with in-patient mortality rates increasing from 6% to 60%. The system is automated and can be applied to different AIDS populations to analyze resource use and outcomes of hospital care.