Maintenance Courses Research Articles

A PRISMA Review on Methods and Challenges in Learning Computer Maintenance Using Augmented Reality Technology

Augmented reality technology which is currently used in mobile phones is convenient for students and educational institutions because it provides flexibility and real-time learning environments. The use of AR applications in higher education learning has rapidly progressed. In view of this, this study investigates the design aspects of augmented reality in computer maintenance learning. In designing augmented reality-driven mobile applications, there are several gaps discovered in the interface components and relevant design principles. This study addresses the methods and challenges regarding the design of augmented reality mobile applications. A preliminary search and selection process using Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) has been conducted and identified 782 articles with 57 full texts assessed for the reviewing eligibility. The results may help to develop the visual aspects of augmented reality systems in prototypes more effectively for computer maintenance courses in future.

Development of Short Tutorial Video Learning Media Instagram in the Motorcycle Chassis Maintenance Courses at Vocational High Schools

This study uses a Research and Development (R&D) design, with the ASSURE development model. ASSURE development procedures, namely Analyze learner characteristics, State Standards and Objectives, Select Strategies, Technology, Media, and Materials, utilize media and materials, require learner participation, evaluate and revise. The data analysis technique used describes the validity, practicality, and effectiveness of the developed media. The product results obtained from this development research are video tutorial learning media. Based on the results of this study it was concluded that the developed media was declared "valid" by media experts with an average value of 0.77, and also declared "valid" by material experts with an average value of 0.85. The media developed was declared "practical" with a practicality value from the teacher's response with a result of 96.41% and a student response of 88.10%, and the video tutorials produced were effectively used with the results of a comparison of pretest and posttest learning outcomes seen from students' classical completeness of 100% and a gain score of 0.61 in the medium category. From the results of the research conducted, it can be concluded that short video tutorial learning media via Instagram are valid, practical and effective in the subject of maintaining motorcycle chassis in vocational high schools.

A Phase 1b/2 Study of Atezolizumab with or Without Bacille Calmette-Guérin in Patients with High-risk Non–muscle-invasive Bladder Cancer

BackgroundBacille Calmette-Guérin (BCG) is the standard therapy after transurethral resection of bladder tumour for high-risk non–muscle-invasive bladder cancer (NMIBC). However, post-BCG recurrence/progression occurs frequently, and noncystectomy options are limited. ObjectiveTo evaluate the safety and clinical activity of atezolizumab ± BCG in high-risk BCG-unresponsive NMIBC. Design, setting, and participantsThis phase 1b/2 GU-123 study (NCT02792192) treated patients with BCG-unresponsive NMIBC who had carcinoma in situ with atezolizumab ± BCG. InterventionPatients in cohorts 1A and 1B received atezolizumab 1200 mg IV q3w for ≤96 wk. Those in cohort 1B also received standard BCG induction (six weekly doses) and maintenance courses (three doses weekly starting at month 3) with optional maintenance at 6, 12, 18, 24, and 30 mo. Outcome measurements and statistical analysisCoprimary endpoints were safety and 6-mo complete response (CR) rate. Secondary endpoints included 3-mo CR rate and duration of CR; 95% confidence intervals were calculated using the Clopper-Pearson method. Results and limitationsAt data cut-off (September 29, 2020), 24 patients were enrolled (cohort 1A, n = 12; cohort 1B, n = 12), and the recommended BCG dose was 50 mg in cohort 1B. Four patients (33%) had adverse events (AEs) leading to BCG dose modification/interruption. Three patients (25%) in cohort 1A reported atezolizumab-related grade 3 AEs; cohort 1B had no atezolizumab- or BCG-related grade ≥3 AEs. No grade 4/5 AEs were reported. The 6-mo CR rate was 33% in cohort 1A (median duration of CR, 6.8 mo) and 42% in cohort 1B (median duration of CR, not reached [≥12 mo]). These results are limited by the small sample size of GU-123. ConclusionsIn this first report of the atezolizumab-BCG combination in NMIBC, atezolizumab ± BCG was well tolerated, with no new safety signals or treatment-related deaths. Preliminary results suggested clinically meaningful activity; the combination favoured a longer duration of response. Patient summaryWe studied atezolizumab with and without bacille Calmette-Guérin (BCG) to determine whether this combination was safe and had clinical activity in patients with high-risk noninvasive bladder cancer (high-grade bladder tumours that affect the outermost lining of the bladder wall) that has previously been treated with BCG and is still present or occurred again. Our results suggest that atezolizumab with or without BCG was generally safe and could be used to treat patients unresponsive to BCG.

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours

IntroductionDuring 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression–free survival rates and tumoral relapse specific characteristics. MethodsRetrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain.Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan–Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. ResultsMedian follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145–448) during 2019 and 382 days (215–567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04–3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. ConclusionBCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

El desabastecimiento de BCG para instilación intravesical se asocia a la recidiva tumoral precoz en pacientes con tumor vesical no-músculo invasor de alto riesgo

IntroductionDuring 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression–free survival rates and tumoral relapse specific characteristics. MethodsRetrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain.Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. ResultsMedian follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank P=.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 P=.036). No statistically significant differences in tumoral relapse characteristics were observed. ConclusionBCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

Fremantle protocol: Multicenter clinical outcomes for a pragmatic protocol for intravesical bacillus Calmette-Guerin.

To examine the utility and efficacy of a multifaceted protocol for the administration of intravesical bacillus Calmette-Guerin (BCG) for non-muscle-invasive bladder cancer (NMIBC). A multicenter retrospective review was conducted among 83 patients undergoing Fremantle protocol intravesical BCG for NMIBC within 4 major hospitals in Western Australia between January 2016 and December 2018. The Fremantle protocol consists of weekly BCG instillations for 6 weeks during the induction phase, followed by monthly BCG instillations for 10 months during the maintenance phase with integrated clearance-to-proceed algorithms for urine MSU checks, flexible cystoscopies performed at 3 monthly intervals during maintenance BCG, and repeat GA cystoscopies with four quadrant bladder biopsies routinely obtained following the completion of induction and maintenance treatment. For patients undergoing Fremantle protocol BCG, 98.8% (82/83) and 75.9% (63/83) of patients completed their induction and maintenance courses of BCG, respectively. Induction BCG was delivered over a median duration of 35 days (range 34-84 days), and maintenance BCG was delivered over a median duration of 266 days (range 1-682 days). The tumor recurrence rate was 10.8% (9/83) at the time of post-induction biopsies, 2.4% (2/83) during maintenance treatment, 0% (0/60) at the time of post-maintenance biopsies, and 8.8% (5/57) after a median further follow-up of 16 months (range 0-51 months). The Fremantle protocol appears to be a safe and effective BCG regimen with several advantages over other BCG protocols, including high completion rates, low recurrence rates, and being highly pragmatic.

Hands-On Practice on Sustainable Simulators in the Context of Training for Rural and Remote Practice Through a Fundamental Skills Workshop.

Simulation-based education (SBE) is a sustainable method to allow healthcare professionals to develop competencies in clinical skills that can be difficult to maintain in rural and remote settings. Simulation-based skills training is necessary for healthcare professionals that experience difficulties accessing skills development and maintenance courses to address the needs of rural communities. However, simulators, a key element of simulation, are often prohibitively expensive and follow a “one-size-fits-all” approach. Using additive manufacturing (AM) techniques, more specifically three-dimensional (3D) printing, to produce inexpensive yet functional and customizable simulators is an ideal solution for learners to practice and improve their procedural skills anywhere and anytime. AM allows for the customization of simulators to fit any context while reducing costs and is an economic solution that moves away from the use of animal products to a more ethical, sustainable method for training. This technical report describes the delivery of a fundamental skills workshop to provide hands-on training to rural and remote healthcare professionals using 3D-printed simulators purposefully designed following design-to-cost principles. The workshop was delivered at a three-hour session hosted at a rural and remote medicine course in Ottawa, Canada. The workshop consisted of four technical skills: suturing, cricothyrotomy, episiotomy, and intraosseous infusion (tibial) (IO) and used a blended learning approach to train healthcare professionals and trainees who practice in rural and remote areas. In addition, the learners were granted access to a custom-designed learning management system, which provided a repository of instructional materials, and enabled them to record and upload personal practice sessions, review other learners' practice sessions, collaborate, and provide feedback to other learners. The feedback collected from participants, instructors, and observations on the delivery of the workshop will help improve the structure and training provided to learners. The delivery of this workshop annually is an ideal solution to ensure parsimonious delivery of simulation training for rural and remote healthcare professionals.

An Evaluation of Built Environment Students’ Training in Building Maintenance (A Case Study of Federal Polytechnics in Osun State, Nigeria)

Aims: This study is aimed at evaluating the training acquired by built environment students in maintenance courses to determine areas of training inadequacy and improvements. This is achieved by identifying of learning outcomes in maintenance courses acquired by built environment students, accessing the level of competence in training maintenance courses, and the barriers to the competence in the training maintenance courses.
 Study Design: The study adopted a quantitative analysis technique, relative important index (RII) was used to analyze the data collected. In other to determine the reliability of the data collected, the study sought information on the learning outcome of students in maintenance specifically, student competence area in the training of maintenance, and the barrier to student competence in the maintenance training.
 Place and Duration of Study: Data is collected through well-structured questionnaires administered to the selected department in the built environment in Federal Polytechnic Ede. 100 questionnaires were administered, while 90 were duly completed and returned for analysis.
 Data Analysis: The data was analyzed using Statistical Software for Social Sciences (SPSS) and an excel statistical package for prediction.
 Results: The observed that built environment students are not sufficiently trained in some topics in the Building maintenance courses. Also, students are not competent in the ability to prepare documents for work alteration, maintenance of high rise building and estate roads. The major barriers to the competence of students in building maintenance are lack practical in maintenance, the lack of student’s interest in the course, lack of conducive environment and limited time for learning.
 Conclusion: The study concluded that Built environment Students did not receive adequate training in building maintenance courses and recommended that sufficient time should be allocated to carryout practical works in building maintenance and the adoption of training methods to enhance the learning and competency of students in carrying out maintenance work.

Treatment and disease management patterns for bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer in North America, Europe and Asia: A real-world data analysis.

BackgroundThis study examined real-world treatment and management of bacillus Calmette-Guérin (BCG)-unresponsive patients across 3 continents, including patients unable or unwilling to undergo cystectomy.Materials and methodsPhysicians actively involved in managing patients with nonmuscle invasive bladder cancer completed online case report forms for their 5 consecutive patients from the broad BCG-unresponsive population and a further 5 consecutive BCG-unresponsive patients who did not undergo cystectomy (in Japan, physicians provided a total of 5 patients across both cohorts).ResultsMost patients had received 1 (37%) or 2 (24%) maintenance courses of BCG. Five or more maintenance BCG courses were received by patients in Japan (59%) and China (31%), while in Germany 76% of patients received only 1 course. Most patients became BCG-unresponsive during their first (44%) or second (22%) treatment course; in Germany, 77% became BCG-unresponsive during their first treatment course. Most countries did not provide another course of BCG after a patient first became unresponsive, whereas unresponsive patients in Japan and China were most likely to be retreated with BCG. “Untreated - on watch and wait” was the main treatment/management approach received post-BCG treatment for 42% or more of patients in most countries except China (39%) and the United States (36%). “Following treatment guidelines” was consistently the top reason for post-BCG treatment selection across all treatment options.ConclusionsThis study confirmed the global unmet need for patients with nonmuscle invasive bladder cancer, and found that many patients experienced periods of no treatment after not responding to BCG therapy.

MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING

You have accessJournal of UrologyCME1 May 2022MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING Marina Valeri, Roberto Contieri, Vittorio Fasulo, Miriam Cieri, Grazia M. Elefante, Massimo Lazzeri, Gianluigi Taverna, Luigi M. Terracciano, Rodolfo Hurle, and Piergiuseppe Colombo Marina ValeriMarina Valeri More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Miriam CieriMiriam Cieri More articles by this author , Grazia M. ElefanteGrazia M. Elefante More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Gianluigi TavernaGianluigi Taverna More articles by this author , Luigi M. TerraccianoLuigi M. Terracciano More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , and Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of T1 high-grade (HG) bladder cancer (BC) patients is still a challenging issue in urological practice. Depth and amount of lamina propria (LP) tumor invasion is a key prognostic variable. Compared to other substaging methods, the Rete Oncologica Lombarda (ROL) system - simply based on a 1-mm threshold- showed a high predictive value for tumor progression after transurethral resections of the bladder (TUR) in recent retrospective studies. Our aim was to validate ROL system on a large monoistitutional prospective series of primary urothelial carcinomas from TUR. METHODS: From 2013 to 2020, we prospectively maintained a database of pT1HG BC patients with available clinicopathologic data. Using ROL system for T1 substaging, we adopted a cut-off of 1 mm (diameter of a high-power field, HPF, objective 20x) to stratify tumors in ROL1 and ROL2, corresponding to invasive focus or multiple foci extending together for <1 HPF and for >1 HPF, respectively. Univariate and multivariate Cox proportional hazard models were employed to identify significant independent predictors of recurrence and progression after TUR. Kaplan-Meier (KM) survival estimates were used to investigate ROL’s predictive role on progression free survival (PFS) and recurrence free survival (RFS). RESULTS: A total of 229 confirmed T1HG BC entered the prospective study. Mean age was 73 yr and most patients were male (74.7%); 70 tumors were multifocal (30.57%), 33 cases had divergent differentiation (14.4%), associated carcinoma in situ (CIS) and lymphovascular invasion (LVI) occurred in 32 (14%) and 20 (9%) cases, respectively. ROL was feasible in all but one case (99.6%): 94 cases were ROL1 (41%) and 134 ROL2 (59%). All patients completed the BCG induction course and at least 1 or 2 maintenance courses. At a median follow up of 23 months (IQR 12.33-38.5), 59 patients had recurrence (25.76%) and 37 patients had progression (16%). ROL was a significant predictor of progression in univariate Cox regression analysis (OR= 3.58, 95% CI, 1.50-8.56; p=0.004), confirmed by the multivariate analysis (OR= 2.95, 95% CI, 1.11-7.87; p=0.03). In KM estimates for PFS and RFS, ROL showed a significant correlation with progression (p <0.01), while no significance was reached for recurrence (p >0.05). CONCLUSIONS: Our results confirmed the strong predictive role of ROL for progression on a large prospective series. We foster the application of ROL system for substaging T1HG BC, a simple and feasible method that might identify high risk patients and drive urological decision making. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e391 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marina Valeri More articles by this author Roberto Contieri More articles by this author Vittorio Fasulo More articles by this author Miriam Cieri More articles by this author Grazia M. Elefante More articles by this author Massimo Lazzeri More articles by this author Gianluigi Taverna More articles by this author Luigi M. Terracciano More articles by this author Rodolfo Hurle More articles by this author Piergiuseppe Colombo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Atezolizumab (atezo) with or without Bacille Calmette-Guérin (BCG) in patients (pts) with high-risk nonmuscle-invasive bladder cancer (NMIBC): Results from a phase Ib/II study.

493 Background: Standard treatment (tx) for high-risk NMIBC is transurethral resection of bladder tumor (TURBT) followed by BCG induction and maintenance. However, ≈50% of pts experience recurrence and/or progression after tx and may be ineligible for or refuse cystectomy. The PD-L1/PD-1 pathway may be involved with immune escape in NMIBC following BCG exposure. Here, we report results of atezo (anti–PD-L1) ± BCG in BCG-unresponsive, high-risk NMIBC. Methods: This multicenter study (NCT02792192) enrolled pts with BCG-unresponsive NMIBC with carcinoma in situ who had repeat TURBT. Cohort 1A and 1B pts received atezo 1200 mg IV q3w for ≤96 wk. Cohort 1B pts also received standard BCG induction (qw × 6 doses) and maintenance (qw × 3 doses at 3 mo), with optional maintenance courses at 6, 12, 18, 24, and 30 mo. For cohort 1B only, de-escalation was allowed for ≤3 BCG dose levels (full dose 50 mg, 66% and 33% of full dose). Co-primary outcomes were safety and complete response (CR) rate at 6 mo (6-mo bladder biopsy required). Duration of CR and 3-mo CR rate (key secondary outcomes) and 12-mo CR rate (exploratory) were also shown. Results: Cohorts 1A and 1B enrolled 12 pts each. Median age was 74 y; most pts had ECOG PS 0 (n = 7 [58%] in each cohort). At data cutoff (Sep 29, 2020), median atezo tx duration was 22.7 wk in cohort 1A and 31.6 wk in 1B. Following dose de-escalation in cohort 1B, the recommended BCG dose was 50 mg. BCG dose modification/interruption occurred in 4 pts (33%) due to an AE. The most common reason for tx discontinuation was disease recurrence or progression in both cohorts. Three pts (25%) in cohort 1A had atezo-related Gr 3 AEs (most common: maculopapular rash, n = 2); no atezo- or BCG-related Gr ≥3 AEs were seen in cohort 1B. Three dose-limiting toxicities occurred (1 [8%] in cohort 1A and 2 [17%] in cohort 1B), all reported as AEs of special interest. No Gr 4/5 AEs were reported. CRs, which appeared durable, were seen in both cohorts (Table). Conclusions: In this first report of atezo + BCG in NMIBC, atezo as mono- and combination therapy was well tolerated, with no new safety signals or tx-related deaths. Preliminary data suggested clinically meaningful activity, especially with atezo + BCG, requiring confirmation in a larger setting. Clinical trial information: NCT02792192. [Table: see text]

Intensive Chemotherapy Is Not Recommended for Patients with AML or High-Risk MDS Aged over 60 Years with Complex Karyotype Anomalies.

Background: Intensive chemotherapy for patients with MDS or AML aged over 60 years still is a matter of debate. Although there are some patients with long-term survival after intensive chemotherapy, it is discussed controversially how to treat old patients with AML or high-risk MDS.Methods: Between 1991 and 2003, 158 patients with MDS or AML underwent intensive chemotherapy with either Ida-Ara-C or TAD, followed by a second course of Ida-Ara-C or TAD, and followed by 2 years maintenance chemotherapy at our institution. Patients were either followed up until relapse, death or to July, 31.th.2004. Median time of follow up was 14 months.Results: Median age at diagnosis was 67 years (60–78). There were 92 males and 66 females. In 101 patients, initial karyotype was available. 51 patients had a normal karyotype and in 50 patients an abnormal karyotype could be detected, 26 of whom had a complex karyotype.94 patients (60%) entered complete remission (CR), 7 patients achieved partial remission (PR), 41 patients failed to respond (26%), and 16 patients succumbed within 4 weeks after the beginning of the induction therapy (10%). Patients with a normal or non-complex karyotype entered CR in 72%, whereas only 34% of patients with complex karyotype achieved CR (p=0.001). 86 (54%) patients received a consolidation therapy with another course of Ida-Ara-C or TAD. 20 patients received at least three courses of maintenance chemotherapy.Median survival of the entire group was 15 months. At the time of analysis, only 19 patients were still alive. Patients with normal karyotype had a median survival of 19 months, as compared to 5 months in patients with abnormal karyotype (p<0.00005). Patients with a complex karyotype had a median survival of 4 months only (p=0.00005).Two years after the beginning of the treatment, only 27% of the patients were still alive. A very small group of patients (n=9) achieved long-lasting remission of more than 3 years. 20 patients died in CR due to infectious complications during the consolidation chemotherapy or due to causes not related to the disease. The initial karyotype and entering CR after induction chemotherapy could be identified as the only prognostic parameters for predicting survival within in entire group. In a multivariate analysis, initial karyotype was the only independent predictive parameter.Conclusions: Intensive chemotherapy is not recommended for patients with AML or high-risk MDS aged over 60 years with complex karyotype anomalies, because of a very poor prognosis, due to low CR rates and early relapses. Alternative treatment strategies, like deacetylating agents or demethylating agents should be performed for those patients.

The role of the teacher in heritage language maintenance courses in Finland

ABSTRACT Globalisation has resulted in European families that have a variety of home languages, leading to the need for heritage language learning (HLL). The purpose of HLL is to ensure that in addition to learning the language of their schools, children with migrant backgrounds also maintain their heritage language (HL). Besides the ‘regular’ teaching, in many countries, there are usually voluntary, extra-curricular maintenance courses available for migrant children. The purpose of our study was to investigate the impact that HL teachers working in Finnish schools have on the process of learning HLs. The data were collected using a Likert-scale questionnaire (N = 25) and semi-structured interviews (N = 15) with HL teachers representing 24 different languages. Principal Component Analysis (PCA) was conducted to check the survey construct validity. The statistical and qualitative analysis of the data indicated that HL teachers act as multilingual identity supporter, that is that they showed understanding of their students’ multilingualism and were convinced about the positive impact of HL for students’ future lives. Our study also reported on the challenges teachers face in the classroom.

Is there a role for urine cytology following BCG therapy for non-muscle-invasive bladder cancer (NMIBC)?

404 Background: Voided urine cytology has been used as an adjunct in the diagnosis of non-muscle invasive bladder cancer (NMIBC), with a sensitivity and specificity ranging between 13-75% and 76-100% respectively. There is limited data on the accuracy and utility of cytology following BCG therapy. We reviewed the results of cytology in patients undergoing induction and maintenance BCG immunotherapy in our institution. Methods: Newly diagnosed patients who had received induction and maintenance intravesical BCG therapy from 2004 - 2019 were identified from a prospective database and their outcomes reviewed retrospectively. Histopathology results of biopsies / resected specimens and voided urine cytology results were examined for 273 patients. Results: A total of 2567 cytology results and 638 biopsy results were recorded. The average age was 73.2 years and median number of BCG treatments was four (induction followed by three maintenance courses). Median follow up was 38 months. 94 patients (34.4%) had recurrence following BCG therapy. Of those 33 patients (12.1%) had progression to muscle invasive disease. The number of cytology samples per patient after BCG therapy ranged from 1-23 (median 7), with several patients having repeated, potentially unnecessary negative urine cytology. Overall accuracy of cytology (n = 526) was sensitivity 44.2%, specificity 84.7%, PPV 38.9%, NPV 87.3%. Patients that had an erythematous bladder or red patch at flexible cystoscopy underwent subgroup analysis; this gave a very high NPV of 95.9%, with additional sensitivity being 65.5%, specificity 85.9% and PPV 33.3%. Number of positive cytology results (Chi2 = 44.30, P = 0.002), any positive cytology (Chi2 = 27.94, P &lt; 0.001) and positive cytology after induction BCG therapy (Chi2 = 30.381, P &lt; 0.001) were all strongly associated with recurrence. Conclusions: Positive urine cytology in patients undergoing intravesical BCG therapy predicts increased risk of recurrence and has good specificity. We would recommend using voided urine cytology in patients who have an erythematous bladder or red patch at flexible cystoscopy. If the cytology is positive then proceed to biopsy, however, if it is negative continue with surveillance. [Table: see text]

A Hybrid Virtual Cloud Learning Model During the COVID-19 Pandemic

The COVID-19 pandemic has affected the educational systems worldwide, leading to the near-total closures of schools, universities, and colleges. Universities need to adapt to changes to face this crisis without negatively affecting students’ performance. Accordingly, the purpose of this study is to identify and help solve to critical challenges and factors that influence the e-learning system for Computer Maintenance courses during the COVID-19 pandemic. The paper examines the effect of a hybrid modeling approach that uses Cloud Computing Services (CCS) and Virtual Reality (VR) in a Virtual Cloud Learning Environment (VCLE) system. The VCLE system provides students with various utilities and educational services such as presentation slides/text, data sharing, assignments, quizzes/tests, and chatrooms. In addition, learning through VR enables the students to simulate physical presence, and they respond well to VR environments that are closer to reality as they feel that they are an integral part of the environment. Also, the research presents a rubric assessment that the students can use to reflect on the skills they used during the course. The research findings offer useful suggestions for enabling students to become acquainted with the proposed system’s usage, especially during the COVID-19 pandemic, and for improving student achievement more than the traditional methods of learning.

Consecuencias del desabastecimiento de BCG para instilación endovesical y su efecto sobre la supervivencia libre de recurrencia en tumores vesicales no infiltrantes de alto riesgo

Objectives: During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective of the present study is to analyze whether patients affected during the shortage by reduced dose courses, are at a higher risk of tumor recurrence than those receiving full dose schemes. Methods: Retrospective cohort study with a total sample of 154 subjects (60 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated by survival analysis using the Kaplan-Meier method. Relapse-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. Results: Median follow-up in the 2019 sample was 503 days and 1197 days in the 2017 group, with a median number of instillations of 8 and 12 respectively. There was a 37.7% proportion of tumoral relapse observed in the 2019 group and 29.03% during 2017. Survival analysis revealed mean relapse-free follow-up of 683 days (95%CI 601.3-765.5) in the 2019 group and of 1359 days (95%CI 1244.3-1474) in 2017. Further analysis using LogRank test revealed observed differences to be statistically significant (p=0.02) Multivariable analysis revealed a proportional Hazard ratio (HR) for relapse-free survival rate of 2.2 (95% CI: 1.13-4.25; p=0.019) regarding the 2019 sample treated with a reduced-dose course. Conclusions: BCG shortage and the subsequent reduced-dose schemes used for intravesical instillation, due to limited availability, had a significant impact on tumor relapse rates during follow-up. These findings are consistent with other published studies and show the need for full-dose BCG courses in order to prevent higher relapse rates after TURB.

Lenalidomide maintenance after autologous haematopoietic stem-cell transplantation in mantle cell lymphoma: results of a Fondazione Italiana Linfomi (FIL) multicentre, randomised, phase 3 trial

Fit patients with mantle cell lymphoma aged 18-65 years are usually given cytarabine and rituximab-based induction regimens followed by autologous haematopoetic stem-cell transplantation (HSCT). We investigated whether post-autologous HSCT maintenance with lenalidomide improves progression-free survival in this population. This open-label, randomised, multicentre, phase 3 trial was done at 49 haematology and oncology units in Italy and Portugal. Eligible patients had Ann Arbor stage III or IV treatment-naive mantle cell lymphoma (or stage II plus bulky disease [≥5 cm] or B symptoms), and had evidence of cyclin D1 overexpression or the translocation t(11;14)(q13;q32). Patients were aged 18-59 years with Eastern Cooperative Oncology Group (ECOG) performance status 0-3, or aged 60-65 years with ECOG 0-2. After an optional prephase with vincristine and steroids (intravenous vincristine 1·4 mg/m2 on day 1, oral prednisone 100 mg [total dose] on days 1-5), patients were given three courses of R-CHOP (21-day cycle, intravenous rituximab 375 mg/m2 on day 1; intravenous doxorubicin 50 mg/m2, vincristine 1·4 mg/m2, and cyclophosphamide 750 mg/m2 on day 2; oral prednisone 100 mg/m2 on day 2-6). Patients then received one cycle of high-dose CTX (intravenous cyclophosphamide 4 g/m2 on day 1, intravenous rituximab 375 mg/m2 on day 4). After restaging, patients received two cycles of R-HD-cytarabine (high-dose intravenous cytarabine 2 g/m2 every 12 h on days 1-3, intravenous rituximab 375 mg/m2 on days 4 and 10). Patients with complete remission or partial remission proceeded to autologous HSCT and responding patients (complete remission or partial remission) with haematological recovery were randomly assigned (1:1) to receive 24 courses of oral lenalidomide maintenance (15 mg per day for patients with platelets >100 × 109 cells per L or 10 mg per day for platelets 60-100 × 109 cells per L, days 1-21 every 28 days) for 24 months, or observation. The primary endpoint was progression-free survival, measured in the randomised population. This study is registered with EudraCT (2009-012807-25) and ClinicalTrials.gov (NCT02354313). Between May 4, 2010, and Aug 24, 2015, 303 patients were screened for inclusion and 300 patients were enrolled (median age 57 years, IQR 51-62; 235 [78%] male). 95 patients were excluded before randomisation, mostly due to disease progression, adverse events, and inadequate recovery. 104 patients were randomly assigned to the lenalidomide maintenance group and 101 patients to the observation group. 11 (11%) of 104 patients assigned to lenalidomide did not start treatment (3 withdrew, 6 adverse events or protocol breach, 2 lost to follow-up). At a median follow-up of 38 months after randomisation (IQR 24-50), 3-year progression-free survival was 80% (95% CI 70-87) in the lenalidomide group versus 64% (53-73) in the observation group (log-rank test p=0·012; hazard ratio 0·51, 95% CI 0·30-0·87). 41 (39%) of 104 patients discontinued lenalidomide for reasons including death or progression. Treatment-related deaths were recorded in two (2%) of 93 patients in the lenalidomide group (1 pneumonia, 1 thrombotic thrombocytopenic purpura), and one (1%) of 101 in the observation group (pneumonia). 59 (63%) of 93 patients in the lenalidomide group had grade 3-4 haematological adverse events versus 12 (12%) of 101 patients in the observation group (p<0·0001). 29 (31%) of 93 patients in the lenalidomide group and eight (8%) of 101 patients in the observation group had grade 3-4 non-haematological adverse events (p<0·0001), of which infections were the most common.Serious adverse events were reported in 22 (24%) of 93 patients in the lenalidomide group and five (5%) of 101 patients in the observation group. Pneumonia and other infections were the most common serious adverse events. Despite non-negligibile toxicity, lenalidomide after autologous HSCT improved progression-free survival in patients with mantle cell lymphoma, highlighting the role of maintenance in mantle cell lymphoma. Fondazione Italiana Linfomi and Celgene.

ULTRABRIEF RIGHT UNILATERAL ECT AND CATATONIA: A CASE SERIES AND LITERATURE REVIEW

Introduction Catatonia is a neuropsychiatric syndrome that affects both behavior and motor function, resulting potentially in unresponsiveness in an individual who otherwise appears to be awake. Catatonia can occur in the context of several underlying psychiatric or medical condition. Electroconvulsive Therapy (ECT) is an evidence-based, first-line treatment for catatonia and its efficacy has been demonstrated since the early 1930s. ECT is not only proven to relieve catatonia but some of the underlying psychopathology including mood disorders. The conventional modality of ECT that has been used for the treatment of catatonia is bilateral (BL) lead placement with brief pulse width (>0.5 milisec). Although (BL) ECT placement is more commonly used, cognitive side effects are an important limitation for the use of this technique. The literature is limited regarding the use of ultrabrief pulse width (UB) ( Methods A case series of two catatonic patients successfully treated with RUL ECT at an academic center is presented. Ms. B, a 66-year-old female with bipolar disorder with psychotic features and a recent history of intentional overdose, presenting for depression and catatonia. During the past four years she had 6 hospital admissions due to similar episodes.Ms. K, a 55-year-old female with MDD with psychotic features and catatonia presenting for worsening mood, neurovegetative symptoms, psychosis and catatonic symptoms. Her catatonic symptoms had partially improved with initiation and titration of Lorazepam.Existing literature is reviewed to compared with other published cases and discussion of treatment effectiveness. A table presenting the cases found in the literature will be added. Results The patients were cleared by anesthesia. Ms. B completed an acute course of 11 UB-RUL ECT treatments with 2 more UB-RU ECT treatments were completed as taper. Her baseline QIDS improved from baseline 10 to post-ECT 1. CGI post treatment was very much improved. No major side effects were noted or reported.Ms. K completed an acute course of 13 UB-RUL ECT treatments. 3 more UB-RUL ECT treatments were completed as taper over a period of twenty-three days. Her baseline QIDS improved from 18 to 6 post treatment. Her CGI was rated as very much improved. No major side effects were noted or reported.Both patients experienced significant improvement of their symptoms. Conclusions UB RUL ECT is a safe and effective treatment modality for patients with Catatonia independent of the underlying cause. Patient with catatonia are vulnerable to relapse and may require prolonged courses of ECT and maintenance. To mitigate the risk of cognitive side effects these patients may benefit from UB RUL ECT. This research was funded by: No funding

Analyzing Deterioration on Arterial Roads Caused by Overloaded Business Vehicles

The many business vehicles performing important roles in the distribution of goods and services cause flexible pavement to experience overloading, which will eventually result in diminished pavement quality and durability. Roads need to be maintained periodically to maintain a high level of service. This research aims to discover the pattern of weight increments on overloaded business vehicles with the highest potential for road deterioration; analyze the relationships between said patterns and types of heavy vehicles; and determine what steps and relevant maintenance methods need to be taken. Research is performed on type 6a through 7c3 vehicles weighing 12 to 45 metric tons with various axle configurations, during both peak and off-peak hours on both workdays and holidays, to calculate the Average Daily Traffic in vehicle/day. Load on the road is then calculated to discover load value measured in Equivalent Single Axle Load (ESAL). Load is simulated up to 125 per cent heavier than total permitted weight according to data from Weight in Motion devices installed on certain arterial roads. Remaining pavement life is then calculated with the AASHTO 1993 method in accordance with its planned lifespan. Analysis shows that single-axle vehicles with double rear wheels weighing sixteen metric tons dominate national arterial roads and possess the highest potential to cause deterioration. Road deterioration, most of which consists of various forms of cracks, is accordingly determined using the Binamarga method. Relevant maintenance courses are thus formulated, comprising the forms of routine maintenance, periodical maintenance, and improvements to the roads in question.

Management of non-muscle-invasive bladder cancer: quality of clinical practice guidelines and variations in recommendations

BackgroundBladder cancer (BC) has become a major worldwide public health issue, especially non-muscle-invasive bladder cancer (NMIBC). A flood of related clinical practice guidelines (CPGs) have emerged; however, the quality and recommendations of the guidelines are controversial. We aimed to appraise the quality of the CPGs for NMIBC within the past 5 years and compare the similarities and differences between recommendations for therapies.MethodsA systematic search to identify CPGs for NMIBC was performed using electronic databases (including PubMed, Embase, Web of Science), guideline development organizations, and professional societies from January 12, 2014 to January 12, 2019. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was performed to assess the overall agreement among reviewers.ResultsNine CPGs were included. The overall agreement among reviewers was excellent. The interquartile range (IQR) of scores for each domain were as follows: scope and purpose 69.44% (35.42, 85.42%); stakeholder involvement 41.67% (30.56, 75.00%); rigour of development 48.96% (27.08, 65.63%); clarity and presentation 80.56% (75.00, 86.11%); applicability 34.38% (22.92, 40.63%) and editorial independence 70.83% (35.42, 85.42%). The NICE, AUA, EAU and CRHA/CPAM clinical practice guidelines consistently scored well in most domains.It was generally accepted that the transurethral resection of bladder tumour (TURBT) and intravesical chemotherapy should be performed in the management of bladder cancer. The application of chemotherapy was highly controversial in high risk NMIBC. The courses of BCG maintenance were similar and included 3 years of therapy at full maintenance doses.ConclusionsThe quality of NMIBC guidelines within the past 5 years varied, especially regarding stakeholders, rigour and applicability. Despite many similarities, the recommendations had some inconsistencies in the details.