Reasonable Expectations Research Articles

Endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for palliation of malignant gastric outlet obstruction (ENDURO): study protocol for a randomized controlled trial

BackgroundMalignant gastric outlet obstruction (GOO) is a debilitating condition that frequently occurs in patients with malignancies of the distal stomach and (peri)ampullary region. The standard palliative treatment for patients with a reasonable life expectancy and adequate performance status is a laparoscopic surgical gastrojejunostomy (SGJ). Recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) emerged as a promising alternative to the surgical approach. The present study aims to compare these treatment modalities in terms of efficacy, safety, and costs.MethodsThe ENDURO-study is a multicentre, open-label, parallel-group randomized controlled trial. In total, ninety-six patients with gastric outlet obstruction caused by an irresectable or metastasized malignancy will be 1:1 randomized to either SGJ or EUS-GE. The primary endpoint is time to tolerate at least soft solids. The co-primary endpoint is the proportion of patients with persisting or recurring symptoms of gastric outlet obstruction for which a reintervention is required. Secondary endpoints are technical and clinical success, quality of life, gastroenterostomy dysfunction, reinterventions, time to reintervention, adverse events, quality of life, time to start chemotherapy, length of hospital stay, readmissions, weight, survival, and costs.DiscussionThe ENDURO-study assesses whether EUS-GE, as compared to SGJ, results in a faster resumption of solid oral intake and is non-inferior regarding reinterventions for persistent or recurrent obstructive symptoms in patients with malignant GOO. This trial aims to guide future treatment strategies and to improve quality of life in a palliative setting.Trial registrationInternational Clinical Trials Registry Platform (ICTRP): NL9592. Registered on 07 July 2021.

Early predictive model for COVID-19 mortality and ventilator support: reducing risks for patients

The COVID-19 virus, which is caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has the potential to generate a wide range of symptoms, including mild respiratory symptoms, severe respiratory distress, and even death. Prediction models cannot replace clinical judgment and patient assessment. Instead of depending solely on the estimates provided by models, healthcare providers should use them as decision-support tools to help them make the best possible choices. As part of this investigation, we construct a prediction model that we refer to as the Hybrid Spider Monkey Optimized eXtreme Gradient Boosting (HSMO-XGB). Patients who were part of the COVID-19 trial were hospitalized in King Abdul-Aziz Medical City in Riyadh for the purpose of this study. The dataset includes the patient's personal data, the outcomes of any tests performed in laboratories, and any chest X-ray (CXR) outcomes. The first step in preprocessing is called normalization, and the second step is called feature extraction using linear discriminate analysis (LDA). The reasonable expectation model for HSMO-XGB that is presently being shown will work on the administration of clinics by helping doctors in the early recognizable proof of Coronavirus patients who are in danger of death or need respiratory support. The model that has been provided can be utilized, in particular, as a tool that can assist physicians in predicting patients who are at risk and that can assist hospitals in effectively managing and organizing their resources.

Optimal Strategies for Managing Prostate-specific Antigen Recurrence After Primary Radiotherapy in Prostate Cancer: The Finnish Perspective

Biochemical recurrence after radiotherapy for prostate cancer is a clinical dilemma. Patients at low risk of disease progression can be safely monitored. In Finland, options for those with reasonable life expectancy include salvage high-dose-rate brachytherapy and transurethral ultrasound ablation under magnetic resonance imaging guidance.

Public sense of dental implants on social media: A cross-sectional study based on text analysis of comments

ObjectivesTo investigate the most discussed topics and possible new interests in dental implants among the public, as well as the public sentiments toward dental implants through topic and sentiment analysis of online comments. MethodsComments of the top 100 most viewed dental implant-related YouTube videos were studied. The comments were analyzed by topic analysis (LDA topic model, Word co-occurrence analysis) and sentiment analysis. The basic information of videos was collected and classified. Video quality was evaluated by GQS criteria and 9-point usefulness scoring system. Statistical analyses were performed using Kruskal-Wallis test, Mann-Whitney U-tests, and Spearman correlation analysis. Results74 videos with 61,618 comments were considered eligible in this study. Most videos targeted the public with high viewing and comments, but the theme was single and the quality was low. From topic analysis, the most discussed topics in the comments were procedure, cost, feelings associated with prognosis, and expectations. Multidisciplinary approaches in implant dentistry were frequently discussed. From sentiment analysis, the public mainly expressed positive sentiment through comments. In detail, the public had positive feelings about aesthetics and health, negative feelings about pain, and neutral feelings about cost. ConclusionThe hot topics of public concern were procedure, cost, feelings associated with prognosis, and expectations. Intriguingly, multidisciplinary approaches in implant dentistry have emerged as a new hot subtopic within the topic “procedure”. Based on the sentiment analysis of the comments, the general sentiment expressed by the public toward dental implants was predominantly positive. Clinical SignificanceText mining can extract data from social media to explore public interest in dentistry. Clinicians should convey reasonable expectations and understanding about dental implants, especially addressing the most public-concerned topics (procedure, cost, feelings, and expectations), and provide patients with well-grounded multidisciplinary treatment plans to meet the growing public demand.

Priorities, barriers, and facilitators for nutrition-related care for autistic children: a qualitative study comparing interdisciplinary health professional and parent perspectives.

Children with autism spectrum disorder often face nutrition-related challenges, such as food selectivity, gastrointestinal issues, overweight and obesity, and inadequate nutrient intake. However, the role of routine nutrition-related screening or care by interdisciplinary health professionals is not well understood. This study aimed to compare the beliefs of health professionals with those of parents of autistic children regarding high-priority nutrition-related challenges, barriers and facilitators to care, and desired education and resources related to nutrition for autistic children. Interdisciplinary health professionals (n = 25) (i.e., pediatricians, occupational therapists, speech-language pathologists, board certified behavior analysts, registered dietitians) and parents of autistic children (n = 22). The study used semi-structured phone interviews, which were recorded, transcribed, verified, and double-coded using the Framework Method. Thematic analysis of transcripts revealed that while health professionals and parents of autistic children shared some perspectives on nutrition-related challenges and care, they also had distinct viewpoints. Parents emphasized the importance of addressing food selectivity, behavioral eating challenges, sensory issues, and sleep disturbances affecting appetite. Both groups acknowledged the need for tailored support, access to an interdisciplinary care team, and reasonable expectations. Some health professionals perceived parents as lacking motivation or the ability to make changes. In contrast, many parents felt that health professionals lacked the knowledge and motivation to take nutrition or growth concerns seriously. Health professionals acknowledged that their lack of knowledge or capacity to provide nutrition education or referrals was a common barrier to care, particularly given limited community resources. Health professionals who serve autistic children are motivated to address nutrition-related challenges but lack resources related to nutrition. To promote better health outcomes for autistic children, professionals should identify and support parent motivations around nutrition-related care. Both groups expressed interest in accessing autism-specific resources for education, referral, and screening guidance. Future research could explore the development of healthcare training models that improve the competency of health professionals in providing nutrition care and referral for autistic children.

Five Year Survival in Medicare Patients Undergoing Interventions for Peripheral Arterial Disease: a Retrospective Cohort Analysis of Linked Registry Claims Data

To justify upfront risks of offering elective interventions for intermittent claudication (IC), patients should have reasonable life expectancy to derive durable clinical benefits. Open surgery for chronic limb threatening ischaemia (CLTI) is maximally beneficial in patients surviving ≥ 2 years. Our goal was to assess long term survival after IC and CLTI interventions. In a retrospective cohort analysis, the Vascular Quality Initiative (VQI) registry from 1 January 2010 to 31 May 2021 was queried for peripheral vascular intervention (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB) for IC and CLTI across 286 US centres. VQI linkage to Medicare insurance claims provided 5 year survival data. Multivariable analysis identified factors associated with 5 year mortality. There were 31 457 PVIs (44.7% IC, 55.3% CLTI), 7 978 IIBs (26.9% IC, 73.1% CLTI), and 2 149 SIBs (50.1% IC, 49.9% CLTI) recorded in the VQI. Among PVI, IIB, and SIB cohorts, average ages were 75, 73, and 72 years, respectively. Respective 5 year mortality after PVI for IC and CLTI was 37.2% and 71.1%; after IIB for IC and CLTI it was 37.8% and 60%; and after SIB for IC and CLTI it was 33.8% and 53.8%. On multivariable analysis, across all procedures, end-stage renal disease, CLTI, congestive heart failure, anaemia, chronic obstructive pulmonary disease, and prior amputation were independently associated with increased mortality. Pre-admission home living and pre-operative aspirin use were independently associated with decreased mortality. Long term survival in Medicare patients undergoing interventions in VQI centres for peripheral arterial disease is poor. Two thirds of CLTI patients and over one third of IC patients were not alive at 5 years. Intervening for IC in patients with high mortality risk should be avoided. For CLTI patients identified with decreased survival likelihood, intervention durability may be less important than invasiveness. Pre-operative medical optimisation should always be undertaken.

Стабильность условий предоставления налоговых льгот как принципиальная основа режима инвестиционной деятельности в Российской Федерации

This paper covers aspects of the legal nature of stabilisation with regard to investment tax incentives. The relevance of the research is related both to the current macroeconomic difficulties and the corresponding need to encourage investment activity, and to the latest trends in jurisprudence and lawmaking. This article will examine the effect of the tax “stabilisation clause” in the use of investment tax incentives. The article will substantiate the thesis that stabilisation applies to any investment incentive due to the fact that the invariability of investor support measures follows from the constitutional regulation of the operation of law over time. It will also define the content of a legitimate reasonable expectation, which is ensured through the stability of tax benefits.

ILLUMINA CAMBRIDGE LTD v LATVIA MGI TECH SIA

H1 Patents — European Patents — Validity — DNA sequencing systems––Sequencing by synthesis — Obviousness — Hindsight — Reasonable expectation of success — Priority — Plausibility — Common general knowledge — Mere collocations — Appeal to Court of Appeal — Procedure — Affirming decision on alternative or additional grounds

Controls on the Stratiform Copper Mineralization in the Western Syncline, Upper Peninsula, Michigan

The Western Syncline hosts reduced-facies, or Kupferschiefer-type, sedimentary rock-hosted stratiform Cu deposits (SSC) in the lowermost meters of the Nonesuch Formation, which is part of a thick section of clastic sedimentary rocks that comprise the upper fill of the Mesoproterozoic Midcontinent Rift of North America. Located in the Porcupine Mountains Cu district in Upper Peninsula, Michigan, these blind deposits were discovered in 1956, but are not yet developed, although recent renewed interest may result in near-term production. The deposits are distinguished by their relatively undeformed nature and lack of superposed hydrothermal events. Prior to lithification, chalcocite mineralization replaced diagenetic pyrite within two discrete tabular, albeit discontinuous, potential orebodies referred to as the lower Cu-bearing sequence (LCBS) and the upper Cu-bearing sequence (UCBS). The Top Cu Zone transgresses lithologic boundaries, suggesting that a limited volume of Cu-bearing fluids moved vertically upwards through the unlithified stratigraphy, since reductant pyritic rocks above this zone are essentially barren of Cu. The total Cu inventory that has a reasonable expectation of economic extraction is 3678 M lbs. of Cu with 15.3 M oz. of byproduct Ag. When a cutoff grade of 0.9% Cu over a minimum thickness of 2 m is applied to justify an underground room-and-pillar mine, the LCBS and UCBS are not continuous over the Western Syncline. Sedimentology is the first-order control of potential ore and its continuity; dark-gray shales and siltstones deposited under low-energy, anoxic conditions are preferred host rocks, whose thickness must be >2 m to be potential ore since host-rock thickness determines economic viability of extraction. Furthermore, stratigraphy influences the time constraints on mineralization as the lithification process impedes vertical permeability and thus the flow of Cu-bearing fluids upward through the unlithified section. Syn-sedimentary tectonic movements, likely along pre-existing buried faults, are a third-order control as the thickness of host rocks is enhanced under such conditions. Therefore, an understanding of the depositional and tectonic history throughout the Western Syncline is fundamental to understanding the limits of possible economic exploitation and to optimizing ore extraction.

Use of tailoring features and reasons for dropout in a guided internet-based transdiagnostic individually-tailored cognitive behavioral therapy for symptoms of depression and/or anxiety in college students

Transdiagnostic individually-tailored digital interventions reduce symptoms of depression and anxiety in adults with moderate effects. However, research into these approaches for college students is scarce and contradicting. In addition, the exact reasons for intervention dropout in this target group are not well known, and the use of individually-tailored intervention features, such as optional modules, has not yet been explored. The current study aimed to (1) investigate reasons for dropout from a guided internet-based transdiagnostic individually-tailored intervention for college students assessed in a randomized controlled trial (RCT) and (2) evaluate whether participants used tailoring features intended for their baseline symptoms. A sample of college students with mild to moderate depression and/or anxiety symptoms (n = 48) in the Netherlands (partially) followed a guided internet-based transdiagnostic individually-tailored intervention. We contacted those who did not complete the entire intervention (n = 29) by phone to report the reasons for intervention dropout. Further, we descriptively explored the use of tailoring features (i.e., depression versus anxiety trajectory) and optional modules of the intervention in the whole sample. We identified a range of person- and intervention-related reasons for intervention dropout, most commonly busy schedules, needs for different kinds of help, or absence of personal contact. Furthermore, only less than half of the participants used the individually-tailoring features to address the symptoms they reported as predominant. In conclusion, digital interventions clear about the content and targeted symptoms, tested in user research could prevent dropout and create reasonable expectations of the intervention. Participants would benefit from additional guidance when using tailoring features of digital interventions, as they often do not choose the tailoring features targeting their baseline symptoms.

A Study to Assess Indian Patients' Expectations of Check-Up and Diagnosis or Discussion about Treatment at their Initial Orthodontic Visit.

To access the patient's expectations of orthodontic treatment at the first visit. Three hundred new patients to the orthodontics department were included in the analysis. Their demographic details and their opinions on what they hoped to gain from orthodontic treatment were gleaned from their replies to a well-crafted questionnaire. Most respondents were more concerned with the cosmetic results of orthodontic treatment than they were with the therapy's practical benefits. They hoped that after having their teeth straightened, they would feel more comfortable interacting with others and have a better overall appearance. In terms of improving one's job and making one's speaking simpler, the mean scores were the lowest. The female participants averaged higher marks than the male participants across all areas studied, with the greatest mark coming in the area of improved smiles. An effective outcome from orthodontic therapy requires full patient participation. Before beginning treatment, it is important for the orthodontist and patient to have an agreement on the patient's reasonable expectations for the therapy's outcomes.

Perspective: Performance Loss Rate in Photovoltaic Systems

Photovoltaic systems may underperform expectations for several reasons, including inaccurate initial estimates, suboptimal operations and maintenance, or component degradation. Accurate assessment of these loss factors aids in addressing root causes of underperformance and in realizing accurate expectations and models. The performance loss rate (PLR) is a commonly cited high‐level metric for the change in system output over time, but there is no precise, standard definition. Herein, an annualized definition of PLR that is inclusive of all loss factors and that can capture nonlinear changes to performance over time is proposed. The importance of distinguishing between recoverable and nonrecoverable losses which underly PLR is highlighted.

The wrong of mercenarism: a promissory account

The wrong of mercenarism: a promissory account

‘Surely a little discretion isn’t too difficult’? The discursive construction of discretion in users’ comments on UK newspaper articles about public breastfeeding

Objective This paper explores how discourses of discretion are constructed in online discussions about breastfeeding in public. Method and Measures We analysed 4204 online newspaper comment threads from 15 UK-based publications using Discursive Psychology. We explored how discretion was constructed and mobilised to facilitate discourses of breastfeeding in public. Results Indiscretion was used to construct dispositional traits of mothers typically associated with sexualised, immoral female behaviour and therefore incompatible with ‘good’ motherhood. Responsibility for preventing public upset was placed on breastfeeding mothers, whilst discretion was constructed as easily achievable, and therefore a reasonable expectation. By implication, women who chose not to be discreet, were constructed as deliberately provocative, and so not entitled to claim or protest negative treatment. Notably, within our data the relevance of discretion when breastfeeding in public appeared discursively difficult to reject or challenge. Conclusion Our findings confirm empirically that support for public breastfeeding is constructed as contingent on mothers displaying discretion. Our analysis highlights the challenges for mothers and babies for whom breastfeeding is compromised by an unwillingness to feed in public, perhaps due to pervasive constructions of breastfeeding women as selfish, exhibitionist, inconsiderate and unfit mothers in public discourse. Finally, our findings demonstrate the practical accomplishment in everyday life of the type of constructions of breastfeeding women that have been powerfully conceptualised by previous researchers.

Real-World User and Clinician Perspective and Experience with MiniMed™ 780G Advanced Hybrid Closed Loop System.

The advanced hybrid closed loop (AHCL) MiniMed™ 780G system changes basal insulin delivery every 5min and auto bolus in response to sensor glucose values. We assessed the performance of the AHCL system in real-world settings for individuals with type 1 diabetes (T1DM) as well as user and clinician perspectives and satisfaction. We held two peer group discussions: one having adults with T1DM/parents of children and adolescents with T1DM to understand their experiences with the AHCL system and another with healthcare providers (HCPs). Responses from the discussions were analyzed and categorized into themes by two independent researchers, with any inconsistencies resolved by consensus. We also analyzed data from the system uploaded to CareLink personal software. Glycemic outcomes, including time in range (TIR), time below range (TBR), time above range (TAR), mean sensor glucose (SG) levels, glucose management indicator (GMI), sensor use, and percentage of time spent in AHCL, were determined. The peer group discussions revealed numerous key themes and issues for each group, such as the significance of setting reasonable expectations, carbohydrate counting and bolus dosing, technical difficulties, and overall user experience. The users (n = 25; T1DM; 17 female; age 13.8 ± 7.49years; A1C 6.54 ± 0.45%; duration of diabetes 6 ± 6.78years) were very satisfied with the system. Most users experienced consistent blood glucose values with very few hypoglycemic episodes. However, there were a few limitations reported, such as hyperglycemic episodes caused by inaccuracies in carb counting, issues with sensor connectivity, and cannula blockages or kinking for those using insulin Fiasp. Users achieved a mean GMI of 6.4 ± 0.26%, TIR of 83.0 ± 8.12%, TBR (54-70mg/dL) of 2.0 ± 0.81%, TBR* (< 54mg/dL) of 0%. All of the users achieved a TIR of > 70%. The use of the AHCL system in T1DM resulted in robust glycemic control, minimizing hypoglycemia. Providing training to both users and HCPs can help them use the system effectively.

I am not aging soulfully

ABSTRACT The author protests lofty criteria for soulful aging, basing his argument on the centrality of hope, defined as maintaining the balance between presumption and despair. Lofty criteria are presumptuous and a sense of failure to meet them can promote despair. Hope is predicated on reasonable expectations, and challenges inherent in aging call for discerning expectations. One might hope for a “good-enough” life of aging, a criterion that provides ample latitude.

Fixing Reasonable Expectations in European Contract Law

Abstract The reasonable expectations standard permeates European contract law. An influential objection against reasonable expectations, related to it being formulated as a standard, is its apparent vagueness: it does not sufficiently specify its criteria, and is thus redundant in providing guidance for individuals’ behaviour. This article argues that European contract law clarifies the content of reasonable expectations by identifying different grounds for them – mandatory rules, action-based rules, default rules, indicative rules, industry-related rules and (unregulated) practices – and establishing a relatively structured hierarchy between them. For this reason, the standard of reasonable expectations contributes to effective guidance for the behaviour of subjects of European contract law.

Delivering written peer support as a patient resource during hematopoietic stem cell transplant: Pros, cons, and clinician feedback on a new website.

e24215 Background: We developed a website that allows hematologic cancer patients undergoing stem cell transplant (SCT) to access a searchable, filterable database of peer support narratives—written first-hand accounts of SCT experiences and advice created by SCT survivors. The website, called Mosaic (Mosaico in Spanish), pairs the narratives with resources informed by patients, clinicians, and behavioral scientists including psychoeducation, support for patient-provider communication, and stress management and coping resources. This presentation will describe feedback about Mosaic from interviews with SCT clinicians and discuss pros and cons of delivering peer support in written form. Methods: We conducted semi-structured interviews with 13 SCT clinicians (3 oncologists, 3 nurse practitioners, 3 social workers, 3 registered nurses, 1 physician assistant; 92% women; 53.8% white). After describing Mosaic’s content and features, we asked for feedback on Mosaic’s potential benefits, harms, and recommended changes. Interviews were audio recorded, transcribed, and content analyzed by trained coders. Results: All clinicians noted potential benefits of Mosaic. Some focused on novel informational benefits (e.g., getting “the real patient experience,” giving patients “a sense of less isolation”). Others liked that Mosaic could help patients develop reasonable expectations of SCT, including things that can go wrong. A few clinicians liked features designed to meet patients’ differing needs (e.g., “they can filter out what they [don’t] want”). Overall, there was enthusiasm for Mosaic as a patient resource. Yet, all clinicians also mentioned at least one concern. Several wanted to see Mosaic’s full content before recommending it to patients. Others wanted evidence showing Mosaic’s benefits. A more frequent concern about misinformation suggested the need to edit narratives to remove medical advice and identifiable information. Some clinicians were concerned that patients might inappropriately worry about medical risks and complications described in narratives, although others felt that Mosaic’s disclaimers and other features mitigated this concern. Some recommendations for Mosaic addressed this concern (e.g., clearly disclosing that “it’s not medical advice” and that their SCT “experience may be completely different”). Other recommendations included a need for disclosures to help patients make an informed decision about using Mosaic and the need to monitor for adverse events such as distress. A recommended new feature included grouping narratives by year of SCT due to changing treatments. Conclusions: SCT clinicians felt Mosaic could provide important emotional and informational benefits. Their concerns and recommendations will be used to refine Mosaic to optimize safety and potential benefits in preparation for a clinical efficacy trial.

Exploration of the feasibility of steering wheelless cars based on Robotaxi operation data

With the development of autonomous driving technology, higher-level autonomous driving is hopeful to be applied in vehicles, and drivers control of the car will also be replaced by intelligent algorithms. At the same time, a question has been raised as to whether the traditional steering wheel can be replaced when advanced autonomous driving becomes commonplace. To this end, a survey on steering wheelless cars was conducted to explore the feasibility of autonomous vehicles without the steering wheel. As a result, the operational data of Waymo and Apollo, two Robotaxi (a self-driving car operated by a ridesharing company) companies in the United States and China, is analyzed. The results show that at this stage, autonomous driving cannot fully control the car, and the driver still needs to take over the vehicle in complex situations. Of course, according to the data, Miles per Intervention (MPI) is gradually rising and is expected to reach a reasonable expectation, so steering wheelless cars still have a certain feasibility in the future.

Strengths and Struggles among High Academic Achievers in Senior High School: A Philippine Setting

The purpose of this qualitative research project is to investigate the strengths and weaknesses among high academic achievers faced in their senior high school years. In-depth interviews are used in the study to collect rich, nuanced material, which is then thematically evaluated to find major themes. Expectation and Pressure from Others, Losing Interest, "Procrastination and Cramming", Distractions, and Family Pressure are the five issues that the research focuses on. The results show that high academic achievers experience tremendous external pressure from peers, teachers, and parents, which can cause stress and anxiety. Academic burnout is evident since some individuals also express a progressive loss of enthusiasm and love for their study. When used to handle workload and pressure, unhealthy coping techniques like procrastination and cramming have a negative effect on learning outcomes. Academic performance is further hampered by personal interests and technological distractions. Additionally, family pressure has a significant impact on how students experience school, highlighting the need of setting reasonable expectations and maintaining open lines of communication. The study comes to the conclusion that high achievers in senior high school require specialized assistance and interventions. It's crucial to establish a welcoming workplace that values individual goals, encourages intrinsic drive, and supports a good work-life balance. Time management abilities, study habits, and stress management strategies should all be covered in interventions. Concentration and productivity can be improved by reducing distractions and encouraging focused study time. To combat family pressure and create a healthier family dynamic, it is essential that parents, students, and educators have open communication with one another. Hence, this study adds to our understanding of the difficulties high academic achievers in senior high school confront and offers insightful information for legislators, parents, and teachers. Stakeholders may establish an atmosphere that supports the well-being, engagement, and academic success of high achievers by recognizing and resolving these problems, eventually supporting their holistic development and future successes.