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Abstract Objective Evaluate the oncologic outcomes and cost analysis of transitioning to a specimen oriented intraoperative margin assessment protocol from a tumour bed sampling protocol in oral cavity (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC). Study design Retrospective case series and subsequent prospective cohort study Setting Tertiary care academic teaching hospital Subjects and methods Retrospective case series of all institutional T1-T2 OCSCC or OPSCC treated with primary surgery between January 1st 2009 – December 31st 2014. Kaplan-Meier survival estimates with log rank tests were used to compare patients based on final margin status. Cost analysis was performed for escalation of therapy due to positive final margins. Following introduction of a specimen derived margin protocol, successive prospective cohort study of T1-T4 OCSCC or OPSCC treated with primary surgery from January 1st 2017 – December 31st 2018. Analysis and comparison of both protocols included review of intraoperative margins, final pathology and treatment cost. Results Analysis of our intra-operative tumour bed frozen section protocol revealed 15 of 116 (12.9%) patients had positive final pathology margins, resulting in post-operative escalation of therapy for 14/15 patients in the form of re-resection (7/14), radiation therapy (6/14) and chemoradiotherapy (1/14). One other patient with positive final margins received escalated therapy for additional negative prognostic factors. Recurrence free survival at 3 years was 88.4 and 50.7% for negative and positive final margins respectively (p = 0.048). Implementation of a specimen oriented frozen section protocol resulted in 1 of 111 patients (0.9%) having positive final pathology margins, a statistically significant decrease (p

Abstract Background Health care delivery and outcomes can be improved by using innovations (i.e., new ideas, technologies, and practices) supported by scientific evidence. However, scientific evidence may not be the foremost factor in adoption decisions and is rarely sufficient. The objective of this study was to examine the role of scientific evidence in decisions to adopt complex innovations in cancer care. Methods Using an explanatory, multiple case study design, we examined the adoption of complex innovations in five purposively sampled cases in Nova Scotia, Canada. Data were collected via documents and key informant interviews. Data analysis involved an in-depth analysis of each case, followed by a cross-case analysis to develop theoretically informed, generalizable knowledge on the role of scientific evidence in innovation adoption that may be applied to similar settings and contexts. Results The analyses identified key concepts alongside important caveats and considerations. Key concepts were (1) scientific evidence underpinned the adoption process, (2) evidence from multiple sources informed decision-making, (3) decision-makers considered three key issues when making decisions, and (4) champions were essential to eventual adoption. Caveats and considerations related to the presence of urgent problems and short-term financial pressures and minimizing risk. Conclusions The findings revealed the different types of issues decision-makers consider while making these decisions and why different sources of evidence are needed in these processes. Future research should examine how different types of evidence are legitimized and why some types are prioritized over others.

The Banff classification was introduced to achieve uniformity in the assessment of renal allograft biopsies. The primary aim of this study was to evaluate the impact of specimen adequacy on the Banff classification. All renal allograft biopsies obtained between July 2010 and June 2012 for suspicion of acute rejection were included. Pre-biopsy clinical data on suspected diagnosis and time from renal transplantation were provided to a nephropathologist who was blinded to the original pathological report. Second pathological readings were compared with the original to assess agreement stratified by specimen adequacy. Cohen's kappa test and Fisher's exact test were used for statistical analyses. Forty-nine specimens were reviewed. Among these specimens, 81.6% were classified as adequate, 6.12% as minimal, and 12.24% as unsatisfactory. The agreement analysis among the first and second readings revealed a kappa value of 0.97. Full agreement between readings was found in 75% of the adequate specimens, 66.7 and 50% for minimal and unsatisfactory specimens, respectively. There was no agreement between readings in 5% of the adequate specimens and 16.7% of the unsatisfactory specimens. For the entire sample full agreement was found in 71.4%, partial agreement in 20.4% and no agreement in 8.2% of the specimens. Statistical analysis using Fisher's exact test yielded a P value above 0.25 showing that - probably due to small sample size - the results were not statistically significant. Specimen adequacy may be a determinant of a diagnostic agreement in renal allograft specimen assessment. While additional studies including larger case numbers are required to further delineate the impact of specimen adequacy on the reliability of histopathological assessments, specimen quality must be considered during clinical decision making while dealing with biopsy reports based on minimal or unsatisfactory specimens.

Maintenance decision making becomes more and more a management concern. Some decades ago, maintenance was still often considered as an unavoidable side effect of production. The perception of maintenance has evolved considerably. One of the current issues is the maintenance concept, being the mix of maintenance interventions and the general framework for determining this mix. In this paper we describe a modular framework, called Knowledge Based Maintenance, for developing a customised maintenance concept. After describing the general framework and its decision support use, some case experiences are given. This experience covers some elements of the proposed framework.

Electrochemical characterization of positively and negatively charged membranes is performed by analyzing membrane potential values on the basis of the Teorell-Meyer-Sievers (TMS) model. This analysis allows the separate estimation of Donnan (interfacial effects) and diffusion (differences in ions transport through the membrane) contributions, and it permits the evaluation of the membrane's effective fixed charge concentration and the transport number of the ions in the membrane. Typical ion-exchange commercial membranes (AMX, Ionics or Nafion) are analyzed, though other experimental and commercial membranes, which are derived from different materials and have diverse structures (dense, swollen or nanoporous structures), are also considered. Moreover, for some membranes, changes associated with different modifications and other effects (concentration gradient or level, solution stirring, etc.) are also analyzed.

A highly hydrophilic planar membrane fabricated with regenerated cellulose (RC-4 membrane), a biocompatible polymer, was modified by inclusion of water-soluble silicon quantum dot nanoparticles (SiQDs). Both bare SiQDs and SiQDs coated with a PAMAM-OH dendrimer were employed in order to obtain luminescent and thermally stable membrane systems (RC-4/SiQDs and RC-4/SiQDs-PAMAM-OH membranes). Original and SiQDs-modified membranes were characterized by fluorescence spectroscopy (steady and confocal), derivative thermogravimetric analysis and impedance spectroscopy measurements. According to these results, both SiQDs-regenerated cellulose composite membranes present luminescent character as well as higher thermal resistance and conductivity than the original sample, although the dendrimer coverage of the SiQDs might partially shield such effects. Moreover, the permanence of SiQDs nanoparticles in the structure of the cellulosic support in aqueous environments and their effect on diffusive transport were determined by water uptake as well as by membrane potential measurements at different concentrations of a model electrolyte (KCl). These results demonstrate the possible use of these stable nano-engineered membranes, which are based on SiQDs nanoparticles, in electrochemical devices under flow conditions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)