This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

This study investigated the feasibility of quantitative accuracy and harmonized image quality in 89 Zr-PET/CT multicenter studies. Methods: Five PET/CT scanners from 3 vendors were included. 89 Zr activity was measured in a central dose calibrator before delivery. Local activity assays were based on volume as well as on the local dose calibrator. Accuracy and image noise were determined from a cross calibration experiment. Image quality was assessed from recovery coefficients derived from different volume-of-interest (VOI) methods (VOI A50% , based on a 3-dimensional isocontour at 50% of the maximum voxel value with local background correction; VOI Max , based on the voxel with the highest uptake; and VOI 3Dpeak , based on a spheric VOI of 1.2-cm diameter positioned so as to maximize the enclosed average). PET images were analyzed before and after postreconstruction smoothing, applied to match image noise. Results: PET/CT accuracy and image noise ranged from 23% to 10% and from 13% to 22%, respectively. VOI 3Dpeak produced the most reproducible recovery coefficients. After calibration of the local dose calibrator to the central dose calibrator, differences between the local activity assays were within 6%. Conclusion: This study showed that quantitative accuracy and harmonized image quality can be reached in 89 Zr PET/CT multicenter studies. PET using labeled monoclonal antibodies, also known as immuno-PET, shows promise as a tool to predict the outcome of cancer treatment based on monoclonal antibodies (1). Their kinetics dictate the need for a positron label with a long half-life. An ideal radionuclide is 89 Zr (half-life, 78.41 h) because its physical half-life matches the biologic half-life of most antibodies. Additionally, it can easily and stably be coupled to monoclonal antibodies (2). To date, all 89 Zr-monoclonal antibody PET/CT studies that have been reported were performed within a single center (3-5). More recently, several multicenter studies have been initiated. Multicenter studies with 18 F-labeled tracers have shown the need for standardization of image acquisition, reconstruction, and analysis procedures, such as outlined in the European Association of Nuclear Medicine guidelines for tumor imaging (6) and implemented in the form of an accreditation (EANM Research Ltd.[EARL]). For 89 Zr, there are several additional factors that need to be considered: nonprompt emission of 909-keV g rays after each positron emission may influence cross calibration between the local dose calibrator and the PET/CT camera, and low counting rates (due to both low positron abundance and low injected activity) may potentially lead to poorer image quality. The aim of this study was therefore to investigate the feasibility of quantitative accuracy and harmonized image quality in 89 Zr-PET/CT multicenter studies. MATERIALS AND METHODS ScannersThree Gemini TF PET/CT scanners (Philips Healthcare) (7), a Biograph mCT PET/CT scanner (Siemens Medical Solutions) (8), and a Discovery-690 PET/CT scanner (GE Healthcare) (9) were us...

All three phantoms may be used to harmonize parameters for data acquisition, processing and analysis. However, the SNM-CTN and EANM/NEMA phantoms are the most sensitive to parameter changes and are suitable for harmonizing SUV quantification based on 3D VOIs, such as VOI(A50%) and VOI(3Dpeak), and VOImax. Variability in SUV quantification after harmonization could be further minimized using VOI(3Dpeak) analysis, which was least sensitive to residual variability in image quality and quantification.

This paper summarizes research on how cognizance, that is, awareness of mental processes, interacts with executive control and reasoning from childhood to adolescence. Central positions are that (a) cognizance changes extensively with age; (b) it contributes to the formation of executive control, and (c) mediates between executive control and reasoning. Cognizance recycles with changes in executive and inferential possibilities in four developmental cycles: it registers their present state, yielding insight into their operation, allowing their better management; this catalyzes their transformation into the next level. Implications for theory of intellectual development and practical implications for education are discussed. This article is categorized under: Psychology > Development and Aging Neuroscience > Cognition Neuroscience > Development Philosophy > Consciousness.

We present a theory of mental architecture and development focusing on general intelligence (g). The theory integrates psychometric and developmental theories of intelligence into an overarching framework. The paper first focuses on the composition of g. It is shown that g involves attention control, flexibility, working memory, cognizance of mental processes, and inference. We then present a model of intellectual development involving four cycles - episodic, realistic representation-based, rule-based, and principle-based thought - and summarize several studies showing how the processes involved in g interact in each cycle. We then present research aiming to increase intelligence. Finally, we discuss the implications of this theory for psychometric, cognitive, and developmental science and show how it solves long-standing theoretical and practical problems not solved by other theories, such as the decreasing likelihood of attaining high intelligence, the differentiation of abilities with development, and the training fade-out problem.