Complete cytogenetic response and major molecular response as surrogate outcomes for overall survival in first-line treatment of chronic myelogenous leukemia: A case study for technology appraisal on the basis of surrogate outcomes evidence

Objectives In 2012, the National Institute for Health and Care Excellence assessed dasatinib, nilotinib, and standard-dose imatinib as first-line treatment of chronic phase chronic myelogenous leukemia (CML). Licensing of these alternative treatments was based on randomized controlled trials assessing complete cytogenetic response (CCyR) and major molecular response (MMR) at 12 months as primary end points. We use this case study to illustrate the validation of CCyR and MMR as surrogate outcomes for overall survival in CML and how this evidence was used to inform National Institute for Health and Care Excellence’s recommendation on the public funding of these first-line treatments for CML. Methods We undertook a systematic review and meta-analysis to quantify the association between CCyR and MMR at 12 months and overall survival in patients with chronic phase CML. We estimated life expectancy by extrapolating long-term survival from the weighted overall survival stratified according to the achievement of CCyR and MMR. Results Five studies provided data on the observational association between CCyR or MMR and overall survival. Based on the pooled association between CCyR and MMR and overall survival, our modeling showed comparable predicted mean duration of survival (21–23 years) following first-line treatment with imatinib, dasatinib, or nilotinib. Conclusions This case study illustrates the consideration of surrogate outcome evidence in health technology assessment. Although it is often recommended that the acceptance of surrogate outcomes be based on randomized controlled trial data demonstrating an association between the treatment effect on both the surrogate outcome and the final outcome, this case study shows that policymakers may be willing to accept a lower level of evidence (i.e., observational association).

The sublime, affective process + architectural production

A year before Kate Nesbitt’s Theorising a New Agenda For Architecture (1996), the author penned a chapter on the significance of the sublime and its contribution to post-modern architecture via the uncanny or disturbing through the theories of Vidler and Eisenman (Nesbit, 1995). Twenty years on, we see its ongoing presence within the contemporary works of artists Kapoor, Ellison and Viola. Eisenmann and Libeskind aside, explicit reference to the Sublime whether through architectural praxis or theory appears to have been trumped by ecological derivatives and associated transactions, as catalyst for new architecture and architectural thinking. For Edmund Burke (1757), the Sublime was seen as a leading, an overpowering of self to a state of intense self-presence, often leading to a state of otherness. To experience the sublime is to experience affect, physiologically overwhelming the mental faculties through intensities of astonishment, terror, obscurity, magnificence, and reverence. Key here is Burke’s articulation of the stages of the sublime encounter, particularly so, its implications for the process of production which architectural theorists appear to have overstepped in their valorisation of the sublime object. This paper seeks to resituate the sublime within the context of architectural production. Through concepts such as material thinking, bodies and making strange, the paper explores a shift in focus toward affective processes traced from Burke’s inquiry. Rather than proposing strategies solely for affect within the work itself, the focus lies upon the designing experience, where blockage and desirous forces are critical partners in the process of production, as revealed through recent studio programs entitled Strange Space.

An operational-level multi-stage mine production timetabling model for optimally synchronising drilling, blasting and excavating operations

This paper proposes a new multi-stage mine production timetabling (MMPT) model to optimise open-pit mine production operations including drilling, blasting and excavating under real-time mining constraints. The MMPT problem is formulated as a mixed integer programming model and can be optimally solved for small-size MMPT instances by IBM ILOG-CPLEX. Due to NP-hardness, an improved shifting-bottleneck-procedure algorithm based on the extended disjunctive graph is developed to solve large-size MMPT instances in an effective and efficient way. Extensive computational experiments are presented to validate the proposed algorithm that is able to efficiently obtain the near-optimal operational timetable of mining equipment units. The advantages are indicated by sensitivity analysis under various real-life scenarios. The proposed MMPT methodology is promising to be implemented as a tool for mining industry because it is straightforwardly modelled as a standard scheduling model, efficiently solved by the heuristic algorithm, and flexibly expanded by adopting additional industrial constraints.

Effects of glycerol on enzymatic hydrolysis and ethanol production using sugarcane bagasse pretreated by acidified glycerol solution

In this study, for the first time the effects of glycerol on enzymatic hydrolysis and ethanol fermentation were investigated. Enzymatic hydrolysis was inhibited slightly with 2.0 wt% glycerol, leading to reduction in glucan digestibility from 84.9% without glycerol to 82.9% (72 h). With 5.0 wt% and 10.0 wt% glycerol, glucan digestibility reduced by 4.5% and11.0%, respectively. However, glycerol appeared not detrimental to cellulase enzymes. Ethanol fermentation was not affected with glycerol up to 5.0 wt%, and was inhibited slightly with 10.0 wt% glycerol, which resulted in reduction in ethanol yield from 86.0% without glycerol to 83.7% (20 h). Based on laboratory and pilot scale enzymatic hydrolysis and ethanol production results, it was estimated that 0.142 kg ethanol could be produced from 1.0 kg dry bagasse (a glucan content of 38.0%) after pretreatment with acidified glycerol solution.

Evaluation of oil production from oil palm empty fruit bunch by oleaginous micro-organisms

Oil palm empty fruit bunch (EFB) is a readily available, lignocellulosic biomass that has potential to be utilized as a carbon substrate for microbial oil production. In order to evaluate the production of microbial oil from EFB, a technical study was performed through the cultivation of oleaginous micro-organisms (Rhodotorula mucilaginosa, Aspergillus oryzae, and Mucor plumbeus) on EFB hydrolyzates. EFB hydrolyzates were prepared through dilute acid pre-treatment of the biomass, where the liquid fraction of pre-treatment was detoxified and used as an EFB liquid hydrolyzate (EFBLH). The solid residue was enzymatically hydrolyzed prior to be used as an EFB enzymatic hydrolyzate (EFBEH). The highest oil concentrations were obtained from M. plumbeus (1.9 g/L of oil on EFBLH and 4.7 g/L of oil on EFBEH). In order to evaluate the feasibility of large-scale microbial oil production, a techno-economic study was performed based on the oil yields of M. plumbeus per hectare of plantation, followed by the estimation of the feedstock cost for oil production. Other oil palm biomasses (frond and trunk) were also included in this study, as it could potentially improve the economics of large-scale microbial oil production. Microbial oil from oil palm biomasses was estimated to potentially increase oil production in the palm oil industry up to 25%, at a cheaper feedstock cost. The outcome of this study demonstrates the potential integration of microbial oil production from oil palm biomasses with existing palm oil industry (biodiesel, food and oleochemicals production), that could potentially enhance sustainability and profitability of microbial oil production.

Microbial oil production from sugarcane bagasse hydrolysates by oleaginous yeast and filamentous fungi

This study investigated the potential use of sugarcane bagasse as a feedstock for oil production through microbial cultivation. Bagasse was subjected to dilute acid pretreatment with 0.4 wt% H2SO4 (in liquid) at a solid/liquid ratio of 1:6 (wt/wt) at 170 °C for 15 min, followed by enzymatic hydrolysis of solid residue. The liquid fractions of the pretreatment process and the enzymatic hydrolysis process were detoxified and used as liquid hydrolysate (SCBLH) and enzymatic hydrolysate (SCBEH) for the microbial oil production by oleaginous yeast (Rhodotorula mucilaginosa) and filamentous fungi (Aspergillus oryzae and Mucor plumbeus). The results showed that all strains were able to grow and produce oil from bagasse hydrolysates. The highest oil concentrations produced from bagasse hydrolysates were by M. plumbeus at 1.59 g/L (SCBLH) and 4.74 g/L (SCBEH). The microbial oils obtained have similar fatty acid compositions to vegetable oils, indicating that the oil can be used for the production of second generation biodiesel. On the basis of oil yields obtained by M. plumbeus, from 10 million t (wet weight) of bagasse generated annually from sugar mills in Australia, it is estimated that the total biodiesel that could be produced would be equivalent to about 9% of Queensland’s diesel consumption.