The value of innovation:the interaction of competition, R&D and IP

This paper analyses market valuations of UK companies using a new data set of their R&D and IP activities (1989–2002). In contrast to previous studies, the analysis is conducted at the sectoral-level, where the sectors are based on the technological classification originating from Pavitt [Pavitt, K., 1984. Sectoral patterns of technical change. Research Policy 13, 343–373]. The first main result is that the valuation of R&D varies substantially across these sectors. Another important result is that, on average, firms that receive only UK patents tend to have no significant market premium. In direct contrast, patenting through the European Patent Office does raise market value, as does the registration of trade marks in the UK for most sectors. To explore these variations the paper links competitive conditions with the market valuation of innovation. Using profit persistence as a measure of competitive pressure, we find that the sectors that are the most competitive have the lowest market valuation of R&D. Furthermore, within the most competitive sector (‘science based’ manufacturing), firms with larger market shares (an inverse indicator of competitive pressure) also have higher R&D valuations, as well as some positive return to UK patents. We conclude that this evidence supports Schumpeter by finding higher returns to innovation in less than fully competitive markets and contradicts Arrow [Arrow, K., 1962. Economic welfare and the allocation of resources for invention. In: Nelson, R. (Ed.), The Rate and Direction of Inventive Activity. Princeton University Press, Princeton], who argued that, with the existence of IP rights, competitive market structure provides higher incentives to innovate.

Developing actions to minimise avoidable waste and its challenge to plant safety

Purpose: Considering the UK's limited capacity for waste disposal (particularly for hazardous/radiological waste) there is growing focus on waste avoidance and minimisation to lower the volumes of waste being sent to disposal. The hazardous nature of some waste can complicate its management and reduction. To address this problem there was a need for a decision making methodology to support managers in the nuclear industry as they identify ways to reduce the production of avoidable hazardous waste. The methodology we developed is called Waste And Sourcematter Analysis (WASAN). A methodology that begins the thought process at the pre-waste creation stage (i.e. Avoid). Design/methodology/ approach: The methodology analyses the source of waste, the production of waste inside the facility, the knock on effects from up/downstream facilities on waste production, and the down-selection of waste minimisation actions/options. WASAN has been applied to case studies with licencees and this paper reports on one such case study - the management of plastic bags in Enriched Uranium Residues Recovery Plant (EURRP) at Springfields (UK) where it was used to analyse the generation of radioactive plastic bag waste. Findings: Plastic bags are used in EURRP as a strategy to contain hazard. Double bagging of materials led to the proliferation of these bags as a waste. The paper reports on the philosophy behind WASAN, the application of the methodology to this problem, the results, and views from managers in EURRP. Originality/value: This paper presents WASAN as a novel methodology for analyzing the minimization of avoidable hazardous waste. This addresses an issue that is important to many industries e.g. where legislation enforces waste minimization, where waste disposal costs encourage waste avoidance, or where plant design can reduce waste. The paper forms part of the HSE Nuclear Installations Inspectorate's desire to work towards greater openness and transparency in its work and the development in its thinking.© Crown Copyright 2011.

The body matters: Understanding social differences in mental health

This doctoral dissertation illuminates the salience of body image to sociological investigations of mental health. It is argued that concerns over body-appearance evident in America embody a dimension of distress over the physical self that may be appropriately considered a mental health outcome, called body dysphoria. Using cross-sectional data on 1,183 young adults comprising Hispanic, African American, and non-Hispanic white males and females from varying social classes, a valid and reliable measure of body dysphoria is developed and demonstrated to be a distinct dimension of psychological distress. ^ From the standpoint of the sociology of mental health, the social distribution of body dysphoria makes known individual consequences of the stratified arrangements of society based on gender, race/ethnicity, and social class. Results reveal significant social differences in body dysphoria that are both consistent with and contrary to clinical studies attributing eating disorders to white, upper-class females. Body dysphoria is substantially greater among females supporting that unrealistic cultural ideals and standards of body-appearance remain disproportionately targeted at females in the development and presentation of self. Compared to non-Hispanic whites, Hispanics exhibit higher average levels of body dysphoria while African Americans exhibit lower levels of comparable proportion. The question is addressed whether identification with the dominant (white) culture influences distress over body-appearance among racial/ethnic minorities. A small inverse association is revealed between social class origin and body dysphoria suggesting that individuals from lower social class backgrounds are as greatly affected by body image concerns generally presumed to preoccupy upper social classes. ^ The stress process is a widely used theoretical paradigm for explaining structurally driven social differences in mental health outcomes. New evidence is introduced that the stress process may contribute to understanding body image problems. Regression analyses reveal that stress exposure has a significant positive association with body dysphoria that is mediated by varying psychosocial resources. Overall, the stress process explains the effects of social class origin and African American race/ethnicity on body dysphoria but does not account for the larger effects of being female or Hispanic. ^

Essays on international lending and increasing returns to scale

Standard economic theory suggests that capital should flow from rich countries to poor countries. However, capital has predominantly flowed to rich countries. The three essays in this dissertation attempt to explain this phenomenon. The first two essays suggest theoretical explanations for why capital has not flowed to the poor countries. The third essay empirically tests the theoretical explanations.^ The first essay examines the effects of increasing returns to scale on international lending and borrowing with moral hazard. Introducing increasing returns in a two-country general equilibrium model yields possible multiple equilibria and helps explain the possibility of capital flows from a poor to a rich country. I find that a borrowing country may need to borrow sufficient amounts internationally to reach a minimum investment threshold in order to invest domestically.^ The second essay examines how a poor country may invest in sectors with low productivity because of sovereign risk, and how collateral differences across sectors may exacerbate the problem. I model sovereign borrowing with a two-sector economy: one sector with increasing returns to scale (IRS) and one sector with diminishing returns to scale (DRS). Countries with incomes below a threshold will only invest in the DRS sector, and countries with incomes above a threshold will invest mostly in the IRS sector. The results help explain the existence of a bimodal world income distribution.^ The third essay empirically tests the explanations for why capital has not flowed from the rich to the poor countries, with a focus on institutions and initial capital. I find that institutional variables are a very important factor, but in contrast to other studies, I show that institutions do not account for the Lucas Paradox. Evidence of increasing returns still exists, even when controlling for institutions and other variables. In addition, I find that the determinants of capital flows may depend on whether a country is rich or poor.^

Contribution of lipophilic secondary metabolites to the toxicity of strains of freshwater cyanobacterial harmful algal blooms, identified using the zebrafish (Danio rerio) embryo as a model for vertebrate development

Cyanobacteria ("blue-green algae") are known to produce a diverse repertoire of biologically active secondary metabolites. When associated with so-called "harmful algal blooms", particularly in freshwater systems, a number of these metabolites have been associated—as "toxins", or commonly "cyanotoxins"—with human and animal health concerns. In addition to the known water-soluble toxins from these genera (i.e. microcystins, cylindrospermopsin, and saxitoxins), our studies have shown that there are metabolites within the lipophilic extracts of these strains that inhibit vertebrate development in zebrafish embryos. Following these studies, the zebrafish embryo model was implemented in the bioassay-guided purification of four isolates of cyanobacterial harmful algal blooms, namely Aphanizomenon, two isolates of Cylindrospermopsis, and Microcystis, in order to identify and chemically characterize the bioactive lipophilic metabolites in these isolates. ^ We have recently isolated a group of polymethoxy-1-alkenes (PMAs), as potential toxins, based on the bioactivity observed in the zebrafish embryos. Although PMAs have been previously isolated from diverse cyanobacteria, they have not previously been associated with relevant toxicity. These compounds seem to be widespread across the different genera of cyanobacteria, and, according to our studies, suggested to be derived from the polyketide biosynthetic pathway which is a common synthetic route for cyanobacterial and other algal toxins. Thus, it can be argued that these metabolites are perhaps important contributors to the toxicity of cyanobacterial blooms. In addition to the PMAs, a set of bioactive glycosidic carotenoids were also isolated because of their inhibition of zebrafish embryonic development. These pigmented organic molecules are found in many photosynthetic organisms, including cyanobacteria, and they have been largely associated with the prevention of photooxidative damage. This is the first indication of these compounds as toxic metabolites and the hypothesized mode of action is via their biotransformation to retinoids, some of which are known to be teratogenic. Additional fractions within all four isolates have been shown to contain other uncharacterized lipophilic toxic metabolites. This apparent repertoire of lipophilic compounds may contribute to the toxicity of these cyanobacterial harmful algal blooms, which were previously attributed primarily to the presence of the known water-soluble toxins.^

Hispanic orientalism: The literary development of a cultural paradigm, from medieval Spain to modern Latin America

This dissertation offers a novel approach to Hispanic Orientalism, developing a dynamic paradigm from its origins in medieval and Renaissance Iberia during the process of the Christian Reconquest, to its transatlantic migration and establishment in the early years of the Colony, from where it changed in late colonial and post-Independence Latin America, and onto modernity. ^ The study argues that Hispanic Orientalism does not necessarily imply a negative depiction of the Other, a quality associated with the traditional critique of Saidian Orientalism. Neither, does it entirely comply with the positivist approach suggested in the theoretical research of Said’s opponents, like Julia Kushigian. This dissertation also argues that sociopolitical changes and the shift in the discourse of powers, from imperial to non-imperial, had a significant impact of the development of Hispanic Orientalism, shaping the relationship with the Other. The methodology involves close reading of representative texts depicting the interactions of the dominant and dominated societies from each of the four historic periods that coincided with significant sociopolitical transformations in Hispanic society. Through an intercultural approach to literary studies, social history, and religious studies, this project develops an original paradigm of Hispanic Orientalism, derived from the image of the reinvented Semitic Other portrayed in the literary works depicting the relationship between the hegemonic and the subaltern cultures during the Reconquest period in Spain. Then, it traces the turn of the original paradigm towards reinterpretation during its transatlantic migration to Latin America through the analysis of the chronicles and travelogs of the first colonizers and explorers. During the transitional late colonial and early Independence periods Latin America sees a significant change in the discourse of powers, and Hispanic Orientalism reflects this oscillation between the past and the present therough the works of the Latin American authors from the seventeenth to the nineteenth centuries. Finally, once the non-imperial discourse of power established itself in the former Colony, a new modern stage in the development of Hispanic Orientalist paradigm takes place. It is marked by the desire to differentiate itself from the O(o)thers, as manifested in the works of the representatives of Modernism and the Boom.^

Morbidity and mortality following pelvic rami fractures in an elderly Newfoundland population

Introduction: Pelvic rami fractures in the elderly are associated with significant morbidity and mortality. Despite our rapidly aging population there is a paucity of literature dealing with fractures of the pelvic rami in this age group. The purpose of this study is report mortality rates following these injuries in the Eastern region of Newfoundland. Additionally, we aim to describe and quantify the important resultant morbidity in this vulnerable elderly population . Methods: A retrospective chart review was performed of all the pelvic fractures in individuals over the age of 60 between 2000 and 2005 in the Eastern Health region of Newfoundland and Labrador. From these patients, only those with the radiographic parameters consistent with low energy pattern pelvic ring injuries were included. Excluded from the study were those with concurrent fractures of the femur. Survival data, comorbidities, injury characteristics, hospital stay, ambulatory status, and place of residence were recorded from the chart. A surrogate control group was formulated from Statistics Canada survival data for use as a survival comparison group. Results: There were 80 fractures of the pelvis identified in patients over 60 years old from 2000-2005. Of these, 43 met our inclusion/exclusion criteria and were used in our analysis. The one and five year mortalities of these patients were 16.3% (95% CI; 7.80% to 30.3%) and 58.1% (95% CI; 43.3% to 71.6%), respectively. These were both significantly different from the point estimates from our constructed age and gender matched control group from the Statistics Canada data of 6.58% (one year mortality) and 31.3% (five year mortality). Morbidity was quantified by change in ambulatory status (independent, walker/cane assisted, wheelchair) and change in residential independence (independent, assisted living, nursing home). Post fracture, 36% of patients permanently required increased ambulatory aids and 21% of patients required a permanent increase in everyday level of care. Conclusion: This study suggests that there may be significantly increased mortality and morbidity following low energy pattern pelvic rami fractures in an elderly population compared to age and gender matched controls. In contrast to previous studies describing these injuries, there is greater homogeneity in this population with respect to age and mechanism of injury. This study generates several important hypotheses for future research and in particular highlights the need for larger prospective studies to identify factors predicting the highest risk for poor outcomes in this population.

Variability of the IFN-γ ELISpot assay in the context of proficiency testing and bridging studies.

Assays that assess cellular mediated immune responses performed under Good Clinical Laboratory Practice (GCLP) guidelines are required to provide specific and reproducible results. Defined validation procedures are required to establish the Standard Operating Procedure (SOP), include pass and fail criteria, as well as implement positivity criteria. However, little to no guidance is provided on how to perform longitudinal assessment of the key reagents utilized in the assay. Through the External Quality Assurance Program Oversight Laboratory (EQAPOL), an Interferon-gamma (IFN-γ) Enzyme-linked immunosorbent spot (ELISpot) assay proficiency testing program is administered. A limit of acceptable within site variability was estimated after six rounds of proficiency testing (PT). Previously, a PT send-out specific within site variability limit was calculated based on the dispersion (variance/mean) of the nine replicate wells of data. Now an overall 'dispersion limit' for the ELISpot PT program within site variability has been calculated as a dispersion of 3.3. The utility of this metric was assessed using a control sample to calculate the within (precision) and between (accuracy) experiment variability to determine if the dispersion limit could be applied to bridging studies (studies that assess lot-to-lot variations of key reagents) for comparing the accuracy of results with new lots to results with old lots. Finally, simulations were conducted to explore how this dispersion limit could provide guidance in the number of replicate wells needed for within and between experiment variability and the appropriate donor reactivity (number of antigen-specific cells) to be used for the evaluation of new reagents. Our bridging study simulations indicate using a minimum of six replicate wells of a control donor sample with reactivity of at least 150 spot forming cells per well is optimal. To determine significant lot-to-lot variations use the 3.3 dispersion limit for between and within experiment variability.

Associations between smoking behavior-related alleles and the risk of melanoma.

Several studies have reported that cigarette smoking is inversely associated with the risk of melanoma. This study further tested whether incorporating genetic factors will provide another level of evaluation of mechanisms underlying the association between smoking and risk of melanoma. We investigated the association between SNPs selected from genome-wide association studies (GWAS) on smoking behaviors and risk of melanoma using 2,298 melanoma cases and 6,654 controls. Among 16 SNPs, three (rs16969968 [A], rs1051730 [A] and rs2036534 [C] in the 15q25.1 region) reached significance for association with melanoma risk in men (0.01 < = P values < = 0.02; 0.85 < = Odds Ratios (ORs) <= 1.20). There was association between the genetic scores based on the number of smoking behavior-risk alleles and melanoma risk with P-trend = 0.005 among HPFS. Further association with smoking behaviors indicating those three SNPs (rs16969968 [A], rs1051730 [A] and rs2036534 [C]) significantly associated with number of cigarettes smoked per day, CPD, with P = 0.009, 0.011 and 0.001 respectively. The SNPs rs215605 in the PDE1C gene and rs6265 in the BDNF gene significantly interacted with smoking status on melanoma risk (interaction P = 0.005 and P = 0.003 respectively). Our study suggests that smoking behavior-related SNPs are likely to play a role in melanoma development and the potential public health importance of polymorphisms in the CHRNA5-A3-B4 gene cluster. Further larger studies are warranted to validate the findings.

Robust Uncertainty Quantification and Scalable Computation for Computer Models with Massive Output

Uncertainty quantification (UQ) is both an old and new concept. The current novelty lies in the interactions and synthesis of mathematical models, computer experiments, statistics, field/real experiments, and probability theory, with a particular emphasize on the large-scale simulations by computer models. The challenges not only come from the complication of scientific questions, but also from the size of the information. It is the focus in this thesis to provide statistical models that are scalable to massive data produced in computer experiments and real experiments, through fast and robust statistical inference.

Chapter 2 provides a practical approach for simultaneously emulating/approximating massive number of functions, with the application on hazard quantification of Soufri\`{e}re Hills volcano in Montserrate island. Chapter 3 discusses another problem with massive data, in which the number of observations of a function is large. An exact algorithm that is linear in time is developed for the problem of interpolation of Methylation levels. Chapter 4 and Chapter 5 are both about the robust inference of the models. Chapter 4 provides a new criteria robustness parameter estimation criteria and several ways of inference have been shown to satisfy such criteria. Chapter 5 develops a new prior that satisfies some more criteria and is thus proposed to use in practice.

Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery.

BACKGROUND: Postoperative delirium is prevalent in older patients and associated with worse outcomes. Recent data in animal studies demonstrate increases in inflammatory markers in plasma and cerebrospinal fluid (CSF) even after aseptic surgery, suggesting that inflammation of the central nervous system may be part of the pathogenesis of postoperative cognitive changes. We investigated the hypothesis that neuroinflammation was an important cause for postoperative delirium and cognitive dysfunction after major non-cardiac surgery. METHODS: After Institutional Review Board approval and informed consent, we recruited patients undergoing major knee surgery who received spinal anesthesia and femoral nerve block with intravenous sedation. All patients had an indwelling spinal catheter placed at the time of spinal anesthesia that was left in place for up to 24 h. Plasma and CSF samples were collected preoperatively and at 3, 6, and 18 h postoperatively. Cytokine levels were measured using ELISA and Luminex. Postoperative delirium was determined using the confusion assessment method, and cognitive dysfunction was measured using validated cognitive tests (word list, verbal fluency test, digit symbol test). RESULTS: Ten patients with complete datasets were included. One patient developed postoperative delirium, and six patients developed postoperative cognitive dysfunction. Postoperatively, at different time points, statistically significant changes compared to baseline were present in IL-5, IL-6, I-8, IL-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, IL-6/IL-10, and receptor for advanced glycation end products in plasma and in IFN-γ, IL-6, IL-8, IL-10, MCP-1, MIP-1α, MIP-1β, IL-8/IL-10, and TNF-α in CSF. CONCLUSIONS: Substantial pro- and anti-inflammatory activity in the central neural system after surgery was found. If confirmed by larger studies, persistent changes in cytokine levels may serve as biomarkers for novel clinical trials.

Hispanic Orientalism: The Literary Development of a Cultural Paradigm, from Medieval Spain to Modern Latin America

This dissertation offers a novel approach to Hispanic Orientalism, developing a dynamic paradigm from its origins in medieval and Renaissance Iberia during the process of the Christian Reconquest, to its transatlantic migration and establishment in the early years of the Colony, from where it changed in late colonial and post-Independence Latin America, and onto modernity. The study argues that Hispanic Orientalism does not necessarily imply a negative depiction of the Other, a quality associated with the traditional critique of Saidian Orientalism. Neither, does it entirely comply with the positivist approach suggested in the theoretical research of Said’s opponents, like Julia Kushigian. This dissertation also argues that sociopolitical changes and the shift in the discourse of powers, from imperial to non-imperial, had a significant impact of the development of Hispanic Orientalism, shaping the relationship with the Other. The methodology involves close reading of representative texts depicting the interactions of the dominant and dominated societies from each of the four historic periods that coincided with significant sociopolitical transformations in Hispanic society. Through an intercultural approach to literary studies, social history, and religious studies, this project develops an original paradigm of Hispanic Orientalism, derived from the image of the reinvented Semitic Other portrayed in the literary works depicting the relationship between the hegemonic and the subaltern cultures during the Reconquest period in Spain. Then, it traces the turn of the original paradigm towards reinterpretation during its transatlantic migration to Latin America through the analysis of the chronicles and travelogs of the first colonizers and explorers. During the transitional late colonial and early Independence periods Latin America sees a significant change in the discourse of powers, and Hispanic Orientalism reflects this oscillation between the past and the present therough the works of the Latin American authors from the seventeenth to the nineteenth centuries. Finally, once the non-imperial discourse of power established itself in the former Colony, a new modern stage in the development of Hispanic Orientalist paradigm takes place. It is marked by the desire to differentiate itself from the O(o)thers, as manifested in the works of the representatives of Modernism and the Boom.

Methane concentrations and methane oxidation rates from June 2012 - June 2013 in the Elbe Estuary, from Hamburg to Cuxhaven, Germany

Rivers represent a transition zone between terrestric and aquatic environments, and between methane rich and methane poor environments. The Elbe River is one of the important rivers draining into the North Sea and with the Elbe potentially high amounts of methane could be imported into the water column of the North Sea. Twelve cruises from October 2010 until June 2013 were conducted from Hamburg towards the Elbe mouth at Cuxhaven. The dynamic of methane concentration in the water column and its consumption via methane oxidation was measured. In addition, physico-chemical parameters were used to estimate their influence on the methanotrophic activity. We observed high methane concentrations at the stations in the area of Hamburg harbor ("inner estuary") and about 10 times lower concentrations in the outer estuary (median of 416 versus 40 nmol/L). The methane oxidation (MOX) rate mirrowed the methane distribution with high values in the inner estuary and low values in the outer estuary (median of 161 versus 10 nmol/L/d respectively) Methane concentrations were significantly influenced by the river hydrology (falling water level) and the trophic state of the water (biological oxygen demand). In contrast to other studies no clear relation to the amount of suspendended particulate matter (SPM) was found. Methane oxidation rates were significantly influenced by methane concentration and to a weaker extent by temperature. Methane oxidation accounted for 41 ± 12% of the total loss of methane in summer/fall, but only for 5 ± 3% of the total loss in winter/spring. We applied a modified box model taking into account the residence times of a water parcel depending on discharge and tidal impact. We observed almost stable methane concentrations in the outer estuary, despite a strong loss of methane through diffusion and oxidation. Thus we postulate that in the outer Elbe estuary a strong additional input of methane is required, which could be provided by the extensive salt marshes near the river mouth.

d11B and metal/Ca ratios versus size fractions in the Surface and deep dwelling species, ODP Holes 130-806B and 108-664C

We have assessed the reliability of several foraminifer-hosted proxies of the ocean carbonate system (d11B, B/Ca, and U/Ca) using Holocene samples from the Atlantic and Pacific oceans. We examined chemical variability over a range of test sizes for two surface-dwelling foraminifers (Globigerinoides sacculifer and Globigerinoides ruber). Measurements of d11B in G. ruber show no significant relationship with test size in either Atlantic or Pacific sites and appear to provide a robust proxy of surface seawater pH. Likewise there is no significant variability in the d11B of our Atlantic core top G. sacculifer, but we find that d11B increases with increasing test size for G. sacculifer in the Pacific. These systematic differences in d11B are inferred to be a consequence of isotopically light gametogenic calcite in G. sacculifer and its preferential preservation during postdepositional dissolution. The trace element ratio proxies of ocean carbonate equilibria, U/Ca and B/Ca, show systematic increases in both G. ruber and G. sacculifer with increasing test size, possibly as a result of changing growth rates. This behavior complicates their use in paleoceanographic reconstructions. In keeping with several previous studies we find that Mg/Ca ratios increase with increasing size fraction in our well-preserved Atlantic G. sacculifer but not in G. ruber. In contrast to previous interpretations we suggest that these observations reflect a proportionally larger influence of compositionally distinct gametogenic calcite in small individuals compared to larger ones. As with d11B this influences G. sacculifer but not G. ruber, which has negligible gametogenic calcite.

A cloud-based system for measuring radiation treatment plan similarity

PURPOSE: Radiation therapy is used to treat cancer using carefully designed plans that maximize the radiation dose delivered to the target and minimize damage to healthy tissue, with the dose administered over multiple occasions. Creating treatment plans is a laborious process and presents an obstacle to more frequent replanning, which remains an unsolved problem. However, in between new plans being created, the patient's anatomy can change due to multiple factors including reduction in tumor size and loss of weight, which results in poorer patient outcomes. Cloud computing is a newer technology that is slowly being used for medical applications with promising results. The objective of this work was to design and build a system that could analyze a database of previously created treatment plans, which are stored with their associated anatomical information in studies, to find the one with the most similar anatomy to a new patient. The analyses would be performed in parallel on the cloud to decrease the computation time of finding this plan. METHODS: The system used SlicerRT, a radiation therapy toolkit for the open-source platform 3D Slicer, for its tools to perform the similarity analysis algorithm. Amazon Web Services was used for the cloud instances on which the analyses were performed, as well as for storage of the radiation therapy studies and messaging between the instances and a master local computer. A module was built in SlicerRT to provide the user with an interface to direct the system on the cloud, as well as to perform other related tasks. RESULTS: The cloud-based system out-performed previous methods of conducting the similarity analyses in terms of time, as it analyzed 100 studies in approximately 13 minutes, and produced the same similarity values as those methods. It also scaled up to larger numbers of studies to analyze in the database with a small increase in computation time of just over 2 minutes. CONCLUSION: This system successfully analyzes a large database of radiation therapy studies and finds the one that is most similar to a new patient, which represents a potential step forward in achieving feasible adaptive radiation therapy replanning.