Impact of tumor board recommendations on treatment outcome for locally advanced head and neck cancer

Background/Aims: To identify physician selection factors in the treatment of locally advanced head and neck cancer and how treatment outcome is affected by Tumor Board recommendations. Methods: A retrospective analysis of 213 patients treated for locally advanced head and neck cancer in a single institution was performed. All treatments followed Tumor Board recommendations: 115 patients had chemotherapy and radiation, and 98 patients received postoperative radiation. Patient characteristics, treatment toxicity, locoregional control and survival between these two treat- ment groups were compared. Patient survival was compared with survival data reported in randomized studies of locally advanced head and neck cancer. Results: There were no differences in comorbidity factors, and T or N stages between the two groups. A statistically significant number of patients with oropharyngeal and oral cavity tumors had chemoradiation and postoperative radiation, respectively (p < 0.0001). Grade 3-4 toxicities during treatment were 48 and 87% for the postoperative radiation and chemoradiation groups, respectively (p = 0.0001). There were no differences in survival, locoregional recurrences and distant metastases between the two groups. Patient survival was comparable to survival rates reported by randomized studies of locally advanced head and neck cancer. Conclusion: Disease sites remained the key determining factor for treatment selection. Multidisciplinary approaches provided optimal treatment outcome for locally advanced head and neck cancer, with overall survival in these patients being comparable to that reported in randomized clinical trials. Copyright © 2008 S. Karger AG.

Doxifluridine and leucovorin: an oral treatment combination in advanced colorectal cancer

Purpose: This study was designed to test the activity and feasibility of an all-oral regimen of levo-leucovorin and doxifluridine (dFUR) in the treatment of advanced colorectal cancer and to establish whether the pharmacokinetics of dFUR and fluorouracil (FU) are affected by demographic and/or biologic parameters. Materials and Methods: One hundred eight patients with histologically proven colorectal cancer received orally administered levo-leucovorin 25 mg followed 2 hours later by dFUR 1,200 mg/m2 on days 1 to 5, with the cycle being repeated every 10 days. Results: Among 62 previously untreated patients, two complete responses (CRs) and 18 partial responses (PRs) were observed (overall response rate, 32%; 95% confidence interval, 21% to 45%). The median response duration was 4 months (range, 2 to 13) and the median survival time, 14 months. Among 46 pretreated patients, there were three CRs and three PRs (response rate, 13%; 95% confidence interval, 5% to 26%). In this group of patients, the median response duration was 4 months (range, 1 to 12) and the median survival time, 12 months. No toxic deaths were observed. The only World Health Organization (WHO) grade 3 to 4 side effect was diarrhea (32 patients). Conclusion: This regimen is active in previously untreated colorectal cancer patients and combines good compliance with safety. Limited but definite efficacy was also detected in the patients previously treated with FU, which suggests incomplete cross- resistance between the two drugs. The pharmacokinetic results suggest that the conversion rate of dFUR to FU increases between days 1 and 5, but that FU levels remain low in comparison to those measured after classical FU therapy. Under the experimental conditions used in this study, the interpatient variability of pharmacokinetic parameters remains largely unexplained by the tested variables.

Multicenter randomized trial of dacarbazine alone or in combination with two different doses and schedules of interferon alfa-2a in the treatment of advanced melanoma

Purpose: Some phase II studies have suggested that the combination of interferons (IFNs) with dacarbazine (DTIC) in the treatment of malignant melanoma (MM) increases the antitumor activity of DTIC alone. In an attempt to confirm this hypothesis, a randomized study was performed with the further intent of observing whether low doses of recombinant interferon alfa-2a (rIFNα2a) could be as effective as intermediate doses. Patients and Methods: Two hundred sixty-six patients were randomized onto three different treatment arms: DTIC 800 mg/m 2 intravenously (IV) days 1 and 21; DTIC plus rIFNα2a 9 mIU intramuscularly (IM) daily; and DTIC plus rIFNα2a 3 mIU IM three times per week. Major prognostic factors were well balanced among the three arms. Chemotherapy was administered for a maximum of eight cycles. After 6 months of therapy, rIFNα2a was continued until disease progression at 3 mIU three times per week in responding patients who had received the combined treatment. Results: The percentage of objective responses did not differ among the three groups (20%, 28%, and 23%, respectively), although a significant prolongation of response duration was observed when rIFNα2a was added to DTIC (2.6 v 8.4 v 5.5 months, respectively). However, this improvement in response duration did not translate into an amelioration of overall survival. The addition of rIFNα2a led to the onset of flu-like syndrome, but in no case was it necessary to withdraw the treatment program and no toxic deaths or life-threatening toxicities were reported. Conclusion: In this study, rIFNα2a significantly prolonged response duration, whereas no effects on response rate and survival were observed; rIFNα2a 3 mIU appeared to be equally effective and better tolerated than 9 mIU.

Advanced occupant behavioural features of the building-EXODUS evacuation model

The purpose of this paper is to describe and demonstrate some of the advanced behavioral features currently being developed for the building-EXODUS evacuation model. These advanced features involve the ability to specify roles for particular individuals during the evacuation. With these enhancements to the Behavioral Sub model of building-EXODUS, it is possible to include a number of procedural and behavioral aspects previously ignored in evacuation simulations. These include the behavioral aspect of group bonding, the procedural aspects involved with the role of the fire warden and rescue operations undertaken by the fire services. The importance of these enhancements are discussed and demonstrated through three simple simulations.

The development of an advanced ship evacuation simulation software product and associated large scale testing facility for the collection of human shipboard behaviour data

When designing a new passenger ship or modifying an existing design, how do we ensure that the proposed design and crew emergency procedures are safe from an evacuation point of view? In the wake of major maritime disasters such as the Herald of Free Enterprise and the Estonia and in light of the growth in the numbers of high density, high-speed ferries and large capacity cruise ships, issues concerned with the evacuation of passengers and crew at sea are receiving renewed interest. In the maritime industry, ship evacuation models offer the promise to quickly and efficiently bring evacuation considerations into the design phase, while the ship is "on the drawing board". maritimeEXODUS-winner of the BCS, CITIS and RINA awards - is such a model. Features such as the ability to realistically simulate human response to fire, the capability to model human performance in heeled orientations, a virtual reality environment that produces realistic visualisations of the modelled scenarios and with an integrated abandonment model, make maritimeEXODUS a truly unique tool for assessing the evacuation capabilities of all types of vessels under a variety of conditions. This paper describes the maritimeEXODUS model, the SHEBA facility from which data concerning passenger/crew performance in conditions of heel is derived and an example application demonstrating the models use in performing an evacuation analysis for a large passenger ship partially based on the requirements of MSC circular 1033.

Fire safety engineering and ship design using advanced fire and evacuation simulation

When designing a new passenger ship or modifying an existing design, how do we ensure that the proposed design and crew emergency procedures are safe from an evacuation resulting from fire or other incident? In the wake of major maritime disasters such as the Scandinavian Star, Herald of Free Enterprise, Estonia and in light of the growth in the number of high density, high-speed ferries and large capacity cruise ships, issues concerning the evacuation of passengers and crew at sea are receiving renewed interest. Fire and evacuation models with features such as the ability to realistically simulate the spread of heat and smoke and the human response to fire as well as the capability to model human performance in heeled orientations linked to a virtual reality environment that produces realistic visualisations of the modelled scenarios are now available and can be used to aid the engineer in assessing ship design and procedures. This paper describes the maritimeEXODUS ship evacuation and the SMARTFIRE fire simulation model and provides an example application demonstrating the use of the models in performing fire and evacuation analysis for a large passenger ship partially based on the requirements of MSC circular 1033

Advanced evacuation simulation software and its use in warships

The newly formed Escape and Evacuation Naval Authority regulates the provision of abandonment equipment and procedures for all Ministry of Defence Vessels. As such, it assures that access routes on board are evaluated early in the design process to maximize their efficiency and to eliminate, as far as possible, any congestion that might occur during escape. This analysis can be undertaken using a computer-based simulation for given escape scenarios and replicates the layout of the vessel and the interactions between each individual and the ship structure. One such software tool that facilitates this type of analysis is maritimeEXODUS. This tool, through large scale testing and validation, emulates human shipboard behaviour during emergency scenarios; however it is largely based around the behaviour of civilian passengers and fixtures and fittings of merchant vessels. Hence there existed a clear requirement to understand the behaviour of well-trained naval personnel as opposed to civilian passengers and be able to model the fixtures and fittings that are exclusive to warships, thus allowing improvements to both maritimeEXODUS and other software products. Human factor trials using the Royal Navy training facilities at Whale Island, Portsmouth were recently undertaken to collect data that improves our understanding of the aforementioned differences. It is hoped that this data will form the basis of a long-term improvement package that will provide global validation of these simulation tools and assist in the development of specific Escape and Evacuation standards for warships. © 2005: Royal Institution of Naval Architects.

Optimisation modelling for design of advanced interconnects

This paper describes a computational strategy for virtual design and prototyping of electronic components and assemblies. The design process is formulated as a design optimisation problem. The solution of this problem identifies not only the design which meets certain user specified requirements but also the design with the maximum possible improvement in particular aspects such as reliability, cost, etc. The modelling approach exploits numerical techniques for computational analysis (Finite Element Analysis) integrated with numerical methods for approximation, statistical analysis and optimisation. A software framework of modules that incorporates the required numerical techniques is developed and used to carry out the design optimisation modelling of fine-pitch flip-chip lead free solder interconnects.

Advanced microwave oven for rapid curing of encapsulant

The curing of a thermosetting polymer materials utilized on micro-electronics packaging applications can be performed using microwave systems. The use of microwave energy enables the cure process to be completed more rapidly than with alternative approaches due to the ability to heat volumetrically. Furthermore, advanced dual-section microwave systems enable curing of individual components on a chip-on-board assembly. The dielectric properties of thermosetting polymer materials, commonly used in microelectronics packaging applications, vary significantly with temperature and degree of cure. The heating rate within a material subjected to an electric field is primarily dependant on the dielectric loss properties of the material itself. This article examines the variation in dielectric properties of a commercially available encapsulant paste with frequency and temperature and the resulting influence on the cure process. The 'FAMOBS' dual section microwave system and its application to microelectronics manufacture are described. The measurement of the dielectric properties of 'Henkel EO1080' encapsulant paste uses a commercially available 'dielectric probe kit' and is described in this paper. The FAMOBS heating system is used to encapsulate a small op-amp chip. A numerical model formulated to assess the cure process in thermosetting polymer materials under microwave heating is outlined. Numerical results showing that the microwave processing systems is capable of rapidly and evenly curing thermosetting polymer materials are presented.

Optimisation methodology for risk mitigation in advanced micro-system electronics manufacturing

This paper presents a design methodology based on numerical modelling, integrated with optimisation techniques and statistical methods, to aid the development of new advanced technologies in the area of micro and nano systems. The design methodology is demonstrated for a micro-machining process called Focused Ion Beam (FIB). This process has been modelled to provide knowledge of how a pre-defined geometry can be achieved through this direct milling. The geometry characterisation is obtained using a Reduced Order Models (ROM), generated from the results of a mathematical model of the Focused Ion Beam, and Design of Experiment (DoE) methods. In this work, the focus is on the design flow methodology which includes an approach on how to include process parameter uncertainties into the process optimisation modelling framework. A discussion on the impact of the process parameters, and their variations, on the quality and performance of the fabricated structure is also presented. The design task is to identify the optimal process conditions, by altering the process parameters, so that certain reliability and confidence of the application is achieved and the imposed constraints are satisfied. The software tools used and developed to demonstrate the design methodology are also presented.

Advanced scrub practitioner toolkit

Toolkit for operating department staff and operating departments for role development NAASP (National Association Of Assistants In Surgical Practice) advanced practitioner toolkit provides outline strategies and a framework within the advanced scrub practitioner (ASP) role can be developed. this document defines the range of knowledge and skills required and sets the standards of practice for the ASP.

Advanced product development integration architecture: an out-of-box solution to support distributed production networks

This paper presents novel collaboration methods implemented using a centralized client/server product development integration architecture, and a decentralized peer-to-peer network for smaller and larger companies using open source solutions. The product development integration architecture has been developed for the integration of disparate technologies and software systems for the benefit of collaborative work teams in design and manufacturing. This will facilitate the communication of early design and product development within a distributed and collaborative environment. The novelty of this work is the introduction of an‘out-of-box’ concept which provides a standard framework and deploys this utilizing a proprietary state-of-the-art product lifecycle management system (PLM). The term ‘out-of-box’ means to modify the product development and business processes to suit the technologies rather than vice versa. The key business benefits of adopting such an approach are a rapidly reconfigurable network and minimal requirements for software customization to avoid systems instability

Teaching and cognitive outcomes in A-levels and Advanced GNVQ's: Case studies from Science and Business Studies Classrooms

The purpose of the paper is to demonstrate how a research diary methodology, designed to analyse A-level and GNVQ classrooms, can be a powerful tool for examining pedagogy and quality of learning at the level of case study. Two subject areas, science and business studies, are presented as cases. Twelve teachers and thirty-four students were studied over a four-week period in May 1997 and contrasts were drawn between lessons from three A-level physics teachers/three Advanced GNVQ science teachers and two A-level business/economics teachers/four Advanced GNVQ business teachers. Lessons were analysed within a cognitive framework which distinguishes between conceptual and procedural learning and emphasizes the importance of metacognition and epistemological beliefs. Two dimensions of lessons were identified: pedagogical activities (e.g. teacher-led explanation, teacher-led guidance on a task, question/answer sessions, group discussions, working with IT) and cognitive outcomes (e.g. structuring and memorizing facts, understanding concepts and arguments, critical thinking, problem-solving, learning core skills, identifying values). Immediately after each lesson, teachers and students (three per class) completed structured research diaries with respect to the above dimensions. Data from the diaries reveal general and unique features of the lessons. Time-ofyear effects were evident (examinations pending in May), particularly in A-level classrooms. Students in business studies classes reported a wider range of learning activities and greater variety in cognitive outcomes than did students in science classes. Science students self-rating of their ability to manage and direct their own learning was generally low. The phenomenological aspects of the classrooms were consistently linked to teachers' lesson plans and what their teaching objectives were for those particular students at that particular time of the year.