BENCHMARKING AND IMPLEMENTATION OF A NEW INDEPENDENT MONTE CARLO DOSE CALCULATION QUALITY ASSURANCE AUDIT TOOL FOR CLINICAL TRIALS

Introduction Commercial treatment planning systems employ a variety of dose calculation algorithms to plan and predict the dose distributions a patient receives during external beam radiation therapy. Traditionally, the Radiological Physics Center has relied on measurements to assure that institutions participating in the National Cancer Institute sponsored clinical trials administer radiation in doses that are clinically comparable to those of other participating institutions. To complement the effort of the RPC, an independent dose calculation tool needs to be developed that will enable a generic method to determine patient dose distributions in three dimensions and to perform retrospective analysis of radiation delivered to patients who enrolled in past clinical trials. Methods A multi-source model representing output for Varian 6 MV and 10 MV photon beams was developed and evaluated. The Monte Carlo algorithm, know as the Dose Planning Method (DPM), was used to perform the dose calculations. The dose calculations were compared to measurements made in a water phantom and in anthropomorphic phantoms. Intensity modulated radiation therapy and stereotactic body radiation therapy techniques were used with the anthropomorphic phantoms. Finally, past patient treatment plans were selected and recalculated using DPM and contrasted against a commercial dose calculation algorithm. Results The multi-source model was validated for the Varian 6 MV and 10 MV photon beams. The benchmark evaluations demonstrated the ability of the model to accurately calculate dose for the Varian 6 MV and the Varian 10 MV source models. The patient calculations proved that the model was reproducible in determining dose under similar conditions described by the benchmark tests. Conclusions The dose calculation tool that relied on a multi-source model approach and used the DPM code to calculate dose was developed, validated, and benchmarked for the Varian 6 MV and 10 MV photon beams. Several patient dose distributions were contrasted against a commercial algorithm to provide a proof of principal to use as an application in monitoring clinical trial activity.

Genes in glucose metabolism and association with spina bifida.

The authors test single nucleotide polymorphisms (SNPs) in coding sequences of 12 candidate genes involved in glucose metabolism and obesity for associations with spina bifida. Genotyping was performed on 507 children with spina bifida and their parents plus anonymous control DNAs from Hispanic and Caucasian individuals. The transmission disequilibrium test was performed to test for genetic associations between transmission of alleles and spina bifida in the offspring (P < .05). A statistically significant association between Lys481 of HK1 (G allele), Arg109Lys of LEPR (G allele), and Pro196 of GLUT1 (A allele) was found ( P = .019, .039, and .040, respectively). Three SNPs on 3 genes involved with glucose metabolism and obesity may be associated with increased susceptibility to spina bifida.

Über die bürgerliche Verbesserung der Juden

von Wolf Davidson

Adjuvant ovarian suppression in premenopausal breast cancer.

BACKGROUND Suppression of ovarian estrogen production reduces the recurrence of hormone-receptor-positive early breast cancer in premenopausal women, but its value when added to tamoxifen is uncertain. METHODS We randomly assigned 3066 premenopausal women, stratified according to prior receipt or nonreceipt of chemotherapy, to receive 5 years of tamoxifen, tamoxifen plus ovarian suppression, or exemestane plus ovarian suppression. The primary analysis tested the hypothesis that tamoxifen plus ovarian suppression would improve disease-free survival, as compared with tamoxifen alone. In the primary analysis, 46.7% of the patients had not received chemotherapy previously, and 53.3% had received chemotherapy and remained premenopausal. RESULTS After a median follow-up of 67 months, the estimated disease-free survival rate at 5 years was 86.6% in the tamoxifen-ovarian suppression group and 84.7% in the tamoxifen group (hazard ratio for disease recurrence, second invasive cancer, or death, 0.83; 95% confidence interval [CI], 0.66 to 1.04; P=0.10). Multivariable allowance for prognostic factors suggested a greater treatment effect with tamoxifen plus ovarian suppression than with tamoxifen alone (hazard ratio, 0.78; 95% CI, 0.62 to 0.98). Most recurrences occurred in patients who had received prior chemotherapy, among whom the rate of freedom from breast cancer at 5 years was 82.5% in the tamoxifen-ovarian suppression group and 78.0% in the tamoxifen group (hazard ratio for recurrence, 0.78; 95% CI, 0.60 to 1.02). At 5 years, the rate of freedom from breast cancer was 85.7% in the exemestane-ovarian suppression group (hazard ratio for recurrence vs. tamoxifen, 0.65; 95% CI, 0.49 to 0.87). CONCLUSIONS Adding ovarian suppression to tamoxifen did not provide a significant benefit in the overall study population. However, for women who were at sufficient risk for recurrence to warrant adjuvant chemotherapy and who remained premenopausal, the addition of ovarian suppression improved disease outcomes. Further improvement was seen with the use of exemestane plus ovarian suppression. (Funded by Pfizer and others; SOFT ClinicalTrials.gov number, NCT00066690.).

Simulation in vascular access surgery

In the last years, simulation training has become widespread in different areas of medicine due to social expectations, political accountability and professional regulation. Different types of simulators allow to improve knowledge, skills, communication and team behavior. Simulation sessions have been proven to shorten the learning curve and allow education in a safe environment. Patients on dialysis are an expanding group. They often suffer from several comorbidities and need complex surgical procedures with regard to their dialysis access. Therefore, education in evidence-based algorithms is as important as teaching of practical skills. In this chapter, we are presenting an overview of available dialysis access training modalities. We are convinced that simulation will become more important in the near future and has a substantial impact on strategies to improve aspects of patient safety. © 2015 S. Karger AG, Basel.

Play in Rats: Association across Contexts and Types , and Analysis of Structure.

Play has been proposed as a promising indicator of positive animal welfare. We aimed to study play in rats across contexts (conspecific/heterospecific) and types (social: pinning, being pinned; solitary: scampering), and we investigated its structure using behavioral sequence analysis. Group-housed (three per cage) adolescent male Lister Hooded rats (n = 21) were subjected to a Play-In-Pairs test: after a 3 hour isolation period, a pair of cage-mates was returned to the home cage and both social and solitary play were scored for 20 min. This procedure was repeated for each pair combination across three consecutive days, and individual play scores were calculated. Heterospecific play was measured using a Tickling test: rats were individually tickled by the experimenter through bouts of gentle, rapid finger movements on their underside, and the number of positive 50 kHz frequency modulated vocalizations and experimenter-directed approach behaviors were recorded. Both of the above tests were compared with social play in the home cage. While conspecific play in both the Play-In-Pairs test and home cage were correlated, both seemed to be unrelated to heterospecific play in the Tickling test. During the Play-In-Pairs test, although both solitary and social play types occurred, they were unrelated, and solitary locomotor play of one rat did not predict the subsequent play behavior of its cage mate. Analysis of play structure revealed that social play occurred more often in bouts of repeated behaviors while solitary play sequences did not follow a specific pattern. If play is to be used as an indicator of positive welfare in rats, context, type and structure differences should be taken into account.

Refinement of experimental design and conduct in laboratory animal research.

The scientific literature of laboratory animal research is replete with papers reporting poor reproducibility of results as well as failure to translate results to clinical trials in humans. This may stem in part from poor experimental design and conduct of animal experiments. Despite widespread recognition of these problems and implementation of guidelines to attenuate them, a review of the literature suggests that experimental design and conduct of laboratory animal research are still in need of refinement. This paper will review and discuss possible sources of biases, highlight advantages and limitations of strategies proposed to alleviate them, and provide a conceptual framework for improving the reproducibility of laboratory animal research.

Team training to establish a safety culture in dialysis access surgery.

Operating room (OR) team safety training and learning in the field of dialysis access is well suited for the use of simulators, simulated case learning and root cause analysis of adverse outcomes. The objectives of OR team training are to improve communication and leadership skills, to use checklists and to prevent errors. Other objectives are to promote a change in the attitudes towards vascular access from learning through mistakes in a nonpunitive environment, to positively impact the employee performance and to increase staff retention by making the workplace safer, more efficient and user friendly.

Incidence of AIDS-Defining and Other Cancers in HIV-Positive Children in South Africa: Record Linkage Study.

BACKGROUND Little is known on the risk of cancer in HIV-positive children in sub-Saharan Africa. We examined incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa. METHODS We linked the records of five ART programs in Johannesburg and Cape Town to those of pediatric oncology units, based on name and surname, date of birth, folder and civil identification numbers. We calculated incidence rates and obtained hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression models including ART, sex, age, and degree of immunodeficiency. Missing CD4 counts and CD4% were multiply imputed. Immunodeficiency was defined according to World Health Organization 2005 criteria. RESULTS Data of 11,707 HIV-positive children were included in the analysis. During 29,348 person-years of follow-up 24 cancers were diagnosed, for an incidence rate of 82 per 100,000 person-years (95% CI 55-122). The most frequent cancers were Kaposi Sarcoma (34 per 100,000 person-years) and Non Hodgkin Lymphoma (31 per 100,000 person-years). The incidence of non AIDS-defining malignancies was 17 per 100,000. The risk of developing cancer was lower on ART (HR 0.29, 95%CI 0.09-0.86), and increased with age at enrolment (>10 versus <3 years: HR 7.3, 95% CI 2.2-24.6) and immunodeficiency at enrolment (advanced/severe versus no/mild: HR 3.5, 95%CI 1.1-12.0). The HR for the effect of ART from complete case analysis was similar but ceased to be statistically significant (p=0.078). CONCLUSIONS Early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in HIV-positive children in South Africa and elsewhere.

An Exploration Based Cognitive Bias Test for Mice: Effects of Handling Method and Stereotypic Behaviour

Behavioural tests to assess affective states are widely used in human research and have recently been extended to animals. These tests assume that affective state influences cognitive processing, and that animals in a negative affective state interpret ambiguous information as expecting a negative outcome (displaying a negative cognitive bias). Most of these tests however, require long discrimination training. The aim of the study was to validate an exploration based cognitive bias test, using two different handling methods, as previous studies have shown that standard tail handling of mice increases physiological and behavioural measures of anxiety compared to cupped handling. Therefore, we hypothesised that tail handled mice would display a negative cognitive bias. We handled 28 female CD-1 mice for 16 weeks using either tail handling or cupped handling. The mice were then trained in an eight arm radial maze, where two adjacent arms predicted a positive outcome (darkness and food), while the two opposite arms predicted a negative outcome (no food, white noise and light). After six days of training, the mice were also given access to the four previously unavailable intermediate ambiguous arms of the radial maze and tested for cognitive bias. We were unable to validate this test, as mice from both handling groups displayed a similar pattern of exploration. Furthermore, we examined whether maze exploration is affected by the expression of stereotypic behaviour in the home cage. Mice with higher levels of stereotypic behaviour spent more time in positive arms and avoided ambiguous arms, displaying a negative cognitive bias. While this test needs further validation, our results indicate that it may allow the assessment of affective state in mice with minimal training— a major confound in current cognitive bias paradigms.

Bemerkung zu der "Elegie auf die Austreibung aus Spanien"

Israel Davidson

Na 1 Nachlass Max Horkheimer, 4 - Korrespondenzen u.a. mit Richard Bach (p. I 2, 131-358)

24 Briefe zwischen Richard Bach und Max Horkheimer, 1938-1940; 2 Briefe zwischen Alfred Chalk und Max Horkheimer, 17.10.1939, 14.11.1939; 3 Briefe von Morduch Lexandrowitsch und der American Consulate General, 1939; 4 Briefe von der American Consulate General und Max Horkheimer, 1938-1939; 1 Brief von Max Horkheimer an das Amtstgericht Berlin, 15.03.1939; 1 Brief von Max Horkheimer an Stiedry, 05.12.1938; 1 Brief von Max Horkheimer an den Collector of Custom, 26.10.1938; 2 Briefe zwischen Josef Maier und Carson Alexandrowitsch, 28.06.1938, 29.06.1938; 1 Brief von Margarete Baruch an Alice Maier, 11.04.1938; 1 Brief von Emanuel List an Carson Alexandrowitsch, 23.02.1938; 1 Abschrift des Briefes von der Metropolitan Opera Association New York an Morduch Lexandrowitsch, 22.02.1938; 1 Brief von Jacques Barzun an Max Horkheimer, 09.07.1947; 4 Briefe zwischen K. Baschwitz und Max Horkheimer, 1938-1946; 2 Briefe zwischen E. Bauer und Max Horkheimer, 08.04.1935, 27.05.1935; 4 Briefe zwischen Fritz Bauer und Max Horkheimer, 1937-1938; 2 Briefe zwischen Lina Bauer und Max Horkheimer, 20.07.1942, 16,08,1942; 4 Briefe zwsichen Rudolf Bauer und Max Horkheimer, 1937; 15 Briefe zwischen Gertrud Bauer und Max Horkheimer, 1938-1941; 1 Brief von Max Horkheimer an den Collector of Customs, 15.03.1940; 2 Briefe zwischen I. Hannah Davidson vom Jewish Community Center San Francisco und Max Horkheimer, 19.09.1938, 29.09.1938; 2 Briefe zwsichen I. Bauer und Max Horkheimer, 25.09.1938, 29.09.1938; 1 Brief von Max Horkheimer an Klopfer, 27.09.1938; 3 Briefe zwischen Y.M.H.A. - Y.W.H.A The Jewish Center of Saint Louis und Max Horkheimer, 19.09.1938, 1938; 1 Brief von Max Horkheimer an Julius Rosenberg, 17.09.1938; 1 Brief von Max Horkheimer an das Jwish Center Salt Lake City, Utah, 07.09.1938; 1 Brief von Max Horkheimer an das Jewish Community Center San Fransisco, 07.09.1938; 3 Briefe zwischen dem New York Section of the National Council of Jewish Women und Max Horkheimer, 07.04.1938, 1938; 2 Briefe zwischen Baum und Max Horkheimer, 12.03.1946, 25.05.1946; 1 Brief von Max Horkheimer an Charles A. Beard , 12.12.1934; 1 Brief von Charles A. Beard an C. A. Beard; 5 Briefe von Friedrich Pollock an Charles A. Beard, 1940-1941; 5 Briefe zwischen Lilo Beck und Max Horkheimer, 1940-1941; 7 Briefe zwischen Maximilian Beck und Max Horkheimer, 1939-1940; 1 Brief von Paul Tillich an Max Horkheimer , 01.10.1940; 1 Brief von dem Emergency Committee in Aid of Displaced Foreign Scholars New York an Max Horkheimer, 19.04.1940; 5 Briefe zwischen Konrad Bekker und Max Horkheimer, 1936-1939; 2 Briefe von Max Horkheimer an Ludwig Bendix, 1921, 1937; 1 Brief von Peter Bendmann an Max Horkheimer; 1 Brief von Max Horkheimer an Ruth Benedict, 30.07.1937; 1 Brief von Eric Russel Bentley an Max Horkheimer, 30.01.1945; 1 Brief von George Berg an Max Horkheimer, 12.07.1945; 2 Briefe zwischen Egon Bergel und Max Horkheimer, 18.08.1938, 22.08.1938; 1 Brief von Marie Jahoda an Max Horkheimer, 14.07.1928; 1 Brief von Theodor W. Adorno an Kurt Bergel, 09.09.1939; 15 Briefe zwischen Klaus Berger und Max Horkheimer, 1936-1943; 1 Brief von Frederick Pollock an Philip M. Hayden von der Columbia University New York, 05.03.1942; 1 Brief von Hans Venedey an Max Horkheimer, 05.03.1938; 1 Brief von Max Horkheimer an Ida Berger-Chevant, 18.02.1939;

Parody in Jewish literature

by Israel Davidson

Na 1 Nachlass Max Horkheimer, 655 - Vorträge über Antisemitismus (p. IX 40.1-2-IX 48.1-2)

"Summer institute on Modern European Culture" (1947?); 1. Ankündigung für eine Vorlesungsreihe von Max Horkheimer, Theodor W. Adorno, Leo Löwenthal, Herbert Marcuse, Friedrich Pollock. a) Typoskript mit eigenhändigen Ergänzungen, 20 Blatt b) Typoskript mit handschriftlichen Ergänzungen, 19 Blatt; 2. Herbert Marcuse: "Philosophie allemande et francaise 1871-1933". Typoskript mit eigenhändigen Korrekturen, 18 Blatt; "Tentative Program for the Course of Antisemitism". Vorlesungsankündigung 1948 von Max Horkheimer, Theodor W. Adorno, Friedrich Pollock. Typoskript 2 Blatt; Max Horkheimer: Bericht über die Antisemitismus-Forschungen des Instituts für Sozialforschung (GS 12, S. 165-171). Vortrag gehalten am 16.4.1943, englischer Text. a) Typoskript mit eigenhändigen Korrekturen, 5 Blatt b) Typoskript mit eigenhändigen Korrekturen, 8 Blatt c) Typoskript mit handschriftlichen Korrekturen, 8 Blatt; Max Horkheimer: Bericht über die Antisemitismus-Forschungen des Instituts für Sozialforschung (GS 12, S. 172-183). Vortrag gehalten am 30.4.1943, Temple Israel. a) Typoskript mit eigenhändigen Korrekturen und Ergänzungen, 12 Blatt b) Typoskript mit handschriftlichen Korrekturen, 11 Blatt c) Typoskript mit eigenhändigen Korrekturen, 14 Blatt; Max Horkheimer: Über die Psychologie des Judentums und des Antisemitismus; 1. Vortrag, gehalten am 7.10.1943 im Department of Psychology, UCLA, eigenhändige Notizen, 1 Blatt; 2. Auszüge aus Schriften und Arbeitspapieren von: G.M. Davidson, Salomon Andhil Fineberg, A.R.L. Gurland, Oscar I. Janomsky, Paul W. Massing, Typoskript mit eigenhändigen Ergänzungen, 8 Blatt; Max Horkheimer: Anti-Semitism as a Social Phenomenon (GS 5, S.364-372); 1. Vortrag, gehalten am 17.6.1944 in San Francisco, Psychoanalytic Society, veröffentlicht unter dem Titel 'Sociological Background of the Psychoanalytic Approach". In: Ernst Simmel (ed.), "Anti-Semitism. A Social Disease", New York, 1946, S.1-10. a) Typoskript, 13 Blatt, b) Teilstück, Typoskript, 1 Blatt, c) Teilstück, Typoskript mit eigenhändigen Korrekturen, 2 Blatt d) Typoskript mit handschriftlichen Korrekturen, 9 Blatt; 2. "Notes to the Speech in San Francisco", Notizen, 4 Blatt; 3. eigenhändige Notizen zum Vortrag, 5 Blatt; 4. Rede für Maurice Karpf, Typoskript mit eigenhändigen Korrekturen, 2 Blatt; 5. Theodor W. Adorno: "Mammoth Motives", Notizen zum Verhältnis von Soziologie und Psychologie des Antisemitismus, 3 Blatt; 6. Theodor W. Adorno: "Patterns of Anti-Democratic Propaganda", veröffentlicht in: Ernst Simmel, "Anti-Semitism. A Social Disease", New York, 1946, S.125-137. a) Typoskript, 15 Blatt, b) Typoskript, 14 Blatt;; 7. Einladung, Drucksache, 2 Blatt; 8. Max Horkheimer: 2 Brief an Donald MacFerlane, Pacific Palisades, 22.5.1944, 1 Blatt; Max Horkheimer: Vorträge 1944-45; 1. "Report for the N.C.R.A.C.". Über Forschungsprojekte des American Jewish Committee and des American Jewish Congress, vorgetragen am 14.1.1944, Typoskript, 4 Blatt; 2. Notizen zu 1: Über Kurt Lewin, Typoskript, 3 Blatt; 3. eigenhändige Notizen zu 1., 3 Blatt; 4. Über die europäische Tradition der Arbeiten des Instituts für Sozialforschung. Vortrag, gehalten am 8.12.1944. Eigenhändige Notizen, 1 Blatt; 5. Über psychologische Aspekte der Antisemitismusforschung des Instituts für Sozialforschung. Vortrag, gehalten am 19.4.1945. Eigenhändige Notizen, 2 Blatt; 6. Über sozioökonomische Aspekte des Antisemitismus in Europa und in der Arbeiterschaft der USA. Vortrag, gehalten am 8.6.1945. Psychosomatic Society a) Notizen zum Vortrag, 4 Blatt, b) eigenhändige Notizen, 3 Blatt; 7. Notizen zu 6., Typoskript, 17 Blatt,; 8. Notizen zu 6. "Quotations from Labor Study", Typoskript, 12 Blatt; 9. Über neue Forschungsprojekte des Instituts für Sozialforschung zum Antisemitismus. Vortrag, gehalten am 24.10.1945. Eigenhändige Notizen, 2 Blatt; 10. Über Antisemitismus. Vortrag, gehalten am 3.12.1945. Eigenhändige Notizen, 2 Blatt; 11.-15. Vorträge über Antisemitismus. Datierung unklar (etwa 1945) (u.a. "Mountvernon Speech" und "Breakfast Speech"), 17 Blatt; 16. Über Judentum und Katholizismus in der neueren Geschichte. Eigenhändige Notizen zu einem Vortrag, Datierung unklar, 3 Blatt; 17. Über Vorurteil, Vortrag oder Diskussion in einer Synagoge, Datierung unklar, eigenhändige Notizen, 1 Blatt; Max Horkheimer: Über die Antisemitismus-Forschungen des Instituts für Sozialforschung. Vortrag, gehalten beim U.C.R.A.C.-Meeting, 15.-17.6.1946, Chicago:; 1. eigenhändige Notizen, 13 Blatt; 2. Fragebogen, als Typoskript vervielfältigt, mit eigenhändigen Ergänzungen, 6 Blatt;