Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials

Background We aimed to assess the effect of afatinib on overall survival of patients with EGFR mutation-positive lung adenocarcinoma through an analysis of data from two open-label, randomised, phase 3 trials. Methods Previously untreated patients with EGFR mutation-positive stage IIIB or IV lung adenocarcinoma were enrolled in LUX-Lung 3 (n=345) and LUX-Lung 6 (n=364). These patients were randomly assigned in a 2:1 ratio to receive afatinib or chemotherapy (pemetrexed-cisplatin [LUX-Lung 3] or gemcitabine-cisplatin [LUX-Lung 6]), stratified by EGFR mutation (exon 19 deletion [del19], Leu858Arg, or other) and ethnic origin (LUX-Lung 3 only). We planned analyses of mature overall survival data in the intention-to-treat population after 209 (LUX-Lung 3) and 237 (LUX-Lung 6) deaths. These ongoing studies are registered with ClinicalTrials.gov, numbers NCT00949650 and NCT01121393. Findings Median follow-up in LUX-Lung 3 was 41 months (IQR 35–44); 213 (62%) of 345 patients had died. Median follow-up in LUX-Lung 6 was 33 months (IQR 31–37); 246 (68%) of 364 patients had died. In LUX-Lung 3, median overall survival was 28·2 months (95% CI 24·6–33·6) in the afatinib group and 28·2 months (20·7–33·2) in the pemetrexed-cisplatin group (HR 0·88, 95% CI 0·66–1·17, p=0·39). In LUX-Lung 6, median overall survival was 23·1 months (95% CI 20·4–27·3) in the afatinib group and 23·5 months (18·0–25·6) in the gemcitabine-cisplatin group (HR 0·93, 95% CI 0·72–1·22, p=0·61). However, in preplanned analyses, overall survival was significantly longer for patients with del19-positive tumours in the afatinib group than in the chemotherapy group in both trials: in LUX-Lung 3, median overall survival was 33·3 months (95% CI 26·8–41·5) in the afatinib group versus 21·1 months (16·3–30·7) in the chemotherapy group (HR 0·54, 95% CI 0·36–0·79, p=0·0015); in LUX-Lung 6, it was 31·4 months (95% CI 24·2–35·3) versus 18·4 months (14·6–25·6), respectively (HR 0·64, 95% CI 0·44–0·94, p=0·023). By contrast, there were no significant differences by treatment group for patients with EGFR Leu858Arg-positive tumours in either trial: in LUX-Lung 3, median overall survival was 27·6 months (19·8–41·7) in the afatinib group versus 40·3 months (24·3–not estimable) in the chemotherapy group (HR 1·30, 95% CI 0·80–2·11, p=0·29); in LUX-Lung 6, it was 19·6 months (95% CI 17·0–22·1) versus 24·3 months (19·0–27·0), respectively (HR 1·22, 95% CI 0·81–1·83, p=0·34). In both trials, the most common afatinib-related grade 3–4 adverse events were rash or acne (37 [16%] of 229 patients in LUX-Lung 3 and 35 [15%] of 239 patients in LUX-Lung 6), diarrhoea (33 [14%] and 13 [5%]), paronychia (26 [11%] in LUX-Lung 3 only), and stomatitis or mucositis (13 [5%] in LUX-Lung 6 only). In LUX-Lung 3, neutropenia (20 [18%] of 111 patients), fatigue (14 [13%]) and leucopenia (nine [8%]) were the most common chemotherapy-related grade 3–4 adverse events, while in LUX-Lung 6, the most common chemotherapy-related grade 3–4 adverse events were neutropenia (30 [27%] of 113 patients), vomiting (22 [19%]), and leucopenia (17 [15%]). Interpretation Although afatinib did not improve overall survival in the whole population of either trial, overall survival was improved with the drug for patients with del19 EGFR mutations. The absence of an effect in patients with Leu858Arg EGFR mutations suggests that EGFR del19-positive disease might be distinct from Leu858Arg-positive disease and that these subgroups should be analysed separately in future trials.

Predicting crashes using traffic offences. A meta-analysis that examines potential bias between self-report and archival data

Background Traffic offences have been considered an important predictor of crash involvement, and have often been used as a proxy safety variable for crashes. However the association between crashes and offences has never been meta-analysed and the population effect size never established. Research is yet to determine the extent to which this relationship may be spuriously inflated through systematic measurement error, with obvious implications for researchers endeavouring to accurately identify salient factors predictive of crashes. Methodology and Principal Findings Studies yielding a correlation between crashes and traffic offences were collated and a meta-analysis of 144 effects drawn from 99 road safety studies conducted. Potential impact of factors such as age, time period, crash and offence rates, crash severity and data type, sourced from either self-report surveys or archival records, were considered and discussed. After weighting for sample size, an average correlation of r = .18 was observed over the mean time period of 3.2 years. Evidence emerged suggesting the strength of this correlation is decreasing over time. Stronger correlations between crashes and offences were generally found in studies involving younger drivers. Consistent with common method variance effects, a within country analysis found stronger effect sizes in self-reported data even controlling for crash mean. Significance The effectiveness of traffic offences as a proxy for crashes may be limited. Inclusion of elements such as independently validated crash and offence histories or accurate measures of exposure to the road would facilitate a better understanding of the factors that influence crash involvement.

On the effect of matrix cracks in composite helicopter rotor blade

This paper investigates the feasibility of an on-line damage detection capability for helicopter main rotor blades made of composite material. Damage modeled in the composite is matrix cracking. A box-beam with stiffness properties similar to a hingeless rotor blade is designed using genetic algorithm for the typical [+/-theta(m)/90(n)](s) family of composites. The effect of matrix cracks is included in an analytical model of composite box-beam. An aeroelastic analysis of the helicopter rotor based on finite elements in space and time is used to study the effects of matrix cracking in the rotor blade in forward flight. For global fault detection, rotating frequencies, tip bending and torsion response, and blade root loads are studied. It is observed that the effect of matrix cracking on lag bending and elastic twist deflection at the blade tip and blade root yawing moment is significant and these parameters can be monitored for online health monitoring. For implementation of local fault detection technique, the effect on axial and shear strain, for matrix cracks in the whole blade as well as matrix cracks occurring locally is studied. It is observed that using strain measurement along the blade it is possible to locate the matrix cracks as well as to predict density of matrix cracks. (C) 2004 Elsevier Ltd. All rights reserved.

Integrative functional genomics analysis of sustained polyploidy phenotypes in breast cancer cells identifies an oncogenic profile for GINS2

Aneuploidy is among the most obvious differences between normal and cancer cells. However, mechanisms contributing to development and maintenance of aneuploid cell growth are diverse and incompletely understood. Functional genomics analyses have shown that aneuploidy in cancer cells is correlated with diffuse gene expression signatures and that aneuploidy can arise by a variety of mechanisms, including cytokinesis failures, DNA endoreplication and possibly through polyploid intermediate states. Here, we used a novel cell spot microarray technique to identify genes with a loss-of-function effect inducing polyploidy and/or allowing maintenance of polyploid cell growth of breast cancer cells. Integrative genomics profiling of candidate genes highlighted GINS2 as a potential oncogene frequently overexpressed in clinical breast cancers as well as in several other cancer types. Multivariate analysis indicated GINS2 to be an independent prognostic factor for breast cancer outcome (p = 0.001). Suppression of GINS2 expression effectively inhibited breast cancer cell growth and induced polyploidy. In addition, protein level detection of nuclear GINS2 accurately distinguished actively proliferating cancer cells suggesting potential use as an operational biomarker.

Effect of boundary condition description on convergence of solution in a boundary-value problem

It is well known that the numerical accuracy of a series solution to a boundary-value problem by the direct method depends on the technique of approximate satisfaction of the boundary conditions and on the stage of truncation of the series. On the other hand, it does not appear to be generally recognized that, when the boundary conditions can be described in alternative equivalent forms, the convergence of the solution is significantly affected by the actual form in which they are stated. The importance of the last aspect is studied for three different techniques of computing the deflections of simply supported regular polygonal plates under uniform pressure. It is also shown that it is sometimes possible to modify the technique of analysis to make the accuracy independent of the description of the boundary conditions.

Performance Analysis of Guidance Laws Based on Timescale Gap

An analytical treatment of performance analysis of guidance laws is possible only in simplistic scenarios. As the complexity of the guidance system increases, a search for analytical solutions becomes quite impractical. In this paper, a new performance measure, based upon the notion of a timescale gap that can be computed through numerical simulations, is developed for performance analysis of guidance laws. Finite time Lyapunov exponents are used to define the timescale gap. It is shown that the timescale gap can be used for quantification of the rate of convergence of trajectories to the collision course. Comparisonbetween several guidance laws, based on the timescale gap, is presented. Realistic simulations to study the effect of aerodynamicsand atmospheric variations on the timescale gap of these guidance laws are also presented.

An exact analysis for vibration of simply-supported homogeneous and laminated thick rectangular plates

A three-dimensional linear, small deformation theory of elasticity solution by the direct method is developed for the free vibration of simply-supported, homogeneous, isotropic, thick rectangular plates. The solution is exact and involves determining a triply infinite sequence of eigenvalues from a doubly infinite set of closed form transcendental equations. As no restrictions are placed on the thickness variation of stresses or displacements, this formulation yields a triply infinite spectrum of frequencies, instead of only one doubly infinite spectrum by thin plate theory and three doubly infinite spectra by Mindlin's thick plate theory. Further, the present analysis yields symmetric thickness modes which neither of the approximate theories can identify. Some numerical results from the two approximate theories are compared with those from the present solution and some important conclusions regarding the effect of the assumptions made in the approximate theories are drawn. The thickness variations of stresses and displacements are also discussed. The analysis is readily extended for laminated plates of isotropic materials. Numerical results are also given for three-ply laminates, and are used to assess the accuracy of thin plate theory predictions for laminates. Extension to general lateral surface conditions and forced vibrations is indicated.

Analysis of gradually and spatially varied flow in sand-bed channels

Seepage through a sand bed affects the channel hydrodynamics, which in turn alters channel stability. Thus, the effect of seepage on its hydrodynamic parameters needs to be ascertained. The present work analyses spatially varied flow of a sand-bed channel subjected to seepage in the downward direction through a sand bed. Numerically calculated flow profiles affected by seepage have been verified using experimental observations. The present work also analyses the friction slope, velocity and bed shear stress variations along the channel for both seepage and no-seepage conditions. It was found that the downward seepage-induced channel flow has larger friction slope and bed shear stress than that of no-seepage.

The effect of viscosity and surface tension on the Taylor instability of the surface of a cavitation bubble*

This paper is devoted to a consideration of the following problem: A spherical mass of fluid of density varrho1, viscosity μ1 and external radius R is surrounded by a fluid of density varrho2 and viscosity μ2.The fluids are immiscible and incompressible. The interface is accelerated radially by g1: to study the effect of viscosity and surface tension on the stability of the interface. By analyzing the problem in spherical harmonics the mathematical problem is reduced to one of solution of the characteristic determinant equation. The particular case of a cavity bubble, where the viscosity μ1 of the fluid inside the bubble is negligible in comparison with the viscosity μ2 of the fluid outside the bubble, is considered in some detail. It is shown that viscosity has a stabilizing role on the interface; and when g1 > T(n − 1) (n + 2)/R2(varrho2 − varrho1) the stabilizing role of both viscosity and surface tension is more pronounced than would result when either of them is taken individually.

Analysis of Ridge-Loaded Folded-Waveguide Slow-Wave Structures for Broadband Traveling-Wave Tubes

An E-plane serpentine folded-waveguide slow-wave structure with ridge loading on one of its broad walls is proposed for broadband traveling-wave tubes (TWTs) and studied using a simple quasi-transverse-electromagnetic analysis for the dispersion and interaction impedance characteristics, including the effects of the beam-hole discontinuity. The results are validated against cold test measurements, an approximate transmission-line parametric analysis, an equivalent circuit analysis, and 3-D electromagnetic modeling using CST Microwave Studio. The effect of the structure parameters on widening the bandwidth of a TWT is also studied.

Effect of vibration on heat transfer from a horizontal cylinder to a normal air stream

The effect of vibration on heat transfer from a horizontal copper cylinder, 0.344 in. in diameter and 6 in. long, was investigated. The cylinder was placed normal to an air stream and was sinusoidally vibrated in a direction perpendicular to the direction of the air stream. The flow velocity varied from 19 ft/s to 92 ft/s; the double amplitude of vibration from 0.75 cm to 3.2 cm, and the frequency of vibration from 200 to 2800 cycles/min. A transient technique was used to determine the heat transfer coefficients. The experimental data in the absence of vibration is expressed by NNu = 0.226 NRe0.6 in the range 2500 < NRe < 15 000. By imposing vibrational velocities as high as 20 per cent of the flow velocity, no appreciable change in the heat transfer coefficient was observed. An analysis using the resultant of the vibration and the flow velocity explains the observed phenomenon.

Parametric Analysis Of Turbulent Wall Jets

The concept of a fully-developed flow based on the hypothesis of selective memory is here applied to general wall-jet type flows. In the presence of a (constant) external stream, the free-stream velocity and the jet momentum flux are taken to be the chief quantities governing the development of the wall jet: two additional nondimensional parameters, representing a momentum flux Reynolds number and the relative momentum defect in the initial boundary layer, are shown to have only a secondary effect on the fully-developed flow. The standard correlations so determined are also found to predict quite well the flow development in Gartshore and Newman's experiments on wall jets in adverse pressure gradients; possible reasons for this somewhat surprising result are discussed. Finally it is shown, by application to the still-air case, that the parameters discovered in incompressible flow are, with appropriate but straightforward modification, successful in describing compressible wall jets also.

Nonlinear vibration analysis of composite laminated and sandwich plates with random material properties

Nonlinear vibration analysis is performed using a C-0 assumed strain interpolated finite element plate model based on Reddy's third order theory. An earlier model is modified to include the effect of transverse shear variation along the plate thickness and Von-Karman nonlinear strain terms. Monte Carlo Simulation with Latin Hypercube Sampling technique is used to obtain the variance of linear and nonlinear natural frequencies of the plate due to randomness in its material properties. Numerical results are obtained for composite plates with different aspect ratio, stacking sequence and oscillation amplitude ratio. The numerical results are validated with the available literature. It is found that the nonlinear frequencies show increasing non-Gaussian probability density function with increasing amplitude of vibration and show dual peaks at high amplitude ratios. This chaotic nature of the dispersion of nonlinear eigenvalues is also r

The Day of the Week Effect and Option Pricing - A Study of the German Option Market

The use of different time units in option pricing may lead to inconsistent estimates of time decay and spurious jumps in implied volatilities. Different time units in the pricing model leads to different implied volatilities although the option price itself is the same.The chosen time unit should make it necessary to adjust the volatility parameter only when there are some fundamental reasons for it and not due to wrong specifications of the model. This paper examined the effects of option pricing using different time hypotheses and empirically investigated which time frame the option markets in Germany employ over weekdays. The paper specifically tries to get a picture of how the market prices options. The results seem to verify that the German market behaves in a fashion that deviates from the most traditional time units in option pricing, calendar and trading days. The study also showed that the implied volatility of Thursdays was somewhat higher and thus differed from the pattern of other days of the week. Using a GARCH model to further investigate the effect showed that although a traditional tests, like the analysis of variance, indicated a negative return for Thursday during the same period as the implied volatilities used, this was not supported using a GARCH model.

Income Inequality and Healt: A Multi-Country Analysis

This paper investigates the effect of income inequality on health status. A model of health status was specified in which the main variables were income level, income inequality, the level of savings and the level of education. The model was estimated using a panel data set for 44 countries covering six time periods. The results indicate that income inequality (measured by the Gini coefficient) has a significant effect on health status when we control for the levels of income, savings and education. The relationship is consistent regardless of the specification of health status and income. Thus, the study results provide some empirical support for the income inequality hypothesis.