Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial

BACKGROUND: Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone.

METHODS: Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m(2)) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2·5% one-sided α for hazard ratio (HR) 0·75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544).

FINDINGS: 2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79-1·11; p=0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66-0·93; p=0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69-0·97; p=0·022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc.

INTERPRETATION: Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy.

FUNDING: Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research.

Hα Line Profile Asymmetries and the Chromospheric Flare Velocity Field

The asymmetries observed in the line profiles of solar flares can provide important diagnostics of the properties and dynamics of the flaring atmosphere. In this paper the evolution of the Hα and Ca ii λ8542 lines are studied using high spatial, temporal, and spectral resolution ground-based observations of an M1.1 flare obtained with the Swedish 1 m Solar Telescope. The temporal evolution of the Hα line profiles from the flare kernel shows excess emission in the red wing (red asymmetry) before flare maximum and excess in the blue wing (blue asymmetry) after maximum. However, the Ca ii λ8542 line does not follow the same pattern, showing only a weak red asymmetry during the flare. RADYN simulations are used to synthesize spectral line profiles for the flaring atmosphere, and good agreement is found with the observations. We show that the red asymmetry observed in Hα is not necessarily associated with plasma downflows, and the blue asymmetry may not be related to plasma upflows. Indeed, we conclude that the steep velocity gradients in the flaring chromosphere modify the wavelength of the central reversal in the Hα line profile. The shift in the wavelength of maximum opacity to shorter and longer wavelengths generates the red and blue asymmetries, respectively.

Non-equilibrium modeling of the FE XVII 3C/3D Line Ratio in an Intense X-ray Free-electron Laser Excited Plasma

Recent measurements using an X-ray Free Electron Laser (XFEL) and an Electron Beam Ion Trap at the Linac Coherent Light Source facility highlighted large discrepancies between the observed and theoretical values for the Fe XVII 3C/3D line intensity ratio. This result raised the question of whether the theoretical oscillator strengths may be significantly in error, due to insufficiencies in the atomic structure calculations. We present time-dependent spectral modeling of this experiment and show that non-equilibrium effects can dramatically reduce the predicted 3C/3D line intensity ratio, compared with that obtained by simply taking the ratio of oscillator strengths. Once these non-equilibrium effects are accounted for, the measured line intensity ratio can be used to determine a revised value for the 3C/3D oscillator strength ratio, giving a range from 3.0 to 3.5. We also provide a framework to narrow this range further, if more precise information about the pulse parameters can be determined. We discuss the implications of the new results for the use of Fe XVII spectral features as astrophysical diagnostics and investigate the importance of time-dependent effects in interpreting XFEL-excited plasmas.

Line ratio diagnostics in helium and helium seeded argon plasmas

We investigate the potential use of line ratio diagnostics to evaluate electron temperature in either helium or helium seeded argon plasmas. Plasmas are produced in a helicon plasma source. A rf compensated Langmuir probe is used to measure both the electron temperature and plasma density while a spectrometer is used to measure He I line intensities from the plasma. For all plasma densities where the electron temperature remains at 5 ± 1 eV, three He line ratios are measured. Each experimental ratio is compared with the prediction of three different collisional radiative models. One of these models makes uses of recent R-matrix with pseudo-states calculations for collisional rate coefficients. A discussion related to the different observations and model predictions is presented.

Collisional-radiative calculations of He line emission in low-temperature plasmas

We present spectral modeling results for neutral helium. Our underlying atomic data contains radiative transition rates that are generated from atomic structure calculations and electron-impact excitation rates, that are determined from both the standard R-matrix method and the R-matrix with pseudostates RMPS method. In this paper, we focus on transitions of particular importance to diagnostic line ratios. For example, our calculated rate coefficient for the electron-impact transition 1s3s 1S→1s3p 1P, which has a pronounced effect on the 728.1 nm diagnostic spectral line, is found to be in good agreement with previous experimental mea- surements. We also consider transitions from the 1s2 1S ground and 1s2s 3S terms to terms of the n=4 shell. They are found to be affected significantly by coupling of the bound states to the target continuum continuum coupling, which is included in our RMPS calculation, but not in our standard R-matrix calculation. We perform collisional-radiative calculations to determine spectral line intensity ratios for three ratios of particular interest, namely the 504.8 nm/471.3 nm, 492.2 nm/471.3 nm, and 492.2 nm/504.8 nm line ratios. Comparing our results determined from the RMPS excitation rates with those from the standard R-matrix excitation rates, we find that continuum coupling affects the rate coefficients significantly, leading to different values for all three line ratios. We also compare our modeling results with spectral measurements taken recently on the Auburn Helicon plasma device, finding that the ground and metastable populations are not in equilibrium, and that the experimental measurements are more consistent with the 1s2s 3S metastable term populations being short lived in the plasma.

Implementation of a new atomic basis for the He i equilibrium line ratio technique for electron temperature and density diagnostic in the SOL for H-mode plasmas in DIII-D

Evaluating the ratio of selected helium lines allows for measurement of electron densities and temperatures. This technique is applied for L-mode plasmas at TEXTOR (O. Schmitz et al., Plasma Phys. Control. Fusion 50 (2008) 115004). We report our first efforts to extend it to H-mode plasma diagnostics in DIII-D. This technique depends on the accuracy of the atomic data used in the collisional radiative model (CRM). We present predictions for the electron temperatures and densities by using recently calculated R-Matrix With Pseudostates (RMPS) and Convergent Close-Coupling (CCC) electron-impact excitation and ionization data. We include contributions from higher Rydberg states by means of the projection matrix. These effects become significant for high electron density conditions, which are typical in H-mode. We apply a non-equilibrium model for the time propagation of the ionization balance to predict line emission profiles from experimental H-mode data from DIII-D. © 2010 Elsevier B.V. All rights reserved.

Hybrid time dependent/independent solution for the He i line ratio temperature and density diagnostic for a thermal helium beam with applications in the scrape-off layer-edge regions in tokamaks

Spectroscopic studies of line emission intensities and ratios offer an attractive option in the\r\ndevelopment of non-invasive plasma diagnostics. Evaluating ratios of selected He I line\r\nemission profiles from the singlet and triplet neutral helium spin systems allows for simultaneous\r\nmeasurement of electron density (ne) and temperature (Te) profiles. Typically, this powerful\r\ndiagnostic tool is limited by the relatively long relaxation times of the 3S metastable term of helium\r\nthat populates the triplet spin system, and on which electron temperature sensitive lines are based.\r\nBy developing a time dependent analytical solution, we model the time evolution of the two spin\r\nsystems. We present a hybrid time dependent/independent line ratio solution that improves the\r\nrange of application of this diagnostic technique in the scrape-off layer (SOL) and edge plasma\r\nregions when comparing it against the current equilibrium line ratio helium model used at\r\nTEXTOR.

Helium line intensity ratio in microwave-generated plasmas

The line intensity ratio method provides a nonintrusive diagnostic for the measurement of electron temperature in microwave-generated plasmas. For optically thin plasmas of low density, a line intensity method using He I lines can often be used, and is based on the fact that the electron impact excitation rate coefficients for helium singlet and triplet states are insensitive to electron density but differ as a function of the electron temperature. Line intensity measurements are presented from microwave-generated helium plasmas. Both steady-state corona and collision-radiative theoretical models are used to evaluate the ground and excited state populations. The line ratio versus electron temperature obtained from both of these methods are compared with the results from measurements. However, it is not possible to diagnose the electron temperature from the line ratios alone due to the presence of significant opacity and nonnegligible 1s2s S-3 metastable fraction in the plasma. (C) 2004 American Institute of Physics.

A comparison of theoretical Mg VI emission line strengths with active-region observations from SERTS

R-matrix calculations of electron impact excitation rates in N-like Mg VI are used to derive theoretical electron-density-sensitive emission line ratios involving 2s²2p³ - 2s2p⁴ transitions in the 269-403 Å wavelength range. A comparison of these with observations of a solar active region, obtained during the 1989 flight of the Solar EUV Rocket Telescope and Spectrograph (SERTS), reveals good agreement between theory and observation for the 2s²2p^{3 4}S - 2s2p ^{4 4}p transitions at 399.28, 400.67, and 403.30 Å, and the 2s²2p^{3 2}p - 2s2p^{4 2}D lines at 387.77 and 387.97 Å. However, intensities for the other lines attributed to Mg VI in this spectrum by various authors do not match the present theoretical predictions. We argue that these discrepancies are not due to errors in the adopted atomic data, as previously suggested, but rather to observational uncertainties or mis-identifications. Some of the features previously identified as Mg VI lines in the SERTS spectrum, such as 291.36 and 293.15 Å, are judged to be noise, while others (including 349.16 Å) appear to be blended.

A Fast Analysis Method for the Groove Gap Waveguide Using Transmission Line Theory

The Groove Gap Waveguide (GGW) shows a behavior similar to the classical rectangular waveguide (RWG), but it is formed by two pieces which do not require metal contact. This feature suggests the GGW as a suitable alternative to the RGW for mm-wave frequencies, where ensuring the proper metal contact according to the wavelength size results challenging. Nevertheless, there is a lack of effective analysis tools for the complex GGW topology, and assuming a direct equivalence between the RGW and the GGW is too rough, so that dilatory full-wave simulations are required. This work presents a fast analysis method based on transmission line theory, which establishes the proper correspondence between the GGW and the RWG. In addition, below cutoff behavior of the GGW is studied for the first time. Several numerical tests and two manufactured prototypes validate the proposed method, which seems very adequate to optimize future GGW structures.

Resource Efficient Configuration of an Aircraft Assembly Line

The design of efficient assembly systems can significantly contribute to the profitability of products and the competitiveness of manufacturing industries. The configuration of a an efficient assembly line can be supported by suitable methodologies and techniques, such as design for manufacture and assembly, assembly sequence planning, assembly line balancing, lean manufacturing and optimization techniques. In this paper, these methods are applied with reference to the industrial case study of the assembly line of a Skycar light aircraft. The assembly process sequence is identified taking into account the analysis of the assembly structure and the required precedence constraints, and diverse techniques are applied to optimize the assembly line performance. Different line configurations are verified through discrete event simulation to assess the potential increase of efficiency and throughput in a digital environment and propose the most suitable configuration of the assembly line.

Virtual Ergonomics and Time optimization of a Railway Coach Assembly Line

The recent drive towards timely multiple product realizations has caused most Manufacturing Enterprises (MEs) to develop more flexible assembly lines supported by better manufacturing design and planning. The aim of this work is to develop a methodology which will support feasibility analyses of assembly tasks, in order to simulate either a manufacturing process or a single work-cell in which digital human models act. The methodology has been applied in a case study relating to a railway industry. Simulations were applied to help standardize the methodology and suggest new solutions for realizing ergonomic and efficient assembly processes in the railway industry.

Energy of line graphs

The energy of a graph is equal to the sum of the absolute values of its eigenvalues. The energy of a matrix is equal to the sum of its singular values. We establish relations between the energy of the line graph of a graph G and the energies associated with the Laplacian and signless Laplacian matrices of G. © 2010 Elsevier B.V. All rights reserved.

E-assessment em ensino a distância on-line: estudo exploratório no curso de licenciatura em gestão de negócios da Universidade Eduardo Mondlane

A evolução acelerada da tecnologia, com um grande impacto em quase todos os segmentos da humanidade, coloca o homem perante novos desafios, com vários graus de complexidade. Cada dia que passa, estes desafios exigem novas competências e estratégias que devem ser adequadas a cada contexto. A dinâmica das tecnologias de comunicação e informação impulsionaram a evolução do ensino a distância (EaD), o que de certo modo tem exigido grandemente às instituições provedoras do EaD em geral e, em particular, às provedoras do EaD on-line novas formas de gestão, e novas formas de ensinar, fazer aprender os seus estudantes e avaliar as suas aprendizagens. No sentido de contribuir para a evolução e melhoramento do processo de avaliação das aprendizagens on-line, desenvolveu-se um estudo sobre o tema avaliação das aprendizagens on-line como elemento potenciador da interação em EaD. O desenvolvimento do tema foi orientado por um referencial teórico e contextual e concretizou-se, na sua vertente empírica, num estudo de caso exploratório. Este estudo desenvolveu-se em duas fases. Fase I: de caracterização de conceções e “práticas” vigentes de avaliação das aprendizagens on-line no Curso de licenciatura de Gestão de Negócios (LGN) da Universidade Eduardo Mondlane (UEM) de Moçambique; Fase II: de conceção, implementação e avaliação de uma proposta alternativa de avaliação das aprendizagens on-line no Curso de LGN. Para a consecução do estudo empírico concorreram um conjunto de procedimentos metodológicos que envolveu diversas técnicas e instrumentos de recolha de dados. Na fase I recorreu-se à entrevista a seis atores do Curso de LGN (3 professores, 3 assessores pedagógicos e 3 estudantes) e à análise documental (documentos relativos à conceção do Curso e outros relativos à sua implementação). Na fase II recorreu-se à observação participante, a um questionário respondido pelos estudantes participantes, a um relatório elaborado pelo professor colaborador na implementação da proposta por nós concebido, e a documentos retirados da plataforma usada no Curso de LGN, a plataforma Aulanet, nomeadamente quanto às interações dos estudantes em fóruns e chats. Os dados recolhidos foram sujeitos a análises quantitativas e qualitativas.Dos resultados obtidos na Fase I realça-se a necessidade sentida pelos entrevistados de se mudarem práticas de avaliação on-line, nomeadamente de forma a potenciar a interação e interatividade e permitir que a classificação nos módulos não fosse apenas resultado de um exame final. Dos resultados obtidos na Fase II enfatiza-se a apreciação globalmente positiva da nova metodologia de avaliação das aprendizagens on-line, quer pelos estudantes, quer pelo professor participante. Foram identificados como pontos fortes: o aumento das interações na plataforma, em particular nos fóruns e chats; as interações geraram uma dinâmica na evolução dos estudantes no que diz respeito ao desenvolvimento das suas competências no seu sucesso académico; a avaliação, por explicitar os critérios e indicadores, tornou-se mais transparente e orientadora do trabalho dos estudantes e do professor. Porém foram identificados alguns pontos menos fortes, nomeadamente: a sobrecarga de trabalho do professor e a não adesão total dos estudantes à metodologia proposta. Dada a natureza exploratória do estudo sugere-se a sua continuidade, através do envolvimento de outros professores e estudantes.

Rede social de leitores e escritores juniores: portal Biblon: a integração social on-line como catalisador da leitura, criação, expressão e partilha

Com enquadramento nas áreas de Ciência da Informação, Tecnologias de Informação e Comunicação e Educação, o estudo em voga visa formular propostas para o uso de rede social on-line de literatura infantil, em torno da biblioteca, para a educação básica, fundamentadas na teoria de comunidades de prática. O estudo de caso recaiu sobre quatro escolas, do 1º ciclo, da Educação Básica, do Agrupamento de Escolas de Aveiro-Portugal, tendo como instrumento para o experimento o Portal Biblon. A análise dos dados permite afirmar que a leitura de livros on-line não está inclusa nas atividades habituais da comunidade escolar pesquisada e, assim, o aluno encontra-se sem referencial para inserir esta prática cultural em suas rotinas e momentos de ócio. O cenário escolar atual não estimula a confluências da prática da leitura literária e da escrita dos alunos com as redes sociais on-line. O estudo aponta que, em uma rede social on-line, o livro de literatura infantil tem o papel de interagente, agregando leitores, em interação, em torno de si e que nas redes sociais on-line tem-se a presença dos “mediadores sociais centrais” que propiciam reforço e sustentação das práticas de leitura, através do contágio e da influência social e são propulsionadores da estrutura e do dinamismo da rede. Como conclusão geral tem-se que os utilizadores do Biblon desenvolvem experiências de leituras e escritas através da interação social, por meio de práticas, rotinas, diálogos e atividades comuns construídas na rede. A interação dentro da rede influencia o uso das ferramentas e o aprendizado para manuseá-las ocorre com as práticas. Assim, os laços associativos e as reações individuais envolvendo a leitura conduzem à formação de rede social em torno dos livros e os comportamentos e as preferências dos atores motivam a leitura e a escrita. Dessa forma, o Portal Biblon configura-se como um instrumento para formação de rede social on-line em torno da literatura infantil.