Single-agent versus combination chemotherapy in patients with advanced non-small cell lung cancer and a performance status of 2 : prognostic factors and treatment selection based on two large randomized clinical trials

Purpose: Data from two randomized phase III trials were analyzed to evaluate prognostic factors and treatment selection in the first-line management of advanced non-small cell lung cancer patients with performance status (PS) 2. Patients and Methods: Patients randomized to combination chemotherapy (carboplatin and paclitaxel) in one trial and single-agent therapy (gemcitabine or vinorelbine) in the second were included in these analyses. Both studies had identical eligibility criteria and were conducted simultaneously. Comparison of efficacy and safety was performed between the two cohorts. A regression analysis identified prognostic factors and subgroups of patients that may benefit from combination or single-agent therapy. Results: Two hundred one patients were treated with combination and 190 with single-agent therapy. Objective responses were 37 and 15%, respectively. Median time to progression was 4.6 months in the combination arm and 3.5 months in the single-agent arm (p < 0.001). Median survival imes were 8.0 and 6.6 months, and 1-year survival rates were 31 and 26%, respectively. Albumin <3.5 g, extrathoracic metastases, lactate dehydrogenase ≥200 IU, and 2 comorbid conditions predicted outcome. Patients with 0-2 risk factors had similar outcomes independent of treatment, whereas patients with 3-4 factors had a nonsignificant improvement in median survival with combination chemotherapy. Conclusion: Our results show that PS2 non-small cell lung cancer patients are a heterogeneous group who have significantly different outcomes. Patients treated with first-line combination chemotherapy had a higher response and longer time to progression, whereas overall survival did not appear significantly different. A prognostic model may be helpful in selecting PS 2 patients for either treatment strategy. © 2009 by the International Association for the Study of Lung Cancer.

Effects of textured insoles on balance in people with Parkinson’s Disease

Background Degradation of the somatosensory system has been implicated in postural instability and increased falls risk for older people and Parkinson’s disease (PD) patients. Here we demonstrate that textured insoles provide a passive intervention that is an inexpensive and accessible means to enhance the somatosensory input from the plantar surface of the feet. Methods 20 healthy older adults (controls) and 20 participants with PD were recruited for the study. We evaluated effects of manipulating somatosensory information from the plantar surface of the feet using textured insoles. Participants performed standing tests, on two different surfaces (firm and foam), under three footwear conditions: 1) barefoot; 2) smooth insoles; and 3) textured insoles. Standing balance was evaluated using a force plate yielding data on the range of anterior-posterior and medial-lateral sway, as well as standard deviations for anterior-posterior and medial-lateral sway. Results On the firm surface with eyes open both the smooth and textured insoles reduced medial-lateral sway in the PD group to a similar level as the controls. Only the textured insole decreased medial-lateral sway and medial-lateral sway standard deviation in the PD group on both surfaces, with and without visual input. Greatest benefits were observed in the PD group while wearing the textured insoles, and when standing on the foam surface with eyes closed. Conclusions Data suggested that textured insoles may provide a low-cost means of improving postural stability in high falls-risk groups, such as people with PD.

New approaches to making the microenvironment of the female reproductive tract hostile to HIV

The studies presented in this review explore three distinct areas with potential for inhibiting HIV infection in women. Based on emerging information from the physiology, endocrinology and immunology of the female reproductive tract (FRT), we propose unique 'works in progress' for protecting women from HIV. Various aspects of FRT immunity are suppressed by estradiol during the menstrual cycle, making women more susceptible to HIV infection. By engineering commensal Lactobacillus to secrete the anti-HIV molecule Elafin as estradiol levels increase, women could be protected from HIV infection. Selective estrogen response modifiers enhance barrier integrity and enhance secretion of protective anti-HIV molecules. Finally, understanding the interactions and regulation of FRT endogenous antimicrobials, proteases, antiproteases, etc., all of which are under hormonal control, will open new avenues to therapeutic manipulation of the FRT mucosal microenvironment. By seeking new alternatives to preventing HIV infection in women, we may finally disrupt the HIV pandemic.

Learning detectors quickly with stationary statistics

Computer vision is increasingly becoming interested in the rapid estimation of object detectors. The canonical strategy of using Hard Negative Mining to train a Support Vector Machine is slow, since the large negative set must be traversed at least once per detector. Recent work has demonstrated that, with an assumption of signal stationarity, Linear Discriminant Analysis is able to learn comparable detectors without ever revisiting the negative set. Even with this insight, the time to learn a detector can still be on the order of minutes. Correlation filters, on the other hand, can produce a detector in under a second. However, this involves the unnatural assumption that the statistics are periodic, and requires the negative set to be re-sampled per detector size. These two methods differ chie y in the structure which they impose on the co- variance matrix of all examples. This paper is a comparative study which develops techniques (i) to assume periodic statistics without needing to revisit the negative set and (ii) to accelerate the estimation of detectors with aperiodic statistics. It is experimentally verified that periodicity is detrimental.

Exploring the international market selection of small to medium sized enterprises

Research into the international market selection (IMS) of small to medium sized enterprises (SMEs) commonly identifies psychic distance and networks as being the most important determinants of a firm’s IMS. Whether regional factors, such as bilateral and multilateral regional integration, are important as determinants of IMS is not well understood. This paper utilises a multiple case study method through in-depth interviews to investigate, in the context of the current business environment, how important regionalisation, psychic distance and networks are as determinants of IMS among SMEs in the food and beverage industries within Australia and Malaysia. The study found regional considerations to be important to the IMS of Malaysian but not Australian firms, while psychic distance was considered an important determinant on IMS by only half of the sampled firms. The role of networks, however, was considered the most important determinant of IMS among all the sampled firms.

Iterative intersections

Iterative Intersectioning is a body of art works that comes out of the collaboration between author and electronic artist Jen Seevinck and a community of print artists, most particularly Elizabeth Saunders (EJ) and Robert Oakman. The work shown here is concerned with the creative process of collaboration, specifically as this informs visual forms. This is through our focus on process. This process has facilitated a 'conversational' exchange between all artists and a corresponding evolution in the artworks. In each case the dialogue is either between the author, Jen and EJ or between Jen and Robert. It consists of passing work between parties, interpreting it and working into it, before passing it back. The result is a series of art works including those shown here. The concept evolves in parallel to this. Importantly, at each of her iterations of creative work, the author Jen determines a similar 'treatment' or 'interpretation' across both print artists works at that time. A synthesis of EJ and Robert's creative interpretation -- at a high level -- occurs. In this sense the concept and works can be understood to intersect with one another.

Vertical dynamic interaction of trains and rail steel bridges

Rail steel bridges are vulnerable to high impact forces due to the passage of trains; unfortunately the determination of these transient impact forces is not straightforward as these are affected by a large number of parameters, including the wagon design, the wheel-rail contact and the design parameters of the bridge deck and track, as well as the operational parameters – wheel load and speed. To determine these impact forces, a detailed rail train-track/bridge dynamic interaction model has been developed, which includes a comprehensive train model using multi-body dynamics approach and a flexible track/bridge model using Euler– Bernoulli beam theory. Single and multi-span bridges have been modelled to examine their dynamic characteristics. From the single span bridge, the train critical speed is determined; the minimum distance of two peak loadings is found to affect the train critical speed. The impact factor and the dynamic characteristics are discussed.