Maintenance Therapy With Tumor-Treating Fields Plus Temozolomide vs Temozolomide Alone for Glioblastoma: A Randomized Clinical Trial.

IMPORTANCE: Glioblastoma is the most devastating primary malignancy of the central nervous system in adults. Most patients die within 1 to 2 years of diagnosis. Tumor-treating fields (TTFields) are a locoregionally delivered antimitotic treatment that interferes with cell division and organelle assembly. OBJECTIVE: To evaluate the efficacy and safety of TTFields used in combination with temozolomide maintenance treatment after chemoradiation therapy for patients with glioblastoma. DESIGN, SETTING, AND PARTICIPANTS: After completion of chemoradiotherapy, patients with glioblastoma were randomized (2:1) to receive maintenance treatment with either TTFields plus temozolomide (n = 466) or temozolomide alone (n = 229) (median time from diagnosis to randomization, 3.8 months in both groups). The study enrolled 695 of the planned 700 patients between July 2009 and November 2014 at 83 centers in the United States, Canada, Europe, Israel, and South Korea. The trial was terminated based on the results of this planned interim analysis. INTERVENTIONS: Treatment with TTFields was delivered continuously (>18 hours/day) via 4 transducer arrays placed on the shaved scalp and connected to a portable medical device. Temozolomide (150-200 mg/m2/d) was given for 5 days of each 28-day cycle. MAIN OUTCOMES AND MEASURES: The primary end point was progression-free survival in the intent-to-treat population (significance threshold of .01) with overall survival in the per-protocol population (n = 280) as a powered secondary end point (significance threshold of .006). This prespecified interim analysis was to be conducted on the first 315 patients after at least 18 months of follow-up. RESULTS: The interim analysis included 210 patients randomized to TTFields plus temozolomide and 105 randomized to temozolomide alone, and was conducted at a median follow-up of 38 months (range, 18-60 months). Median progression-free survival in the intent-to-treat population was 7.1 months (95% CI, 5.9-8.2 months) in the TTFields plus temozolomide group and 4.0 months (95% CI, 3.3-5.2 months) in the temozolomide alone group (hazard ratio [HR], 0.62 [98.7% CI, 0.43-0.89]; P = .001). Median overall survival in the per-protocol population was 20.5 months (95% CI, 16.7-25.0 months) in the TTFields plus temozolomide group (n = 196) and 15.6 months (95% CI, 13.3-19.1 months) in the temozolomide alone group (n = 84) (HR, 0.64 [99.4% CI, 0.42-0.98]; P = .004). CONCLUSIONS AND RELEVANCE: In this interim analysis of 315 patients with glioblastoma who had completed standard chemoradiation therapy, adding TTFields to maintenance temozolomide chemotherapy significantly prolonged progression-free and overall survival. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00916409.

To return or to discard? Randomised trial on gastric residual volume management

Background: The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients" clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients. Method: A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs. Results: Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia. Conclusions: The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.

Unitizing in Supply Chain – Case SECU Container

The aim of this thesis is to analyze how increasing the level of unitizing affects to the costs in the transport system of a Finnish paper and board company. The parts of the supply chain where costs are analyzed are limited to domestic inland transport and port operations. Supply Chain management is important aspect of modern day companies’ strategies. Intermodal transport and different transport systems are the key items which are studied in the theory part of this thesis. In the case study the payload simulations for SECU container (Stora Enso Cargo Unit) stuffed in mills sites are base of the cost analyze of this thesis. Thesis also makes a glance for the restrictions and development trends in Finnish railroads. In analyze SECU containers are moved up to the mill site for stuffing. This increases the level of unitizing in supply chain. Analyze is made for three variation of current traffic lines. Analyze shows that when idea of intermodalism is well used there is considerable cost savings to gather in pre-transportation and port operations. But also effects to mill sites and destination ports needs to be take under considering. In analyze the effects of increased axle weight for SECU container transportation in Finnish railroads is studied. When transport unit is stuffed in earliest possible point supply chain and unloaded the last possible point the savings made in chain can be considerable. In case study of this thesis almost 40% savings in total costs could be reached in pre transportation and port operations when unitizing level is increased in supply chain.

Container logistic innovations in forest-energy sector: Markets, future service concepts and technical improvements

The report presents the results of the commercialization project called the Container logistic services for forest bioenergy. The project promotes new business that is emerging around overall container logistic services in the bioenergy sector. The results assess the European markets of the container logistics for biomass, enablers for new business creation and required service bundles for the concept. We also demonstrate the customer value of the container logistic services for different market segments. The concept analysis is based on concept mapping, quality function deployment process (QFD) and business network analysis. The business network analysis assesses key shareholders and their mutual connections. The performance of the roadside chipping chain is analysed by the logistic cost simulation, RFID system demonstration and freezing tests. The EU has set the renewable energy target to 20 % in 2020 of which Biomass could account for two-thirds. In the Europe, the production of wood fuels was 132.9 million solid-m3 in 2012 and production of wood chips and particles was 69.0 million solidm3. The wood-based chips and particle flows are suitable for container transportation providing market of 180.6 million loose- m3 which mean 4.5 million container loads per year. The intermodal logistics of trucks and trains are promising for the composite containers because the biomass does not freeze onto the inner surfaces in the unloading situations. The overall service concept includes several packages: container rental, container maintenance, terminal services, RFID-tracking service, and simulation and ERP-integration service. The container rental and maintenance would provide transportation entrepreneurs a way to increase the capacity without high investment costs. The RFID-concept would lead to better work planning improving profitability throughout the logistic chain and simulation supports fuel supply optimization.

Evaluation of temperatures in a refrigerated container for chilled and frozen food transport

The objective of this work was to monitor the operational conditions of the transport of chilled and frozen foods during delivery within cities and to evaluate the impact of the door openings on the alteration of the internal temperature of the refrigerated environment. Several temperature and pressure sensors were used in a refrigerated container with two compartments and they were installed in the refrigeration system unit and on the internal and external surfaces of the container. After the monitoring tests, it was verified that door openings during deliveries resulted in a disturbance that raised the internal temperature of the refrigerated container above values recommended for adequate conservation of the products transported. Moreover, increasing the number of door openings promoted a cumulative effect on the internal temperature, mainly in the chilled food compartment of the container. It was concluded that the refrigeration system unit presented serious limitations with regard to the maintenance of the container's internal temperature during the actual distribution routine, since it does not possess enough instantaneous capacity to restore the temperature set-point between deliveries.

FEM based Virtual Prototyping and Design of Third Harmonic Excitation System for Low Voltage Brushless Alternators

Salient pole brushless alternators coupled to IC engines are extensively used as stand-by power supply units for meeting in- dustrial power demands. Design of such generators demands high power to weight ratio, high e ciency and low cost per KVA out- put. Moreover, the performance characteristics of such machines like voltage regulation and short circuit ratio (SCR) are critical when these machines are put into parallel operation and alterna- tors for critical applications like defence and aerospace demand very low harmonic content in the output voltage. While designing such alternators, accurate prediction of machine characteristics, including total harmonic distortion (THD) is essential to mini- mize development cost and time. Total harmonic distortion in the output voltage of alternators should be as low as possible especially when powering very sophis- ticated and critical applications. The output voltage waveform of a practical AC generator is replica of the space distribution of the ux density in the air gap and several factors such as shape of the rotor pole face, core saturation, slotting and style of coil disposition make the realization of a sinusoidal air gap ux wave impossible. These ux harmonics introduce undesirable e ects on the alternator performance like high neutral current due to triplen harmonics, voltage distortion, noise, vibration, excessive heating and also extra losses resulting in poor e ciency, which in turn necessitate de-rating of the machine especially when connected to non-linear loads. As an important control unit of brushless alternator, the excitation system and its dynamic performance has a direct impact on alternator's stability and reliability. The thesis explores design and implementation of an excitation i system utilizing third harmonic ux in the air gap of brushless al- ternators, using an additional auxiliary winding, wound for 1=3rd pole pitch, embedded into the stator slots and electrically iso- lated from the main winding. In the third harmonic excitation system, the combined e ect of two auxiliary windings, one with 2=3rd pitch and another third harmonic winding with 1=3rd pitch, are used to ensure good voltage regulation without an electronic automatic voltage regulator (AVR) and also reduces the total harmonic content in the output voltage, cost e ectively. The design of the third harmonic winding by analytic methods demands accurate calculation of third harmonic ux density in the air gap of the machine. However, precise estimation of the amplitude of third harmonic ux in the air gap of a machine by conventional design procedures is di cult due to complex geome- try of the machine and non-linear characteristics of the magnetic materials. As such, prediction of the eld parameters by conven- tional design methods is unreliable and hence virtual prototyping of the machine is done to enable accurate design of the third har- monic excitation system. In the design and development cycle of electrical machines, it is recognized that the use of analytical and experimental methods followed by expensive and in exible prototyping is time consum- ing and no longer cost e ective. Due to advancements in com- putational capabilities over recent years, nite element method (FEM) based virtual prototyping has become an attractive al- ternative to well established semi-analytical and empirical design methods as well as to the still popular trial and error approach followed by the costly and time consuming prototyping. Hence, by virtually prototyping the alternator using FEM, the important performance characteristics of the machine are predicted. Design of third harmonic excitation system is done with the help of results obtained from virtual prototype of the machine. Third harmonic excitation (THE) system is implemented in a 45 KVA ii experimental machine and experiments are conducted to validate the simulation results. Simulation and experimental results show that by utilizing third harmonic ux in the air gap of the ma- chine for excitation purposes during loaded conditions, triplen harmonic content in the output phase voltage is signi cantly re- duced. The prototype machine with third harmonic excitation system designed and developed based on FEM analysis proved to be economical due to its simplicity and has the added advan- tage of reduced harmonics in the output phase voltage.

The economic viability and potential of a novel poultry agroforestry system

Investigating agroforestry systems that incorporate poultry is warranted in Northern Europe as they may offer benefits including: improved welfare and use of range; reduced feed costs; price premia on products; reduced payback periods for forests; and, greater returns on investment. Free-range egg production accounts for 27% of the United Kingdom egg market and demand for outdoor broilers is increasing. No research has been conducted recently on the economic viability of agroforestry systems with poultry. An economic model was constructed to: assess economic viability of a broiler agroforestry system; and, investigate the sensitivity of economic performance to key factors and interactions, and identify those which warrant attention in research and management. The system modelled is a commercial trial established in Southern England in 2002 where deciduous trees were planted and broilers reared in six- or nine-week periods. The model uses Monte Carlo simulation and financial performance analyses run for a 120-year period. An Internal Rate of Return (IRR) of 15.5% is predicted for the six-week system which remains viable under a 'worst case' scenario (IRR of 12.6%). Factors which affect financial performance most (decreasing in magnitude) are prices achieved for broilers, costs of brooding houses, chicks, arks, feed and timber prices. The main anticipated effects of biological interactions on financial performance (increased ranging on feed conversion and excess nutrient supply on tree health) were not supported by analysis. Further research is particularly warranted on the welfare benefits offered by the tree component and its relation to price premia.

Regulation of plant growth in container-grown ornamentals through the use of controlled irrigation

The aim of this research was to determine whether shoot growth could be regulated and plant quality improved through two controlled irrigation techniques: Regulated Deficit Irrigation (RDI) or Partial Root Drying (PRD). An additional benefit of such techniques is that they would also improve the efficiency of irrigation application and reduce the volume of water used on commercial nurseries. Results from two ornamental woody plant species (Cotinus and Forsythia) demonstrated that plant quality could be significantly improved when RDI was applied at ≤ 60% of potential evapo-transpiration (ETp). Stomatal closure and reduced leaf and internode growth rates were associated with both the RDI and PRD techniques, but reduced leaf water potential was only recorded in the RDI system. Changes in xylem sap pH and ABA concentrations were correlated with changes in shoot physiology, and thought to be generated by those roots exposed to drying soil. By adopting such controlled irrigation systems on commercial holdings it is estimated that water consumption could be reduced by 50 to 90%.

A novel galactooligosaccharide mixture increases the bifidobacterial population numbers in a continuous in vitro fermentation system and in the proximal colonic contents of pigs in vivo

Prebiotics are nondigestible food ingredients that encourage proliferation of selected groups of the colonic microflora, thereby altering the composition toward a more beneficial community. In the present study, the prebiotic potential of a novel galactooligosaccharide (GOS) mixture, produced by the activity of galactosyltransferases from Bifidobacterium bifidum 41171 on lactose, was assessed in vitro and in a parallel continuous randomized pig trial. In situ fluorescent hybridization with 16S rRNA-targeted probes was used to investigate changes in total bacteria, bifidobacteria, lactobacilli, bacteroides, and Clostridium histolyticum group in response to supplementing the novel GOS mixture. In a 3-stage continuous culture system, the bifidobacterial numbers for the first 2 vessels, which represented the proximal and traverse colon, increased (P < 0.05) after the addition of the oligosaccharide mixture. In addition, the oligosaccharide mixture strongly inhibited the attachment of enterohepatic Escherichia coli (P < 0.01) and Salmonella enterica serotype Typhimurium (P < 0.01) to HT29 cells. Addition of the novel mixture at 4% (wt:wt) to a commercial diet increased the density of bificlobacteria (P < 0.001) and the acetate concentration (P < 0.001), and decreased the pH (P < 0.001) compared with the control diet and the control diet supplemented with inulin, suggesting a great prebiotic potential for the novel oligosaccharide mixture. J. Nutr. 135: 1726-1731, 2005.

Single-trial event-related potential analysis for brain-computer interfaces

Abstract. Different types of mental activity are utilised as an input in Brain-Computer Interface (BCI) systems. One such activity type is based on Event-Related Potentials (ERPs). The characteristics of ERPs are not visible in single-trials, thus averaging over a number of trials is necessary before the signals become usable. An improvement in ERP-based BCI operation and system usability could be obtained if the use of single-trial ERP data was possible. The method of Independent Component Analysis (ICA) can be utilised to separate single-trial recordings of ERP data into components that correspond to ERP characteristics, background electroencephalogram (EEG) activity and other components with non- cerebral origin. Choice of specific components and their use to reconstruct “denoised” single-trial data could improve the signal quality, thus allowing the successful use of single-trial data without the need for averaging. This paper assesses single-trial ERP signals reconstructed using a selection of estimated components from the application of ICA on the raw ERP data. Signal improvement is measured using Contrast-To-Noise measures. It was found that such analysis improves the signal quality in all single-trials.

The effect of the GENTLE/s robot-mediated therapy system on arm function after stroke

Objective: To evaluate the effect of robot-mediated therapy on arm dysfunction post stroke. Design: A series of single-case studies using a randomized multiple baseline design with ABC or ACB order. Subjects (n = 20) had a baseline length of 8, 9 or 10 data points. They continued measurement during the B - robot-mediated therapy and C - sling suspension phases. Setting: Physiotherapy department, teaching hospital. Subjects: Twenty subjects with varying degrees of motor and sensory deficit completed the study. Subjects attended three times a week, with each phase lasting three weeks. Interventions: In the robot-mediated therapy phase they practised three functional exercises with haptic and visual feedback from the system. In the sling suspension phase they practised three single-plane exercises. Each treatment phase was three weeks long. Main measures: The range of active shoulder flexion, the Fugl-Meyer motor assessment and the Motor Assessment Scale were measured at each visit. Results: Each subject had a varied response to the measurement and intervention phases. The rate of recovery was greater during the robot-mediated therapy phase than in the baseline phase for the majority of subjects. The rate of recovery during the robot-mediated therapy phase was also greater than that during the sling suspension phase for most subjects. Conclusion: The positive treatment effect for both groups suggests that robot-mediated therapy can have a treatment effect greater than the same duration of non-functional exercises. Further studies investigating the optimal duration of treatment in the form of a randomized controlled trial are warranted.

Statistical monitoring of student performance: an early warning system

Weekly monitoring of profiles of student performances on formative and summative coursework throughout the year can be used to quickly identify those who need additional help, possibly due to acute and sudden-onset problems. Such an early-warning system can help retention, but also assist students in overcoming problems early on, thus helping them fulfil their potential in the long run. We have developed a simple approach for the automatic monitoring of student mark profiles for individual modules, which we intend to trial in the near future. Its ease of implementation means that it can be used for very large cohorts with little additional effort when marks are already collected and recorded on a spreadsheet.

Impact of serving method on the consumption of nutritional supplement drinks: randomised trial in older adults with cognitive impairment

Aim: To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment. Background: Oral nutritional supplement drinks have positive benefits on increasing nutritional status within undernourished elderly people leading to weight gain. However, consumption of these drinks is low and therefore limits their effectiveness. Design: This study was a non blind randomised control trial where participants either consumed nutritional supplement drinks in a glass/beaker or consumed them through a straw inserted directly into the container. Method: Participants with longstanding cognitive impairment were recruited from nursing homes (n=31) and hospitals (n=14). Participants were randomised to serving method. Nursing and care staff were instructed to give the supplement drinks three times per day on alternate days over a week by the allocated serving method. The researcher weighed the amount of supplement drink remaining after consumption. Data were collected over 12 months in 2011-2012. Results: 45 people participated in this study mean age 86.7 (SD 7.5 ) years. After randomisation there was no significant difference between the baseline characteristics of the two groups. Participants randomised to consume nutritional drinks from a glass / beaker drank significantly more than those who consumed them via a straw inserted directly into the container. However, supplements allocated to be given in a glass/beaker were more frequently omitted. Conclusion: Nutritional supplement drinks should be given to people with dementia who are able to feed themselves in a glass or a beaker if staffing resources allow (NIHR CSP ref 31101).

Linking alkaline phosphatase activity with bacterial phoD gene abundance in soil from a long-term management trial

Changes in land management practices may have significant implications for soil microbial communities important in organic P turnover. Soil bacteria can increase plant P availability by excreting phosphatase enzymes which catalyze the hydrolysis of ester-phosphate bonds. Examining the diversity and abundance of alkaline phosphatase gene harboring bacteria may provide valuable insight into alkaline phosphatase production in soils. This study examined the effect of 20 years of no input organic (ORG), organic with composted manure (ORG + M), conventional (CONV) and restored prairie (PRA) management on soil P bioavailability, alkaline phosphatase activity (ALP), and abundance and diversity of ALP gene (phoD) harboring bacteria in soils from the northern Great Plains of Canada. Management system influenced bioavailable P (P < 0.001), but not total P, with the lowest concentrations in the ORG systems and the highest in PRA. Higher rates of ALP were observed in the ORG and ORG + M treatments with a significant negative correlation between bioavailable P and ALP in 2011 (r2 = 0.71; P = 0.03) and 2012 (r2 = 0.51; P = 0.02), suggesting that ALP activity increased under P limiting conditions. The phoD gene abundance was also highest in ORG and ORG + M resulting in a significant positive relationship between bacterial phoD abundance and ALP activity (r2 = 0.71; P = 0.009). Analysis of phoD bacterial community fingerprints showed a higher number of species in CONV compared to ORG and ORG + M, contrary to what was expected considering greater ALP activity under ORG management. In 2012, banding profiles of ORG + M showed fewer phoD bacterial species following the second manure application, although ALP activity is higher than in 2011. This indicates that a few species may be producing more ALP and that quantitative gene analysis was a better indicator of activity than the number of species present.

LASER-TESTING RIG : Measurement System for evaluation of Shape of concentrating reflector for solar collector Absolicon X10

This Thesis project is a part of the all-round automation of production of concentrating solar PV/T systems Absolicon X10. ABSOLICON Solar Concentrator AB has been invented and started production of the prospective solar concentrated system Absolicon X10. The aims of this Thesis project are designing, assembling, calibrating and putting in operation the automatic measurement system intended to evaluate the shape of concentrating parabolic reflectors.On the basis of the requirements of the company administration and needs of real production process the operation conditions for the Laser testing rig were formulated. The basic concept to use laser radiation was defined.At the first step, the complex design of the whole system was made and division on the parts was defined. After the preliminary conducted simulations the function and operation conditions of the all parts were formulated.At the next steps, the detailed design of all the parts was conducted. Most components were ordered from respective companies. Some of the mechanical components were made in the workshop of the company. All parts of the Laser-testing rig were assembled and tested. Software part, which controls the Laser-testing rig work, was created on the LabVIEW basis. To tune and test software part the special simulator was designed and assembled.When all parts were assembled in the complete system, the Laser-testing rig was tested, calibrated and tuned.In the workshop of Absolicon AB, the trial measurements were conducted and Laser-testing rig was installed in the production line at the plant in Soleftea.