How Reliable Is Ki-67 Immunohistochemistry in Grade 2 Breast Carcinomas? A QA Study of the Swiss Working Group of Breast- and Gynecopathologists.

Adjuvant chemotherapy decisions in breast cancer are increasingly based on the pathologist's assessment of tumor proliferation. The Swiss Working Group of Gyneco- and Breast Pathologists has surveyed inter- and intraobserver consistency of Ki-67-based proliferative fraction in breast carcinomas. METHODS: Five pathologists evaluated MIB-1-labeling index (LI) in ten breast carcinomas (G1, G2, G3) by counting and eyeballing. In the same way, 15 pathologists all over Switzerland then assessed MIB-1-LI on three G2 carcinomas, in self-selected or pre-defined areas of the tumors, comparing centrally immunostained slides with slides immunostained in the different laboratoires. To study intra-observer variability, the same tumors were re-examined 4 months later. RESULTS: The Kappa values for the first series of ten carcinomas of various degrees of differentiation showed good to very good agreement for MIB-1-LI (Kappa 0.56-0.72). However, we found very high inter-observer variabilities (Kappa 0.04-0.14) in the read-outs of the G2 carcinomas. It was not possible to explain the inconsistencies exclusively by any of the following factors: (i) pathologists' divergent definitions of what counts as a positive nucleus (ii) the mode of assessment (counting vs. eyeballing), (iii) immunostaining technique, and (iv) the selection of the tumor area in which to count. Despite intensive confrontation of all participating pathologists with the problem, inter-observer agreement did not improve when the same slides were re-examined 4 months later (Kappa 0.01-0.04) and intra-observer agreement was likewise poor (Kappa 0.00-0.35). CONCLUSION: Assessment of mid-range Ki-67-LI suffers from high inter- and intra-observer variability. Oncologists should be aware of this caveat when using Ki-67-LI as a basis for treatment decisions in moderately differentiated breast carcinomas.

Flash floods and their effects on the development in El-Qaá plain area in South Sinai, Egypt

The arid regions are dominated to a much larger degree than humid regions by major catastrophic events. Although most of Egypt lies within the great hot desert belt; it experiences especially in the north some torrential rainfall, which causes flash floods all over Sinai Peninsula. Flash floods in hot deserts are characterized by high velocity and low duration with a sharp discharge peak. Large sediment loads may be carried by floods threatening fields and settlements in the wadis and even people who are living there. The extreme spottiness of rare heavy rainfall, well known to desert people everywhere, precludes any efficient forecasting. Thus, although the limitation of data still reflects pre-satellite methods, chances of developing a warning system for floods in the desert seem remote. The relatively short flood-to-peak interval, a characteristic of desert floods, presents an additional impediment to the efficient use of warning systems. The present thesis contains introduction and five chapters, chapter one points out the physical settings of the study area. There are the geological settings such as outcrop lithology of the study area and the deposits. The alluvial deposits of Wadi Moreikh had been analyzed using OSL dating to know deposits and palaeoclimatic conditions. The chapter points out as well the stratigraphy and the structure geology containing main faults and folds. In addition, it manifests the pesent climate conditions such as temperature, humidity, wind and evaporation. Besides, it presents type of soils and natural vegetation cover of the study area using unsupervised classification for ETM+ images. Chapter two points out the morphometric analysis of the main basins and their drainage network in the study area. It is divided into three parts: The first part manifests the morphometric analysis of the drainage networks which had been extracted from two main sources, topographic maps and DEM images. Basins and drainage networks are considered as major influencing factors on the flash floods; Most of elements were studied which affect the network such as stream order, bifurcation ratio, stream lengths, stream frequency, drainage density, and drainage patterns. The second part of this chapter shows the morphometric analysis of basins such as area, dimensions, shape and surface. Whereas, the third part points the morphometric analysis of alluvial fans which form most of El-Qaá plain. Chapter three manifests the surface runoff through rainfall and losses analysis. The main subject in this chapter is rainfall which has been studied in detail; it is the main reason for runoff. Therefore, all rainfall characteristics are regarded here such as rainfall types, distribution, rainfall intensity, duration, frequency, and the relationship between rainfall and runoff. While the second part of this chapter concerns with water losses estimation by evaporation and infiltration which are together the main losses with direct effect on the high of runoff. Finally, chapter three points out the factors influencing desert runoff and runoff generation mechanism. Chapter four is concerned with assessment of flood hazard, it is important to estimate runoff and tocreate a map of affected areas. Therefore, the chapter consists of four main parts; first part manifests the runoff estimation, the different methods to estimate runoff and its variables such as runoff coefficient lag time, time of concentration, runoff volume, and frequency analysis of flash flood. While the second part points out the extreme event analysis. The third part shows the map of affected areas for every basin and the flash floods degrees. In this point, it has been depending on the DEM to extract the drainage networks and to determine the main streams which are normally more dangerous than others. Finally, part four presets the risk zone map of total study area which is of high inerest for planning activities. Chapter five as the last chapter concerns with flash flood Hazard mitigation. It consists of three main parts. First flood prediction and the method which can be used to predict and forecast the flood. The second part aims to determine the best methods which can be helpful to mitigate flood hazard in the arid zone and especially the study area. Whereas, the third part points out the development perspective for the study area indicating the suitable places in El-Qaá plain for using in economic activities.

How reliable is Ki-67 immunohistochemistry in grade 2 breast carcinomas? A QA study of the Swiss Working Group of Breast- and Gynecopathologists

Adjuvant chemotherapy decisions in breast cancer are increasingly based on the pathologist's assessment of tumor proliferation. The Swiss Working Group of Gyneco- and Breast Pathologists has surveyed inter- and intraobserver consistency of Ki-67-based proliferative fraction in breast carcinomas. Methods Five pathologists evaluated MIB-1-labeling index (LI) in ten breast carcinomas (G1, G2, G3) by counting and eyeballing. In the same way, 15 pathologists all over Switzerland then assessed MIB-1-LI on three G2 carcinomas, in self-selected or pre-defined areas of the tumors, comparing centrally immunostained slides with slides immunostained in the different laboratoires. To study intra-observer variability, the same tumors were re-examined 4 months later. Results The Kappa values for the first series of ten carcinomas of various degrees of differentiation showed good to very good agreement for MIB-1-LI (Kappa 0.56–0.72). However, we found very high inter-observer variabilities (Kappa 0.04–0.14) in the read-outs of the G2 carcinomas. It was not possible to explain the inconsistencies exclusively by any of the following factors: (i) pathologists' divergent definitions of what counts as a positive nucleus (ii) the mode of assessment (counting vs. eyeballing), (iii) immunostaining technique, and (iv) the selection of the tumor area in which to count. Despite intensive confrontation of all participating pathologists with the problem, inter-observer agreement did not improve when the same slides were re-examined 4 months later (Kappa 0.01–0.04) and intra-observer agreement was likewise poor (Kappa 0.00–0.35). Conclusion Assessment of mid-range Ki-67-LI suffers from high inter- and intra-observer variability. Oncologists should be aware of this caveat when using Ki-67-LI as a basis for treatment decisions in moderately differentiated breast carcinomas.

COMPREHENSIVE CALCULATION-BASED IMRT QA USING R&V DATA, TREATMENT RECORDS, AND A SECOND TREATMENT PLANNING SYSTEM

Purpose: Traditional patient-specific IMRT QA measurements are labor intensive and consume machine time. Calculation-based IMRT QA methods typically are not comprehensive. We have developed a comprehensive calculation-based IMRT QA method to detect uncertainties introduced by the initial dose calculation, the data transfer through the Record-and-Verify (R&V) system, and various aspects of the physical delivery. Methods: We recomputed the treatment plans in the patient geometry for 48 cases using data from the R&V, and from the delivery unit to calculate the “as-transferred” and “as-delivered” doses respectively. These data were sent to the original TPS to verify transfer and delivery or to a second TPS to verify the original calculation. For each dataset we examined the dose computed from the R&V record (RV) and from the delivery records (Tx), and the dose computed with a second verification TPS (vTPS). Each verification dose was compared to the clinical dose distribution using 3D gamma analysis and by comparison of mean dose and ROI-specific dose levels to target volumes. Plans were also compared to IMRT QA absolute and relative dose measurements. Results: The average 3D gamma passing percentages using 3%-3mm, 2%-2mm, and 1%-1mm criteria for the RV plan were 100.0 (σ=0.0), 100.0 (σ=0.0), and 100.0 (σ=0.1); for the Tx plan they were 100.0 (σ=0.0), 100.0 (σ=0.0), and 99.0 (σ=1.4); and for the vTPS plan they were 99.3 (σ=0.6), 97.2 (σ=1.5), and 79.0 (σ=8.6). When comparing target volume doses in the RV, Tx, and vTPS plans to the clinical plans, the average ratios of ROI mean doses were 0.999 (σ=0.001), 1.001 (σ=0.002), and 0.990 (σ=0.009) and ROI-specific dose levels were 0.999 (σ=0.001), 1.001 (σ=0.002), and 0.980 (σ=0.043), respectively. Comparing the clinical, RV, TR, and vTPS calculated doses to the IMRT QA measurements for all 48 patients, the average ratios for absolute doses were 0.999 (σ=0.013), 0.998 (σ=0.013), 0.999 σ=0.015), and 0.990 (σ=0.012), respectively, and the average 2D gamma(5%-3mm) passing percentages for relative doses for 9 patients was were 99.36 (σ=0.68), 99.50 (σ=0.49), 99.13 (σ=0.84), and 98.76 (σ=1.66), respectively. Conclusions: Together with mechanical and dosimetric QA, our calculation-based IMRT QA method promises to minimize the need for patient-specific QA measurements by identifying outliers in need of further review.

AN EVALUATION OF THE CONSISTENCY OF IMRT PATIENT-SPECIFIC QA TECHNIQUES

To ensure the integrity of an intensity modulated radiation therapy (IMRT) treatment, each plan must be validated through a measurement-based quality assurance (QA) procedure, known as patient specific IMRT QA. Many methods of measurement and analysis have evolved for this QA. There is not a standard among clinical institutions, and many devices and action levels are used. Since the acceptance criteria determines if the dosimetric tools’ output passes the patient plan, it is important to see how these parameters influence the performance of the QA device. While analyzing the results of IMRT QA, it is important to understand the variability in the measurements. Due to the different form factors of the many QA methods, this reproducibility can be device dependent. These questions of patient-specific IMRT QA reproducibility and performance were investigated across five dosimeter systems: a helical diode array, radiographic film, ion chamber, diode array (AP field-by-field, AP composite, and rotational composite), and an in-house designed multiple ion chamber phantom. The reproducibility was gauged for each device by comparing the coefficients of variation (CV) across six patient plans. The performance of each device was determined by comparing each one’s ability to accurately label a plan as acceptable or unacceptable compared to a gold standard. All methods demonstrated a CV of less than 4%. Film proved to have the highest variability in QA measurement, likely due to the high level of user involvement in the readout and analysis. This is further shown by how the setup contributed more variation than the readout and analysis for all of the methods, except film. When evaluated for ability to correctly label acceptable and unacceptable plans, two distinct performance groups emerged with the helical diode array, AP composite diode array, film, and ion chamber in the better group; and the rotational composite and AP field-by-field diode array in the poorer group. Additionally, optimal threshold cutoffs were determined for each of the dosimetry systems. These findings, combined with practical considerations for factors such as labor and cost, can aid a clinic in its choice of an effective and safe patient-specific IMRT QA implementation.

Implantación de técnicas de QA en un proyecto de desarrollo software

Hoy en día existe una preocupación creciente por la calidad del software entregado en los proyectos que se realizan a lo largo del mundo. El trabajo de fin de grado que va a ser desarrollado en estas páginas pretende demostrar la importancia de la realización de tests funcionales durante el proceso de desarrollo de software para que el proyecto alcance la calidad requerida tan demandada en estos días. Para ello, después de una pequeña introducción a la historia del software, se presentarán y compararán diversos tipos de metodologías de desarrollo de software, tanto pesadas (cascada, espiral, etc.) como ágiles (Extreme Programming y Scrum), se enfatizará en dichas metodologías ágiles y cómo el proceso de testing y control de calidad encaja perfectamente con la filosofía de las citadas metodologías ágiles. Se desarrollará una explicación del papel de QA en el desarrollo de software, asi como una explicación de los tipos de test existentes, y las herramientas, tecnologías y patrones que existen a disposición de aquellos que quieran desempeñar el papel de QA. Para complementar el punto de vista teórico de este trabajo se presentará un caso práctico real realizado en la empresa bq bajo una metodología Scrum. Dicho caso práctico muestra el uso de ciertas herramientas y su aporte para el control de calidad del proyecto bajo desarrollo, demostrando su importancia. Se realizará énfasis en el proceso de automatización de ciertas baterías de test (llamadas test suites), mostrando desde el planteamiento inicial de las diferentes historias de usuario y la batería de test, pasando por la elección de las tecnologías más adecuadas para la elaboración de los test hasta llegar al lanzamiento de dicha batería de pruebas y la comprobación de éstas. El punto de vista práctico quedará complementado por una explicación del framework nightwatch.js, framework utilizado en el desarrollo del proyecto en bq para la automatización de test funcionales. Esta explicación comprenderá tanto la configuración y uso del framework como el uso de patrones y la estructura de las pruebas. ABSTRACT Nowadays there is a growing concern about the Quality of the software delivered in the projects that are made all around the world. This final project will try to prove the importance of performing functional tests during the Software Development Process in order to be able to reach the demanded Quality. To fulfill this objective, different types of Software Development methodologies will be presented and compared. Heavy methodologies (waterfall, spiral methodologies, etc.) as well as agile methodologies (Extreme Programming and Scrum). There will be an emphasis in the second kind (agile methodologies) and how the testing and quality assurance process fits perfectly in their philosophy. A deep explanation of the role that Quality Assurance holds on software development will be presented, as well as an explanation on the current types of testing and an explanation of the different tools; technologies and patrons that exist to help anyone who wants to perform the role of QA. To complement the theoretical perspective of this work a real case study, performed at the company bq under a Scrum methodology, will be presented. The mentioned study covers the use of certain tools and their input for the quality assurance of the project under development, proving its relevance. Emphasis will be made in the process of conducting a set of tests (called test suite), showing from the initial approach of the different users stories and the set of tests, going through the choosing of the most suitable technologies for the tests development, and ending with the performance of this battery of tests and their checkout. The practical point of view will be complemented by a deep explanation of the creation process using the nightwatch.js automated test framework, used in the project in bq. This explanation will cover both the configuration and use of the framework as the use of patterns and structure of the tests.

T cell vaccination induces T cell receptor Vβ-specific Qa-1-restricted regulatory CD8+ T cells

Vaccination of mice with activated autoantigen-reactive CD4+ T cells (T cell vaccination, TCV) has been shown to induce protection from the subsequent induction of a variety of experimental autoimmune diseases, including experimental allergic encephalomyelitis (EAE). Although the mechanisms involved in TCV-mediated protection are not completely known, there is some evidence that TCV induces CD8+ regulatory T cells that are specific for pathogenic CD4+ T cells. Previously, we demonstrated that, after superantigen administration in vivo, CD8+ T cells emerge that preferentially lyse and regulate activated autologous CD4+ T cells in a T cell receptor (TCR) Vβ-specific manner. This TCR Vβ-specific regulation is not observed in β2-microglobulin-deficient mice and is inhibited, in vitro, by antibody to Qa-1. We now show that similar Vβ8-specific Qa-1-restricted CD8+ T cells are also induced by TCV with activated CD4+ Vβ8+ T cells. These CD8+ T cells specifically lyse murine or human transfectants coexpressing Qa-1 and murine TCR Vβ8. Further, CD8+ T cell hybridoma clones generated from B10.PL mice vaccinated with a myelin basic protein-specific CD4+Vβ8+ T cell clone specifically recognize other CD4+ T cells and T cell tumors that express Vβ8 and the syngeneic Qa-1a but not the allogeneic Qa-1b molecule. Thus, Vβ-specific Qa-1-restricted CD8+ T cells are induced by activated CD4+ T cells. We suggest that these CD8+ T cells may function to specifically regulate activated CD4+ T cells during immune responses.

Efficient exchange of the primary quinone acceptor QA in isolated reaction centers of Rhodopseudomonas viridis

A key step in the conversion of solar energy into chemical energy by photosynthetic reaction centers (RCs) occurs at the level of the two quinones, QA and QB, where electron transfer couples to proton transfer. A great deal of our understanding of the mechanisms of these coupled reactions relies on the seminal work of Okamura et al. [Okamura, M. Y., Isaacson, R. A., & Feher, G. (1975) Proc. Natl. Acad. Sci. USA 88, 3491–3495], who were able to extract with detergents the firmly bound ubiquinone QA from the RC of Rhodobacter sphaeroides and reconstitute the site with extraneous quinones. Up to now a comparable protocol was lacking for the RC of Rhodopseudomonas viridis despite the fact that its QA site, which contains 2-methyl-3-nonaprenyl-1,4-naphthoquinone (menaquinone-9), has provided the best x-ray structure available. Fourier transform infrared difference spectroscopy, together with the use of isotopically labeled quinones, can probe the interaction of QA with the RC protein. We establish that a simple incubation procedure of isolated RCs of Rp. viridis with an excess of extraneous quinone allows the menaquinone-9 in the QA site to be almost quantitatively replaced either by vitamin K1, a close analogue of menaquinone-9, or by ubiquinone. To our knowledge, this is the first report of quinone exchange in bacterial photosynthesis. The Fourier transform infrared data on the quinone and semiquinone vibrations show a close similarity in the bonding interactions of vitamin K1 with the protein at the QA site of Rp. viridis and Rb. sphaeroides, whereas for ubiquinone these interactions are significantly different. The results are interpreted in terms of slightly inequivalent quinone–protein interactions by comparison with the crystallographic data available for the QA site of the two RCs.

Enhancing QA systems with complex temporal question processing capabilities

This paper presents a multilayered architecture that enhances the capabilities of current QA systems and allows different types of complex questions or queries to be processed. The answers to these questions need to be gathered from factual information scattered throughout different documents. Specifically, we designed a specialized layer to process the different types of temporal questions. Complex temporal questions are first decomposed into simple questions, according to the temporal relations expressed in the original question. In the same way, the answers to the resulting simple questions are recomposed, fulfilling the temporal restrictions of the original complex question. A novel aspect of this approach resides in the decomposition which uses a minimal quantity of resources, with the final aim of obtaining a portable platform that is easily extensible to other languages. In this paper we also present a methodology for evaluation of the decomposition of the questions as well as the ability of the implemented temporal layer to perform at a multilingual level. The temporal layer was first performed for English, then evaluated and compared with: a) a general purpose QA system (F-measure 65.47% for QA plus English temporal layer vs. 38.01% for the general QA system), and b) a well-known QA system. Much better results were obtained for temporal questions with the multilayered system. This system was therefore extended to Spanish and very good results were again obtained in the evaluation (F-measure 40.36% for QA plus Spanish temporal layer vs. 22.94% for the general QA system).

Evaluation of complex temporal questions in CLEF-QA

This paper presents the evaluation of a QA system for the treatment of complex temporal questions. The system was implemented in a multilayered architecture where complex temporal questions are first decomposed into simple questions, according to the temporal relations expressed in the original question. These simple questions are then processed independently by our standard Question Answering engine and their respective answers are filtered to satisfy the temporal restrictions of each simple question. The answers to the simple decomposed questions are then combined, according to the temporal relations extracted from the original complex question, to give the final answer. This evaluation was performed as a pilot task in the Spanish QA Track of the Cross Language Evaluation Forum 2004.

Going beyond traditional QA systems: challenges and keys in opinion question answering

The treatment of factual data has been widely studied in different areas of Natural Language Processing (NLP). However, processing subjective information still poses important challenges. This paper presents research aimed at assessing techniques that have been suggested as appropriate in the context of subjective - Opinion Question Answering (OQA). We evaluate the performance of an OQA with these new components and propose methods to optimally tackle the issues encountered. We assess the impact of including additional resources and processes with the purpose of improving the system performance on two distinct blog datasets. The improvements obtained for the different combination of tools are statistically significant. We thus conclude that the proposed approach is adequate for the OQA task, offering a good strategy to deal with opinionated questions.