Prognosis of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer by immunological urinary measurements: statistically weighted syndrome analysis

PURPOSE: The goal of this research was to discover new biological indicators in urine which could be used for short-term prognosis of local Bacillus Calmette-Guerin (BCG) therapy outcome in patients with superficial bladder cancer. PATIENTS AND METHODS: We measured and statistically evaluated soluble immunological molecules in urine from bladder cancer patients (n = 34) receiving BCG intravesically. Urine was collected following each of 6 weekly treatments, processed and assayed. The data base included measurements of interleukin-1 (IL-2, IL-4, IL-6, IL-10, IL-12, soluble intercellular adhesion molecule-1 (sICAM-1), tumour necrosis factor-alpha (TNF alpha), soluble CD14 (sCD14), interferon-gamma (IFN gamma), GM-CSF, volume of urine and its pH. The clinical response was evaluated by urine histology and random quadrant biopsy 3 months after the start of therapy. Patients were divided into 2 groups, with good and poor therapeutic effect. The initial complete response rate was 62% (21/34). The data base was analyzed using traditional multivariate statistical methods and a pattern recognition method which deals with combinatorial-statistical analysis (statistically weighted syndromes (SWS) method) of the gradated features. The SWS method is capable of identifying robust patterns in small "fuzzy" sets with high dimensional objects and some missing values. RESULTS: Only one parameter gave significant differences at p < 0.05, GM-CSF at instillation 6. Repeated measurement analysis of variance, backward stepwise multiple logistic regression and linear discriminant analysis failed to show any significance. However, significant differences in the structure of correlation between features in the groups with and without therapeutic effect were observed and four highly informative variables (the masses of sICAM-1, TNF alpha, sCD14 and pH) relating to 5th-6th installations were selected by SWS. These features provided accurate individual prediction of therapeutic outcome for all our patients. Cross-validation analysis and computer simulation showed the statistically significant stability of the prediction. CONCLUSION: We have selected a set of urinary variables that could be considered as a perspective combination of indicators (syndromes) of outcome of pre-operation BCG therapy of patients with superficial bladder cancer. A larger patient database will provide testing and evaluation of the biological and clinical significance of selected features. The computational syndrome-disease approach should be applicable for the solution of decision-making problems for management of cancer.     

Holographic correction of large telescope primaries by proximal, off-axis beacons

Compact telescope configurations incorporating a holographic correction of large, low-quality primary collectors are demonstrated. Aberration correction is demonstrated with an off-axis laser beacon located close to the primary. This arrangement results in a compact telescope with minimum obscuration. The reduction of additional off-axis aberrations introduced by the method is also demonstrated.     

Clinical trial designs--made to order

At times, clinical trial design presents difficult problems for the consulting statistician. The nature of the disease under study or the inadequacies of standard methodology often suggest alternative strategies for the development of useful clinical trial designs. This paper examines two case of novel clinical trial designs that are "made-to-order" for the problem at hand. Both address disease-specific issues. The first case considers the use of adaptive allocation of treatments to patients in a trial in major depressive disorder. The second case reviews the design of a novel efficacy parameter in advanced pancreatic cancer.     

Participatory ergonomics in design processes: the role of boundary objects

The aim of this paper is to introduce the concept of boundary objects in order to better understand the role of objects in participatory ergonomics (PE) design processes. The research question is: What characterizes boundary objects in PE processes? Based on two case studies, we identify eight characteristics of boundary objects and their use, which make them particularly useful in PE design processes. These characteristics go beyond the object itself and extend into the context of their use. We argue that the selection of boundary objects in PE processes is of great importance, since different objects enable workers’ participation and collaborative design in different ways. The framework developed may serve to provide criteria to guide practitioners and intervention researchers in the selection of objects to facilitate a PE process. The paper concludes with a list of recommendations for ergonomic practitioners that are based on the framework.     

Real-time path planning in dynamic virtual environments using multiagent navigation graphs

We present a novel approach for efficient path planning and navigation of multiple virtual agents in complex dynamic scenes. We introduce a new data structure, Multi-agent Navigation Graph (MaNG), which is constructed using first- and second-order Voronoi diagrams. The MaNG is used to perform route planning and proximity computations for each agent in real time. Moreover, we use the path information and proximity relationships for local dynamics computation of each agent by extending a social force model [Helbing05]. We compute the MaNG using graphics hardware and present culling techniques to accelerate the computation. We also address undersampling issues and present techniques to improve the accuracy of our algorithm. Our algorithm is used for real-time multi-agent planning in pursuit-evasion, terrain exploration and crowd simulation scenarios consisting of hundreds of moving agents, each with a distinct goal.     

Optical information for car following: the driving by visual angle (DVA) model

OBJECTIVE: The present study developed and tested a model of car following by human drivers. BACKGROUND: Previous models of car following are based on 3-D parameters such as lead vehicle speed and distance information, which are not directly available to a driver. In the present paper we present the driving by visual angle (DVA) model, which is based on the visual information (visual angle and rate of change of visual angle) available to the driver. METHOD: Two experiments in a driving simulator examined car-following performance in response to speed variations of a lead vehicle defined by a sum of sine wave oscillations and ramp acceleration functions. In addition, the model was applied to six driving events using real world-driving data. RESULTS: The model provided a good fit to car-following performance in the driving simulation studies as well as in real-world driving performance. A comparison with the advanced interactive microscopic simulator for urban and nonurban networks (AIMSUN) model, which is based on 3-D parameters, suggests that the DVA was more predictive of driver behavior in matching lead vehicle speed and distance headway. CONCLUSION: Car-following behavior can be modeled using only visual information to the driver and can produce performance more predictive of driver performance than models based on 3-D (speed or distance) information. APPLICATION: The DVA model has applications to several traffic safety issues, including automated driving systems and traffic flow models.     

Patient views of adverse events: comparisons of self-reported healthcare staff attitudes with disclosure of accident information

In the present paper, we report results of surveys in 2003 in Japan and Denmark about patients' views about adverse events, focusing on the actions of healthcare staff involved in a medical accident. Results show that patients were more likely to indicate negative expectations to a doctor's reactions after a medical accident when asked in general terms than when asked in relation to concrete case stories. When asked in general terms, 66% (47%) of Japanese (Danish) respondents expected that doctors sometimes hold back on providing information to patients about a medical accident, while 37% (7%) did so when asked about a concrete, mild-outcome case. We examine some possible reasons for the relatively high level of distrust of Japanese patients, and we discuss whether the seemingly lower level of disclosure in Japan than in Denmark and the negative stories in the Japanese press may have an impact. We also suggest some implications for introducing a patient-centred or customer-centred approach to risk management in healthcare and other domains.     

Relationship of passive cigarette-smoking to sudden infant death syndrome

The smoking habits of 56 families who lost babies to the sudden infant death syndrome (SIDS) were compared to those of 86 control families. A higher proportion of SIDS mothers smoked both during pregnancy (61% vs. 42%) and after their babies were born (59% vs. 37%). SIDS mother also smoked a significantly greater number of cigarettes than controls. Exposure to cigarette smoke ("passive smoking") appears to enhance the risk of SIDS for reasons not known.