Selection bias, survival, and brachytherapy for glioma

✓ Interstitial irradiation is a promising treatment for malignant glioma. Longer than expected survival periods following treatment of recurrent tumor have led to the use of brachytherapy as an adjuvant treatment. The impact of patient selection on survival data was studied among candidates for this therapy. Consecutive, conventionally treated adults with newly diagnosed supratentorial tumors were identified retrospectively at a center where experience with glioma is population-based. Based on imaging and performance status, two surgeons and a radiation oncologist designated each patient as either eligible or ineligible for adjuvant brachytherapy. The survival and prognostic factors in the eligible and ineligible groups were analyzed. Overall, the patients eligible for brachytherapy (32% of the series) lived significantly longer than the ineligible patients (16.57 vs. 9.30 months), were younger, and had larger resections and better function. For glioblastoma, 40% of patients were eligible, and lived much longer than those who were ineligible (13.90 vs. 5.80 months). It is concluded that better outcome following adjuvant brachytherapy for glioma is at least in part the result of patient selection. Randomized trials of comparably selected patients will be necessary to demonstrate conclusively that longer survival is also a result of treatment.

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Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma

BioMed Research International ◽

10.1155/2014/437852 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 8

Author(s):

Sung Min Kim ◽

Moon Jin Kim ◽

Hyun Ae Jung ◽

Kihyun Kim ◽

Seok Jin Kim ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Elderly Patients ◽

Performance Status ◽

Solid Cancer ◽

Newly Diagnosed ◽

History Of ◽

Comorbidity Index ◽

And Performance ◽

The Impact

Multiple myeloma occurs primarily in elderly patients. Considering the high prevalence of comorbidities, comorbidity is an important issue for the management of myeloma. However, the impact of comorbidity on clinical outcomes has not been fully investigated. We retrospectively analyzed patients with newly diagnosed myeloma. Comorbidities were assessed based on the Charlson comorbidity index (CCI) and the Freiburg comorbidity index (FCI). The CCI is a summary measure of 19 comorbid conditions. FCI is determined by performance status, renal impairment, and lung disease. This study included 127 patients with a median age of 71 years. Approximately half of the patients had additional disorders at the time of diagnosis, and diabetes mellitus was the most frequent diagnosis (18.9%). The most significant factors for prognosis among patient-related conditions were a history of solid cancer and performance status (ECOG ≥ 2). The FCI score was divided into 3 groups (0, 1, and 2-3), and the CCI score was divided into 2 groups (2-3 and ≥4). FCI was a strong prognostic tool for OS (P>0.001) and predicted clinical outcome better than CCI (P=0.059). In conclusion, FCI was more useful than CCI in predicting overall survival in elderly patients with myeloma.

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Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project

Journal of Neurosurgery ◽

10.3171/jns.2003.99.3.0467 ◽

2003 ◽

Vol 99 (3) ◽

pp. 467-473 ◽

Cited By ~ 422

Author(s):

Edward R. Laws ◽

Ian F. Parney ◽

Wei Huang ◽

Fred Anderson ◽

Angel M. Morris ◽

...

Keyword(s):

Prognostic Factors ◽

Survival Data ◽

Performance Status ◽

Malignant Gliomas ◽

Karnofsky Performance Scale ◽

Median Length ◽

Content Type ◽

The Impact ◽

Grade Iii ◽

Fine Print

Object. The Glioma Outcomes Project represents a contemporary analysis of the management of malignant (Grade III and Grade IV/GBM) gliomas in North America. This observational database was used to evaluate the influence of resection, as opposed to biopsy, on patient outcome as measured by the length of survival. Attempts were made to reduce the impact of selection bias by repeating the data analysis after omitting patients with major negative prognostic factors. Methods. Outcome data from 788 patients accrued from multiple sites over a 4-year period (1997–2001) were analyzed with the primary outcome measure being length of survival. Of these, 565 patients with recent diagnoses formed the basis of the present analysis. Patients were systematically followed up until death or up to 24 months after enrollment in the study, and survival data were correlated with the histopathological grade and location of the tumor, the extent of surgery, the patient's performance status, and demographic factors. The median length of survival was 40.9 weeks for patients with recently diagnosed GBMs. The true median length of survival for patients with Grade III gliomas was not reached, although there was a 58% survival rate at 104 weeks. In multivariate analysis, resection rather than biopsy (p < 0.0001), age 60 years or younger (p < 0.0001), and a Karnofsky Performance Scale (KPS) score of 70 or greater (p = 0.0004) were associated with a prolonged survival time for patients with Grade III or IV gliomas. The prognostic value of resection compared with biopsy was maintained (p < 0.0001), even after eliminating patients considered to be “poor risk” (those with age > 60 years, KPS score < 70, or presence of multifocal tumors), who may have been overrepresented in the biopsy group. Survival “tails” at 24 months were 58% for Grade III gliomas and 11% for GBMs. Conclusions. These data provide Class II evidence to support tumor grade, patient's age, and patient's functional status as prognostic factors for survival in individuals with recently diagnosed malignant gliomas. Resection (compared with biopsy) is also a strong prognostic factor; however, no quantitative attempt was made to assess the true extent of the resection.

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Increasing revenue and attendance in Canadian Baptist churches

International Journal of Social Economics ◽

10.1108/ijse-02-2014-0030 ◽

2015 ◽

Vol 42 (12) ◽

pp. 1071-1089

Author(s):

Alan Chan ◽

Bruce G. Fawcett ◽

Shu-Kam Lee

Keyword(s):

Church Health ◽

Eastern Canada ◽

Data Set ◽

Content Type ◽

Factors Affecting ◽

Scarce Resources ◽

Baptist Churches ◽

And Performance ◽

The Impact ◽

Simulation Exercises

Purpose – Church giving and attendance are two important indicators of church health and performance. In the literature, they are usually understood to be simultaneously determined. The purpose of this paper is to estimate if there a sustainable church congregation size using Wintrobe’s (1998) dictatorship model. The authors want to examine the impact of youth and adult ministry as well. Design/methodology/approach – Using the data collected from among Canadian Baptist churches in Eastern Canada, this study investigates the factors affecting the level of the two indicators by the panel-instrumental variable technique. Applying Wintrobe’s (1998) political economy model on dictatorship, the equilibrium level of worship attendance and giving is predicted. Findings – Through various simulation exercises, the actual church congregation sizes is approximately 50 percent of the predicted value, implying inefficiency and misallocation of church resources. The paper concludes with insights on effective ways church leaders can allocate scarce resources to promote growth within churches. Originality/value – The authors are the only researchers getting the permission from the Atlantic Canada Baptist Convention to use their mega data set on church giving and congregation sizes as per the authors’ knowledge. The authors are also applying a theoretical model on dictatorship to religious/not for profits organizations.

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A novel retractable landing gear of a light amphibious airplane design, synthesis, analysis, and implementation

Aircraft Engineering and Aerospace Technology ◽

10.1108/aeat-10-2020-0237 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Sinchai Chinvorarat ◽

Pumyos Vallikul

Keyword(s):

Impact Load ◽

Landing Gear ◽

Drop Test ◽

Drop Height ◽

Core Element ◽

Design Synthesis ◽

Content Type ◽

And Performance ◽

Correct Path ◽

The Impact

Purpose The purpose of this paper is to present a novel retractable main landing gear for a light amphibious airplane, while the design, synthesis and analysis are given in details for constructing the main landing gear. Design/methodology/approach The constraint three-position synthesis has given the correct path of all linkages that suitably fit the landing gear into the compartment. The additional lock-link is introduced into the design to ensure the securement of the mechanism while landing. Having the telescopic gas-oil shock strut as a core element to absorb the impact load, it enhances the ability and efficiency to withstand higher impact than others type of light amphibious airplane. Findings By kinematics bifurcation analysis, the optimized value of the unlock spring stiffness at 90 N/m can be found to tremendously reduce the extended-retracted linear actuator force from 500 N to 150 N at the beginning of the retraction sequence. This could limit the size and weight of the landing gear actuator of the light amphibious airplane. Practical implications The drop test of the landing gear to comply with the ASTM f-2245 (Standard Specification for Design and Performance of a Light Sport Airplane) reveals that the novel landing gear can withstand the impact load at the drop height determined by the standard. The maximum impact loading 4.8 G occurs at the drop height of 300 mm, and there is no sign of any detrimental or failure of the landing gear or the structure of the light amphibious airplane. The impact settling time response reaches the 2% of steady-state value in approximately 1.2 s that ensure the safety and stability of the amphibious airplane if it subjects to an accidentally hard landing. Originality/value This paper presents unique applications of a retractable main landing gear of a light amphibious airplane. The proposed landing gear functions properly and complies with the drop test standard, ensuring the safety and reliability of the airplane and exploiting the airworthiness certification process.

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Association of statins and nivolumab activity in patients with metastatic renal cell carcinoma (mRCC): Results from the phase II nivoren—GETUG AFU 26 trial.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.359 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 359-359

Author(s):

Emeline Colomba ◽

Ronan Flippot ◽

Cécile Dalban ◽

Sylvie Negrier ◽

Christine Chevreau ◽

...

Keyword(s):

Phase Ii ◽

Immune Modulation ◽

Performance Status ◽

Objective Response ◽

Progression Free Survival ◽

Population Based ◽

Metabolic Reprogramming ◽

Oncogenic Signaling ◽

Grade 3 ◽

The Impact

359 Background: Statins are HMG-CoA inhibitors that regulate several mechanisms involved in tumor growth, including mitochondrial metabolism, activation of oncogenic signaling pathways, and immune modulation. Population-based studies showed that statin intake may be negatively associated with RCC onset. The impact of statins on response to immunotherapy in mRCC is unknown. Herein we study the association between statin administration and outcomes in patients with mRCC treated with nivolumab in the NIVOREN-GETUG AFU 26 phase II trial (NCT03013335). Methods: Patients with mRCC who failed previous VEGFR inhibitors were included. We assessed nivolumab activity, including objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) according to statin intake at baseline. Toxicity was assessed using CTCAE v4.0. Results: Overall,133 patients were treated with statins at baseline among 702 evaluable for concomitant therapies (19%). Among them, median age was 68 (49-90), 84% were male, 85% had a performance status ≥ 80%, 42% were overweight and 20% obese. Patients treated with statins had mostly good (23%) or intermediate (58%) IMDC risk, 64% had grade 3 or 4 tumors, and nivolumab was given in a third line setting or more in 55%. Median follow-up was 23.9 months (95%CI 23.0-24.5) in the overall cohort. The ORR was 26% in patients treated with statins, PFS 5.0 months (CI95% 3.0 – 5.5), OS 27.9 months (CI95% 19.4-30.3). Outcomes of patients with or without statins did not differ significantly. Similar rates of grade 3-5 TRAE were reported in patients with (20%) or without (18%) statin intake. Conclusions: This is the first study to evaluate statin intake and outcomes with nivolumab in patients with mRCC. Despite numerically higher ORR, statins were not significantly associated with improved outcomes. These data require other analyzes considering other factors such as BMI and other comorbidities. Further studies may help better understand the interplay between immunity and metabolic reprogramming in RCC.

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Performance measurement and resource sharing among business sub-units in the presence of non-discretionary factors

Journal of Modelling in Management ◽

10.1108/jm2-09-2020-0249 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Rita Shakouri ◽

Maziar Salahi

Keyword(s):

Resource Sharing ◽

Content Type ◽

Development Level ◽

Proposed Model ◽

Decision Making Unit ◽

Efficiency Estimation ◽

Overall Efficiency ◽

And Performance ◽

The Right ◽

The Impact

Purpose This paper aims to apply a new approach for resource sharing and efficiency estimation of subunits in the presence of non-discretionary factors and partial impacts among inputs and outputs in the data envelopment analysis (DEA) framework. Design/methodology/approach First, inspired by the Imanirad et al.’s model (2013), the authors consider that each decision-making unit (DMU) may consist of several subunits, that each of which can be affected by non-discretionary inputs. After that, the Banker and Morey’s model (1996) is used for modeling non-discretionary factors. For measuring performance of several subunits, which can be considered as DMUs, the aggregate efficiency is suggested. At last, the overall efficiency is computed and compared with each other. Findings One of the important features of proposed model is that each output in this model applies discretionary input according to its need; therefore, the result of this study will make it easier for the managers to make better decisions. Also, it indicates that significant predictions of the development of the overall efficiency of DMUs can be based on observing the development level of subunits because of the influence of non-discretionary input. Therefore, the proposed model provides a more reasonable and encompassing measure of performance in participating non-discretionary and discretionary inputs to better efficiency. An application of the proposed model for gaining efficiency of 17 road patrols is provided. Research limitations/implications More non-discretionary and discretionary inputs can be taken into consideration for a better analysis. This study provides us with a framework for performance measures along with useful managerial insights. Focusing upon the right scope of operations may help out the management in improving their overall efficiency and performance. In the recent highway maintenance management systems, the environmental differences exist among patrols and other geotechnical services under the climate diverse. Further, in some cases, there might exist more than one non-discretionary factor that can have different effects on the subunits’ performance. Practical implications The purpose of this paper was to measure the performance of a set of the roadway maintenance crews and to analyze the impact of non-discretionary inputs on the efficiency of the roadway maintenance. The application of the proposed model, on the one hand, showed that each output in this model uses discretionary input according to its requirement, and on the other hand, the result showed that meaningful predictions of the development of the overall efficiency of DMUs can be based on observing the development level of subunits because of the impact of non-discretionary input. Originality/value Providing information on resource sharing by taking into account non-discretionary factors for each subunit can help managers to make better decisions to increase the efficiency.

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Impact of COVID-19 pandemic on indigenous contractors in a developing economy

Journal of Engineering Design and Technology ◽

10.1108/jedt-11-2020-0480 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Nathaniel Ayinde Olatunde ◽

Imoleayo Abraham Awodele ◽

Bosede Olajumoke Adebayo

Keyword(s):

Developing Economies ◽

Sampling Technique ◽

Structured Interview ◽

Additional Cost ◽

Developing Economy ◽

Content Type ◽

Construction Contracts ◽

The Government ◽

And Performance ◽

The Impact

Purpose The purpose of this study is to examine the impact of coronavirus disease 2019 (COVID-19) on indigenous contractors in a developing economy with a view to enhancing their performance. Design/methodology/approach The study used a purposive sampling technique to select 37 indigenous contractors with ongoing construction contracts in Osun State, Nigeria who provided data for the study. A structured interview protocol was used to elicit the required information from the interviewees and frequency, percentage and content analysis were used for data analysis. Findings The results showed that the critical impact of COVID-19 on indigenous contractors in a developing economy is: time overrun, loss of profit and creation of dispute. Further results showed that other impacts are a disruption in supply of labour, locally sourced materials are with additional cost, the additional cost of implementing COVID-19 protocols, difficulty in sourcing imported materials and absence of new jobs with the corresponding retrenchment of workers. Practical implications The study recommended special palliatives for the indigenous contractors from the government so as to cushion the impact of the pandemic on them, thereby enhance their survival and performance. A special arbitration panel is set up in each state of the federation to look at disputes arising from the aftermath of the pandemic, this is with a view to adequately compensate indigenous contractors with genuine and properly compiled claims. inferring from the findings of the study, it suffices to say that the severity of the impact of the pandemic is very high on indigenous contractors in developing economies, as such a better preparedness strategy could lessen the impact of such pandemic in the future. Originality/value The study is an attempt to unearth the impact of COVID-19 on indigenous contractors with ongoing construction contracts in a developing economy. The study will be of value to construction stakeholders in providing the information needed to devise strategies to minimise the impact of a pandemic on indigenous contractors in future projects thereby enhance their performance.

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Exploring the impact of intellectual capital on company reputation and performance

Journal of Intellectual Capital ◽

10.1108/jic-01-2018-0012 ◽

2018 ◽

Vol 19 (5) ◽

pp. 915-934 ◽

Cited By ~ 31

Author(s):

Gianluca Ginesti ◽

Adele Caldarelli ◽

Annamaria Zampella

Keyword(s):

Human Capital ◽

Intellectual Capital ◽

Corporate Reputation ◽

Intangible Asset ◽

Competition Authority ◽

Data Set ◽

Content Type ◽

Capital Efficiency ◽

And Performance ◽

The Impact

Purpose The purpose of this paper is to analyse the impact of intellectual capital (IC) on the reputation and performance of Italian companies. Design/methodology/approach The paper exploits a unique data set of 452 non-listed companies that obtained a reputational assessment from the Italian Competition Authority (ICA). To test the hypotheses, this study implemented several regression analyses. Findings Results support the argument that human capital efficiency is a key driver of corporate reputation. Findings also reveal that companies, which obtained reputational rating under ICA scrutiny, show a positive relationship between IC elements and various measures of financial performance. Research limitations/implications The study focuses on a single country; it is not free from the imprecisions of Pulic’s VAIC model. Practical implications This paper recommends companies that are interested to achieve a robust reputation should consider the human capital as a strategic intangible asset. Second, the results suggest that companies with an ICA reputational rating are able to leverage their intangibles to potentiate performance and competitiveness. Originality/value This is the first empirical investigation on the contribution of IC in generating value for corporate reputation. Additionally, the study contributes to the literature on the link between IC and performance by examining a sample of firms not yet explored in prior research.

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Are In Vitro Susceptibilities to Azole Antifungals Predictive of Clinical Outcome in the Treatment of Candidemia?

Journal of Clinical Microbiology ◽

10.1128/jcm.01072-18 ◽

2018 ◽

Vol 56 (12) ◽

Cited By ~ 9

Author(s):

Twisha S. Patel ◽

Peggy L. Carver ◽

Gregory A. Eschenauer

Keyword(s):

Invasive Candidiasis ◽

Randomized Trials ◽

Published Data ◽

Murine Models ◽

Limited Data ◽

Content Type ◽

Clinical Breakpoints ◽

The Impact ◽

The Relationship

ABSTRACT The purpose of this review is to critically analyze published data evaluating the impact of azole pharmacokinetic and pharmacodynamic parameters, MICs, and Candida species on clinical outcomes in patients with candidemia. Clinical breakpoints (CBPs) for fluconazole and voriconazole, which are used to determine susceptibility, have been defined by the Clinical and Laboratory Standards Institute (CLSI) for Candida species. Studies evaluating the relationship between treatment efficacy and in vitro susceptibility, as well as the pharmacodynamic targets, have been conducted in patients treated with fluconazole for candidemia; however, for species other than Candida albicans and Candida glabrata, and for other forms of invasive candidiasis, data remain limited and randomized trials are not available. Limited data evaluating these relationships with voriconazole are available. While pharmacodynamic targets for posaconazole and isavuconazole have been proposed based upon studies conducted in murine models, CBPs have not been established by CLSI. Fluconazole remains an important antifungal agent for the treatment of candidemia, and data supporting its use based on in vitro susceptibility are growing, particularly for C. albicans and C. glabrata. Further investigation is needed to establish the roles of voriconazole, posaconazole, and isavuconazole in the treatment of candidemia and for all agents in the treatment of other forms of invasive candidiasis.

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