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Sample records for kaplan-meier actuarial local

  1. Understanding survival analysis: Kaplan-Meier estimate

    Science.gov (United States)

    Goel, Manish Kumar; Khanna, Pardeep; Kishore, Jugal

    2010-01-01

    Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate. This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects. PMID:21455458

  2. On an exponential bound for the Kaplan-Meier estimator.

    Science.gov (United States)

    Wellner, Jon A

    2007-12-01

    We review limit theory and inequalities for the Kaplan-Meier Kaplan and Meier (J Am Stat Assoc 53:457-481, 1958) product limit estimator of a survival function on the whole line [Formula: see text] . Along the way we provide bounds for the constant in an interesting inequality due to Biotouzé et al. (Ann Inst H Poincaré Probab Stat 35:735-763, 1999), and provide some numerical evidence in support of one of their conjectures.

  3. A comparison between Kaplan-Meier and weighted Kaplan-Meier methods of five-year survival estimation of patients with gastric cancer.

    Science.gov (United States)

    Zare, Ali; Mahmoodi, Mahmood; Mohammad, Kazem; Zeraati, Hojjat; Hosseini, Mostafa; Holakouie Naieni, Kourosh

    2014-01-01

    The 5-year survival rate is a good prognostic indicator for patients with Gastric cancer that is usually estimated based on Kaplan-Meier. In situations where censored observations are too many, this method produces biased estimations. This study aimed to compare estimations of Kaplan-Meier and Weighted Kaplan-Meier as an alternative method to deal with the problem of heavy-censoring. Data from 330 patients with Gastric cancer who had undergone surgery at Iran Cancer Institute from 1995- 1999 were analyzed. The Survival Time of these patients was determined after surgery, and the 5-year survival rate for these patients was evaluated based on Kaplan-Meier and Weighted Kaplan-Meier methods. A total of 239 (72.4%) patients passed away by the end of the study and 91(27.6%) patients were censored. The mean and median of survival time for these patients were 24.86±23.73 and 16.33 months, respectively. The one-year, two-year, three-year, four-year, and five-year survival rates of these patients with standard error estimation based on Kaplan-Meier were 0.66 (0.0264), 0.42 (0.0284), 0.31 (0.0274), 0.26 (0.0264) and 0.21 (0.0256) months, respectively. The estimations of Weighted Kaplan-Meier for these patients were 0.62 (0.0251), 0.35 (0.0237), 0.24 (0.0211), 0.17 (0.0172), and 0.10 (0.0125) months, consecutively. In cases where censoring assumption is not made, and the study has many censored observations, estimations obtained from the Kaplan-Meier are biased and are estimated higher than its real amount. But Weighted Kaplan-Meier decreases bias of survival probabilities by providing appropriate weights and presents more accurate understanding.

  4. A comparison between Kaplan-Meier and weighted Kaplan-Meier methods of five-year survival estimation of patients with gastric cancer.

    Directory of Open Access Journals (Sweden)

    Ali Zare

    2014-10-01

    Full Text Available The 5-year survival rate is a good prognostic indicator for patients with Gastric cancer that is usually estimated based on Kaplan-Meier. In situations where censored observations are too many, this method produces biased estimations. This study aimed to compare estimations of Kaplan-Meier and Weighted Kaplan-Meier as an alternative method to deal with the problem of heavy-censoring. Data from 330 patients with Gastric cancer who had undergone surgery at Iran Cancer Institute from 1995- 1999 were analyzed. The Survival Time of these patients was determined after surgery, and the 5-year survival rate for these patients was evaluated based on Kaplan-Meier and Weighted Kaplan-Meier methods. A total of 239 (72.4% patients passed away by the end of the study and 91(27.6% patients were censored. The mean and median of survival time for these patients were 24.86±23.73 and 16.33 months, respectively. The one-year, two-year, three-year, four-year, and five-year survival rates of these patients with standard error estimation based on Kaplan-Meier were 0.66 (0.0264, 0.42 (0.0284, 0.31 (0.0274, 0.26 (0.0264 and 0.21 (0.0256 months, respectively. The estimations of Weighted Kaplan-Meier for these patients were 0.62 (0.0251, 0.35 (0.0237, 0.24 (0.0211, 0.17 (0.0172, and 0.10 (0.0125 months, consecutively. In cases where censoring assumption is not made, and the study has many censored observations, estimations obtained from the Kaplan-Meier are biased and are estimated higher than its real amount. But Weighted Kaplan-Meier decreases bias of survival probabilities by providing appropriate weights and presents more accurate understanding.

  5. A Berry-Essen Inequality for the Kaplan-Meier L-Estimator

    Institute of Scientific and Technical Information of China (English)

    Qi Hua WANG; Li Xing ZHU

    2001-01-01

    LetFn be the Kaplan-Meier estimator of distribution function F. Let J(.) be a measureablereal-valued function. In this paper, a U-statistic representation for the Kaplan-Meier L-estimator,T(Fn) = xJ(Fn(x))dFn(x), is derived. Furthermore, the representation is also used to establish aBerry-Essen inequality for T(Fn).

  6. THE LAW OF THE ITERATED LOGARITHM OF THE KAPLAN-MEIER INTEGRAL AND ITS APPLICATION

    Institute of Scientific and Technical Information of China (English)

    HE SHUYUAN; WANG YANHUA

    2004-01-01

    For right censored data, the law of the iterated logarithm of the Kaplan-Meier integral is established. As an application, the authors prove the law of the iterated logarithm for weighted least square estimates of randomly censored linear regression model.

  7. Application of Kaplan-Meier analysis in reliability evaluation of products cast from aluminium alloys

    Directory of Open Access Journals (Sweden)

    J. Szymszal

    2010-04-01

    Full Text Available The article evaluates the reliability of AlSi17CuNiMg alloys using Kaplan-Meier-based technique, very popular as a survival estimation tool in medical science. The main object of survival analysis is a group (or groups of units for which the time of occurrence of an event (failure taking place after some time of waiting is estimated. For example, in medicine, the failure can be patient’s death. In this study, the failure was the specimen fracture during a periodical fatigue test, while the survival time was either the test duration to specimen failure (complete observations, or the test end time (censored observations. The parameters of theoretical survival function were estimated with procedures based on the method of least squares, while typical survival time distribution followed either an exponential or two-parameter Weibull distribution. The goodness of fit of a model survival function was estimated with an incremental chi-square test, based on the values of the log likelihood ratio. The effect of alloy processing history on the run of a survival function was examined. The factors shaping the alloy processing history included: mould type (sand or metal mould, alloy modification process, and heat treatment type (solution heat treatment and ageing.

  8. A practical divergence measure for survival distributions that can be estimated from Kaplan-Meier curves.

    Science.gov (United States)

    Cox, Trevor F; Czanner, Gabriela

    2016-06-30

    This paper introduces a new simple divergence measure between two survival distributions. For two groups of patients, the divergence measure between their associated survival distributions is based on the integral of the absolute difference in probabilities that a patient from one group dies at time t and a patient from the other group survives beyond time t and vice versa. In the case of non-crossing hazard functions, the divergence measure is closely linked to the Harrell concordance index, C, the Mann-Whitney test statistic and the area under a receiver operating characteristic curve. The measure can be used in a dynamic way where the divergence between two survival distributions from time zero up to time t is calculated enabling real-time monitoring of treatment differences. The divergence can be found for theoretical survival distributions or can be estimated non-parametrically from survival data using Kaplan-Meier estimates of the survivor functions. The estimator of the divergence is shown to be generally unbiased and approximately normally distributed. For the case of proportional hazards, the constituent parts of the divergence measure can be used to assess the proportional hazards assumption. The use of the divergence measure is illustrated on the survival of pancreatic cancer patients. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Kaplan-Meier analysis on seizure outcome after epilepsy surgery: do gender and race influence it?

    Science.gov (United States)

    Burneo, Jorge G; Villanueva, Vicente; Knowlton, Robert C; Faught, R Edward; Kuzniecky, Ruben I

    2008-06-01

    To evaluate seizure outcome following epilepsy surgery for patients with temporal lobe epilepsy and evaluate is gender and race/ethnicity influence it. Data were obtained from the discharge database of the University of Alabama at Birmingham, Epilepsy Center, between 1985 and 2001. The sample consisted of all patients with a primary diagnosis of medically intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy. Seizure recurrence was tabulated at 7 days, 2 months, 6 months, 1, 2, 3, 4, 5, and 6 years following surgery. Logistic regression analysis was used to model the presence of seizure recurrence after anterior temporal lobectomy for all patients. Kaplan-Meier analysis was done to obtain estimates and 95% CIs of seizure freedom from baseline. Baseline variables--age at surgery, age at seizure onset, sex, side of resection, immediate postoperative seizures, and pathology results--were assessed as potential predictors of each outcome by comparing the survival curves within each variable with a log rank test. Three hundred sixty-eight patients underwent surgical treatment for TLE, mean age of 30.2 years. Thirty-five patients were African American, 43% were men. Immediate postoperative seizures were seen in 23 patients, while seizure recurrence occurred in 27.3% patients within a year after surgery, and in 33.6% within 6 years. Logistic regression results showed no differences between African Americans and whites, between males and females. The occurrence of immediate postoperative seizures was a strong predictor of late seizure recurrence only at 1 year after surgery. The occurrence of seizures in the immediate postoperative period is a strong predictor of later seizure recurrence. Sex and race/ethnicity do not appear to be predictors of long-term outcome following surgery for temporal lobe epilepsy.

  10. Total Ankle Replacement Survival Rates Based on Kaplan-Meier Survival Analysis of National Joint Registry Data.

    Science.gov (United States)

    Bartel, Annette F P; Roukis, Thomas S

    2015-10-01

    National joint registry data provides unique information about primary total ankle replacement (TAR) survival. We sought to recreate survival curves among published national joint registry data sets using the Kaplan-Meier estimator. Overall, 5152 primary and 591 TAR revisions were included over a 2- to 13-year period with prosthesis survival for all national joint registries of 0.94 at 2-years, 0.87 at 5-years and 0.81 at 10-years. National joint registry datasets should strive for completion of data presentation including revision definitions, modes and time of failure, and patients lost to follow-up or death for complete accuracy of the Kaplan-Meier estimator.

  11. Gastric emptying of solids in humans: improved evaluation by Kaplan-Meier plots, with special reference to obesity and gender

    Energy Technology Data Exchange (ETDEWEB)

    Grybaeck, P. [Department of Diagnostic Radiology, Karolinska Hospital, Stockholm (Sweden); Naeslund, E. [Department of Surgery, Karolinska Institute at Danderyd Hospital, Stockholm (Sweden); Hellstroem, P.M. [Department of Internal Medicine, Karolinska Hospital, Stockholm (Sweden); Jacobsson, H. [Department of Diagnostic Radiology, Karolinska Hospital, Stockholm (Sweden)]|[Department of Nuclear Medicine, Karolinska Hospital, Stockholm (Sweden); Backman, L. [Department of Surgery, Karolinska Institute at Danderyd Hospital, Stockholm (Sweden)

    1996-12-01

    It has been suggested that obesity is associated with an altered rate of gastric emptying, and that there are also sex differences in gastric emptying. The results of earlier studies examining gastric emptying rates in obesity and in males and females have proved inconsistent. The aim of this study was to investigate the influence of obesity and gender on gastric emptying, by extending conventional evaluation methods with Kaplan-Meier plots, in order to assess whether these factors have to be accounted for when interpreting results of scintigraphic gastric emptying tests. Twenty-one normal-weight volunteers and nine obese subjects were fed a standardised technetium-99m labelled albumin omelette. Imaging data were acquired at 5- and 10-min intervals in both posterior and anterior projections with the subjects in the sitting position. The half-emptying time, analysed by Kaplan-Meier plot (log-rank test), were shorter in obese subjects compared to normal-weight subjects and later in females compared to males. Also, the lag-phase and half-emptying time were shorter in obese females than in normal females. This study shows an association between different gastric emptying rates and obesity and gender. Therefore, body mass index and gender have to be accounted for when interpreting results of scintigraphic gastric emptying studies. (orig.). With 6 figs., 4 tabs.

  12. KMWin--a convenient tool for graphical presentation of results from Kaplan-Meier survival time analysis.

    Directory of Open Access Journals (Sweden)

    Arnd Gross

    Full Text Available BACKGROUND: Analysis of clinical studies often necessitates multiple graphical representations of the results. Many professional software packages are available for this purpose. Most packages are either only commercially available or hard to use especially if one aims to generate or customize a huge number of similar graphical outputs. We developed a new, freely available software tool called KMWin (Kaplan-Meier for Windows facilitating Kaplan-Meier survival time analysis. KMWin is based on the statistical software environment R and provides an easy to use graphical interface. Survival time data can be supplied as SPSS (sav, SAS export (xpt or text file (dat, which is also a common export format of other applications such as Excel. Figures can directly be exported in any graphical file format supported by R. RESULTS: On the basis of a working example, we demonstrate how to use KMWin and present its main functions. We show how to control the interface, customize the graphical output, and analyse survival time data. A number of comparisons are performed between KMWin and SPSS regarding graphical output, statistical output, data management and development. Although the general functionality of SPSS is larger, KMWin comprises a number of features useful for survival time analysis in clinical trials and other applications. These are for example number of cases and number of cases under risk within the figure or provision of a queue system for repetitive analyses of updated data sets. Moreover, major adjustments of graphical settings can be performed easily on a single window. CONCLUSIONS: We conclude that our tool is well suited and convenient for repetitive analyses of survival time data. It can be used by non-statisticians and provides often used functions as well as functions which are not supplied by standard software packages. The software is routinely applied in several clinical study groups.

  13. Actuarial and actual analysis of surgical results: empirical validation.

    Science.gov (United States)

    Grunkemeier, G L; Anderson, R P; Starr, A

    2001-06-01

    This report validates the use of the Kaplan-Meier (actuarial) method of computing survival curves by comparing 12-year estimates published in 1978 with current assessments. It also contrasts cumulative incidence curves, referred to as "actual" analysis in the cardiac-related literature with Kaplan-Meier curves for thromboembolism and demonstrates that with the former estimate the percentage of events that will actually occur.

  14. Factors Determining Disease Duration in Alzheimer’s Disease: A Postmortem Study of 103 Cases Using the Kaplan-Meier Estimator and Cox Regression

    Directory of Open Access Journals (Sweden)

    R. A. Armstrong

    2014-01-01

    Full Text Available Factors associated with duration of dementia in a consecutive series of 103 Alzheimer’s disease (AD cases were studied using the Kaplan-Meier estimator and Cox regression analysis (proportional hazard model. Mean disease duration was 7.1 years (range: 6 weeks–30 years, standard deviation = 5.18; 25% of cases died within four years, 50% within 6.9 years, and 75% within 10 years. Familial AD cases (FAD had a longer duration than sporadic cases (SAD, especially cases linked to presenilin (PSEN genes. No significant differences in duration were associated with age, sex, or apolipoprotein E (Apo E genotype. Duration was reduced in cases with arterial hypertension. Cox regression analysis suggested longer duration was associated with an earlier disease onset and increased senile plaque (SP and neurofibrillary tangle (NFT pathology in the orbital gyrus (OrG, CA1 sector of the hippocampus, and nucleus basalis of Meynert (NBM. The data suggest shorter disease duration in SAD and in cases with hypertensive comorbidity. In addition, degree of neuropathology did not influence survival, but spread of SP/NFT pathology into the frontal lobe, hippocampus, and basal forebrain was associated with longer disease duration.

  15. Quantitative estimation of the stability of methicillin-resistant Staphylococcus aureus strain-typing systems by use of Kaplan-Meier survival analysis.

    Science.gov (United States)

    O'Sullivan, Matthew V N; Sintchenko, Vitali; Gilbert, Gwendolyn L

    2013-01-01

    Knowledge concerning stability is important in the development and assessment of microbial molecular typing systems and is critical for the interpretation of their results. Typing system stability is usually measured as the fraction of isolates that change type after several in vivo passages, but this does not necessarily reflect in vivo stability. The aim of this study was to utilize survival analysis to provide an informative quantitative measure of in vivo stability and to compare the stabilities of various techniques employed in typing methicillin-resistant Staphylococcus aureus (MRSA). We identified 100 MRSA pairs (isolated from the same patient ≥ 1 month apart) and typed them using multilocus sequence typing (MLST), phage-derived open reading frame (PDORF) typing, toxin gene profiling (TGP), staphylococcal cassette chromosome mec (SCCmec) subtyping, pulsed-field gel electrophoresis (PFGE), and spa sequence typing. Discordant isolate pairs, belonging to different MLST clonal complexes, were excluded, leaving 81 pairs for analysis. The stabilities of these methods were examined using Kaplan-Meier survival analysis, and discriminatory power was measured by Simpson's index of diversity. The probability percentages that the type remained unchanged at 6 months for spa sequence typing, TGP, multilocus variable number of tandem repeats analysis (MLVA), SCCmec subtyping, PDORF typing, and PFGE were 95, 95, 88, 82, 71, and 58, respectively, while the Simpson's indices of diversity were 0.48, 0.47, 0.70, 0.72, 0.89, and 0.88, respectively. Survival analysis using sequential clinical isolates adds an important quantitative dimension to the measurement of stability of a microbial typing system. Of the methods compared here, PDORF typing provides high discriminatory power, comparable with that of PFGE, and a level of stability suitable for MRSA surveillance and outbreak investigations.

  16. Days of Shanghai Stock Index Successive Rises and Fall Based on Kaplan-Meier Algorithms%基于Kaplan-Meier算法的上证指数涨跌天数研究

    Institute of Scientific and Technical Information of China (English)

    毕建欣

    2011-01-01

    运用Kaplan-Meier算法对上证指数连续上涨和下跌天数进行研究,研究了在不同的市场交易制度(即T+0,T+1和涨停板制度)对上证指数涨跌天数的影响,其结果表明Kaplan-Meier算法对于分析股市的变动是有效的.%In this paper, Days of Shanghai Stock Index Successive rises and fall are analyzed by Kaplan-Meier Algorithms. It demonstrates the policy effect on days of Shanghai Stock Index successive rises and fall , such as" T + 0","T + 1"and"soaring deadline system". It also reveals that Kaplan-Meier Algorithms is valid for analyzing the changes of the stock market.

  17. Actuarial Studies

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) from time to time conducts studies on various aspects of the Medicare and Medicaid...

  18. Actuarial Science.

    Science.gov (United States)

    Warren, Bette

    1982-01-01

    Details are provided of a program on actuarial training developed at the State University of New York (SUNY) at Binghamton through the Department of Mathematical Sciences. An outline of its operation, including a few statistics on students in the program, is included. (MP)

  19. Actuarial Science.

    Science.gov (United States)

    Warren, Bette

    1982-01-01

    Details are provided of a program on actuarial training developed at the State University of New York (SUNY) at Binghamton through the Department of Mathematical Sciences. An outline of its operation, including a few statistics on students in the program, is included. (MP)

  20. Clinical versus actuarial judgment.

    Science.gov (United States)

    Dawes, R M; Faust, D; Meehl, P E

    1989-03-31

    Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consultant's judgmental accuracy. The consultant may rely on one of two contrasting approaches to decision-making--the clinical and actuarial methods. Research comparing these two approaches shows the actuarial method to be superior. Factors underlying the greater accuracy of actuarial methods, sources of resistance to the scientific findings, and the benefits of increased reliance on actuarial approaches are discussed.

  1. Preoperative chemoradiotherapy for locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Pepek Joseph M

    2013-01-01

    Full Text Available Abstract Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT for gastric cancer. Methods Patients with gastroesophageal (GE junction (Siewert type II and III or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS, local control (LC and disease-free survival (DFS were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73% had proximal (GE junction, cardia and fundus tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75% underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

  2. Hazard Rate Estimation for Censored Data via Strong Representation of the Kaplan-Meier Estimator.

    Science.gov (United States)

    1985-08-01

    of bounded variation (condition (k4).) The process( /n 1 has mean zero and covariance SA t (26) r(s,t) E E[C(s) C(t)] - F(s) F(t) f [(u)]- 2 d Lj(u...continuous with density f(x) > 0 at x. Suppose k is of bounded variation and is continuous. Then fn(x) admits the strong approximation on the interval [0,T

  3. The Casualty Actuarial Society: Helping Universities Train Future Actuaries

    Science.gov (United States)

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

    The Casualty Actuarial Society (CAS) believes that the most effective way to advance the actuarial profession is to work in partnership with universities. The CAS stands ready to assist universities in creating or enhancing courses and curricula associated with property/casualty actuarial science. CAS resources for university actuarial science…

  4. The Casualty Actuarial Society: Helping Universities Train Future Actuaries

    Science.gov (United States)

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

    The Casualty Actuarial Society (CAS) believes that the most effective way to advance the actuarial profession is to work in partnership with universities. The CAS stands ready to assist universities in creating or enhancing courses and curricula associated with property/casualty actuarial science. CAS resources for university actuarial science…

  5. The case for an actuary.

    Science.gov (United States)

    Renaud, Patrick N

    2002-12-01

    The author describes the role of the actuary, the need for qualified actuaries and how to find them. Qualified actuarial help, in the form of a Fellow of the Society of Actuaries (FSA), is necessary to ensure the best outcome when setting annual premium rates and realistic budgets for self-funded group benefit plans.

  6. Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

    2012-02-01

    Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

  7. Actually, What Is an Actuary?

    Science.gov (United States)

    Oudshoorn, Susan; Finkelstein, Gary

    1991-01-01

    The actuarial profession is described to provide secondary school mathematics teachers insights into how actuaries use mathematics in solving real life problems. Examples are provided involving compound interest, the probability of dying, and inflation with computer modeling. (MDH)

  8. Long-term local control achieved after hypofractionated stereotactic body radiotherapy for adrenal gland metastases: A retrospective analysis of 34 patients

    Energy Technology Data Exchange (ETDEWEB)

    Scorsetti, Marta; Alongi, Filippo [Radiotherapy and Radiosurgery Dept., IRCCS Istituto Clinico Humanitas, Humanitas Cancer Center, Rozzano, Milano (Italy)], Email: filippo.alongi@humanitas.it; Filippi, Andrea Riccardo [Radiation Oncology Unit, Dept. of Medical and Surgical Sciences, Univ. of Turin, Turin (Italy)] [and others

    2012-05-15

    Aims and background. To describe feasibility, tolerability and clinical outcomes of stereotactic body radiation therapy (SBRT) in the treatment of adrenal metastases in 34 consecutive cancer patients. Material and methods. Between March 2004 and July 2010, a total of 34 consecutive patients, accounting for 36 adrenal metastatic lesions, were treated with SBRT. SBRT treatments were delivered by a Linac Varian 600 with microMLC (3DLine, Elekta, Stockholm, Sweden) and a Linac ELEKTA Precise (Elekta). All 34 patients were clinically and radiologically evaluated during and after completion of SBRT. Following outcomes were taken into account: best clinical response at any time, local control, time to systemic progression, time to local progression, overall survival and toxicity. Survival was estimated by the Kaplan-Meier method and factor potentially affecting outcomes were analyzed with Cox regression analysis. Results. Total RT doses ranged from 20 Gy in 4 fractions to 45 Gy in 18 fractions (median dose: 32 Gy; median number of fractions: 4). All doses were prescribed to the 95% isodose line. No cases of Grade {>=} 3 toxicity were recorded. At a median follow-up time of 41 months (range, 12-75) 22 patients were alive. Three of 28 lesions (11%) showed complete response, 13/28 (46%) partial response, 10/28 (36%) stable disease and 2/28 (7%) progressed in the treated area. Local failure was observed in 13 cases. Actuarial local control rates at one and two years were 66% and 32%, respectively. Median time to local progression was 19 months. Median survival was 22 months. Conclusion. SBRT in adrenal gland metastasis is feasible without significant acute and late toxicities, with a good rate of local control. New SBRT fractionation schemes and the possibility to combine new systemic approaches should be investigated in order to further increase local control and reduce systemic disease progression.

  9. Health insurance basic actuarial models

    CERN Document Server

    Pitacco, Ermanno

    2014-01-01

    Health Insurance aims at filling a gap in actuarial literature, attempting to solve the frequent misunderstanding in regards to both the purpose and the contents of health insurance products (and ‘protection products’, more generally) on the one hand, and the relevant actuarial structures on the other. In order to cover the basic principles regarding health insurance techniques, the first few chapters in this book are mainly devoted to the need for health insurance and a description of insurance products in this area (sickness insurance, accident insurance, critical illness covers, income protection, long-term care insurance, health-related benefits as riders to life insurance policies). An introduction to general actuarial and risk-management issues follows. Basic actuarial models are presented for sickness insurance and income protection (i.e. disability annuities). Several numerical examples help the reader understand the main features of pricing and reserving in the health insurance area. A short int...

  10. Application of Actuarial Modelling in Insurance Industry

    OpenAIRE

    Burcã Ana-Maria; Bãtrînca Ghiorghe

    2011-01-01

    In insurance industry, the financial stability of insurance companies represents an issue of vital importance. In order to maintain the financial stability and meet minimum regulatory requirements, actuaries apply actuarial modeling. Modeling has been at the center of actuarial science and of all the sciences from the beginning of their journey. In insurance industry, actuarial modeling creates a framework that allows actuaries to identify, understand, quantify and manage a wide range of risk...

  11. Application of Actuarial Modelling in Insurance Industry

    OpenAIRE

    Burcã Ana-Maria; Bãtrînca Ghiorghe

    2011-01-01

    In insurance industry, the financial stability of insurance companies represents an issue of vital importance. In order to maintain the financial stability and meet minimum regulatory requirements, actuaries apply actuarial modeling. Modeling has been at the center of actuarial science and of all the sciences from the beginning of their journey. In insurance industry, actuarial modeling creates a framework that allows actuaries to identify, understand, quantify and manage a wide range of risk...

  12. How Fair Is Actuarial Fairness?

    DEFF Research Database (Denmark)

    Landes, Xavier

    2015-01-01

    in exchange for the payment of premi- ums. In the insurance industry, the concept of actuarial fairness serves to establish what could be adequate, fair premiums. Accordingly, premiums paid by policyholders should match as closely as possible their risk exposure (i.e. their expected losses). Such premiums...... are the product of the probabilities of losses and the expected losses. This article presents a discussion of the fairness of actuarial fairness through three steps: (1) defining the concept based on its formulation within the insurance industry; (2) determining in which sense it may be about fairness; and (3......) raising some objections to the actual fairness of actu- arial fairness. The necessity of a normative evaluation of actuarial fairness is justified by the influence of the concept on the current reforms of public insurance systems and the fact that it highlights the question of the repartition of the gains...

  13. Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

    Science.gov (United States)

    Carrara, Guilherme Freire Angotti; Scapulatempo-Neto, Cristovam; Abrahão-Machado, Lucas Faria; Brentani, Maria Mitzi; Nunes, João Soares; Folgueira, Maria Aparecida Azevedo Koike; da Costa Vieira, René Aloisio

    2017-01-01

    OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01). CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors. PMID:28355358

  14. A look inside the actuarial black box.

    Science.gov (United States)

    Math, S E; Youngerman, H

    1992-12-01

    Hospital executives often rely on actuaries (and their "black boxes") to determine self-insurance program liabilities and funding contributions. Typically, the hospital supplies the actuary with a myriad of statistics, and eventually the hospital receives a liability estimate and recommended funding level. The mysterious actuarial calculations that occur in between data reporting and receipt of the actuary's report are akin to a black box--a complicated device whose internal mechanism is hidden from or mysterious to the user.

  15. How well does the new lung cancer staging system predict for local/regional recurrence after surgery?: A comparison of the TNM 6 and 7 systems.

    Science.gov (United States)

    Pepek, Joseph M; Chino, Junzo P; Marks, Lawrence B; D'amico, Thomas A; Yoo, David S; Onaitis, Mark W; Ready, Neal E; Hubbs, Jessica L; Boyd, Jessamy; Kelsey, Chris R

    2011-04-01

    To evaluate how well the tumor, node, metastasis (TNM) 6 and TNM 7 staging systems predict rates of local/regional recurrence (LRR) after surgery alone for non-small cell lung cancer. All patients who underwent surgery for non-small cell lung cancer at Duke between 1995 and 2005 were reviewed. Those undergoing sublobar resections, with positive margins or involvement of the chest wall, or those who received any chemotherapy or radiation therapy (RT) were excluded. Disease recurrence at the surgical margin, or within ipsilateral hilar and/or mediastinal lymph nodes, was considered as a LRR. Stage was assigned based on both TNM 6 and TNM 7. Rates of LRR were estimated using the Kaplan-Meier method. A Cox regression analysis evaluated the hazard ratio of LRR by stage within TNM 6 and TNM 7. A total of 709 patients were eligible for the analysis. Median follow-up was 32 months. For all patients, the 5-year actuarial risk of LRR was 23%. Conversion from TNM 6 to TNM 7 resulted in 21% stage migration (upstaging in 13%; downstaging in 8%). Five-year rates of LRR for stages IA, IB, IIA, IIB, and IIIA disease using TNM 6 were 16%, 26%, 43%, 35%, and 40%, respectively. Using TNM 7, corresponding rates were 16%, 23%, 37%, 39%, and 30%, respectively. The hazard ratios for LRR were statistically different for IA and IB in both TNM 6 and 7 but were also different for IB and IIA in TNM 7. LRR risk increases monotonically for stages IA to IIB in the new TNM 7 system. This information might be valuable when designing future studies of postoperative RT.

  16. 75 FR 63505 - Renewal of Advisory Committee on Actuarial Examinations

    Science.gov (United States)

    2010-10-15

    ... ENROLLMENT OF ACTUARIES Renewal of Advisory Committee on Actuarial Examinations AGENCY: Joint Board for the Enrollment of Actuaries. ACTION: Renewal of Advisory Committee. ] SUMMARY: The Joint Board for the Enrollment of Actuaries announces the renewal of the Advisory Committee on Actuarial Examinations. FOR...

  17. Computational Intelligence. Mortality Models for the Actuary

    NARCIS (Netherlands)

    Willemse, W.J.

    2001-01-01

    This thesis applies computational intelligence to the field of actuarial (insurance) science. In particular, this thesis deals with life insurance where mortality modelling is important. Actuaries use ancient models (mortality laws) from the nineteenth century, for example Gompertz' and Makeham's la

  18. Modern actuarial risk theory: using R

    NARCIS (Netherlands)

    Kaas, R.; Goovaerts, M.; Dhaene, J.; Denuit, M.

    2008-01-01

    Modern Actuarial Risk Theory -- Using R contains what every actuary needs to know about non-life insurance mathematics. It starts with the standard material like utility theory, individual and collective model and basic ruin theory. Other topics are risk measures and premium principles, bonus-malus

  19. Market-consistent actuarial valuation

    CERN Document Server

    Wüthrich, Mario V

    2016-01-01

    This is the third edition of this well-received textbook, presenting powerful methods for measuring insurance liabilities and assets in a consistent way, with detailed mathematical frameworks that lead to market-consistent values for liabilities. Topics covered are stochastic discounting with deflators, valuation portfolio in life and non-life insurance, probability distortions, asset and liability management, financial risks, insurance technical risks, and solvency. Including updates on recent developments and regulatory changes under Solvency II, this new edition of Market-Consistent Actuarial Valuation also elaborates on different risk measures, providing a revised definition of solvency based on industry practice, and presents an adapted valuation framework which takes a dynamic view of non-life insurance reserving risk.

  20. 76 FR 17762 - Regulations Governing the Performance of Actuarial Services Under the Employee Retirement Income...

    Science.gov (United States)

    2011-03-31

    ... actuarial experience means actuarial experience (1) involving participation in making determinations that... means responsible actuarial experience involving valuations of the liabilities of pension plans, wherein.... These regulations define certified responsible actuarial experience to mean responsible actuarial...

  1. 42 CFR 403.258 - Statement of actuarial opinion.

    Science.gov (United States)

    2010-10-01

    ... actuarial opinion means a signed declaration in which a qualified actuary states that the assumptions used... policy experience, if any, and reasonable expectations. (b) Qualified actuary means— (1) A member in good standing of the American Academy of Actuaries; or (2) A person who has otherwise demonstrated his or...

  2. 26 CFR 301.6059-1 - Periodic report of actuary.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Periodic report of actuary. 301.6059-1 Section...-1 Periodic report of actuary. (a) In general. The actuarial report described in this section must be... funding deficiency (as defined in section 412(a)) to zero, (4) A statement by the enrolled actuary...

  3. 20 CFR 901.2 - Eligibility to perform actuarial services.

    Science.gov (United States)

    2010-04-01

    .... 901.2 Section 901.2 Employees' Benefits JOINT BOARD FOR THE ENROLLMENT OF ACTUARIES REGULATIONS.... (a) Enrolled actuary. Subject to the standards of performance set forth in subpart C of this part, any individual who is an enrolled actuary as defined in § 901.1(g) may perform actuarial...

  4. The gender profile of the South African actuarial profession | Ramjee ...

    African Journals Online (AJOL)

    The gender profile of the South African actuarial profession. ... the perception of the profession and the experiences of women in the classroom and workplace. Keywords: Actuarial science; exemption rates; gender diversity; persistency ...

  5. Strategic Curricular Decisions in Butler University's Actuarial Science Major

    Science.gov (United States)

    Wilson, Christopher James

    2014-01-01

    We describe specific curricular decisions employed at Butler University that have resulted in student achievement in the actuarial science major. The paper includes a discussion of how these decisions might be applied in the context of a new actuarial program.

  6. Strategic Curricular Decisions in Butler University's Actuarial Science Major

    Science.gov (United States)

    Wilson, Christopher James

    2014-01-01

    We describe specific curricular decisions employed at Butler University that have resulted in student achievement in the actuarial science major. The paper includes a discussion of how these decisions might be applied in the context of a new actuarial program.

  7. A review and comparison of methods for recreating individual patient data from published Kaplan-Meier survival curves for economic evaluations: a simulation study.

    Directory of Open Access Journals (Sweden)

    Xiaomin Wan

    Full Text Available In general, the individual patient-level data (IPD collected in clinical trials are not available to independent researchers to conduct economic evaluations; researchers only have access to published survival curves and summary statistics. Thus, methods that use published survival curves and summary statistics to reproduce statistics for economic evaluations are essential. Four methods have been identified: two traditional methods 1 least squares method, 2 graphical method; and two recently proposed methods by 3 Hoyle and Henley, 4 Guyot et al. The four methods were first individually reviewed and subsequently assessed regarding their abilities to estimate mean survival through a simulation study.A number of different scenarios were developed that comprised combinations of various sample sizes, censoring rates and parametric survival distributions. One thousand simulated survival datasets were generated for each scenario, and all methods were applied to actual IPD. The uncertainty in the estimate of mean survival time was also captured.All methods provided accurate estimates of the mean survival time when the sample size was 500 and a Weibull distribution was used. When the sample size was 100 and the Weibull distribution was used, the Guyot et al. method was almost as accurate as the Hoyle and Henley method; however, more biases were identified in the traditional methods. When a lognormal distribution was used, the Guyot et al. method generated noticeably less bias and a more accurate uncertainty compared with the Hoyle and Henley method.The traditional methods should not be preferred because of their remarkable overestimation. When the Weibull distribution was used for a fitted model, the Guyot et al. method was almost as accurate as the Hoyle and Henley method. However, if the lognormal distribution was used, the Guyot et al. method was less biased compared with the Hoyle and Henley method.

  8. Recruiting and Advising Challenges in Actuarial Science

    Science.gov (United States)

    Case, Bettye Anne; Guan, Yuanying Michelle; Paris, Stephen

    2014-01-01

    Some challenges to increasing actuarial science program size through recruiting broadly among potential students are identified. Possible solutions depend on the structures and culture of the school. Up to three student cohorts may result from partition of potential students by the levels of academic progress before program entry: students…

  9. Recruiting and Advising Challenges in Actuarial Science

    Science.gov (United States)

    Case, Bettye Anne; Guan, Yuanying Michelle; Paris, Stephen

    2014-01-01

    Some challenges to increasing actuarial science program size through recruiting broadly among potential students are identified. Possible solutions depend on the structures and culture of the school. Up to three student cohorts may result from partition of potential students by the levels of academic progress before program entry: students…

  10. 26 CFR 300.7 - Enrollment of enrolled actuary fee.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Enrollment of enrolled actuary fee. 300.7... AND ADMINISTRATION USER FEES § 300.7 Enrollment of enrolled actuary fee. (a) Applicability. This section applies to the initial enrollment of enrolled actuaries with the Joint Board for the Enrollment...

  11. Actuarial considerations of medical malpractice evaluations in M&As.

    Science.gov (United States)

    Frese, Richard C

    2014-11-01

    To best project an actuarial estimate for medical malpractice exposure for a merger and acquisition, a organization's leaders should consider the following factors, among others: How to support an unbiased actuarial estimation. Experience of the actuary. The full picture of the organization's malpractice coverage. The potential for future loss development. Frequency and severity trends.

  12. 20 CFR 200.9 - Selection of members of Actuarial Advisory Committee.

    Science.gov (United States)

    2010-04-01

    ... actuaries to serve on an Actuarial Advisory Committee. This section describes how the two actuaries are selected. (b) Carrier actuary. One member of the Actuarial Advisory Committee shall be selected by... railroad mileage within the United States. (c) Railway labor actuary. The other member of the...

  13. Punishing the lemon: the ethics of actuarial fairness.

    Science.gov (United States)

    Jha, Saurabh

    2012-12-01

    The Patient Protection and Affordable Care Act rejects the notion that actuarial fairness is a normative ideal. The author discusses the ethics of actuarial fairness and attempts to draw a distinction between actuarial fairness and moral fairness. The ethics of wellness programs are discussed with both actuarial fairness and moral fairness in mind. The potential tension between physicians and patients in the zealous pursuit of healthy goals is described. Finally, the logical end point of actuarial fairness with the widespread availability of genetic information is highlighted. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Actuarial contributions to life table analysis.

    Science.gov (United States)

    Lew, E A

    1985-05-01

    The correct principles for the construction of life tables and more particularly select life tables were developed by actuaries in England in the first half of the 19th century. Actuaries explored the phenomenon of selection not only between the insured and annuitants but also in the general population, distinguishing among initial temporary selection, antiselection, and class selection. The conclusion was reached early that no such thing as an unselected population exists. Group life insurance experience among the actively employed has been shown to provide a more appropriate standard of expected mortality than general population death rates in studies of medical impairments and occupational hazards at ages under 65 years. Mortality rates derived from the Cancer Prevention Study can serve as a useful standard of expected mortality when the objective is determination of excess mortality compared with ostensibly healthy persons at ages 65 years and older.

  15. Internship at Taylor Fry Consulting Actuaries

    OpenAIRE

    Kierkels, Bram Joseph Johannes

    2013-01-01

    Mestrado em Ciências Actuariais As the final part of the master degree, I started my internship on 25 Febru- ary 2013 at Taylor Fry Consulting Actuaries. During the internship my work mainly involved analyzing the outstanding workers compensation liabilities for self-insured clients. In this report I will describe the process of this anal- ysis. Throughout this report I will explain the procedures I used to value outstanding claims.

  16. Do actuaries believe in longevity deceleration?

    OpenAIRE

    Debonneuil, Edouard; Planchet, Frédéric; Loisel, Stéphane

    2015-01-01

    As more and more people believe that significant life extensions may come soon, should commonly used future mortality assumptions be considered prudent? We find here that commonly used actuarial tables for annuitants – as well as the Lee-Carter model – do not extrapolate life expectancy at the same rate for future years as for past years; instead they produce some longevity deceleration. This is typically because their mortality improvements decrease after a certain age, and those age-specifi...

  17. Three essays on actuarial social security theory

    OpenAIRE

    Ventura Marco, Manuel

    2015-01-01

    Esta tesis se centra en dos de los instrumentos básicos para mejorar los sistemas de pensiones de reparto (PAYG pension systems): el balance actuarial (ABS) y las cuentas nocionales de aportación definida (NDC). Las investigaciones sobre dichos instrumentos consideran, en general, sólo la contingencia de jubilación. La tesis explora las posibilidades de generalizarlos añadiendo dos nuevas contingencias, la invalidez permanente (disability) y la dependencia (LTC). Los objetivos principales que...

  18. actuar: An R Package for Actuarial Science

    Directory of Open Access Journals (Sweden)

    Christophe Dutang

    2008-02-01

    Full Text Available actuar is a package providing additional Actuarial Science functionality to the R statistical system. The project was launched in 2005 and the package is available on the Comprehensive R Archive Network since February 2006. The current version of the package contains functions for use in the fields of loss distributions modeling, risk theory (including ruin theory, simulation of compound hierarchical models and credibility theory. This paper presents in detail but with few technical terms the most recent version of the package.

  19. 42 CFR 440.340 - Actuarial report for benchmark-equivalent coverage.

    Science.gov (United States)

    2010-10-01

    ... individual who is a member of the American Academy of Actuaries (AAA). (2) Using generally accepted actuarial... actuary preparing the opinion must select and specify the standardized set of factors and the...

  20. 20 CFR 901.20 - Standards of performance of actuarial services.

    Science.gov (United States)

    2010-04-01

    ... GOVERNING THE PERFORMANCE OF ACTUARIAL SERVICES UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974... designation. An enrolled actuary shall not advertise his/her status as an enrolled actuary in any...

  1. Development of an Actuarial Science Program at Salisbury University

    Science.gov (United States)

    Wainwright, Barbara A.

    2014-01-01

    This paper focuses on the development of an actuarial science track for the mathematics major at Salisbury University (SU). A timeline from the initial investigation into such a program through the proposal and approval processes is shared for those who might be interested in developing a new actuarial program. It is wise to start small and take…

  2. Development of an Actuarial Science Program at Salisbury University

    Science.gov (United States)

    Wainwright, Barbara A.

    2014-01-01

    This paper focuses on the development of an actuarial science track for the mathematics major at Salisbury University (SU). A timeline from the initial investigation into such a program through the proposal and approval processes is shared for those who might be interested in developing a new actuarial program. It is wise to start small and take…

  3. 29 CFR 4231.10 - Actuarial calculations and assumptions.

    Science.gov (United States)

    2010-07-01

    ... MULTIEMPLOYER PLANS § 4231.10 Actuarial calculations and assumptions. (a) Most recent valuation. All calculations required by this part must be based on the most recent actuarial valuation as of the date of... this part must be based on methods and assumptions that are reasonable in the aggregate, based on...

  4. Actuarial models of life insurance with stochastic interest rate

    Science.gov (United States)

    Wei, Xiang; Hu, Ping

    2009-07-01

    On the basis of general actuarial model of life insurance, this article has carried on research to continuous life insurance actuarial models under the stochastic interest rate separately. And it provide net single premium for life insurance and life annuity due over a period based on that de Moivre law of mortality and Makeham's law of mortality separately.

  5. 77 FR 63337 - Renewal of Charter of Advisory Committee on Actuarial Examinations

    Science.gov (United States)

    2012-10-16

    ... ENROLLMENT OF ACTUARIES Renewal of Charter of Advisory Committee on Actuarial Examinations AGENCY: Joint Board for the Enrollment of Actuaries. ACTION: Notice of Renewal of Advisory Committee. SUMMARY: The Joint Board for the Enrollment of Actuaries announces the renewal of the charter of the...

  6. 76 FR 81362 - Regulations Governing the Performance of Actuarial Services Under the Employee Retirement Income...

    Science.gov (United States)

    2011-12-28

    ... ENROLLMENT OF ACTUARIES 20 CFR Part 901 RIN 1545-BC82 Regulations Governing the Performance of Actuarial... Enrollment of Actuaries. ACTION: Correction to final regulations. SUMMARY: This document contains corrections..., 2011 (76 FR 17762) relating to the enrollment of actuaries. DATES: This correction is effective...

  7. 42 CFR 457.431 - Actuarial report for benchmark-equivalent coverage.

    Science.gov (United States)

    2010-10-01

    ...— (1) By an individual who is a member of the American Academy of Actuaries; (2) Using generally accepted actuarial principles and methodologies of the American Academy of Actuaries; (3) Using a... coverage. (c) The actuary who prepares the opinion must select and specify the standardized set...

  8. 20 CFR 901.32 - Receipt of information concerning enrolled actuaries.

    Science.gov (United States)

    2010-04-01

    ... actuaries. 901.32 Section 901.32 Employees' Benefits JOINT BOARD FOR THE ENROLLMENT OF ACTUARIES REGULATIONS... Suspension or Termination of Enrollment § 901.32 Receipt of information concerning enrolled actuaries. If an... Guaranty Corporation, or a member of the Joint Board has reason to believe that an enrolled actuary...

  9. Mixed models for predictive modeling in actuarial science

    NARCIS (Netherlands)

    Antonio, K.; Zhang, Y.

    2012-01-01

    We start with a general discussion of mixed (also called multilevel) models and continue with illustrating specific (actuarial) applications of this type of models. Technical details on (linear, generalized, non-linear) mixed models follow: model assumptions, specifications, estimation techniques

  10. ACTUARIAL TECHNIQUES TO ASSESS THE FINANCIAL PERFORMANCE. INSURANCE APPLICATIONS

    Directory of Open Access Journals (Sweden)

    CORINA IOANĂŞ

    2012-01-01

    Full Text Available The XXI century was marked by the convergence and harmonization, this century is distinguished in that it lays the foundation of accounting actuarial, which is characterized by up to date values and actuarial calculations . Actuarial accounting is reflected best in insurance system. In the market economy, insurance system is on one hand a means of protecting the business and property of citizens, on the other hand a business that generates profits. From this context, we can say that the subject of actuarial accounting is the measurement and recognition of assets and result of the change in time value of money. Time is an important variable considered in any economic decision investing and financing.

  11. The Role and Importance of an Actuary in the Insurance

    OpenAIRE

    Zapart, Tomasz

    2013-01-01

    Actuary on the basis of the tasks arising from the audit process of an insurance undertaking is obliged to submit their opinion on all activities of that establishment which could have an impact on the financial position of an insurance undertaking and consequently affect your ability to meet long-term liabilities of the undertaking by providing professional analysis of the internal and external insurance for the governing bodies. The knowledge and perspective on actuarial topi...

  12. Breast conserving treatment of breast carcinoma T2 ({<=} 4 cm) and T3 by neoadjuvant chemotherapy, quadrantectomy, high dose rate brachytherapy as a boost, external beam radiotherapy and adjuvant chemotherapy: local control and overall survival analysis; Tratamento conservador do cancer de mama T2 ({<=} 4 cm) e T3 por quimioterapia neoadjuvante, quadrantectomia, braquiterapia com alta taxa de dose como reforco de dose, teleterapia complementar e quimioterapia adjuvante: analise de controle local e sobrevida global

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Celia Regina; Miziara Filho, Miguel Abrao; Fogaroli, Ricardo Cesar; Baraldi, Helena Espindola; Pellizzon, Antonio Cassio Assis; Pelosi, Edilson Lopes [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Radioterapia], e-mail: celiarsoares@terra.com.br; Fristachi, Carlos Elias [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Onco-Ginecologia e Mastologia; Paes, Roberto Pinto [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil)

    2008-12-15

    Objective: to assess the treatment of breast cancer T2 ({<=} 4 cm) and T3 through neoadjuvant chemotherapy, quadrantectomy and high dose rate brachytherapy as a boost, complementary radiotherapy and adjuvant chemotherapy, considering local control and overall survival. Material and method: this clinical prospective descriptive study was based on the evaluation of 88 patients ranging from 30 to 70 years old, with infiltrating ductal carcinoma, clinical stage IIb and IIIa, responsive to the neoadjuvant chemotherapy, treated from June/1995 to December/2006. Median follow-up was 58 months. Using clinical methods the tumor was evaluated before and after three or four cycles of chemotherapy based on anthracyclines. Overall survival and local control were assessed according to Kaplan-Meier methodology. Results: Local control and overall survival in five years were 90% and 73.5%, respectively. Conclusion: local control and overall survival were comparable to other forms of treatment. (author)

  13. Mathematical and statistical methods for actuarial sciences and finance

    CERN Document Server

    Sibillo, Marilena

    2014-01-01

    The interaction between mathematicians and statisticians working in the actuarial and financial fields is producing numerous meaningful scientific results. This volume, comprising a series of four-page papers, gathers new ideas relating to mathematical and statistical methods in the actuarial sciences and finance. The book covers a variety of topics of interest from both theoretical and applied perspectives, including: actuarial models; alternative testing approaches; behavioral finance; clustering techniques; coherent and non-coherent risk measures; credit-scoring approaches; data envelopment analysis; dynamic stochastic programming; financial contagion models; financial ratios; intelligent financial trading systems; mixture normality approaches; Monte Carlo-based methodologies; multicriteria methods; nonlinear parameter estimation techniques; nonlinear threshold models; particle swarm optimization; performance measures; portfolio optimization; pricing methods for structured and non-structured derivatives; r...

  14. Mathematical and statistical methods for actuarial sciences and finance

    CERN Document Server

    Pizzi, Claudio

    2014-01-01

    The interaction between mathematicians and statisticians has been shown to be an effective approach for dealing with actuarial, insurance and financial problems, both from an academic perspective and from an operative one. The collection of original papers presented in this volume pursues precisely this purpose. It covers a wide variety of subjects in actuarial, insurance and finance fields, all treated in the light of the successful cooperation between the above two quantitative approaches. The papers published in this volume present theoretical and methodological contributions and their applications to real contexts. With respect to the theoretical and methodological contributions, some of the considered areas of investigation are: actuarial models; alternative testing approaches; behavioral finance; clustering techniques; coherent and non-coherent risk measures; credit scoring approaches; data envelopment analysis; dynamic stochastic programming; financial contagion models; financial ratios; intelli...

  15. 1st International Congress on Actuarial Science and Quantitative Finance

    CERN Document Server

    Garrido, José; Hernández-Hernández, Daniel; ICASQF

    2015-01-01

    Featuring contributions from industry and academia, this volume includes chapters covering a diverse range of theoretical and empirical aspects of actuarial science and quantitative finance, including portfolio management, derivative valuation, risk theory and the economics of insurance. Developed from the First International Congress on Actuarial Science and Quantitative Finance, held at the Universidad Nacional de Colombia in Bogotá in June 2014, this volume highlights different approaches to issues arising from industries in the Andean and Carribean regions. Contributions address topics such as Reverse mortgage schemes and urban dynamics, modeling spot price dynamics in the electricity market, and optimizing calibration and pricing with SABR models.

  16. A multiple Markov switching model for actuarial use in South Africa ...

    African Journals Online (AJOL)

    ... the smoothed inferences obtained from a univariate analysis of the variables. ... used for various actuarial applications, especially those involving long-term projections. ... financial projections, actuarial, stochastic model, time-series models ...

  17. An Overview of the Society of Actuaries and Its Education Programs

    Science.gov (United States)

    Klugman, Stuart; Long, Gena

    2014-01-01

    The Society of Actuaries (SOA) is the world's largest actuarial organization. This article describes the SOA with particular attention paid to its education and qualification processes and resources available for university and college programs.

  18. 78 FR 773 - Hartford Financial Services Group, Inc., Commercial/Actuarial/Information Delivery Services (IDS...

    Science.gov (United States)

    2013-01-04

    ... Employment and Training Administration Hartford Financial Services Group, Inc., Commercial/Actuarial/ Information Delivery Services (IDS)/Corporate & Financial Reporting Group, Hartford, CT; Notice of Affirmative... workers of Hartford Financial Services Group, Inc., Commercial/ Actuarial/Information Delivery...

  19. 78 FR 8596 - Hartford Financial Services Group, Inc., Commercial/Actuarial/ Information Delivery Services (IDS...

    Science.gov (United States)

    2013-02-06

    .../ Information Delivery Services (IDS)/Corporate & Financial Reporting Group, Hartford, CT; Notice of Negative... Services Group, Inc., Commercial/Actuarial/Information Delivery Services (IDS)/Corporate & Financial... Hartford Financial Services Group, Inc., Commercial/Actuarial/Information Delivery Services...

  20. Actuarial Science at One Four-Year Comprehensive University

    Science.gov (United States)

    Charlwood, Kevin E.

    2014-01-01

    Building an Actuarial Science program designated as advanced requires dedicated faculty, support from the administration, and a core group of strong students. Washburn University may serve as a model for those wishing to start or enhance such a program at their institution. We face three main ongoing challenges: first, the hiring and retention of…

  1. Starting an Actuarial Science Major at a Liberal Arts College

    Science.gov (United States)

    Mills, Mark A.

    2014-01-01

    The article provides details of the process of starting an actuarial science major at a small, liberal arts college. Some critique of the major is included, as well as some challenges that may be faced by others wanting to start such a major at their institution.

  2. Actuarial Science at One Four-Year Comprehensive University

    Science.gov (United States)

    Charlwood, Kevin E.

    2014-01-01

    Building an Actuarial Science program designated as advanced requires dedicated faculty, support from the administration, and a core group of strong students. Washburn University may serve as a model for those wishing to start or enhance such a program at their institution. We face three main ongoing challenges: first, the hiring and retention of…

  3. Conversations with your actuary: getting to the right number.

    Science.gov (United States)

    Frese, Richard C

    2013-05-01

    A healthcare finance leader can guarantee recognition of his or her organization's insurance program and better manage the program's liability by discussing changes in the following areas with an actuary: Claims management. Exposure. Coverage or retention Financial reporting of losses. Management goals. Other insurance and operational matters.

  4. Starting an Actuarial Science Major at a Liberal Arts College

    Science.gov (United States)

    Mills, Mark A.

    2014-01-01

    The article provides details of the process of starting an actuarial science major at a small, liberal arts college. Some critique of the major is included, as well as some challenges that may be faced by others wanting to start such a major at their institution.

  5. The Role of an Actuarial Director in the Development of an Introductory Program

    Science.gov (United States)

    Staples, Susan G.

    2014-01-01

    We describe the roles and duties of a director in developing an introductory actuarial program. Degree plan design, specialized exam courses, internship classes, coordination of efforts with Economics and Finance Departments, opportunities for creating a minor in actuarial mathematics, actuarial clubs, career advice, and interaction with actuarial…

  6. Including an Exam P/1 Prep Course in a Growing Actuarial Science Program

    Science.gov (United States)

    Wakefield, Thomas P.

    2014-01-01

    The purpose of this article is to describe the actuarial science program at our university and the development of a course to enhance students' problem solving skills while preparing them for Exam P/1 of the Society of Actuaries (SOA) and the Casualty Actuary Society (CAS). The Exam P/1 prep course, formally titled Mathematical Foundations of…

  7. 26 CFR 300.8 - Renewal of enrollment of enrolled actuary fee.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Renewal of enrollment of enrolled actuary fee...) PROCEDURE AND ADMINISTRATION USER FEES § 300.8 Renewal of enrollment of enrolled actuary fee. (a) Applicability. This section applies to the renewal of enrollment of enrolled actuaries with the Joint Board...

  8. 77 FR 12577 - Department of Defense (DoD) Board of Actuaries; Federal Advisory Committee Meeting

    Science.gov (United States)

    2012-03-01

    ... of the Secretary Department of Defense (DoD) Board of Actuaries; Federal Advisory Committee Meeting... committee meeting of the DoD Board of Actuaries will take place. DATES: July 19, 2012, from 1 p.m. to 5 p.m... Point of Contact: Persons desiring to attend the DoD Board of Actuaries meeting or make an...

  9. Including an Exam P/1 Prep Course in a Growing Actuarial Science Program

    Science.gov (United States)

    Wakefield, Thomas P.

    2014-01-01

    The purpose of this article is to describe the actuarial science program at our university and the development of a course to enhance students' problem solving skills while preparing them for Exam P/1 of the Society of Actuaries (SOA) and the Casualty Actuary Society (CAS). The Exam P/1 prep course, formally titled Mathematical Foundations of…

  10. 76 FR 67774 - Actuarial Advisory Committee With Respect to the Railroad Retirement Account; Notice of Public...

    Science.gov (United States)

    2011-11-02

    ... hold a meeting on November 14, 2011, at 9:30 a.m. at the office of the Chief Actuary of the U.S... experience on which the recommendations are based will have been sent by the Chief Actuary to the Committee... Advisory Committee, cio Chief Actuary, U.S. Railroad Retirement Board, 844 North Rush Street,...

  11. 75 FR 6359 - Federal Advisory Committee; DoD Board of Actuaries; Meeting

    Science.gov (United States)

    2010-02-09

    ... of the Secretary Federal Advisory Committee; DoD Board of Actuaries; Meeting AGENCY: Department of... amended), and 41 CFR 102-3.150, the Department of Defense announces that the DoD Board of Actuaries will..., VA 22203. FOR FURTHER INFORMATION CONTACT: Inger Pettygrove at the DoD Office of the Actuary, 4040...

  12. The Undergraduate Statistics Major--A Prelude to Actuarial Science Training.

    Science.gov (United States)

    Ratliff, Michael I.; Williams, Raymond E.

    Recently there has been increased interest related to the Actuarial Science field. An actuary is a business professional who uses mathematical skills to define, analyze, and solve financial and social problems. This paper examines: (1) the interface between Statistical and Actuarial Science training; (2) statistical courses corresponding to…

  13. 75 FR 22754 - Federal Advisory Committee; Department of Defense Board of Actuaries; Charter Renewal

    Science.gov (United States)

    2010-04-30

    ... of the Secretary Federal Advisory Committee; Department of Defense Board of Actuaries; Charter... Defense gives notice that it is renewing the charter for the Department of Defense Board of Actuaries... members appointed by the Secretary of Defense from among qualified professional actuaries who are...

  14. 77 FR 24233 - Actuarial Advisory Committee With Respect to the Railroad Retirement Account; Notice of Public...

    Science.gov (United States)

    2012-04-23

    ... hold a meeting on May 30, 2012, at 9:30 a.m. at the office of the Chief Actuary of the U.S. Railroad... communications or notices to the RRB Actuarial Advisory Committee, c/o Chief Actuary, U.S. Railroad...

  15. 75 FR 47650 - Actuarial Advisory Committee With Respect to the Railroad Retirement Account; Notice of Public...

    Science.gov (United States)

    2010-08-06

    ... hold a meeting on September 23, 2010, at 9:30 a.m. at the office of the Chief Actuary of the U.S... experience on which the recommendations are based will have been sent by the Chief Actuary to the Committee... Advisory Committee, c/o Chief Actuary, U.S. Railroad Retirement Board, 844 North Rush Street,...

  16. Basal {sup 18}F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Soriano Castrejon, Angel [University General Hospital, Nuclear Medicine Department, Ciudad Real (Spain); Lopez-Fidalgo, Jesus Fernando; Amo-Salas, Mariano [University of Castilla-La Mancha, Department of Mathematics, Ciudad Real (Spain); Mar Munoz Sanchez, Maria del [Virgen de la Luz Hospital, Oncology Department, Cuenca (Spain); Alvarez Cabellos, Ruth [Virgen de la Salud Hospital, Oncology Department, Toledo (Spain); Espinosa Aunion, Ruth [La Mancha Centro Hospital, Oncology Department, Ciudad Real (Spain)

    2015-11-15

    To explore the relationship between basal {sup 18}F-FDG PET/CT information in breast tumours and survival in locally advanced breast cancer (LABC). This prospective, multicentre study included 198 women diagnosed with LABC. All patients underwent {sup 18}F-FDG PET/CT prior to treatment. The maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N) and the N/T ratio was obtained in all cases. Stage according to PET/CT imaging (metabolic stage) and conventional imaging techniques (clinical stage) was established. During follow-up, patient status was established (disease free status or not). The relationship between all the variables and overall survival (OS) and disease-free survival (DFS) was analysed using the Kaplan-Meier and Cox regression methods. A ROC analysis was performed to obtain a cut-off value of SUVmax that was useful in the prediction of outcome. The mean SUVmax ± SD values in the primary tumour, lymph nodes and the SUVmax N/T index were 7.40 ± 5.57, 4.17 ± 4.74 and 0.73 ± 1.20, respectively. Higher semiquantitative metabolic values were found in more advanced metabolic and clinical stages. During follow-up, 78.4 % of patients were free of disease. Significant relationships were observed between SUVT and SUVN and patient status. With respect to OS and DFS, significant differences were detected for the metabolic stage. Kaplan-Meier analysis revealed that using the cut-off values, a primary-tumour SUVmax ≥ 6.05 or a nodal SUVmax ≥2.25 were significantly correlated with DFS and OS. PET imaging with {sup 18}F-FDG offers prognostic information for LABC that can be obtained preoperatively and noninvasively. (orig.)

  17. The early predictive value of a decrease of metabolic tumor volume in repeated (18)F-FDG PET/CT for recurrence of locally advanced non-small cell lung cancer with concurrent radiochemotherapy.

    Science.gov (United States)

    Huang, Wei; Liu, Bo; Fan, Min; Zhou, Tao; Fu, Zheng; Zhang, Zicheng; Li, Hongsheng; Li, Baosheng

    2015-03-01

    The aim of this study is to investigate the value of [(18)F] fluorodeoxyglucose positron emission tomography/computed tomography ((18)F FDG PET/CT) to predict recurrence of patients with locally advanced non-small cell lung cancer (NSCLC) during the early stage of concurrent chemoradiotherapy (CCRT). A total of 53 stage III NSCLC patients without diabetics or undergoing surgery were enrolled in the prospective study. Those patients were evaluated by FDG PET before and following 40Gy radiotherapy (RT) with a concurrent cisplatin-based heterogeneous chemotherapy regimen. Semiquantitative assessment was used to determine maximum and mean SUVs (SUVmax/SUVmean) and metabolic tumor volume (MTV) of the primary tumor. The prognostic significance of PET/CT parameters and other clinical variables was assessed using Cox regression analyses. The cutoffs of PET/CT parameters which have been determined by the previous study were used to separate the groups with Kaplan-Meier curves. Recurrence rates at 1- and 2-years were 18.9% (10/53) and 50.9% (27/53) for all patients, respectively. Cox regression analysis showed that the only prognostic factor for recurrence was a decrease of MTV. Using the cutoff of 29.7%, a decrease of MTV can separate the patients into 2 groups with Kaplan-Meier curve successfully. The prospective study has reinforced the early predictive value of MTV in repeated (18)F-FDG PET/CT for recurrence in a subgroup of locally advanced NSCLC who underwent CCRT. A decrease of MTV in (18)F-FDG uptake by the primary tumor correlates with higher LRFS. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Have We Finally Achieved Actuarial Fairness of Social Security Retirement Benefits and Will It Last?

    OpenAIRE

    Heiland, Frank W.; Na Yin

    2014-01-01

    This paper develops a framework to analyze the actuarial adjustments faced by American workers who claim Social Security benefits before or after their Full Retirement Age (FRA). We derive the conditions under which these adjustments are “actuarially fair” (or “neutral”) and develop measures to characterize the devi- ation from the fair form. Fair adjustment schedules are increasing at an increasing rate in take-up age and become flatter as longevity rises. We document that the actuarial fit ...

  19. 78 FR 9890 - DoD Board of Actuaries; Notice of Federal Advisory Committee Meeting

    Science.gov (United States)

    2013-02-12

    ... of the Secretary DoD Board of Actuaries; Notice of Federal Advisory Committee Meeting AGENCY: DoD... Committee meeting of the DoD Board of Actuaries will take place. DATES: July 18, 2013, from 1:00 p.m. to 5... Human Resource Activity, DoD Office of the Actuary, 4800 Mark Center Drive, STE 06J25-01, Alexandria,...

  20. "Cult of equity": actuaries and the transformation of pension fund investing, 1948–1960

    OpenAIRE

    2015-01-01

    This article examines the mid-twentieth-century transformation of U.K. pension fund investment policy known as the “cult of equity.” It focuses on the influence exercised by the Association of Superannuation and Pension Funds over actuarial and corporate governance standards, through actuaries who were members of its council. This intervention led to increasingly permissive actuarial valuations that reduced contributions for sponsors of pension funds investing in equities. Increased demand fo...

  1. Estadística actuarial : modelos estocásticos

    OpenAIRE

    Ferreira García, María Eva; Garín Martín, María Araceli

    2010-01-01

    Son destinatarios de estas notas de clase, los alumnos de la asignatura Estadística Actuarial: modelos estocásticos, actualmente impartida dentro de la Licenciatura en Ciencias Actuariales y Financieras, futuro grado en Finanzas y Seguros. El contenido se estructura en cinco capítulos. El primero contiene una colección de ejercicios propuestos, con la idea de revisar mediante su resolución, una serie de conceptos básicos del cálculo de probabilidades, que serán necesarios en el resto de ...

  2. Optimization of the Actuarial Model of Defined Contribution Pension Plan

    Directory of Open Access Journals (Sweden)

    Yan Li

    2014-01-01

    Full Text Available The paper focuses on the actuarial models of defined contribution pension plan. Through assumptions and calculations, the expected replacement ratios of three different defined contribution pension plans are compared. Specially, more significant considerable factors are put forward in the further cost and risk analyses. In order to get an assessment of current status, the paper finds a relationship between the replacement ratio and the pension investment rate using econometrics method. Based on an appropriate investment rate of 6%, an expected replacement ratio of 20% is reached.

  3. Estadística actuarial : regresión lineal

    OpenAIRE

    Esteban González, María Victoria

    2008-01-01

    Estas notas de clase son de utilidad como material docente para los alumnos de la asignatura Estadística Actuarial: Regresión de la Licenciatura en Ciencias Actuariales y Financieras. También pueden ser útiles a los alumnos de asignaturas afines como es Introducción a la Econometría en la Licenciatura de Administración y Dirección de Empresas y en la Licenciatura de Economía. En estos dos últimos casos sólo necesitarían los capítulos 1, 2 y 3. Las notas de clase se estructuran siguiendo ...

  4. Gender and Extended Actuarial Functions in Pension Insurance

    Directory of Open Access Journals (Sweden)

    Jana Špirková

    2012-12-01

    Full Text Available This paper brings analysis of the impact of a ban on the use of gender in insurance, with special stress on pension annuity, according to the requirements of the European Court of Justice. The paper brings a state-of-theart overview of known and extended actuarial functions which relate to modeling of a premium of endowment, term life insurance and pension annuity. Moreover, the amounts of the pension annuities payable thly per year in a model of the third pillar pension are modeled and analyzed for different interest rates using life tables for both genders and unisex.

  5. Radical prostatectomy in clinically localized high-risk prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Berg, Kasper Drimer; Christensen, Ib Jarle;

    2013-01-01

    Abstract Objective. The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP) is regar......Abstract Objective. The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP......) is regarded as primary therapy by others. This study examined the outcome for high-risk localized PCa patients treated with RP. Material and methods. Of 1300 patients who underwent RP, 231 were identified as high-risk. Patients were followed for biochemical recurrence (BCR) (defined as prostate......-specific antigen ≥ 0.2 ng/ml), metastatic disease and survival. Excluding node-positive patients, none of the patients received adjuvant therapy before BCR was confirmed. Univariate and multivariate analysis was performed with Kaplan-Meier and Cox proportional hazard models. Results. Median follow-up was 4.4 years...

  6. Predictors of Individual Tumor Local Control After Stereotactic Radiosurgery for Non-Small Cell Lung Cancer Brain Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Garsa, Adam A. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Badiyan, Shahed N.; DeWees, Todd; Simpson, Joseph R.; Huang, Jiayi; Drzymala, Robert E. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Barani, Igor J. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Dowling, Joshua L.; Rich, Keith M.; Chicoine, Michael R.; Kim, Albert H.; Leuthardt, Eric C. [Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri (United States); Robinson, Clifford G., E-mail: crobinson@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2014-10-01

    Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS). Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant. Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16%) and 335 supratentorial metastases (84%). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74%. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84% versus 69% for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60%, compared with 77% for supratentorial lesions, controlling for tumor volume and conformality index. Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective

  7. An actuarial approach to retrofit savings in buildings

    Energy Technology Data Exchange (ETDEWEB)

    Subbarao, Krishnappa; Etingov, Pavel V.; Reddy, T. A.

    2014-01-01

    An actuarial method has been developed for determining energy savings from retrofits from energy use data for a number of buildings. This method should be contrasted with the traditional method of using pre- and post-retrofit data on the same building. This method supports the U.S. Department of Energy Building Performance Database of real building performance data and related tools that enable engineering and financial practitioners to evaluate retrofits. The actuarial approach derives, from the database, probability density functions (PDFs) for energy savings from retrofits by creating peer groups for the user’s pre post buildings. From the energy use distribution of the two groups, the savings PDF is derived. This provides the basis for engineering analysis as well as financial risk analysis leading to investment decisions. Several technical issues are addressed: The savings PDF is obtained from the pre- and post-PDF through a convolution. Smoothing using kernel density estimation is applied to make the PDF more realistic. The low data density problem can be mitigated through a neighborhood methodology. Correlations between pre and post buildings are addressed to improve the savings PDF. Sample size effects are addressed through the Kolmogorov--Smirnov tests and quantile-quantile plots.

  8. Criminal Behavior as a Function of Clinical and Actuarial Variables in a Sexual Offender Population.

    Science.gov (United States)

    Hall, Gordon C. Nagayama

    1988-01-01

    Investigated ability of clinical and actuarial variables to predict criminal behavior of 342 sexual offenders previously studied in 1987. Results suggested linear combination of actuarial variables was significantly predictive of sexual reoffenses against adults and of nonsexual reoffending. Clinical judgment was not significantly predictive of…

  9. An analysis of possible applications of fuzzy set theory to the actuarial credibility theory

    Science.gov (United States)

    Ostaszewski, Krzysztof; Karwowski, Waldemar

    1992-01-01

    In this work, we review the basic concepts of actuarial credibility theory from the point of view of introducing applications of the fuzzy set-theoretic method. We show how the concept of actuarial credibility can be modeled through the fuzzy set membership functions and how fuzzy set methods, especially fuzzy pattern recognition, can provide an alternative tool for estimating credibility.

  10. A Comparison of Logistic Regression, Neural Networks, and Classification Trees Predicting Success of Actuarial Students

    Science.gov (United States)

    Schumacher, Phyllis; Olinsky, Alan; Quinn, John; Smith, Richard

    2010-01-01

    The authors extended previous research by 2 of the authors who conducted a study designed to predict the successful completion of students enrolled in an actuarial program. They used logistic regression to determine the probability of an actuarial student graduating in the major or dropping out. They compared the results of this study with those…

  11. Clinical versus Actuarial Predictions of Violence in Patients with Mental Illness.

    Science.gov (United States)

    Gardner, William; And Others

    1996-01-01

    Compared accuracy of an actuarial procedure for the prediction of community violence by patients with mental illnesses to accuracy of clinicians' concern ratings of patient violence. Data came from a study of 357 pairs of patients seen in a psychiatric emergency room. Actuarial predictions based only on patients' histories of violence were more…

  12. A Comparison of Logistic Regression, Neural Networks, and Classification Trees Predicting Success of Actuarial Students

    Science.gov (United States)

    Schumacher, Phyllis; Olinsky, Alan; Quinn, John; Smith, Richard

    2010-01-01

    The authors extended previous research by 2 of the authors who conducted a study designed to predict the successful completion of students enrolled in an actuarial program. They used logistic regression to determine the probability of an actuarial student graduating in the major or dropping out. They compared the results of this study with those…

  13. 78 FR 64943 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

    Science.gov (United States)

    2013-10-30

    ... percent reserve ratio has been the normal target used to calculate the Part B premium. In view of the... physician update, a contingency reserve ratio in excess of 20 percent of the following year's expenditures... deductible by the ratio of the 2014 aged actuarial rate to the 2013 aged actuarial rate. The...

  14. 76 FR 67572 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

    Science.gov (United States)

    2011-11-01

    ... has been set for a given year, a contingency reserve ratio in excess of 20 percent of the following... deductible by the ratio of the 2012 aged actuarial rate over the 2011 aged actuarial rate. The amount... physician fees in 2012, it is appropriate to maintain a significantly larger Part B contingency reserve...

  15. Subcellular localization of APE1/Ref-1 in human hepatocellular carcinoma: possible prognostic significance.

    Science.gov (United States)

    Di Maso, Vittorio; Avellini, Claudio; Crocè, Lory Saveria; Rosso, Natalia; Quadrifoglio, Franco; Cesaratto, Laura; Codarin, Erika; Bedogni, Giorgio; Beltrami, Carlo Alberto; Tell, Gianluca; Tiribelli, Claudio

    2007-01-01

    APE1/Ref-1, normally localized in the nucleus, is a regulator of the cellular response to oxidative stress. Cytoplasmic localization has been observed in several tumors and correlates with a poor prognosis. Because no data are available on liver tumors, we investigated APE1/Ref-1 subcellular localization and its correlation with survival in 47 consecutive patients undergoing hepatocellular carcinoma (HCC) resection. APE1/Ref-1 expression was determined by immunohistochemistry in HCC and surrounding liver cirrhosis (SLC) and compared with normal liver tissue. Survival probability was evaluated using Kaplan-Meier curves (log-rank test) and Cox regression. Cytoplasmic expression of APE1/Ref-1 was significantly higher in HCC than in SLC (P = 0.00001); normal liver showed only nuclear reactivity. Patients with poorly differentiated HCC showed a cytoplasmic expression three times higher than those with well-differentiated HCC (P = 0.03). Cytoplasmic localization was associated with a median survival time shorter than those with negative cytoplasmic reactivity (0.44 compared with 1.64 years, P = 0.003), and multivariable analysis confirmed that cytoplasmic APE1/Ref-1 localization is a predictor of survival. Cytoplasmic expression of APE1/Ref-1 is increased in HCC and is associated with a lower degree of differentiation and a shorter survival time, pointing to the use of the cytoplasmic localization of APE1/Ref-1 as a prognostic marker for HCC.

  16. A Note on Realistic Dividends in Actuarial Surplus Models

    Directory of Open Access Journals (Sweden)

    Benjamin Avanzi

    2016-10-01

    Full Text Available Because of the profitable nature of risk businesses in the long term, de Finetti suggested that surplus models should allow for cash leakages, as otherwise the surplus would unrealistically grow (on average to infinity. These leakages were interpreted as ‘dividends’. Subsequent literature on actuarial surplus models with dividend distribution has mainly focussed on dividend strategies that either maximise the expected present value of dividends until ruin or lead to a probability of ruin that is less than one (see Albrecher and Thonhauser, Avanzi for reviews. An increasing number of papers are directly interested in modelling dividend policies that are consistent with actual practice in financial markets. In this short note, we review the corporate finance literature with the specific aim of fleshing out properties that dividend strategies should ideally satisfy, if one wants to model behaviour that is consistent with practice.

  17. The Actuarial Society of South Africa AIDS model.

    Science.gov (United States)

    1997-01-01

    The AIDS Committee of the Actuarial Society of South Africa has developed a demographic model to allow researchers to project the impact of HIV and AIDS in South Africa. The model is available for use as a projection tool rather than to endorse a given projected scenario as being representative. It is very flexible and can be adapted to suit different purposes by anyone with a working knowledge of Microsoft Excel. The need for a model, calibration of the model, the lack of allowance in the model for racial and cultural heterogeneity in the underlying population, and default scenario projections are discussed. The model is available free of charge via E-mail and on the worldwide web at the following respective addresses: awhitelo@oldmutual.com and http://www.und.ac.za/und/eco/eru/eru.htm.

  18. 75 FR 6360 - Federal Advisory Committee; DoD Medicare-Eligible Retiree Health Care Board of Actuaries

    Science.gov (United States)

    2010-02-09

    ... Actuaries AGENCY: Department of Defense (DoD). ACTION: Meeting notice. SUMMARY: Under the provisions of the... that the DoD Medicare-Eligible Retiree Health Care Board of Actuaries will meet on August 18, 2010... Actuary, 4040 N. Fairfax Drive, Suite 308, Arlington, VA 22203; phone 703-696-7404....

  19. 77 FR 12577 - Department of Defense (DoD) Medicare-Eligible Retiree Health Care Board of Actuaries; Federal...

    Science.gov (United States)

    2012-03-01

    ... of the Secretary Department of Defense (DoD) Medicare-Eligible Retiree Health Care Board of Actuaries... Board of Actuaries will take place. DATES: Friday, August 3, 2012, from 1:30 p.m. to 3:30 p.m. ADDRESSES... Medicare- Eligible Retiree Health Care Board of Actuaries meeting or make an oral presentation or submit...

  20. Fiducial-free CyberKnife stereotactic body radiation therapy (SBRT for single vertebral body metastases: acceptable local control and normal tissue tolerance with 5 fraction approach

    Directory of Open Access Journals (Sweden)

    Beant S Gill

    2012-04-01

    Full Text Available This retrospective analysis examines the local control and toxicity of 5 fraction fiducial-free CyberKnife stereotactic body radiation therapy (SBRT for single vertebral body metastases. All patients had favorable performance status (ECOG 0-1, oligometastatic disease and no prior spine irradiation. A prescribed dose of 30 to 35 Gy was delivered in 5 fractions to the planning treatment volume (PTV using the CyberKnife with X-sight spine tracking. Suggested maximum spinal cord and esophagus point doses were 30 Gy and 40 Gy, respectively. A median 30 Gy (range, 30 - 35 Gy dose was delivered to a median prescription isodose line of 70% (range, 60 - 80% to 20 patients. At 34 months median follow-up (range, 12-62 months for surviving patients, the 1- and 2-year Kaplan-Meier local control estimates were 80% and 73%, respectively. Two of the 5 local failures were infield in patients who had received partial vertebral body irradiation and 3 were paravertebral failures just outside the PTV in patients with prior corpectomy. No local failures occurred in patients who completed total vertebral body radiation alone. The 1- and 2-year Kaplan-Meier overall survival estimates were 80% and 57%, respectively. Most deaths were attributed to metastatic disease; one death was attributed to local recurrence. The mean maximum point doses were 26.4 Gy (range, 16.3 - 31.8 Gy to the spinal cord and 30.7 Gy (15.4- 40.0 Gy to the esophagus. Patients receiving maximum esophagus point doses greater than 35 Gy experienced acute dysphagia (Grade I/II. No spinal cord toxicity was documented. Five fraction fiducial-free CyberKnife SBRT is an acceptable treatment option for newly diagnosed vertebral body metastases with promising local control rates and minimal toxicity despite the close proximity of such tumors to the spinal cord and esophagus. A prospective study aimed at further enhancing local control by targeting the entire intact vertebral body and escalating the total dose

  1. Repetitive transarterial chemoembolization (TACE) of liver metastases from renal cell carcinoma: Local control and survival results

    Energy Technology Data Exchange (ETDEWEB)

    Nabil, Mohamed [Johann Wolfgang Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Klinikum der Johann Wolfgang Goethe-Universitaet, Institut fuer Diagnostische und Interventionelle Radiologie, Frankfurt am Main (Germany); Gruber, Tatjana; Zangos, Stephan; Vogl, Thomas J. [Johann Wolfgang Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Yakoub, Danny [Imperial College London, St Mary' s Hospital, Department of Biosurgery and Surgical Technology, London (United Kingdom); Ackermann, Hanns [Johann Wolfgang Goethe University, Department of Biostatistics and Medical Information, Frankfurt am Main (Germany)

    2008-07-15

    The purpose was to evaluate the effectiveness of transarterial chemoembolization (TACE) in local tumor control and survival in patients with hepatic metastases from renal cell carcinoma (RCC). Prospective evaluation of TACE treatment outcome in 22 patients recruited from 1999 and 2005 was performed. The chemotherapeutic agent used was mitomycin only in 45% of the patients and mitomycin together with gemcitabine in the other 55%. The embolizing materials used in all of the patients were iodized oil (lipiodol) and degradable starch microspheres. Local response was evaluated by MRI and judged according to Response Evaluation Criteria in Solid Tumors (RECIST). Mean and median survival and survival probability after diagnosis and treatment were both calculated by Kaplan-Meier method. Partial response was achieved in 13.7%, stable disease in 59% and progressive disease in 27.3% of patients. Survival time from the diagnosis of metastases ranged from 18 to 307 months and from 2.2 to 35 months from the start of TACE treatment. The median and mean survival times from the date of diagnosis were 68.6 and 102.9 months, respectively. The median and mean survival times from the start of TACE were 8.2 and 11.7 months, respectively. Survival probability from the start of treatment was 31% after 1 year and 6% after 2 years. TACE can result in a favorable local tumor response in patients with hepatic metastases from RCC, but survival results are still limited. (orig.)

  2. Learning Survival Models with On-Line Simulation Activities in the Actuarial Science Degree

    National Research Council Canada - National Science Library

    Antonio Fernandez-Morales

    2011-01-01

    The aim of this paper is to describe an on-line survival laboratory designed to enhance teaching and learning in the Statistics courses of the Actuarial Science Degree of the Uni-versity of Málaga...

  3. Modelización financiero-actuarial de un seguro de dependencia = Long Term Care Insurance Actuarial Model

    Directory of Open Access Journals (Sweden)

    Herranz Peinado, Patricia

    2008-01-01

    Full Text Available España ha seguido la tendencia de otros países en cuanto a la cobertura de las personas dependientes, es decir, aquellas que necesitan ayuda para realizar las tareas básicas de la vida diaria, y lo ha hecho mediante la aprobación de la Ley de Promoción de la Autonomía Personal y Atención a las personas en situación de Dependencia, que se basa en la financiación pública. A pesar de los esfuerzos para el desarrollo de la Ley, ésta no está dando los frutos que debiera haber dado y se hace necesaria la existencia de productos privados de cobertura que puedan atender a las necesidades de aquellos que los demandan. Dado los escasos estudios que sobre este tema existen todavía en nuestro país, el establecer una aproximación a las primas de un seguro privado de dependencia puede servir de referencia para el análisis de su comercialización por parte de las aseguradoras. En este trabajo se trata de analizar una serie de cuestiones que den respuesta a dos objetivos. Por una parte, establecer un modelo financiero-actuarial que sirva como apoyo en el diseño de productos privados que cubran la dependencia y, por otra, realizar una aproximación a las bases técnicas actuariales que lleven a la cuantificación de las primas. = Spain has followed the trend of other countries about long term care, that is, people who need help to perform the basic tasks of daily living. In December 2006, Spanish Parliament approved the law called Ley de Promoción de la Autonomía Personal y Atención a las personas en situación de Dependencia, with public financing. This law is not producing the expected results, and it makes necessary the existence of private insurance. Currently, there are few studies on long term care in our country. An approach to premiums of a private insurance can serve as reference for the studies by insurers. This work tries to study a series of questions responding simultaneously to two goals, establishing an actuarial model and, on

  4. Prediction of margin involvement and local recurrence after skin-sparing and simple mastectomy.

    Science.gov (United States)

    Al-Himdani, S; Timbrell, S; Tan, K T; Morris, J; Bundred, N J

    2016-07-01

    Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and the factors predicting oncological failure. Patients with early breast cancer that underwent mastectomy between 2000 and 2005 at a single institution were studied to ascertain local and systemic recurrence rates between groups. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival. Patients (n = 577) underwent simple mastectomy (80%) or SSM (20%). Median follow up was 80 months. Patients undergoing SSM were of younger average age, less often had involved lymph nodes (22% vs 44%, p mastectomy respectively (p = 0.35). Predictors of locoregional recurrence were lymph node involvement (HR 8.0, for >4 nodes, p mastectomy radiotherapy. Re-excision of involved margins is essential to prevent local recurrence after mastectomy. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  5. Effect of hydralazine on duration of soft tissue local anesthesia following dental treatment: a randomized clinical trial.

    Science.gov (United States)

    Fakheran Esfahani, Omid; Pouraboutaleb, Mohammad Fazel; Khorami, Behnam

    2015-01-01

    Prolonged numbness following routine dental treatments can cause difficulties in speaking and swallowing and may result in inadvertent biting of soft tissues. Local injection of vasodilator agents may represent a solution to this problem. The aim of this study was to evaluate the effect of submucosal injection of hydralazine hydrochloride (HCl) on the duration of oral soft tissue anesthesia after routine dental treatment. This randomized, single-blinded, controlled clinical trial included 50 patients who received inferior alveolar nerve block (2% lidocaine with 1:100,000 epinephrine) for simple restorative treatment. Upon completion of the dental treatment, patients randomly received a hydralazine HCl or sham injection in the same site as the local anesthetic injection. The reversal time to normal sensation of soft tissues (lips, tongue, and perioral skin) was evaluated and reported every 5 minutes by the patients, who followed an assessment protocol that they were taught in advance of treatment. Median recovery times in the hydralazine group and the sham group were 81.4 (SD, 3.6) and 221.8 (SD, 6.3) minutes, respectively. Based on Kaplan-Meier survival analysis, the duration of soft tissue anesthesia in the 2 groups was significantly different (P local anesthetic-induced soft tissue numbness and the related functional problems.

  6. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy.

    Science.gov (United States)

    Scarsbrook, Andrew; Vaidyanathan, Sriram; Chowdhury, Fahmid; Swift, Sarah; Cooper, Rachel; Patel, Chirag

    2017-04-01

    To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4Eleven11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally

  7. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Scarsbrook, Andrew [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Leeds Teaching Hospitals NHS Trust, Department of Nuclear Medicine, Level 1, Bexley Wing, St James' s University Hospital, Leeds (United Kingdom); University of Leeds, Leeds Institute of Cancer and Pathology, Leeds (United Kingdom); Vaidyanathan, Sriram; Chowdhury, Fahmid; Patel, Chirag [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Leeds Teaching Hospitals NHS Trust, Department of Nuclear Medicine, Level 1, Bexley Wing, St James' s University Hospital, Leeds (United Kingdom); Swift, Sarah [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Cooper, Rachel [Leeds Teaching Hospitals NHS Trust, Department of Clinical Oncology, Leeds (United Kingdom)

    2017-04-15

    To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4). 11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally advanced

  8. 78 FR 9890 - DoD Medicare-Eligible Retiree Health Care Board of Actuaries; Notice of Federal Advisory...

    Science.gov (United States)

    2013-02-12

    ... of the Secretary DoD Medicare-Eligible Retiree Health Care Board of Actuaries; Notice of Federal... Board of Actuaries will take place. DATES: Friday, August 2, 2013, from 10:00 a.m. to 11:30 a.m..., DoD Office of the Actuary, 4800 Mark Center Drive, STE 06J25-01, Alexandria, VA 22350-4000....

  9. EpCAM nuclear localization identifies aggressive Thyroid Cancer and is a marker for poor prognosis

    Directory of Open Access Journals (Sweden)

    MacMillan Christina

    2010-06-01

    Full Text Available Abstract Background Proteolytic cleavage of the extracellular domain (EpEx of Epithelial cell adhesion molecule (EpCAM and nuclear signaling by its intracellular oncogenic domain Ep-ICD has recently been implicated in increased proliferation of cancer cells. The clinical significance of Ep-ICD in human tumors remains an enigma. Methods EpEx, Ep-ICD and β-catenin immunohistochemistry using specific antibodies was conducted on 58 archived thyroid cancer (TC tissue blocks from 34 patients and correlated with survival analysis of these patients for up to 17 years. Results The anaplastic (ATC and aggressive thyroid cancers showed loss of EpEx and increased nuclear and cytoplasmic accumulation of Ep-ICD. In contrast, the low grade papillary thyroid cancers (PTC showed membranous EpEx and no detectable nuclear Ep-ICD. The ATC also showed concomitant nuclear expression of Ep-ICD and β-catenin. Kaplan-Meier Survival analysis revealed reduced overall survival (OS for TC patients showing nuclear Ep-ICD expression or loss of membranous EpEx (p Conclusion We report reciprocal loss of membrane EpEx but increased nuclear and cytoplasmic accumulation of Ep-ICD in aggressive TC; nuclear Ep-ICD correlated with poor OS of TC patients. Thus nuclear Ep-ICD localization may serve as a useful biomarker for aggressive TC and may represent a novel diagnostic, prognostic and therapeutic target for aggressive TC.

  10. Prognostic Impact of Pretreatment Plasma Fibrinogen in Patients with Locally Advanced Oral and Oropharyngeal Cancer.

    Directory of Open Access Journals (Sweden)

    Daniel Holzinger

    Full Text Available We aimed to determine the prognostic significance of pretreatment plasma fibrinigen in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC.A cohort of 183 patients with locally advanced OOSCC receiving preoperative chemoradiotherapy was retrospectively examined. Using ROC curve analysis, a pretreatment plasma fibrinogen cutoff value of 447mg/dL was determined. The primary endpoints were overall survival and recurrence-free survival. A secondary endpoint was to determine whether pretreatment plasma fibrinogen could predict treatment response to neoadjuvant chemoradiotherapy. Cox regression models and Kaplan-Meier curves were used for survival analyses.Seventy-one patients had an elevated pretreatment plasma fibrinogen (fibrinogen >447mg/dL. Patients with high fibrinogen showed significantly higher pathologic stages after neoadjuvant treatment than those with low fibrinogen (p = 0.037. In univariate analysis, elevated fibrinogen was associated with poor overall survival (p = 0.005 and recurrence-free survival (p = 0.008 Multivariate analysis revealed that elevated fibrinogen remained an independent risk factor for death (hazard ratio 1.78, 95% CI 1.09-2.90, p = 0.021 and relapse (hazard ratio 1.78, 95% CI 1.11-2.86, p = 0.016.Elevated pretreatment plasma fibrinogen is associated with lack of response to neoadjuvant chemoradiotherapy and reduced OS and RFS in patients with OOSCC. Thus, plasma fibrinogen may emerge as a novel prognostic indicator and a potential therapeutic target in OOSCC.

  11. MODELIZACIÓN ACTUARIAL DE LAS NUEVAS PRESTACIONES SOCIALES EN VENEZUELA

    Directory of Open Access Journals (Sweden)

    Evaristo Diz Cruz

    2014-05-01

    Full Text Available En el presente paper se trata el tema de la valoración actuarial del nuevo esquema de prestaciones sociales contempladas en la nueva Ley Orgánica del Trabajo de Venezuela . Se desarrolla un modelo actuarial en detalle y se ilustra con un ejemplo numérico el impacto en temas de pasivo actuarial para una empresa típica. Besides the usual pension benefits the pension plan of a company may be forced by law in some countries to offer wage based Lump-sum payments for labor termination this is the Venezuela case. An actuarial model of funding severance payment liabilities is formulated and studied. All formulas involved are explained in detail. Finally a specific numerical example illustrates the dynamics of the liabilities determined by the Projected Unit Credit Method for a typical Venezuelan company within the new Labor Law context a Venezuelan accounting College is promoting Actuarial Valuations of this contingencies as mandatory so this model can be used for it.

  12. Actuarial senescence in a long-lived orchid challenges our current understanding of ageing

    DEFF Research Database (Denmark)

    Dahlgren, Johan; Colchero, Fernando; Jones, Owen

    2016-01-01

    The dominant evolutionary theory of actuarial senescence – an increase in death rate with advancing age – is based on the concept of a germ cell line that is separated from the somatic cells early in life. However, such a separation is not clear in all organisms. This has been suggested to explain...... the paucity of evidence for actuarial senescence in plants. We used a 32-year study of Dactylorhiza lapponica that replaces its organs each growing season, to test whether individuals of this tuberous orchid senesce. We performed a Bayesian survival trajectory analysis accounting for reproductive investment......, for individuals under two types of land-use, in two climatic regions. The mortality trajectory was best-approximated by a Weibull model, showing clear actuarial senescence. Rates of senescence in this model declined with advancing age, but were slightly higher in mown plots and in the more benign climatic region...

  13. Actuarial senescence in a long-lived orchid challenges our current understanding of ageing

    DEFF Research Database (Denmark)

    Dahlgren, Johan; Colchero, Fernando; Jones, Owen;

    2016-01-01

    The dominant evolutionary theory of actuarial senescence – an increase in death rate with advancing age – is based on the concept of a germ cell line that is separated from the somatic cells early in life. However, such a separation is not clear in all organisms. This has been suggested to explain...... the paucity of evidence for actuarial senescence in plants. We used a 32-year study of Dactylorhiza lapponica that replaces its organs each growing season, to test whether individuals of this tuberous orchid senesce. We performed a Bayesian survival trajectory analysis accounting for reproductive investment......, for individuals under two types of land-use, in two climatic regions. The mortality trajectory was best-approximated by a Weibull model, showing clear actuarial senescence. Rates of senescence in this model declined with advancing age, but were slightly higher in mown plots and in the more benign climatic region...

  14. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle

    2012-01-01

    of cancer development. Method:  Follow-up of patients in a previous study with gastroduodenoscopy in 1990-2010. Statistical analysis included chi(2) test, actuarial method and Kaplan-Meier analysis. Results:  Among 304 patients, 261 (86%) had more than one endoscopy. The median follow-up was 14 years...

  15. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle

    2012-01-01

    of cancer development. Method: Follow-up of patients in a previous study with gastroduodenoscopy in 1990-2010. Statistical analysis included chi(2) test, actuarial method and Kaplan-Meier analysis. Results: Among 304 patients, 261 (86%) had more than one endoscopy. The median follow-up was 14 years...

  16. Monitoring Actuarial Present Values of Term Life Insurance By a Statistical Process Control Chart

    Science.gov (United States)

    Hafidz Omar, M.

    2015-06-01

    Tracking performance of life insurance or similar insurance policy using standard statistical process control chart is complex because of many factors. In this work, we present the difficulty in doing so. However, with some modifications of the SPC charting framework, the difficulty can be manageable to the actuaries. So, we propose monitoring a simpler but natural actuarial quantity that is typically found in recursion formulas of reserves, profit testing, as well as present values. We shared some simulation results for the monitoring process. Additionally, some advantages of doing so is discussed.

  17. The lifecontingencies Package: Performing Financial and Actuarial Mathematics Calculations in R

    Directory of Open Access Journals (Sweden)

    Giorgio Alfredo Spedicato

    2013-11-01

    Full Text Available It is possible to model life contingency insurances with the lifecontingencies R package, which is capable of performing financial and actuarial mathematics calculations. Its functions permit one to determine both the expected value and the stochastic distribution of insured benefits. Therefore, life insurance coverage can be priced and portfolios risk-based capital requirements can be assessed. This paper briefly summarizes the theory regarding life contingencies that is based on financial mathematics and demographic con- cepts. Then, with the aid of applied examples, it shows how the lifecontingencies package can be a useful tool for executing routine, deterministic, or stochastic calculations for life-contingencies actuarial mathematics.

  18. Modelos estocásticos de la estadística actuarial

    OpenAIRE

    2017-01-01

    El siguiente texto constituye las notas de clase de la asignatura Estadística actuarial: modelos estocásticos, de carácter obligatorio, que se cursa durante el segundo cuatrimestre del primer curso del máster en Ciencias Actuariales y Financieras. Dicha asignatura se sitúa dentro de las asignaturas específicas del mundo asegurador, con especial incidencia en el cálculo actuarial y valoración de riesgos financieros. El seguimiento de estas notas requiere del conocimiento...

  19. Retrospective analysis of prognostic factors for sixty osteosarcoma patients with local recurrence

    Institute of Scientific and Technical Information of China (English)

    Jingjing Sha; Weixiang Qi; Haiyan Hu; Yuanjue Sun; Zan Shen; Yang Yao

    2013-01-01

    Objective: The aim of this study was to identify prognostic factors and imply the appropriate management for lo-cal recurrent osteosarcoma. Methods: The clinical records of 60 patients with local recurrence osteosarcoma were reviewed between January 2002 and December 2010. The mean followed-up time for these patients was 49.1 months (range 13 to 143 months). The factors of age, gender, tumor site, tumor size, surgical procedure, neoadjuvant chemotherapy, frequency of primary postoperative adjuvant chemotherapy, lung metastasis, metastasis of other sites (except for lung) and treatment after local recurrence were selected as the measurements for this analysis. Kaplan-Meier method was used to measure the overall survival and post-recurrence survival. The univariate analysis was used to determine the prognostic factors related with survival by Log-rank test. The COX proportional-hazard regression model was used to analyze the correlation between the prognostic factor and the survival. Results: The median post-recurrence survival and overall survival of 60 patients were 32 months (95% confidence interval: 16.2-47.8) and 55 months (95% confidence interval: 39.3–70.7) respectively. The 2- and 3-year cumulative survival rates were 81.7% and 55.4%, respectively. The Log-rank univariate analysis showed that age, gender, tumor size, metastasis of other sites (except for lung) and treatment after local recurrence were associated with the prognosis of osteosarcoma with local recurrence (P 0.05). Conclusion: The independent prognostic factors for local recurrent osteosarcoma were the metastasis of other site (except for lung) and the treatment after local recurrence. The aggressive surgical treatment for local recurrence and distant metastasis could effectively improve the survival of local recurrent osteosarcoma.

  20. Choosing the 'best' plan in a health insurance exchange: actuarial value tells only part of the story.

    Science.gov (United States)

    Lore, Ryan; Gabel, Jon R; McDevitt, Roland; Slover, Michael

    2012-08-01

    In the health insurance exchanges that will come online in 2014, consumers will be able to compare health plans with respect to actuarial value, or the percentage of health care costs that a plan would pay for a standard population. This analysis illustrates the out-of-pocket costs that might result from plans with various plan designs and actuarial values. We find that average out-of-pocket expense declines as actuarial values rise, but two plans with similar actuarial values can produce very different outcomes for a given person. The overall affordability of a plan also will be influenced by age rating, income-related premium subsidies, and out-of-pocket subsidies. Actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.

  1. High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-01-01

    Full Text Available Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon’s rank-sum or χ2 test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p<0.05. Median oncologic follow-up was 83 months (13–123 months in the HIFU cohort and 44 months (13–89 months in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p<0.05. No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.

  2. Age distributions of Greenlandic dwarf shrubs support concept of negligible actuarial senescence

    DEFF Research Database (Denmark)

    Dahlgren, Johan; Rizzi, Silvia; Schweingruber, Fritz

    2016-01-01

    Many plants and sessile animals may not show actuarial senescence, the increase in mortality with age predicted to be ubiquitous by classic evolutionary theories of aging. Age-structured demographic information is, however, limited for most organisms. We assessed the age distributions of nine dwarf...... to be an important variable for making population projections and determining extinction risks....

  3. Pattern Analysis of an Actuarial Strategy for Computerized Diagnosis of Childhood Exceptionality.

    Science.gov (United States)

    Hale, Robert L.; McDermott, Paul A.

    1984-01-01

    The Multidimensional Actuarial Classification system, which consists of routines and decision making procedures applied to weighting of standardized psychometric, observational, and interview data, was used to classify 200 children (6-16 years old) referred for psychological evaluation. Seven distinct patterns emerged, supporting the approach's…

  4. Actuarial senescence in a long-lived orchid challenges our current understanding of ageing.

    Science.gov (United States)

    Dahlgren, Johan Petter; Colchero, Fernando; Jones, Owen R; Øien, Dag-Inge; Moen, Asbjørn; Sletvold, Nina

    2016-11-16

    The dominant evolutionary theory of actuarial senescence-an increase in death rate with advancing age-is based on the concept of a germ cell line that is separated from the somatic cells early in life. However, such a separation is not clear in all organisms. This has been suggested to explain the paucity of evidence for actuarial senescence in plants. We used a 32 year study of Dactylorhiza lapponica that replaces its organs each growing season, to test whether individuals of this tuberous orchid senesce. We performed a Bayesian survival trajectory analysis accounting for reproductive investment, for individuals under two types of land use, in two climatic regions. The mortality trajectory was best approximated by a Weibull model, showing clear actuarial senescence. Rates of senescence in this model declined with advancing age, but were slightly higher in mown plots and in the more benign climatic region. At older ages, senescence was evident only when accounting for a positive effect of reproductive investment on mortality. Our results demonstrate actuarial senescence as well as a survival-reproduction trade-off in plants, and indicate that environmental context may influence senescence rates. This knowledge is crucial for understanding the evolution of demographic senescence and for models of plant population dynamics.

  5. EL SISTEMA DE PENSIONES DE MARRUECOS: SOSTENIBILIDAD ACTUARIAL DE LA CAJA NACIONAL DE SEGURIDAD SOCIAL

    Directory of Open Access Journals (Sweden)

    José Enrique Devesa Carpio

    2015-09-01

    Full Text Available El trabajo analiza, desde el punto de vista actuarial, la sostenibilidad de la Caja Nacional de Seguridad Social de Marruecos, que es un régimen contributivo que incorpora tanto a trabajadores por cuenta ajena como por cuenta propia. Para ello se llevan a cabo casi 2000 simulaciones, a partir de individuos tipo definidos en función de las peculiaridades del sistema. Además de estudiar la situación actual se analiza el efecto de la reforma que se pretende aplicar al sistema. La conclusión principal es la insostenibilidad actuarial del mismo. The paper analyzes, from the actuarial point of view, the sustainability of the National Social Security Fund in Morocco, which is a contributory scheme that incorporates both employees and self-employed. To do this, almost 2000 simulations are conducted, from different type of individuals defined according to the peculiarities of the system. In addition to studying the current situation, the effect of the reform intended to apply to the system will be analyzed. The main conclusion is the actuarial unsustainability of the system.

  6. The longevity risk of the Dutch Actuarial Association’s projection model

    NARCIS (Netherlands)

    F. Peters (Frederick); W.J. Nusselder (Wilma); J.P. Mackenbach (Johan)

    2012-01-01

    markdownabstractAccurate assessment of the risk that arises from further increases in life expectancy is crucial for the financial sector, in particular for pension funds and life insurance companies. The Dutch Actuarial Association presented a revised projection model in 2010, while in the same yea

  7. Academic Attributes of College Freshmen that Lead to Success in Actuarial Studies in a Business College

    Science.gov (United States)

    Smith, Richard Manning; Schumacher, Phyllis

    2006-01-01

    The authors studied beginning undergraduate actuarial concentrators in a business college. They identified four variables (math Scholastic Aptitude Test [SAT] score, verbal SAT score, percentile rank in high school graduating class, and percentage score on a college mathematics placement exam) that were available for entering college students that…

  8. 75 FR 68790 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

    Science.gov (United States)

    2010-11-09

    ... has been set for a given year, a contingency reserve ratio in excess of 20 percent of the following... deductible is calculated by multiplying the 2010 deductible by the ratio of the 2011 aged actuarial rate over... larger Part B contingency reserve than would otherwise be necessary. The asset level projected for...

  9. Galectin-1 Is an Independent Prognostic Factor for Local Recurrence and Survival After Definitive Radiation Therapy for Patients With Squamous Cell Carcinoma of the Uterine Cervix

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Eng-Yen [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Chanchien, Chan-Chao; Lin, Hao [Department of Gynecologic Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Wang, Chung-Chi; Wang, Chong-Jong [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Huang, Chao-Cheng, E-mail: huangcc@cgmh.org.tw [Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China)

    2013-12-01

    Purpose: To investigate the role of galectin-1 in patients with cervical cancer after definitive radiation therapy. Methods and Materials: We reviewed 154 patients with International Federation of Gynecology and Obstetrics stage I-II squamous cell carcinoma. Patients underwent curative-intent radiation therapy. Paraffin-embedded tissues were analyzed using immunohistochemistry staining for galectin-1. The rates of cancer-specific survival (CSS), local recurrence (LR), and distant metastasis were compared among patient tissue samples with no, weak, and strong galectin-1 expression. The Kaplan-Meier method and the Cox proportional hazard model with hazard ratios and 95% confidence intervals (CIs) were used for univariate and multivariate analyses, respectively. Results: The areas under the curve for the intracellular expression scores of galectin-1 for both LR and CSS were significantly higher than those for stromal expression. There were no significant differences in the demographic data, such as stage and serum tumor markers, between patients with and without intracellular expression of galectin-1 in cancer tissue samples. Using multivariate analyses, the hazard ratios of LR and CSS were 2.60 (95% CI 1.50-4.52) (P=.001) and 1.94 (95% CI 1.18-3.19) (P=.010), respectively. Conclusion: Galectin-1 is an independent prognostic factor associated with LR and CSS in stage I-II cervical cancer patients undergoing definitive radiation therapy. Further studies targeting galectin-1 may improve the local control of cervical cancer.

  10. Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment.

    Science.gov (United States)

    Pompe, Raisa S; Davis-Bondarenko, Helen; Zaffuto, Emanuele; Tian, Zhe; Shariat, Shahrokh F; Leyh-Bannurah, Sami-Ramzi; Schiffmann, Jonas; Saad, Fred; Huland, Hartwig; Graefen, Markus; Tilki, Derya; Karakiewicz, Pierre I

    2017-05-01

    To test discriminant ability of the 2014 ISUP Gleason grade groups (GGG) for prediction of prostate cancer specific mortality (PCSM) after radical prostatectomy (RP), brachytherapy (BT), external beam radiation (EBRT) or no local treatment (NLT) relative to traditional Gleason grading (TGG). In the Surveillance, Epidemiology, and End Results (SEER)-database (2004-2009), 2,42,531 non-metastatic prostate cancer (PCa) patients were identified, who underwent local treatment (RP, BT, EBRT only) or NLT. Follow-up endpoint was PCSM. Biopsy and/or pathological Gleason score (GS) were categorized as TGG ≤6, 7, 8-10 or GGG: I (≤6), II (3 + 4), III (4 + 3), IV (8), and V (9-10). Kaplan-Meier plots, multivariable Cox regression analyses and receiver operating characteristics (ROC) area under the curve analyses (AUC) were used. Median follow-up was 76 months (IQR: 59-94). For the four examined treatment modalities, all five GGG strata and all three TGG strata independently predicted PCSM. GGG yielded 1.5-fold or greater HR differences between GGG II and GGG III, and twofold or greater HR differences between GGG IV and GGG V. Relative to TGG, GGG added 0.4-1.1% to AUC. This large population-based cohort study confirms the added discriminant properties of the novel GGG strata and confirms a modest gain in predictive accuracy. Prostate 77: 686-693, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  11. Concurrent radiochemotherapy of locally recurrent or advanced sarcomas of the uterus

    Energy Technology Data Exchange (ETDEWEB)

    Kortmann, B.; Klautke, G.; Fietkau, R. [Dept. of Radiotherapy, Univ. of Rostock (Germany); Reimer, T.; Gerber, B. [Dept. of Gynecology and Obstetrics, Univ. of Rostock, Suedstadt Hospital (Germany)

    2006-06-15

    Background: uterine sarcomas are rare tumors. Until now, no data on the treatment of recurrent or advanced uterine sarcomas using concurrent radiochemotherapy (RCT) has been available. Patients and methods: from 01/1997 to 03/2004, seven patients with locally recurrent (n = 6) or locally advanced uterine sarcomas (n = 1) received concurrent RCT after tumor surgery (R1/2 resection in 3/7 patients). A total radiation dose of 45 Gy was applied in single doses of 1.8 Gy using an external-beam technique; in addition, three to four intracavitary doses of 5 Gy were applied. Concurrent chemotherapy was generally administered as follows: 1.2 g/m{sup 2} ifosfamide on days 1-5 and 29-33 in combination with 50 or 40 mg/m{sup 2} adriamycin on days 2 and 30. 3/7 patients received further cycles of chemotherapy. The median follow-up was 35 months. Results: all recurrences (before RCT) were localized either in the vagina or in or directly proximal to the vaginal stump. The main side effects of RCT were hemotoxicity (grade 3: n = 3/7; grade 4: n = 4/7; neutropenic fever n = 1/7) and diarrhea (grade 3: n = 5/7). At the median follow-up (35 months), 4/7 patients had recurrences (one local recurrence; one lymph node recurrence outside the irradiated field, two distant metastases). Local control in the irradiated field was 80% {+-} 18% after 3 years. Disease-free survival calculated according to Kaplan-Meier was 57% {+-} 19% after 3 years. Presently, 5/7 patients are still alive, corresponding to a 3-year survival rate of 83% {+-} 15%. Conclusion: concurrent RCT shows good local effectiveness with a good long-term survival. Further evaluation in phase II studies is recommended. (orig.)

  12. Comparison of clinical features and outcomes in patients with extraskeletal versus skeletal localized Ewing sarcoma: A report from the Children's Oncology Group.

    Science.gov (United States)

    Cash, Thomas; McIlvaine, Elizabeth; Krailo, Mark D; Lessnick, Stephen L; Lawlor, Elizabeth R; Laack, Nadia; Sorger, Joel; Marina, Neyssa; Grier, Holcombe E; Granowetter, Linda; Womer, Richard B; DuBois, Steven G

    2016-10-01

    The prognostic significance of having extraskeletal (EES) versus skeletal Ewing sarcoma (ES) in the setting of modern chemotherapy protocols is unknown. The purpose of this study was to compare the clinical characteristics, biologic features, and outcomes for patients with EES and skeletal ES. Patients had localized ES and were treated on two consecutive protocols using five-drug chemotherapy (INT-0154 and AEWS0031). Patients were analyzed based on having an extraskeletal (n = 213) or skeletal (n = 826) site of tumor origin. Event-free survival (EFS) was estimated using the Kaplan-Meier method, compared using the log-rank test, and modeled using Cox multivariate regression. Patients with extraskeletal ES (EES) were more likely to have axial tumors (72% vs. 55%; P 8 cm (9% vs. 17%; P rate were independently associated with inferior EFS. Clinical characteristics, but not key tumor genomic features, differ between EES and skeletal ES. Extraskeletal origin is a favorable prognostic factor, independent of age, race, and primary site. © 2016 Wiley Periodicals, Inc.

  13. Improvement of recurrence-free survival after radical prostatectomy for locally advanced prostate cancer in relation to the time of surgical intervention

    Directory of Open Access Journals (Sweden)

    E. I. Veliev

    2016-01-01

    Full Text Available Objective: to comparatively estimate the frequency of a positive surgical margin and 5-year biochemical recurrent-free survival (BRFS rates in patients with locally advanced prostate cancer in relation to the time of radical retropubic prostatectomy.Subjects and methods. The investigation enrolled 274 patients with prostate cancer (pT3-4N0-1M0 who were divided into 2 groups of 68 and 20 patients operated on in 1997 to 2006 and 2007 to 2012, respectively. Two surgeons made surgical interventions by the standardized procedure. The 5-year BRFS rates were estimated using the Kaplan-Meier method and log-rank test. A biochemical recurrence was defined as a prostatespecific antigen level of t 0.2 ng / ml in 2 consecutive measurements or as the initiation of adjuvant therapy.Results. The detection rate of a positive surgical margin decreased from 55.9 % in 1997–2006 to 37.9 % in 2007–2012 (p = 0.01; the 5-year recurrence-free survival rates were 38.8 % versus 66.2 % (p < 0.001.Conclusion. These changes would probably be a result of surgeons» better experience and improved surgical techniques in the course of time.

  14. Safety and efficacy of nimotuzumab combined with chemoradiotherapy in Chinese patients with locally advanced cervical cancer.

    Science.gov (United States)

    Chen, Yong-Fa; Tang, Wu-Bin; Pan, Xin-Xi; Wu, Chu-Rong; Cao, Yang; Yang, Wen

    2017-01-01

    To evaluate efficacy and safety of nimotuzumab combined with chemotherapy and radiotherapy in women with locally advanced cervical cancer. Women with locally advanced cervical cancer (stage IIB, III, or IVA) who experienced relapse after first-line chemoradiotherapy and one or more lines of palliative chemotherapy were enrolled. All patients received nimotuzumab weekly at 200 mg/m(2) as single agent for 4 weeks (induction phase), then concurrent with 6 cycles (21-day per cycle) of gemcitabine (800 mg/m(2)) or cisplatin (50 mg/m(2)) for 18 weeks (concurrent phase) and then once every 2 weeks (maintenance phase). Overall response rate (ORR) was assessed after 4 weeks of induction therapy and then every 3 months according to response evaluation criteria in solid tumors version 1.1 (primary end point). Secondary end points include progression-free survival (PFS), overall survival (OS), and drug toxicity. Descriptive statistics was used for ORR, and Kaplan-Meier curves were generated for OS and PFS. A total of 80 women with locally advanced cervical cancer were enrolled and evaluated for safety and efficacy. Our results demonstrated that none of the patients had a complete response (0%), 11 patients had a partial response (14%), and 10 patients had progressive disease (13%), giving a tumor response rate of 14%. A total of 59 patients had stable disease (74%), giving a disease control rate of 88% (70/80). Median PFS was 8.21 months (95% confidence interval [CI]: 5.09-12.45). Median OS was 11.96 months (95% CI: 8.11-23.95). The most common adverse events were mucositis, myelosuppression, and gastrointestinal disturbance. Our study results suggested that nimotuzumab in combination with chemotherapy and radiotherapy is well tolerated, and could be a better treatment alternative in patients with locally advanced cervical cancer.

  15. Stochastic Interest Model Based on Compound Poisson Process and Applications in Actuarial Science

    Directory of Open Access Journals (Sweden)

    Shilong Li

    2017-01-01

    Full Text Available Considering stochastic behavior of interest rates in financial market, we construct a new class of interest models based on compound Poisson process. Different from the references, this paper describes the randomness of interest rates by modeling the force of interest with Poisson random jumps directly. To solve the problem in calculation of accumulated interest force function, one important integral technique is employed. And a conception called the critical value is introduced to investigate the validity condition of this new model. We also discuss actuarial present values of several life annuities under this new interest model. Simulations are done to illustrate the theoretical results and the effect of parameters in interest model on actuarial present values is also analyzed.

  16. Actuarial calculation for PSAK-24 purposes post-employment benefit using market-consistent approach

    Science.gov (United States)

    Effendie, Adhitya Ronnie

    2015-12-01

    In this paper we use a market-consistent approach to calculate present value of obligation of a companies' post-employment benefit in accordance with PSAK-24 (the Indonesian accounting standard). We set some actuarial assumption such as Indonesian TMI 2011 mortality tables for mortality assumptions, accumulated salary function for wages assumption, a scaled (to mortality) disability assumption and a pre-defined turnover rate for termination assumption. For economic assumption, we use binomial tree method with estimated discount rate as its average movement. In accordance with PSAK-24, the Projected Unit Credit method has been adapted to determine the present value of obligation (actuarial liability), so we use this method with a modification in its discount function.

  17. Actuarial assessment of violence risk in hospital-based partner assault clinics.

    Science.gov (United States)

    Hilton, N Zoe; Harris, Grant T; Holder, Norah

    2008-12-01

    Hospital-based partner assault clinics are a relatively recent addition to the community response to partner violence. In this study, 66% of 111 women attending hospital clinics for partner assault were physically injured and 43% reported death threats. Few concurrently used other services (shelters or police) and most relied on female friends and relatives for help. Many participants who currently lived with the perpetrator were contemplating leaving but only a third had made plans to do so. Participants faced an unusually high risk of future assault, according to both victim interview using the ODARA actuarial risk assessment and their own perceptions. Findings imply an important role for partner assault clinics and the feasibility of the victim service sector's using the same actuarial risk assessments as the criminal justice system.

  18. PET/CT Response Criteria (European Organization for Research and Treatment of Cancer) Predict Survival Better Than Response Evaluation Criteria in Solid Tumors in Locally Advanced Cervical Cancer Treated With Chemoradiation.

    Science.gov (United States)

    Yoon, Jung Won; Kim, Sunghoon; Kim, Sang Wun; Kim, Young Tae; Kang, Won Jun; Nam, Eun Ji

    2016-09-01

    To investigate whether the ratio of SUVs measured with F-FDG PET/CT between pretreatment and posttreatment has prognostic value in patients with locally advanced cervical cancer treated with primary chemoradiation therapy. Cases of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics stages IB1 to IVA) treated with a nonsurgical curative modality (172 cases including chemoradiation or radiation therapy) were reviewed. F-FDG PET/CT parameters, including SUVmax and SUVmean, were evaluated by F-FDG PET/CT performed prior to treatment and 6 weeks after the end of treatment. Metabolic response was evaluated according to the European Organization for Research and Treatment of Cancer guidelines and was compared with radiologic response measured according to the Response Evaluation Criteria In Solid Tumours (RECIST). In total, 142 patients receiving chemoradiation showed radiologic responses (median 56% decrease in maximal diameter), whereas 160 and 146 patients showed metabolic responses measured with SUVmax and SUVmean, respectively (73% decrease in SUVmax; 48% decrease in SUVmean). Radiologic response and metabolic response were significantly correlated for SUVmax and SUVmean (P = 0.0009; P = 0.0457, respectively). Kaplan-Meier analysis revealed significant differences in overall survival and progression-free survival between the responder and nonresponder groups, based on the European Organization for Research and Treatment of Cancer criteria (both P cervical cancer patients to concurrent chemoradiation therapy, as compared with the RECIST criteria.

  19. ActuArial Accounting – A Branch of the Financial Accounting

    OpenAIRE

    Gheorghe V. Lepadatu; Doina Maria Tilea

    2010-01-01

    The opening of the accounting to the actuarial calculation is a normal consequence of its evolutive spirit. At the origin of the international accounting standards lies the framework for preparing, presenting and disclosing the financial statements. The framework stays as a reference matrix, as a standard of standards, as a constitution of financial accounting. According to the international framework, the financial statements use different evaluation bases: the historical cost, the current c...

  20. The Actuarial Accounting in the Modern Financial-Accounting Management with Applications to the Entities

    OpenAIRE

    Gheorghe V. Lepadatu

    2012-01-01

    The opening of the accounting to the actuarial calculation is a normal consequence of its evolving spirit. At the origin of the international accounting standards lies the framework for preparing, presenting and disclosing the financial statements. The framework stays as a reference matrix, as a standard of standards, as a constitution of financial accounting. According to the international framework, the financial statements use different evaluation bases: the historical cost, the current co...

  1. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    Science.gov (United States)

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  2. Thrown a curve. CMS' actuaries: healthcare spending will continue to increase, despite reform law promises.

    Science.gov (United States)

    Daly, Rich

    2011-08-01

    While CMS actuaries say the 2010 reform law will not slow the nation's healthcare spending in the coming decade, Mary Grealy, of the Healthcare Leadership Council, says the law "was basically a coverage bill. We just didn't get to the other half, which would be aimed at the cost-drivers in the system." She adds that the healthcare system will not control ongoing steep increases in spending until additional legislation reshapes the dominant public insurance plans.

  3. Actuarial modeling of cost of voluntary pension insurance of the population of the region

    Directory of Open Access Journals (Sweden)

    Mikhailova Svetlana Sergeevna

    2013-06-01

    Full Text Available In article approach to determination of net value of the contract of pension insurance for the man's and female population, considering regional demographic features is offered. Results of actuarial calculation of the size pure net - rates of individual pension insurance are presented, "sensitivity" of cost of insurance is defined by methods of statistical modeling to key parameters of a pension product for the region population.

  4. The lifecontingencies Package: Performing Financial and Actuarial Mathematics Calculations in R

    OpenAIRE

    Giorgio Alfredo Spedicato

    2013-01-01

    It is possible to model life contingency insurances with the lifecontingencies R package, which is capable of performing financial and actuarial mathematics calculations. Its functions permit one to determine both the expected value and the stochastic distribution of insured benefits. Therefore, life insurance coverage can be priced and portfolios risk-based capital requirements can be assessed. This paper briefly summarizes the theory regarding life contingencies that is based on financial m...

  5. Valuing structured professional judgment: predictive validity, decision-making, and the clinical-actuarial conflict.

    Science.gov (United States)

    Falzer, Paul R

    2013-01-01

    Structured professional judgment (SPJ) has received considerable attention as an alternative to unstructured clinical judgment and actuarial assessment, and as a means of resolving their ongoing conflict. However, predictive validity studies have typically relied on receiver operating characteristic (ROC) analysis, the same technique commonly used to validate actuarial assessment tools. This paper presents SPJ as distinct from both unstructured clinical judgment and actuarial assessment. A key distinguishing feature of SPJ is the contribution of modifiable factors, either dynamic or protective, to summary risk ratings. With modifiable factors, the summary rating scheme serves as a prognostic model rather than a classification procedure. However, prognostic models require more extensive and thorough predictive validity testing than can be provided by ROC analysis. It is proposed that validation should include calibration and reclassification techniques, as well as additional measures of discrimination. Several techniques and measures are described and illustrated. The paper concludes by tracing the limitations of ROC analysis to its philosophical foundation and its origin as a statistical theory of decision-making. This foundation inhibits the performance of crucial tasks, such as determining the sufficiency of a risk assessment and examining the evidentiary value of statistical findings. The paper closes by noting a current effort to establish a viable and complementary relationship between SPJ and decision-making theory.

  6. Human actuarial aging increases faster when background death rates are lower: a consequence of differential heterogeneity?

    Science.gov (United States)

    Hawkes, Kristen; Smith, Ken R; Blevins, James K

    2012-01-01

    Many analyses of human populations have found that age-specific mortality rates increase faster across most of adulthood when overall mortality levels decline. This contradicts the relationship often expected from Williams' classic hypothesis about the effects of natural selection on the evolution of senescence. More likely, much of the within-species difference in actuarial aging is not due to variation in senescence, but to the strength of filters on the heterogeneity of frailty in older survivors. A challenge to this differential frailty hypothesis was recently posed by an analysis of life tables from historical European populations and traditional societies that reported variation in actuarial aging consistent with Williams' hypothesis after all. To investigate the challenge, we reconsidered those cases and aging measures. Here we show that the discrepancy depends on Ricklefs' aging rate measure, ω, which decreases as mortality levels drop because it is an index of mortality level itself, not the rate of increase in mortality with age. We also show unappreciated correspondence among the parameters of Gompertz-Makeham and Weibull survival models. Finally, we compare the relationships among mortality parameters of the traditional societies and the historical series, providing further suggestive evidence that differential heterogeneity has strong effects on actuarial aging.

  7. Preoperative Erythrocyte Sedimentation Rate Independently Predicts Overall Survival in Localized Renal Cell Carcinoma following Radical Nephrectomy

    Directory of Open Access Journals (Sweden)

    Brian W. Cross

    2012-01-01

    Full Text Available Objectives. To determine the relationship between preoperative erythrocyte sedimentation rate (ESR and overall survival in localized renal cell carcinoma (RCC following nephrectomy. Methods. 167 patients undergoing nephrectomy for localized RCC had ESR levels measured preoperatively. Receiver Operating Characteristics curves were used to determine Area Under the Curve and relative sensitivity and specificity of preoperative ESR in predicting overall survival. Cut-offs for low (0.0–20.0 mm/hr, intermediate (20.1–50.0 mm/hr, and high risk (>50.0 mm/hr groups were created. Kaplan-Meier analysis was conducted to assess the univariate impact of these ESR-based groups on overall survival. Univariate and multivariate Cox regression analysis was conducted to assess the potential of these groups to predict overall survival, adjusting for other patient and tumor characteristics. Results. Overall, 55.2% were low risk, while 27.0% and 17.8% were intermediate and high risk, respectively. Median (95% CI survival was 44.1 (42.6–45.5 months, 35.5 (32.3–38.8 months, and 32.1 (25.5–38.6 months, respectively. After controlling for other patient and tumor characteristics, intermediate and high risk groups experienced a 4.5-fold (HR: 4.509, 95% CI: 0.735–27.649 and 18.5-fold (HR: 18.531, 95% CI: 2.117–162.228 increased risk of overall mortality, respectively. Conclusion. Preoperative ESR values represent a robust predictor of overall survival following nephrectomy in localized RCC.

  8. Local, regional, and systemic recurrence rates in patients undergoing skin-sparing mastectomy compared with conventional mastectomy.

    Science.gov (United States)

    Yi, Min; Kronowitz, Steven J; Meric-Bernstam, Funda; Feig, Barry W; Symmans, W Fraser; Lucci, Anthony; Ross, Merrick I; Babiera, Gildy V; Kuerer, Henry M; Hunt, Kelly K

    2011-03-01

    Although the use of SSM is becoming more common, there are few data on long-term, local-regional, and distant recurrence rates after treatment. The purpose of this study was to examine the rates of local, regional, and systemic recurrence, and survival in breast cancer patients who underwent skin-sparing mastectomy (SSM) or conventional mastectomy (CM) at our institution. Patients with stage 0 to III unilateral breast cancer who underwent total mastectomy at our center from 2000 to 2005 were included in this study. Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups. Of 1810 patients, 799 (44.1%) underwent SSM and 1011 (55.9%) underwent CM. Patients who underwent CM were older (58.3 vs 49.3 years, P<.0001) and were more likely to have stage IIB or III disease (53.0% vs 31.8%, P<.0001). Significantly more patients in the CM group received neoadjuvant chemotherapy and adjuvant radiation therapy (P<.0001). At a median follow-up of 53 months, 119 patients (6.6%) had local, regional, or systemic recurrences. The local, regional, and systemic recurrence rates did not differ significantly between the SSM and CM groups. After adjusting for clinical TNM stage and age, disease-free survival rates between the SSM and CM groups did not differ significantly. SSM is an acceptable treatment option for patients who are candidates for immediate breast reconstruction. Local-regional recurrence rates are similar to those of patients undergoing CM. Cancer 2011. © 2010 American Cancer Society. Copyright © 2010 American Cancer Society.

  9. Risk stratification of patients with locally aggressive differentiated thyroid cancer. Results of the MSDS trial.

    Science.gov (United States)

    Riemann, Burkhard; Krämer, J A; Schmid, K W; Dralle, H; Dietlein, M; Schicha, H; Sauerland, C; Frankewitsch, T; Schober, O

    2010-01-01

    The Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well defined group of patients with locally aggressive thyroid carcinomas (pT4; AJCC/UICC 1997). The aim of the present study was to compare the survival of patients with minimum and extensive extrathyroidal growth according to the new AJCC/UICC TNM staging system 2009. The follow-up data of 347 patients were analysed. Patients were reclassified according to the current AJCC/UICC 2009 classification. The event-free and overall survival was evaluated using Kaplan-Meier analysis. In addition, postoperative complications and status of disease were documented. 327 patients were assigned to stage pT3 and 20 patients to stage pT4a, respectively. Median follow-up was 6.1 years (range 0.04-9.8 years). 92.5% of patients reached complete remission. There were 7.8 % recurrences in the thyroid bed, in locoregional lymph nodes and/or in distant sites. The overall survival was >98% both in pT3 and pT4a patients (p = n. s.). In contrast, the event-free survival was significantly less favourable in pT4a patients (p MSDS patients with locally aggressive differentiated thyroid cancer showed an excellent overall survival during a median follow-up of 6.1 years. According to the current AJCC/UICC 2009 classification, pT3 patients with minimal extrathyroidal extension revealed a significantly better event-free survival than pT4a patients with extensive extrathyroidal growth.

  10. The efficacy of stereotactic body radiation therapy on huge hepatocellular carcinoma unsuitable for other local modalities.

    Science.gov (United States)

    Que, Jenny Y; Lin, Li-Ching; Lin, Kuei-Li; Lin, Chia-Hui; Lin, Yu-Wei; Yang, Ching-Chieh

    2014-05-28

    To evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option. Between 2009 and 2011, 22 patients with unresectable huge HCC (≧10 cm) were treated with SBRT. dose ranged from 26 Gy to 40 Gy in five fractions. Overall survival (OS) and disease-progression free survival (DPFS) were determined by Kaplan-Meier analysis. Tumor response and toxicities were also assessed. After a median follow-up of 11.5 month (range 2-46 months). The objective response rate was achieved in 86.3% (complete response (CR): 22.7% and partial response (PR): 63.6%). The 1-yr. local control rate was 55.56%. The 1-year OS was 50% and median survival was 11 months (range 2-46 months). In univariate analysis, Child-Pugh stage (p = 0.0056) and SBRT dose (p = 0.0017) were significant factors for survival. However, in multivariate analysis, SBRT dose (p = 0.0072) was the most significant factor, while Child-Pugh stage of borderline significance. (p = 0.0514). Acute toxicities were mild and well tolerated. This study showed that SBRT can be delivered safely to huge HCC and achieved a substantial tumor regression and survival. The results suggest this technique should be considered a salvage treatment. However, local and regional recurrence remain the major cause of failure. Further studies of combination of SBRT and other treatment modalities may be reasonable.

  11. Ductal Carcinoma in Situ-The Influence of the Radiotherapy Boost on Local Control

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Philip [Division of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada); Lambert, Christine, E-mail: christine.lambert@muhc.mcgill.ca [Division of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada); Agnihotram, Ramanakumar V. [Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC (Canada); David, Marc; Duclos, Marie; Freeman, Carolyn R. [Division of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada)

    2012-02-01

    Purpose: Local recurrence (LR) of ductal carcinoma in situ (DCIS) is reduced by whole-breast irradiation after breast-conserving surgery (BCS). However, the benefit of adding a radiotherapy boost to the surgical cavity for DCIS is unclear. We sought to determine the impact of the boost on LR in patients with DCIS treated at the McGill University Health Centre. Methods and Materials: A total of 220 consecutive cases of DCIS treated with BCS and radiotherapy between January 2000 and December 2006 were reviewed. Of the patients, 36% received a radiotherapy boost to the surgical cavity. Median follow-up was 46 months for the boost and no-boost groups. Kaplan-Meier survival analyses and Cox regression analyses were performed. Results: Compared with the no-boost group, patients in the boost group more frequently had positive and <0.1-cm margins (48% vs. 8%) (p < 0.0001) and more frequently were in higher-risk categories as defined by the Van Nuys Prognostic (VNP) index (p = 0.006). Despite being at higher risk for LR, none (0/79) of the patients who received a boost experienced LR, whereas 8 of 141 patients who did not receive a boost experienced an in-breast LR (log-rank p = 0.03). Univariate analysis of prognostic factors (age, tumor size, margin status, histological grade, necrosis, and VNP risk category) revealed only the presence of necrosis to significantly correlate with LR (log-rank p = 0.003). The whole-breast irradiation dose and fractionation schedule did not affect LR rate. Conclusions: Our results suggest that the use of a radiotherapy boost improves local control in DCIS and may outweigh the poor prognostic effect of necrosis.

  12. Primary localization and tumor thickness as prognostic factors of survival in patients with mucosal melanoma.

    Directory of Open Access Journals (Sweden)

    Tarun Mehra

    Full Text Available Data on survival with mucosal melanoma and on prognostic factors of are scarce. It is still unclear if the disease course allows for mucosal melanoma to be treated as primary cutaneous melanoma or if differences in overall survival patterns require adapted therapeutic approaches. Furthermore, this investigation is the first to present 10-year survival rates for mucosal melanomas of different anatomical localizations.116 cases from Sep 10 1984 until Feb 15 2011 retrieved from the Comprehensive Cancer Center and of the Central Register of the German Dermatologic Society databases in Tübingen were included in our analysis. We recorded anatomical location and tumor thickness, and estimated overall survival at 2, 5 and 10 years and the mean overall survival time. Survival times were analyzed with the Kaplan-Meier method. The log-rank test was used to compare survival times by localizations and by T-stages.We found a median overall survival time of 80.9 months, with an overall 2-year survival of 71.7%, 5-year survival of 55.8% and 10-year survival of 38.3%. The 10-year survival rates for patients with T1, T2, T3 or T4 stage tumors were 100.0%, 77.9%, 66.3% and 10.6% respectively. 10-year survival of patients with melanomas of the vulva was 64.5% in comparison to 22.3% of patients with non-vulva mucosal melanomas.Survival times differed significantly between patients with melanomas of the vulva compared to the rest (p = 0.0006. It also depends on T-stage at the time of diagnosis (p < 0.0001.

  13. Effects of Local Radiation Combined with Chemotherapy in the treatment of 
Patients with Extensive-stage Small Cell Lung Cancer

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    Di WU

    2015-05-01

    Full Text Available Background and objective Chemotherapy is a highly efficient primary treatment for extensive-stage small cell lung cancer (ES-SCLC. However, patients receiving such treatment are prone to develop drug resistance. Local treatment is palliative and thus can alleviate the local symptoms and improve quality of life, but limited evidence is available for prolonging survival. Hence, this study evaluated the role of local treatment in chemotherapy of patients with ES-SCLC. Methods A total of 302 ES-SCLC cases were enrolled in this retrospective study. Prognostic factors were analyzed by Kaplan-Meier and Cox multivariate proportional hazards model. Results Median progression-free survival (PFS and median survival time (MST of the patients were 4.4 and 10.4 months, respectively. 1-, 2-, and 3-year survival rates were 37.8%, 10.2% and 4.4%, correspondingly. The MST of the primary tumor radiotherapy plus chemotherapy group was 14.3 months, whereas that of the chemotherapy group was 8.2 months (P<0.01. The MSTs of multiple-site, single-site, and non-metastasis local treatments were 18.7, 12.3 and 8.9 months, respectively (P<0.01. The MSTs of initiative, passive, and non-metastasis local treatments were 16.0, 10.9 and 9.4 months, correspondingly (P<0.01. The MSTs of patients with prophylactic cranial irradiation (PCI and those without PCI were 19.8 and 9.9 months, respectively (P<0.01. Primary tumor radiotherapy, metastasis local treatment, and PCI were independent prognostic factors for ES-SCLC. Conclusion Primary tumor radiotherapy, metastasis local treatment, and PCI can significantly improve survival in patients with ES-SCLC.

  14. Actuarial Evaluation of Pension Risks of Russia: from Theory to Practice

    Directory of Open Access Journals (Sweden)

    Aleksandr Anatolyevich Kuklin

    2017-09-01

    Full Text Available The article discusses the origins of the development of pension systems in the world, shows the causes of the emergence of various models of public pension provision. We pay a particular attention to the history of the formation of the Russian pension system, and analyse the stages and causes of modern reform. From the position of modern legislation, we systemise the forms, types of pension provision and pension insurance in the Russian Federation from the point of view of the sources of financing and subjects of pension relations. The authors have defined the concept of “actuarial evaluation” from the point of view of the process and system approach. We have revealed the content of the pension risk category, as well as classified the pension risks by the spheres of origin. The authors have developed the methodology of actuarial estimation of the risks of the pension system classified by different criteria: demographic, economic, financial, labor risks. The proposed methodological approach to the evaluation of pension risks is based on the comprehensive assessment of socio-economic indicators and the identification of dependencies between socio-demographic and economic processes in the pension system and economy of the country. The authors have tested the developed tools on the actuarial estimation of the pension risks of the Russian Federation. The article presents the results of calculations and identifies critical risks for the Russian pension system. We have proved that stagnation processes in the economy and a high share of the shadow economy represent the greatest threat to the Russian pension system in the short term, whereas, the aging of the population and the increase in life expectancy — in the long term.

  15. Expression of IL-4 and IL-13 predicts recurrence and survival in localized clear-cell renal cell carcinoma.

    Science.gov (United States)

    Chang, Yuan; Xu, Le; An, Huimin; Fu, Qiang; Chen, Lian; Lin, Zongming; Xu, Jiejie

    2015-01-01

    Interleukin-4 (IL-4) and IL-13 are anti-inflammatory and immunoregulatory cytokines that can influence cancer-directed immunosurveillance. However, they are not evaluated as biomarkers for ccRCC outcomes. The aim of this study was to investigate the prognostic value of tumor-derived IL-4 and IL-13 in patients with localized ccRCC after surgery. Our study comprised 194 consecutive patients with localized ccRCC undergoing nephrectomy in a single center. Clinical characteristics, recurrence-free survival (RFS) and overall survival (OS) were recorded. We assessed IL-4 and IL-13 expression as continuous variables and dichotomized as low versus high by immunohistochemistry. For associations with RFS and OS, we used the Kaplan-Meier method and Cox regression models. Concordance index was calculated for predictive accuracy. We found that high expression levels of IL-4 and IL-13 were associated with increased recurrence (P IL-13 expression (IL-4/IL-13 signature) was an independent prognostic factor for RFS and OS (P = 0.009 and P = 0.016, respectively). When applied to UISS score, IL-4/IL-13 signature improved the predictive accuracy. Notably, this improvement in prediction was mainly observed in patients with low-risk disease. To conclude, IL-4/IL-13 signature is an independent predictor of outcomes in patients with localized ccRCC, and the prognostic value is more prominent among patients with low-risk disease. Evaluation of IL-4 and IL-13 expression provides the opportunity to optimize postsurgical management and develop novel targeted therapies for ccRCC patients.

  16. Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Wang Xiaodong; Sofocleous, Constantinos T., E-mail: sofoclec@mskcc.org; Erinjeri, Joseph P.; Petre, Elena N. [Memorial Sloan-Kettering Cancer Center, Section of Interventional Radiology, Department of Radiology (United States); Gonen, Mithat [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics (United States); Do, Kinh G. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States); Brown, Karen T.; Covey, Anne M.; Brody, Lynn A.; Alago, William; Thornton, Raymond H. [Memorial Sloan-Kettering Cancer Center, Section of Interventional Radiology, Department of Radiology (United States); Kemeny, Nancy E. [Memorial Sloan-Kettering Cancer Center, Department of Medicine (United States); Solomon, Stephen B. [Memorial Sloan-Kettering Cancer Center, Section of Interventional Radiology, Department of Radiology (United States)

    2013-02-15

    This study was designed to evaluate the relationship between the minimal margin size and local tumor progression (LTP) following CT-guided radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLM). An institutional review board-approved, HIPPA-compliant review identified 73 patients with 94 previously untreated CLM that underwent RFA between March 2003 and May 2010, resulting in an ablation zone completely covering the tumor 4-8 weeks after RFA dynamic CT. Comparing the pre- with the post-RFA CT, the minimal margin size was categorized to 0, 1-5, 6-10, and 11-15 mm. Follow-up included CT every 2-4 months. Kaplan-Meier methodology and Cox regression analysis were used to evaluate the effect of the minimal margin size, tumor location, size, and proximity to a vessel on LTP. Forty-five of 94 (47.9 %) CLM progressed locally. Median LTP-free survival (LPFS) was 16 months. Two-year LPFS rates for ablated CLM with minimal margin of 0, 1-5 mm, 6-10 mm, 11-15 mm were 26, 46, 74, and 80 % (p < 0.011). Minimal margin (p = 0.002) and tumor size (p = 0.028) were independent risk factors for LTP. The risk for LTP decreased by 46 % for each 5-mm increase in minimal margin size, whereas each additional 5-mm increase in tumor size increased the risk of LTP by 22 %. An ablation zone with a minimal margin uniformly larger than 5 mm 4-8 weeks postablation CT is associated with the best local tumor control.

  17. local

    Directory of Open Access Journals (Sweden)

    Abílio Amiguinho

    2005-01-01

    Full Text Available The process of socio-educational territorialisation in rural contexts is the topic of this text. The theme corresponds to a challenge to address it having as main axis of discussion either the problem of social exclusion or that of local development. The reasons to locate the discussion in this last field of analysis are discussed in the first part of the text. Theoretical and political reasons are there articulated because the question is about projects whose intentions and practices call for the political both in the theoretical debate and in the choices that anticipate intervention. From research conducted for several years, I use contributions that aim at discuss and enlighten how school can be a potential locus of local development. Its identification and recognition as local institution (either because of those that work and live in it or because of those that act in the surrounding context are crucial steps to progressively constitute school as a partner for development. The promotion of the local values and roots, the reconstruction of socio-personal and local identities, the production of sociabilities and the equation and solution of shared problems were the dimensions of a socio-educative intervention, markedly globalising. This scenario, as it is argued, was also, intentionally, one of transformation and of deliberate change of school and of the administration of the educative territoires.

  18. Prognostic factors and sites of metastasis in unresectable locally advanced pancreatic cancer.

    Science.gov (United States)

    Peixoto, Renata D'Alpino; Speers, Caroline; McGahan, Colleen E; Renouf, Daniel J; Schaeffer, David F; Kennecke, Hagen F

    2015-08-01

    Due to differences in natural history and therapy, clinical trials of patients with advanced pancreatic cancer have recently been subdivided into unresectable locally advanced pancreatic cancer (LAPC) and metastatic disease. We aimed to evaluate prognostic factors in LAPC patients who were treated with first-line chemotherapy and describe patterns of disease progression. Patients with LAPC who initiated first-line palliative chemotherapy, 2001-2011 at the BC Cancer Agency were included. A retrospective chart review was conducted to identify clinicopathologic variables, treatment, and subsequent sites of metastasis. Kaplan-Meier and Cox-regression survival analyses were performed. A total of 244 patients were included in this study. For the majority of patients (94.3%), first-line therapy was single-agent gemcitabine. About 144 (59%) patients developed distant metastatic disease and the most frequent metastatic sites included peritoneum/omentum (42.3%), liver (41%), lungs (13.9%), and distant lymph nodes (9%). Median overall survival (OS) for the entire cohort was 11.7 months (95% CI, 10.6-12.8). Development of distant metastases was associated with significantly inferior survival (HR 3.56, 95% CI 2.57-4.93), as was ECOG 2/3 versus 0/1 (HR 1.69, 95% CI 1.28-2.23), CA 19.9 > 1000 versus ≤ 1000 (HR 1.59, 95% CI 1.19-2.14) and female gender, (HR 1.57, 95% CI 1.19-2.08). In this population-based study, 41% of LAPC patients treated with first-line chemotherapy died without evidence of distant metastases. Prognostic factors for LAPC were baseline performance status, elevated CA 19.9, gender, and development of distant metastasis. Results highlight the heterogeneity of LAPC and the importance of locoregional tumor control.

  19. Frailty in state-space models: application to actuarial senescence in the Dipper.

    Science.gov (United States)

    Marzolin, Gilbert; Charmantier, Anne; Gimenez, Olivier

    2011-03-01

    Senescence, a decrease in life history traits with age, is a within-individual process. The lack of suitable methods to deal with individual heterogeneity has long impeded progress in exploring senescence in wild populations. Analyses of survival senescence are additionally complicated by the often neglected issue of imperfect detectability. To deal with both these issues, we developed state-space models to analyze capture-mark-recapture data while accounting for individual heterogeneity by incorporating random effects. We illustrated our approach by applying it to 29 years of data on breeding females in a Dipper (Cinclus cinclus) population. We highlighted patterns of age-related variation in annual survival by statistical comparisons of piecewise linear, quadratic, Gompertz, and Weibull survival models. The Gompertz model was ranked first in our set. It provided strong evidence for actuarial senescence with an onset of senescence estimated at about 2.3 years. The probability for this model to involve a frailty was 0.15, and the probability to involve an individual latent effect in detection was about 0.4. The estimated mean age at first reproduction was 1.2 years. The general case model described here in detail should encourage the reanalysis of actuarial senescence in cases where imperfect detection or individual heterogeneity is suspected.

  20. PRESTACIONES NO CONTRIBUTIVAS DE INVALIDEZ: EL LÍMITE DE INGRESOS Y LA EQUIVALENCIA ACTUARIAL

    Directory of Open Access Journals (Sweden)

    Daniel Hernández González

    2009-02-01

    Full Text Available El límite de ingresos es una herramienta útil para objetivar la carencia de rentas y permitir la obtención de pensiones no contributivas. Sin embargo, su aplicación práctica da lugar a escenarios de escasa justificación técnica o social, por lo que el uso de la equivalencia actuarial sería de gran utilidad para determinar de una forma más adecuada el verdadero estado patrimonial del individuo a lo largo del tiempo y, con ello, la realidad de sus derechos en materia de seguridad social. The limit of earnings is an useful tool to define the lack of income and allow access to a non-contributory pension. However, its practical application promotes scenarios with poor technical or social justification, so the use of actuarial equivalence would be useful to determine adequately the person’s real patrimony in the long term and, thus, the reality of their rights of social security.

  1. Ethical practice in sex offender assessment: consideration of actuarial and polygraph methods.

    Science.gov (United States)

    Vess, James

    2011-09-01

    The current generation of community protection laws represents a shift in priorities that may see the individual rights of sex offenders compromised for the goal of public safety. At the center of many judicial decisions under these laws are the risk assessment reports provided by mental health practitioners. The widespread enactment of laws allowing for additional sanctions for sex offenders, and a burgeoning research literature regarding the methods used to assess risk have served to heighten rather than resolve the ethical concerns associated with professional practice in this area. This article examines ethical issues inherent in the use of two assessment methods commonly used with sex offenders in the correctional context, focusing on actuarial measures and polygraph tests. Properly conducted and adequately reported actuarial findings are considered to provide useful information of sufficient accuracy to inform rather than mislead judicial decision makers, although careful consideration must be given to the limitations of current measures in each individual case. Despite its increasing use, polygraph testing is considered controversial, with little consensus regarding its accuracy or appropriate applications. On the basis of the current state of the professional literature regarding the polygraph, its use with sex offenders raises unresolved ethical concerns.

  2. THE EVOLUTION AND FUTURE OF SOCIAL SECURITY IN AFRICA: AN ACTUARIAL PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Fatima Badat

    2015-09-01

    Full Text Available Social Security in most African countries has evolved significantly in terms of perspectives, motives, governance as well as innovation of benefits and administration. African countries are slowly, one by one, beginning to reassess the role of social security in correcting several social ills. Empowerment programs and grants are increasingly being provided via social security to women and the youth. From the roots of social security, even very low income countries, some of which have recently experienced several years of civil war and extreme economic hardships, have begun to improve benefit structures and amounts, which include national medical benefits. The attention being provided to social security and how it fits into a nation’s plans to lift itself out of poverty is increasingly involving the actuarial profession from international organisations such as ILO and ISSA as well as consulting actuaries and academics. Assessing and ensuring sustainability of social security benefits requires actuarial valuations to take long-term consequences involving demographic changes into account in the face of providing the benefits in the short term; asset liability modelling to ensure adequate resources are held; ensuring that results are appropriately reported and communicated to key stakeholders; as well as developing long-term strategic plans and dynamic systems surrounding all of these issues. In this paper, the role of actuaries is brought to the centre of the increasingly changing face and evolving culture of social security in taking Africa closer to poverty alleviation. La Seguridad Social en la mayoría de los países africanos ha evolucionado significativamente en cuanto a perspectivas, motivos, gobernanza, así como en innovación en las prestaciones y la adminsitración. Los países africanos están comenzando a reevaluar el papel de la Seguridad Social en la eliminación de determinados problemas sociales. Los programas de acción y los

  3. Long term outcome of localized aggressive non-Hodgkin lymphoma treated with a short weekly chemotherapy regimen (doxorubicin, cyclophosphamide, bleomycin, vincristine, and prednisone) and involved field radiotherapy: result of a Gruppo Italiano Multiregionale per lo Studio dei Linfomi e Leucenie (GIMURELL) study.

    Science.gov (United States)

    Cabras, Maria Giuseppina; Mamusa, Angela Maria; Vitolo, Umberto; Freilone R, Roberto; Dessalvi, Paolo; Orsucci, Lorella; Tonso, Anna; Levis, Alessandro; Liberati, Marina; Lay, Giancarlo; Angelucci, Emanuele

    2009-09-01

    Recently, management of limited stage diffuse large cell lymphoma (DLCL) is trending toward a low intensity chemotherapy approach. Since 1993 we have used a brief weekly (6 weeks) chemotherapy scheme (Doxorubicin, Cyclophosphamide, Bleomycin, Vincristine, and Prednisone = ACOP-B) followed by involved field radiotherapy in 207 consecutive patients with well defined localized DLCL without age limit (median 57 years, range 18-85). Treatment was completed as designed in 183 of 207 patients (88%). One hundred and ninety-nine patients (96%) achieved complete remission. At a median follow-up of 66 months 170 patients are alive (82%), 168 of them free of disease. Twenty-nine patients experienced relapse after achieving a complete remission. Kaplan-Meier, risk of relapse was 24% after 13 years. Thirty (14.5%) patients have died, 14 (6.8%) due to lymphoma progression, one due to regimen toxicity and 15 (7.2%) from other causes while remaining in complete remission. The probability of overall survival and event free survival at 13 years was 78% (95% CI 70-87%) and 63% (95% CI 50-75), respectively. Crude rate of secondary malignancy was 5.26 /1000 person-years. The ACOP-B regimen plus involved field radiotherapy is well tolerated both short and long term and is an effective chemotherapy scheme for very well defined limited stage aggressive non-Hodgkin lymphomas in all age categories.

  4. Youth Actuarial Risk Assessment Tool (Y-ARAT): The development of an actuarial risk assessment instrument for predicting general offense recidivism on the basis of police records.

    Science.gov (United States)

    van der Put, Claudia E

    2014-06-01

    Estimating the risk for recidivism is important for many areas of the criminal justice system. In the present study, the Youth Actuarial Risk Assessment Tool (Y-ARAT) was developed for juvenile offenders based solely on police records, with the aim to estimate the risk of general recidivism among large groups of juvenile offenders by police officers without clinical expertise. On the basis of the Y-ARAT, juvenile offenders are classified into five risk groups based on (combinations of) 10 variables including different types of incidents in which the juvenile was a suspect, total number of incidents in which the juvenile was a suspect, total number of other incidents, total number of incidents in which co-occupants at the youth's address were suspects, gender, and age at first incident. The Y-ARAT was developed on a sample of 2,501 juvenile offenders and validated on another sample of 2,499 juvenile offenders, showing moderate predictive accuracy (area under the receiver-operating-characteristic curve = .73), with little variation between the construction and validation sample. The predictive accuracy of the Y-ARAT was considered sufficient to justify its use as a screening instrument for the police.

  5. Prognostic significance and molecular mechanism of ATP-binding cassette subfamily C member 4 in resistance to neoadjuvant radiotherapy of locally advanced rectal carcinoma.

    Directory of Open Access Journals (Sweden)

    Zhiqi Yu

    Full Text Available BACKGROUND: Mechanism of radioresistance in rectal carcinoma remains largely unknown. We aimed to evaluate the predictive role of ATP-binding cassette subfamily C member 4 (ABCC4 in locally advanced rectal carcinoma and explore possible molecular mechanisms by which ABCC4 confers the resistance to neoadjuvant radiotherapy. METHODS: The expression of ABCC4 and P53 mutant in biopsy tissue specimens from 121 locally advanced rectal carcinoma patients was examined using immunohistochemistry. The factors contributing to 3-year overall survival and disease-free survival were evaluated using the Kaplan-Meier method and Cox proportional hazard model. Lentivirus-mediated small hairpin RNA was applied to inhibit ABCC4 expression in colorectal carcinoma cell line RKO, and investigate the radiosensitivity in xenograft model. Intracellular cyclic adenosine monophosphate concentration and cell cycle distribution following irradiation were detected. RESULTS: High expression of ABCC4 and p53 mutant in pretreated tumors, poor pathological response, and high final tumor staging were significant factors independently predicted an unfavorable prognosis of locally advanced rectal carcinoma patients after neoadjuvant radiotherapy. Down-regulation of ABCC4 expression significantly enhanced irradiation-induced suppression of tumor growth in xenograft model. Furthermore, down-regulation of ABCC4 expression enhanced intracellular cyclic adenosine monophosphate production and noticeable deficiency of G1-S phase checkpoint in cell cycle following irradiation. CONCLUSIONS: Our study suggests that ABCC4 serves as a novel predictive biomarker that is responsible for the radioresistance and predicts a poor prognosis for locally advanced rectal carcinoma after neoadjuvant radiotherapy.

  6. Radiotherapy dose led to a substantial prolongation of survival in patients with locally advanced rectosigmoid junction cancer: a large population based study.

    Science.gov (United States)

    Guan, Xu; Jiang, Zheng; Ma, Tianyi; Liu, Zheng; Hu, Hanqing; Zhao, Zhixun; Song, Dawei; Chen, Yinggang; Wang, Guiyu; Wang, Xishan

    2016-05-10

    Radiotherapy is widely applied for locally advanced rectal cancer (RC) to improve both local control and long-term outcomes. However, the efficacy of radiotherapy for rectosigmoid junction cancer (RSC) is still undetermined. Here, we identified 10074 patients who were diagnosed with locally advanced RSC from Surveillance, Epidemiology, and End-Results (SEER) cancer registry. These patients were divided into three subgroups according to different therapy strategies, including surgery alone, surgery plus preoperative radiotherapy and surgery plus postoperative radiotherapy. 5-year cancer-specific survival (CSS) and 5-year overall survival (OS) were obtained. Kaplan-Meier methods and Cox regression models were used to estimate the correlations between prognostic factors and survival outcomes.The 5-year CSSs for RSC patients treated with pre- and postoperative radiotherapy were 72.3% and 72.2%, which were significantly higher than surgery alone (64.8%). The 5-year OSs for RSC patients treated with pre- and postoperative radiotherapy were 71.6% and 71.2%, which were higher than surgery alone (64.0%). In the separate analyses of stage II and III RSC patients, the similar trends were also obtained. In addition, pre- and postoperative radiotherapy were equally identified as valuable prognostic factors for better survival outcomes in RSC patients. Furthermore, the results following propensity score matching also confirmed that the long-term survivals of RSC patients were improved following radiotherapy. In conclusion, locally advanced RSCpatients could obtain potential long-term survival benefits from radiotherapy. A prospective randomized control trial should be performed to further validate the strength of evidence in current study.

  7. Competence in Mathematics and Academic Achievement: An Analysis of Enrollees in the Bachelor of Science in Actuarial Science Program

    Science.gov (United States)

    Wamala, Robert; Maswere, Dyson W.; Mwanga, Yeko

    2013-01-01

    This study investigates the role of prior grounding attained in mathematics in predicting the academic achievement of enrollees in Bachelor of Science in Actuarial Science (BSAS). The investigation is based on administrative records of 240 BSAS enrollees at Makerere University, School of Statistics and Planning in the 2007-2009 cohorts. Students'…

  8. Has actuarial aging "slowed" over the past 250 years? A comparison of small-scale subsistence populations and European cohorts.

    Science.gov (United States)

    Gurven, Michael; Fenelon, Andrew

    2009-04-01

    G.C. Williams's 1957 hypothesis famously argues that higher age-independent, or "extrinsic," mortality should select for faster rates of senescence. Long-lived species should therefore show relatively few deaths from extrinsic causes such as predation and starvation. Theoretical explorations and empirical tests of Williams's hypothesis have flourished in the past decade but it has not yet been tested empirically among humans. We test Williams's hypothesis using mortality data from subsistence populations and from historical cohorts from Sweden and England/Wales, and examine whether rates of actuarial aging declined over the past two centuries. We employ three aging measures: mortality rate doubling time (MRDT), Ricklefs's omega, and the slope of mortality hazard from ages 60-70, m'(60-70), and model mortality using both Weibull and Gompertz-Makeham hazard models. We find that (1) actuarial aging in subsistence societies is similar to that of early Europe, (2) actuarial senescence has slowed in later European cohorts, (3) reductions in extrinsic mortality associate with slower actuarial aging in longitudinal samples, and (4) men senesce more rapidly than women, especially in later cohorts. To interpret these results, we attempt to bridge population-based evolutionary analysis with individual-level proximate mechanisms.

  9. Throwing the baby out with the bath water: is it time for clinical judgment to supplement actuarial risk assessment?

    Science.gov (United States)

    Abbott, Brian R

    2011-01-01

    The assessment of the potential for sexual violence is one of three prongs that must be met to satisfy the requirements for civil confinement of dangerous sex offenders in the 21 U.S. jurisdictions that have these laws. In a recent issue of The Journal, Sreenivasan et al. argued that, because of a host of methodological problems, actuarial risk assessment methods in general and the Static-99 and its progeny in particular are insufficient for accurate assessment of risk for dangerous sex offenders. They propose using a combination of clinical judgment with actuarial science as a solution. This analysis and review of Sreenivasan et al. reveals and corrects flaws in the arguments they employed to support their position and shows how the combination of actuarial science with clinical judgment is more error prone than the actuarial approach only, and cannot be forensically defended in court. Recommendations on reporting Static-99R data in expert testimony are provided, taking into account the limitations of the instrument.

  10. An analysis of a three-factor model proposed by the Danish Society of Actuaries for forecasting and risk analysis

    DEFF Research Database (Denmark)

    Jørgensen, Peter Løchte; Slipsager, Søren Kærgaard

    2015-01-01

    This paper provides the explicit solution to the three-factor diffusion model recently proposed by the Danish Society of Actuaries to the Danish industry of life insurance and pensions. The solution is obtained by use of the known general solution to multidimensional linear stochastic differential...

  11. If You Build It, Will They Come? Tales of Developing a New Degree Program in Actuarial Science

    Science.gov (United States)

    Marano, Lisa E.

    2014-01-01

    In 2007, the B.S. in Applied Mathematics program consisting of five concentrations, including Actuarial Science, began at West Chester University of Pennsylvania, and we graduated our first class (of one) that December. We describe our program, some ideas to consider when planning your own program, and share some of the successes of our program…

  12. If You Build It, Will They Come? Tales of Developing a New Degree Program in Actuarial Science

    Science.gov (United States)

    Marano, Lisa E.

    2014-01-01

    In 2007, the B.S. in Applied Mathematics program consisting of five concentrations, including Actuarial Science, began at West Chester University of Pennsylvania, and we graduated our first class (of one) that December. We describe our program, some ideas to consider when planning your own program, and share some of the successes of our program…

  13. Genetic variants of the CYP1B1 gene as predictors of biochemical recurrence after radical prostatectomy in localized prostate cancer patients.

    Science.gov (United States)

    Gu, Cheng-Yuan; Qin, Xiao-Jian; Qu, Yuan-Yuan; Zhu, Yu; Wan, Fang-Ning; Zhang, Gui-Ming; Sun, Li-Jiang; Zhu, Yao; Ye, Ding-Wei

    2016-07-01

    Clinically localized prostate cancer is curative. Nevertheless many patients suffered from biochemical recurrence (BCR) after radical prostatectomy (RP). Mounting evidence suggest that estrogen and xenobiotic carcinogens play an essential role in progression of prostate cancervia oxidative estrogen metabolism. CYP1B1 is an enzyme involved in the hydroxylation of estrogens, a reaction of key relevance in estrogen metabolism. Given the role of CYP1B1 in the oxidative metabolism of endogenous/exogenous estrogen and compounds, CYP1B1 polymorphisms have the potential to modify its expression and subsequently lead to progression. We hypothesize that genetic variants of the CYP1B1 gene may influence clinical outcome in clinically localized prostate cancer patients. In this cohort study, we genotyped 9 tagging single nucleotide polymorphisms (SNPs) from the CYP1B1 gene in 312 patients treated with RP. For replication, these SNPs were genotyped in an independent cohort of 426 patients. The expression level of CYP1B1 in the adjacent normal prostate tissues was quantified by reverse transcription and real-time polymerase chain reaction. Kaplan-Meier analysis and Cox proportional hazard models were utilized to identify SNPs that correlated with BCR. CYP1B1 rs1056836 was significantly associated with BCR (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.40-0.89, P = 0.002) and relative CYP1B1 mRNA expression. Our findings suggest inherited genetic variation in the CYP1B1 gene may contribute to variable clinical outcomes for patients with clinically localized prostate cancer.

  14. Evaluation of the efficacy and toxicity of protocol cisplatin, 5-fluorouracil, leucovorin compared to protocol fluorouracil, doxorubicin and mitomycin C in locally advanced and metastatic gastric cancer

    Directory of Open Access Journals (Sweden)

    Andrić Zoran

    2012-01-01

    Full Text Available Introduction. Still there is no consensus on the choice of the most efficient and the least toxic chemotherapy regimen in the treatment of advanced gastric cancer. Nowadays few therapy protocols are available for treating this disease. Objective. Study was conducted to compare the efficacy and toxicity of FAM (flurouracil, doxorubicin, mitomycin C with CDDP and FU/FA (cisplatin, 5-fluorouracil, leucovorin protocols in patients with locally advanced and metastatic gastric cancer. Methods. This randomized study involved a group of 50 patients with locally advanced or metastatic gastric cancer, who had not previously undergone chemotherapy treatment. Progression free survival, overall survival and drug toxicity were evaluated. For statistical analysis chi-square test, Kaplan-Meier curve and the log rank test were used. Results. The overall response rate was 20% in the group treated with FAM and 24% in the group treated with CDDP, FU/FA (4% of patients from each group had complete response, but without significant statistical difference. Median survival was 10.9 months in the FAM group and 11.8 months in CDDP, FU/FA group, with no statistically significant difference. Non-haematological and haematological toxicities of CDDP, FU/FA were considerably less frequent than of FAM, and there was no treatment related deaths in any of the groups. Conclusion. Both investigated regimens demonstrated moderate efficacy. The study shows in favour of justified application of both protocols, while in regard to toxicity CDDP and FU/FA can be recommended as preferable treatment for locally advanced and metastatic gastric cancer. New strategies should be considered for better efficacy in the treatment of advanced gastric cancer. New strategies are necessary with the goal to achieve a better therapeutic effect.

  15. Optimization of Actuarial Model for Individual Account of Rural Social Pension Insurance

    Institute of Scientific and Technical Information of China (English)

    Wenxian; CAO

    2013-01-01

    This paper firstly analyzes different payment methods of individual account and the pension replacement rate under the pension payment method.Results show that it will be more scientific and reasonable for the individual account of new rural social pension insurance to adopt the actuarial model of payment according to proportion of income and periodic prestation at variable amount.The Guiding Opinions on New Rural Social Pension Insurance sets forth individual account should be paid at fixed amount,and the insured voluntarily selects payment level as per criteria set by the State.The monthly calculation and distribution amount of pension is the total amount of individual account divided by139.Therefore,it should start from continuation of policies and make adjustment of payment level in accordance with growth of per capita net income of rural residents.When condition permits,it is expected to realize transition to payment as per income proportion and periodic prestation at variable amount.

  16. Ruin Probability and Joint Distributions of Some Actuarial Random Vectors in the Compound Pascal Model

    Institute of Scientific and Technical Information of China (English)

    Xian-min Geng; Shu-chen Wan

    2011-01-01

    The compound negative binomial model, introduced in this paper, is a discrete time version. We discuss the Markov properties of the surplus process, and study the ruin probability and the joint distributions of actuarial random vectors in this model. By the strong Markov property and the mass function of a defective renewal sequence, we obtain the explicit expressions of the ruin probability, the finite-horizon ruin probability,the joint distributions of T, U(T - 1), |U(T)| and inf 0≤n<T1 U(n) (i.e., the time of ruin, the surplus immediately before ruin, the deficit at ruin and maximal deficit from ruin to recovery) and the distributions of some actuariai random vectors.

  17. An actuarial approach to comparing early stage and late stage lung cancer mortality and survival.

    Science.gov (United States)

    Goldberg, Sara W; Mulshine, James L; Hagstrom, Dale; Pyenson, Bruce S

    2010-02-01

    Comparing the mortality characteristics of different cohorts is an essential process in the life insurance industry. Pseudodisease, lead-time bias, and length bias, which are critical to determining the value of cancer screening, have close analogues in life insurance company management, including the temporal impact of underwriting. Ratios of all-cause mortality rates for cancer cohorts relative to standard population mortality rates can provide insights into early stage and late stage mortality differences, differences by age, sex, race, and histology, and allow modeling of biases associated with early stage detection or screening protocols. The Surveillance, Epidemiology and End Results (SEER) data set has characteristics that allow efficient application of actuarial techniques. We show the mortality burden associated with treated early stage lung cancer and that identifying all lung cancers at early stage could reduce US lung cancer deaths by over 70,000 per year.

  18. NEW METHOD TO OPTION PRICING FOR THE GENERAL BLACK-SCHOLES MODEL-AN ACTUARIAL APPROACH

    Institute of Scientific and Technical Information of China (English)

    闫海峰; 刘三阳

    2003-01-01

    Using physical probability measure of price process and the principle of fairpremium, the results of Mogers Bladt and Hina Hviid Rydberg are generalized. In twocases of paying intermediate divisends and no intermediate dividends, the Black-Scholesmodel is generalized to the case where the risk-less asset (bond or bank account) earns atime-dependent interest rate and risk asset (stock) has time-dependent the continuouslycompounding expected rate of return, volatility. In these cases the accurate pricing formulaand put- call parity of European option are obtained. The general approach of option pricingis given for the general Black-Scholes of the risk asset (stock) has the continuouslycompounding expected rate of return, volatility. The accurate pricing formula and put- callparity of European option on a stock whose price process is driven by general Ornstein-Uhlenback (O-U) process are given by actuarial approach.

  19. Long-term actuarial survivorship analysis of an interspinous stabilization system.

    Science.gov (United States)

    Sénégas, Jacques; Vital, Jean-Marc; Pointillart, Vincent; Mangione, Paolo

    2007-08-01

    In 1986, an interspinous dynamic stabilization system (the prototype of the current Wallis implant) was designed to stiffen unstable operated degenerate lumbar segments with a hard interspinous blocker to limit extension and a tension band around the spinous processes to secure the implant and limit flexion. Restoring physiological mechanical conditions to the treated level(s) while preserving some intervertebral mobility was intended to treat low-back pain related to degenerative instability without increasing stress forces in the adjacent segments. The procedure was easily reversible. If low back pain persisted or recurred, the device was removed and stability was achieved using fusion. The intermediate-term results were promising, but the long-term safety and efficacy of this dynamic interspinous stabilization device has not been previously documented. We retrospectively reviewed the hospital files of all the patients (n = 241) who had this dynamic stabilization system implanted between 1987 and 1995, contacting as many as possible to determine the actuarial survivorship of the system. In this manner, 142 of the 241 patients (58.9%) were contacted by telephone. The endpoints used for the survivorship analysis were 'any subsequent lumbar operation' and 'implant removal'. At 14 years follow-up, values of actuarial survivorship with 95% confidence interval were 75.9 +/- 8.3 and 81.3 +/- 6.8% for the endpoints 'any subsequent lumbar operation' and 'implant removal', respectively. There was no difference in survivorship of multiple-level implants with respect to single-level devices. Although the conclusions of the present study must be tempered by the 41% attrition rate, these findings support the long-term safety of this system, and possibly long-term protective action against adjacent-level degeneration by motion preservation. Outcomes at least equivalent to those of fusion were observed without the primary drawbacks of fusion.

  20. Intensity-Modulated and Image-Guided Radiotherapy in Patients with Locally Advanced Inoperable Pancreatic Cancer after Preradiation Chemotherapy

    Directory of Open Access Journals (Sweden)

    M. Sinn

    2014-01-01

    Full Text Available Background. Radiotherapy (RT in patients with pancreatic cancer is still a controversial subject and its benefit in inoperable stages of locally advanced pancreatic cancer (LAPC, even after induction chemotherapy, remains unclear. Modern radiation techniques such as image-guided radiotherapy (IGRT and intensity-modulated radiotherapy (IMRT may improve effectiveness and reduce radiotherapy-related toxicities. Methods. Patients with LAPC who underwent radiotherapy after chemotherapy between 09/2004 and 05/2013 were retrospectively analyzed with regard to preradiation chemotherapy (PRCT, modalities of radiotherapy, and toxicities. Progression-free (PFS and overall survival (OS were estimated by Kaplan-Meier curves. Results. 15 (68% women and 7 men (median age 64 years; range 40–77 were identified. Median duration of PRCT was 11.1 months (range 4.3–33.0. Six patients (27% underwent conventional RT and 16 patients (73% advanced IMRT and IGRT; median dosage was 50.4 (range 9–54 Gray. No grade III or IV toxicities occurred. Median PFS (estimated from the beginning of RT was 5.8 months, 2.6 months in the conventional RT group (conv-RT, and 7.1 months in the IMRT/IGRT group (P=0.029; median OS was 11.0 months, 4.2 months (conv-RT, and 14.0 months (IMRT/IGRT; P=0.141. Median RT-specific PFS for patients with prolonged PRCT > 9 months was 8.5 months compared to 5.6 months for PRCT 9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P=0.049. Conclusions. IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

  1. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambrecht, M.; Nevens, D.; Nuyts, S. [University Hospitals Leuven (Belgium). Dept. of Radiation Oncology

    2013-03-15

    Background and purpose: Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT). Material and methods: A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system. Results: Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis {>=} grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia {>=} grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia {>=} grade 2 in the IMRT group although differences failed to reach statistical significance. Conclusion: The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique. (orig.)

  2. Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Jegadeesh, Naresh; Rajpara, Raj; Esiashvili, Natia; Shi, Zheng [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Liu, Yuan [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia (United States); Okwan-Duodu, Derrick [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Flowers, Christopher R. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Medical Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2015-05-01

    Purpose: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (DLBCL) in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. Methods and Materials: Two hundred eleven patients with stage III and IV DLBCL treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed, with local recurrence (LR) as the primary outcome. Results: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV≥15 (P=.10). Conclusions: Advanced-stage DLBCL patients with stage III disease or with disease ≥5 cm appear to be at an increased risk for LR. Patients with <5-cm disease and SUVmax ≥15 may be at higher risk for LR. These patients may benefit from consolidative RT after chemoimmunotherapy.

  3. FEASIBILITY OF INDUCTION DOCETAXEL, CISPLATIN, 5-FLUOROURACIL, CETUXIMAB (TPF-C FOLLOWED BY CONCURRENT CETUXIMAB RADIOTHERAPY FOR LOCALLY ADVANCED HEAD AND NECK SQUAMOUS CELL CARCINOMA

    Directory of Open Access Journals (Sweden)

    Nikolaos eCharalambakis

    2013-01-01

    Full Text Available Purpose: To report our experience with a sequential regimen of induction TPF-C followed by radioimmunotherapy with cetuximab in patients with locally advanced head and neck squamous cell carcinoma (HNSCC. Patients and Methods: Toxicity and outcome was retrospectively analyzed in 22 patients receiving sequential therapy with induction TPF-C followed by radioimmunotherapy between October 2008 and December 2011. Outcome was estimated using Kaplan-Meier analyses. In addition, we performed mutation analysis for PIK3CA genes and high-risk HPV-DNA detection using PCR. Results: Median follow-up was 16 months. Six patients were TNM Stage III, 15 patients IV (IVA or IVB and 1 patient Stage II with bulky disease. During TPF-C, Grade 3 and 4 toxicities occurred in 8 patients (36.4%, dose modifications in 7 (31.8%, delays in 1 (4.5%, and unplanned admissions in 5 (22.7%. Clinical tumor response was documented in 18 of the 21 patients who completed at least 3 cycles of TPF-C (85.7% with 3 patients developing complete response and 15 partial responses. Grade 3/4 mucositis was observed in 6 (31.6% patients. At a median follow up of 19 months, 13 patients were alive and 9 (40.9% had died including 7 patients as a result of disease persistence or recurrence and two as a result of unrelated causes. PIK3CA mutations were not identified and our 2 oropharynx cases were HPV negative.Conclusions: The combination of induction TPF-C with concurrent cetuximab radioimmunotherapy in patients with locally advanced HNSCC is tolerable, with encouraging efficacy.Keywords: HNSCC, TPF-C, cetuximab radiotherapy, toxicity and outcome, mutation analysis, PIK3CA, HPV-DNA.

  4. The predictive value of histological tumor regression grading (TRG) for therapeutic evaluation in locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Kang Guo; Lan-Jun Zhang; Ling Cai; Yu Zhang; Jian-Fei Zhu; Tie-Hua Rong; Peng Lin; Chong-Li Hao; Wu-Ping Wang; Zhe Li

    2012-01-01

    Response criteria remain controversial in therapeutic evaluation for locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy.We aimed to identify the predictive value of tumor regression grading (TRG) in tumor response and prognosis.Fifty-two patients who underwent neoadjuvant chemotherapy followed by esophagectomy and radical 2-field lymphadenectomy between June 2007 and June 2011 were included in this study.All tissue specimens were reassessed according to the TRG scale.Potential prognostic factors,including clinicopathologic factors,were evaluated.Survival curves were generated by using the Kaplan-Meier method and compared with the log-rank test.Prognostic factors were determined with multivariate analysis by using the Cox regression model.Our results showed that of 52 cases,43 (83%) were squamous cell carcinoma and 9 (17%) were adenocarcinoma.TRG was correlated with pathologic T (P =0.006) and N (P < 0.001) categories.Median overall survival for the entire cohort was 33 months.The 1- and 2-year overall survival rates were 71% and 44%,respectively.Univariate survival analysis results showed that favorable prognostic factors were histological subtype (P =0.003),pathologic T category (P =0.026),pathologic N category (P < 0.001),and TRG G0 (P =0.041).Multivariate analyses identified pathologic N category (P < 0.001) as a significant independent prognostic parameter.Our results indicate that histomorphologic TRG can be considered as an alternative option to predict the therapeutic efficacy and prognostic factor for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy.

  5. The prognostic implication of the expression of EGFR, p53, cyclin D1, Bcl-2 and p16 in primary locally advanced oral squamous cell carcinoma cases: a tissue microarray study.

    Science.gov (United States)

    Solomon, Monica Charlotte; Vidyasagar, M S; Fernandes, Donald; Guddattu, Vasudev; Mathew, Mary; Shergill, Ankur Kaur; Carnelio, Sunitha; Chandrashekar, Chetana

    2016-12-01

    Oral squamous cell carcinomas comprise a heterogeneous tumor cell population with varied molecular characteristics, which makes prognostication of these tumors a complex and challenging issue. Thus, molecular profiling of these tumors is advantageous for an accurate prognostication and treatment planning. This is a retrospective study on a cohort of primary locally advanced oral squamous cell carcinomas (n = 178) of an Indian rural population. The expression of EGFR, p53, cyclin D1, Bcl-2 and p16 in a cohort of primary locally advanced oral squamous cell carcinomas was evaluated. A potential biomarker that can predict the tumor response to treatment was identified. Formalin-fixed paraffin-embedded tumor blocks of (n = 178) of histopathologically diagnosed cases of locally advanced oral squamous cell carcinomas were selected. Tissue microarray blocks were constructed with 2 cores of 2 mm diameter from each tumor block. Four-micron-thick sections were cut from these tissue microarray blocks. These tissue microarray sections were immunohistochemically stained for EGFR, p53, Bcl-2, cyclin D1 and p16. In this cohort, EGFR was the most frequently expressed 150/178 (84%) biomarker of the cases. Kaplan-Meier analysis showed a significant association (p = 0.038) between expression of p53 and a poor prognosis. A Poisson regression analysis showed that tumors that expressed p53 had a two times greater chance of recurrence (unadjusted IRR-95% CI 2.08 (1.03, 4.5), adjusted IRR-2.29 (1.08, 4.8) compared with the tumors that did not express this biomarker. Molecular profiling of oral squamous cell carcinomas will enable us to categorize our patients into more realistic risk groups. With biologically guided tumor characterization, personalized treatment protocols can be designed for individual patients, which will improve the quality of life of these patients.

  6. El tratamiento actuarial de los periodos de carencia y el contraseguro de primas en el seguro de dependencia.

    Directory of Open Access Journals (Sweden)

    Ricote Gil, Fernando.

    2003-01-01

    Full Text Available La dependencia es un estado en el que se encuentran las personas que por razones ligadas a la falta o la pérdida de autonomía física, psíquica o intelectual tienen necesidad de asistencia y/o atención significativa para la realización los actos corrientes de la vida diaria. Dentro de la iniciativa privada, el sector asegurador juega un importante papel para la prestación de garantías derivadas de esta cobertura. Un aspecto fundamental en el estudio de esta cobertura es la consideración de los periodos de carencia y el tratamiento del contraseguro de primas durante los mismo. Se analiza el riesgo actuarial y su tratamiento en esta cobertura y la incidencia en la valoración actuarial de las primas por prestaciones de dependencia.

  7. KRAS and BRAF Mutations and PTEN Expression Do Not Predict Efficacy of Cetuximab-Based Chemoradiotherapy in Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Erben, Philipp, E-mail: philipp.erben@medma.uni-heidelberg.de [III. Medizinische Klinik, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Stroebel, Philipp [Pathologisches Institut, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Horisberger, Karoline [Chirurgische Klinik, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Popa, Juliana; Bohn, Beatrice; Hanfstein, Benjamin [III. Medizinische Klinik, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Kaehler, Georg; Kienle, Peter; Post, Stefan [Chirurgische Klinik, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Wenz, Frederik [Klinik fuer Strahlentherapie und Radioonkologie, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Hochhaus, Andreas [III. Medizinische Klinik, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany); Klinik fuer Innere Medizin II, Abteilung Haematologie/Onkologie, Universitaetsklinikum Jena, Jena (Germany); Hofheinz, Ralf-Dieter [III. Medizinische Klinik, Universitaetsmedizin Mannheim, Universitaet Heidelberg, Mannheim (Germany)

    2011-11-15

    Purpose: Mutations in KRAS and BRAF genes as well as the loss of expression of phosphatase and tensin homolog (PTEN) (deleted on chromosome 10) are associated with impaired activity of antibodies directed against epidermal growth factor receptor in patients with metastatic colorectal cancer. The predictive and prognostic value of the KRAS and BRAF point mutations as well as PTEN expression in patients with locally advanced rectal cancer (LARC) treated with cetuximab-based neoadjuvant chemoradiotherapy is unknown. Methods and Materials: We have conducted phase I and II trials of the combination of weekly administration of cetuximab and irinotecan and daily doses of capecitabine in conjunction with radiotherapy (45 Gy plus 5.4 Gy) in patients with LARC (stage uT3/4 or uN+). The status of KRAS and BRAF mutations was determined with direct sequencing, and PTEN expression status was determined with immunohistochemistry testing of diagnostic tumor biopsies. Tumor regression was evaluated by using standardized regression grading, and disease-free survival (DFS) was calculated according to the Kaplan-Meier method. Results: A total of 57 patients were available for analyses. A total of 31.6% of patients carried mutations in the KRAS genes. No BRAF mutations were found, while the loss of PTEN expression was observed in 9.6% of patients. Six patients achieved complete remission, and the 3-year DFS rate was 73%. No correlation was seen between tumor regression or DFS rate and a single marker or a combination of all markers. Conclusions: In the present series, no BRAF mutation was detected. The presence of KRAS mutations and loss of PTEN expression were not associated with impaired response to cetuximab-based chemoradiotherapy and 3-year DFS.

  8. Hypoxic Prostate/Muscle PO{sub 2} Ratio Predicts for Outcome in Patients With Localized Prostate Cancer: Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Turaka, Aruna [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Buyyounouski, Mark K., E-mail: mark.buyyounouski@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Hanlon, Alexandra L. [School of Nursing, University of Pennsylvania, Philadelphia, PA (United States); Horwitz, Eric M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Greenberg, Richard E. [Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States)

    2012-03-01

    Purpose: To correlate tumor oxygenation status with long-term biochemical outcome after prostate brachytherapy. Methods and Materials: Custom-made Eppendorf PO{sub 2} microelectrodes were used to obtain PO{sub 2} measurements from the prostate (P), focused on positive biopsy locations, and normal muscle tissue (M), as a control. A total of 11,516 measurements were obtained in 57 men with localized prostate cancer immediately before prostate brachytherapy was given. The Eppendorf histograms provided the median PO{sub 2}, mean PO{sub 2}, and % <5 mm Hg or <10 mm Hg. Biochemical failure (BF) was defined using both the former American Society of Therapeutic Radiation Oncology (ASTRO) (three consecutive raises) and the current Phoenix (prostate-specific antigen nadir + 2 ng/mL) definitions. A Cox proportional hazards regression model evaluated the influence of hypoxia using the P/M mean PO{sub 2} ratio on BF. Results: With a median follow-up time of 8 years, 12 men had ASTRO BF and 8 had Phoenix BF. On multivariate analysis, P/M PO{sub 2} ratio <0.10 emerged as the only significant predictor of ASTRO BF (p = 0.043). Hormonal therapy (p = 0.015) and P/M PO{sub 2} ratio <0.10 (p = 0.046) emerged as the only independent predictors of the Phoenix BF. Kaplan-Meier freedom from BF for P/M ratio <0.10 vs. {>=}0.10 at 8 years for ASTRO BF was 46% vs. 78% (p = 0.03) and for the Phoenix BF was 66% vs. 83% (p = 0.02). Conclusions: Hypoxia in prostate cancer (low mean P/M PO{sub 2} ratio) significantly predicts for poor long-term biochemical outcome, suggesting that novel hypoxic strategies should be investigated.

  9. Can an IL13 -1112 C/T (rs1800925) polymorphism predict responsiveness to neoadjuvant chemoradiotherapy and survival of Chinese Han patients with locally advanced rectal cancer?

    Science.gov (United States)

    Chang, Hui; Xi, Shaoyan; Xiao, Weiwei; Zeng, Zhifan; Zhang, Huizhong; Xu, Ruihua; Gao, Yuanhong

    2016-01-01

    We sought to determine whether a polymorphism in the Interleukin 13 gene (IL13), 1112 C/T (rs1800925) predicts responsiveness to neoadjuvant chemoradiotherapy (neoCRT) and prognosis in Chinese Han patients with locally advanced rectal cancer (LARC). Pre-treatment biopsies of primary rectal lesion and surgical specimens were collected from 58 patients with LARC, who were treated with neoCRT and surgery. Tumor DNA was extracted from these biopsies and sequenced to analyze the rs1800925 polymorphism. The tumor response to neoCRT was categorized using a tumor regression grade (TRG, 0-2 were poor responders; 3-4 were good responders). Analyses of progression free survival (PFS) and overall survival (OS) were carried out using the Kaplan-Meier method. Of the forty-six patients for whom tumor DNA was successfully sequenced, 23 were good responders to neoCRT (11 patients with a pathological complete response, i.e. pCR) and the other 23 were poor responders. Good and poor responders were equally likely to have a C/C genotype at rs1800925 (73.9%) as a T/T or C/T genotype (26.1%). There were no differences between the C/C and T/T+C/T genotypes with respect to the ypT0-2 ratio (38.2% vs. 41.7%, P = 1.0), ypN0 nodal status (67.6% vs. 50.0%, P= 0.314), 6-year PFS (67.6% vs. 50%, P=0.274), or 6-year OS (76.5% vs. 66.7%, P=0.441). Thus, the IL13-1112 C/T (rs1800925) polymorphism does not predict responsiveness to neoCRT or prognosis of Chinese Han patients with LARC. PMID:27167201

  10. Post-treatment PET/CT and p16 status for predicting treatment outcomes in locally advanced head and neck cancer after definitive radiation

    Energy Technology Data Exchange (ETDEWEB)

    Awan, Musaddiq J.; Machtay, Mitchell; Yao, Min [Case Western Reserve University and University Hospitals, Department of Radiation Oncology, Cleveland, OH (United States); Lavertu, Pierre; Zender, Chad; Rezaee, Rod; Fowler, Nicole [University Hospitals, Department of Otolaryngology and Head and Neck Surgery, Cleveland, OH (United States); Karapetyan, Lilit; Gibson, Michael [University Hospitals, Department of Medical Oncology, Cleveland, OH (United States); Wasman, Jay [University Hospitals, Department of Pathology, Cleveland, OH (United States); Faulhaber, Peter [University Hospitals, Department of Nuclear Medicine and Radiology, Cleveland, OH (United States)

    2017-06-15

    To retrospectively review post-treatment (post-tx) FDG-PET/CT scans in patients with advanced head and neck squamous cell carcinoma (HNSCC) and known p16 status, treated with definitive (chemo)radiation (RT). A total of 108 eligible patients had N2A or greater HNSCC treated with chemoRT from August 1, 2008, to February 28, 2015, with post-tx PET/CT within 6 months after RT. Kaplan-Meier curves, log-rank statistics, and Cox proportional hazards regression were used for statistical analysis. Median follow-up was 2.38 years. Sixty-eight (63.0%) patients had p16+ and 40 (37.0%) had p16- status. Two-year overall survival and recurrence-free survival were 93.4% and 77.8%, respectively. The negative predictive value (NPV) of PET/CT for local recurrence (LR) was 100%. The NPV for regional recurrence (RR) was 96.5% for all patients, 100% for p16+ patients, and 88.5% for p16- patients. The positive predictive value (PPV) of PET/CT for recurrence was 77.3% for all patients, 50.0% for p16+, and 78.6% for p16-. The PPV for LR was 72.7% for all patients, 50.0% for p16+ patients, and 72.7% for p16- patients. The PPV for RR was 50.0% for all patients, 33% for p16+, and 66.6% for p16-. Post-tx PET/CT and p16 status were independent predictors of recurrence-free survival (p < 0.01). Post-tx PET/CT predicts treatment outcomes in both p16 + and p16- patients, and does so independently of p16 status. P16- patients with negative PET have a 10% risk of nodal recurrence, and closer follow-up in these patients is warranted. (orig.)

  11. Long-term outcomes for surgical treatment in patients with locally advanced and disseminated gastric cancer combined with intraoperative photodynamic therapy

    Directory of Open Access Journals (Sweden)

    L. A. Vashakmadze

    2013-01-01

    Full Text Available This article represents the study of safety and efficiency of intraoperative photodynamic peritoneal therapy (IOPDT developed in P.A. Herzen Moscow Cancer Research Institute. IPPDT was performed in 84 patients with locally advanced and disseminated gastric cancer. The control group included 100 patients with surgical treatment only. All patients underwent subradical or palliative subtotal distal gastroectomy or total gastrectomy with D2, D3 lymph node dissection. For IOPDT group Photohem was administrated intravenously in dose 2,5 mg/kg 48 h prior to operation, the session of peritoneal irradiation was performed after completion of the surgery (with laser device LFT-630-01 «Biospec», wavelength 630nm, light dose 6 J/cm2. IOPDT of peritoneum was associated with good tolerance, did not increase the rate and severity of post-operative complications. The efficiency of IOPDT was assessed with adjusted survival rates in study and control groups by Kaplan-Meier analysis. IOPDT significantly improved the prognosis in patients with subradical treatment, with metastasis in less then 15 lymph nodes. The use of IOPDT after surgery in this group of patients contributed to increase of median survival rate from 29.3 up to 43.6 months, annual survival rates from 80.0±5.7% to 93.7±4.2%, 3-year survival rates from 45.5±7.6% to 82.1±7.1%. Accordingly, IOPDT did not improved outcomes for palliative surgery R1–R2 and in patients with more than 15 involved lymph nodes. 

  12. An analysis of a three-factor model proposed by the Danish Society of Actuaries for forecasting and risk analysis

    DEFF Research Database (Denmark)

    Jørgensen, Peter Løchte; Slipsager, Søren Kærgaard

    2016-01-01

    This paper provides the explicit solution to the three-factor diffusion model recently proposed by the Danish Society of Actuaries to the Danish industry of life insurance and pensions. The solution is obtained by use of the known general solution to multidimensional linear stochastic differential...... well-known risk measures under both schemes. Finally, we conduct a sensitivity analysis and find that the relative performance of the two schemes depends on the chosen model parameter estimates....

  13. A theoretical model of the evolution of actuarial senescence under environmental stress.

    Science.gov (United States)

    Watson, H; Cohen, A A; Isaksson, C

    2015-11-01

    Free-living organisms are exposed to a wide range of stressors, all of which can disrupt components of stress-related and detoxification physiology. The subsequent accumulation of somatic damage is widely believed to play a major role in the evolution of senescence. Organisms have evolved sophisticated physiological regulatory mechanisms to maintain homeostasis in response to environmental perturbations, but these systems are likely to be constrained in their ability to optimise robustness to multiple stressors due to functional correlations among related traits. While evolutionary change can accelerate due to human ecological impacts, it remains to be understood how exposure to multiple environmental stressors could affect senescence rates and subsequently population dynamics and fitness. We used a theoretical evolutionary framework to quantify the potential consequences for the evolution of actuarial senescence in response to exposure to simultaneous physiological stressors--one versus multiple and additive versus synergistic--in a hypothetical population of avian "urban adapters". In a model in which multiple stressors have additive effects on physiology, species may retain greater capacity to recover, or respond adaptively, to environmental challenges. However, in the presence of high synergy, physiological dysregulation suddenly occurs, leading to a rapid increase in age-dependent mortality and subsequent population collapse. Our results suggest that, if the synergistic model is correct, population crashes in environmentally-stressed species could happen quickly and with little warning, as physiological thresholds of stress resistance are overcome.

  14. Intraoperative Radiotherapy in the Management of Locally Recurrent Extremity Soft Tissue Sarcoma

    Directory of Open Access Journals (Sweden)

    Christopher L. Tinkle

    2015-01-01

    Full Text Available Purpose. To investigate the efficacy and morbidity of limb-sparing surgery with intraoperative radiotherapy (IORT for patients with locally recurrent extremity soft tissue sarcoma (ESTS. Methods and Materials. Twenty-six consecutively treated patients were identified in a single institution retrospective analysis of patients with locally recurrent ESTS treated with IORT following salvage limb-sparing resection from May 2000 to July 2011. Fifteen (58% patients received external beam radiotherapy (EBRT prior to recurrence (median dose 63 Gy, while 11 (42% patients received EBRT following IORT (median dose 52 Gy. The Kaplan-Meier product limit method was used to estimate disease control and survival and subsets were compared using a log rank statistic, Cox’s regression model was used to determine independent predictors of disease outcome, and toxicity was reported according to CTCAE v4.0 guidelines. Results. With a median duration of follow-up from surgery and IORT of 34.9 months (range: 4 to 139 mos., 10 patients developed a local recurrence with 4 subsequently undergoing amputation. The 5-year estimate for local control (LC was 58% (95% CI: 36–75%, for amputation-free was 81% (95% CI: 57–93%, for metastasis-free control (MFC was 56% (95% CI: 31–75%, for disease-free survival (DFS was 35% (95% CI: 17–54%, and for overall survival (OS was 50% (95% CI: 24–71%. Prior EBRT did not appear to influence disease control (LC, p=0.74; MFC, p=0.66 or survival (DFS, p=0.16; OS, p=0.58. Grade 3 or higher acute and late toxicities were reported for 6 (23% and 8 (31% patients, respectively. The frequency of both acute and late grade 3 or higher toxicities occurred equally between patients who received EBRT prior to or after IORT. Conclusions. IORT in combination with oncologic resection of recurrent ESTS yields good rates of local control and limb-salvage with acceptable morbidity. Within the limitations of small subsets, these data suggest

  15. Prediction of Basic Math Course Failure Rate in the Physics, Meteorology, Mathematics, Actuarial Sciences and Pharmacy Degree Programs

    Directory of Open Access Journals (Sweden)

    Luis Rojas-Torres

    2014-09-01

    Full Text Available This paper summarizes a study conducted in 2013 with the purpose of predicting the failure rate of math courses taken by Pharmacy, Mathematics, Actuarial Science, Physics and Meteorology students at Universidad de Costa Rica (UCR. Using the Logistics Regression statistical techniques applied to the 2010 cohort, failure rates were predicted of students in the aforementioned programs in one of their Math introductory courses (Calculus 101 for Physics and Meteorology, Math Principles for Mathematics and Actuarial Science and Applied Differential Equations for Pharmacy. For these models, the UCR admission average, the student’s genre, and the average correct answers in the Quantitative Skills Test were used as predictor variables. The most important variable for all models was the Quantitative Skills Test, and the model with the highest correct classification rate was the Logistics Regression. For the estimated Physics-Meteorology, Pharmacy and Mathematics-Actuarial Science models, correct classifications were 89.8%, 73.6%, and 93.9%, respectively.

  16. Prognostic Impact of External Beam Radiation Therapy in Patients Treated With and Without Extended Surgery and Intraoperative Electrons for Locally Recurrent Rectal Cancer: 16-Year Experience in a Single Institution

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, Felipe A. [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Sole, Claudio V., E-mail: cvsole@uc.cl [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Alvarez de Sierra, Pedro [Service of General Surgery, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Gómez-Espí, Marina [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Blanco, Jose [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); and others

    2013-08-01

    Purpose: To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). Methods and Materials: From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. Conclusions: EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.

  17. Salvage surgery for local recurrence after carbon ion radiotherapy for patients with lung cancer.

    Science.gov (United States)

    Mizobuchi, Teruaki; Yamamoto, Naoyoshi; Nakajima, Mio; Baba, Masayuki; Miyoshi, Kentaro; Nakayama, Haruhiko; Watanabe, Syun-Ichi; Katoh, Ryoichi; Kohno, Tadasu; Kamiyoshihara, Mitsuhiro; Nishio, Wataru; Kamada, Tadashi; Fujisawa, Takehiko; Yoshino, Ichiro

    2016-05-01

    Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT. From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed. There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%. The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio

  18. Comparing Concurrent Chemoradiotherapy to Chemotherapy Alone for Locally Advanced Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Hoon; Kim, Woo Chul; Kim, Hun Jung; Gwak, Hee Keun [Inha University Hospital, Incheon (Korea, Republic of)

    2009-06-15

    Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced unresectable pancreatic cancer. However, the introduction of gemcitabine and the recognition of a benefit in patients with advanced disease stimulated the design of trials that compare chemotherapy alone to concurrent chemoradiation. Therefore, we evaluated role of CCRT for locally advanced unresectable pancreatic cancer. We carried out a retrospective analysis of treatment results for patients with locally advanced unresectable pancreatic cancer between January 2000 and January 2008. The radiation was delivered to the primary tumor and regional lymph nodes with a 1{approx}2 cm margin at a total dose of 36.0{approx}59.4 Gy (median: 54 Gy). The chemotherapeutic agent delivered with the radiation was 5-FU (500 mg/m{sup 2}). The patients who underwent chemotherapy alone received gemcitabine (1,000 mg/m{sup 2}) alone or gemcitabine with 5-FU. The follow-up period ranged from 2 to 38 months. The survival and prognostic factors were analyzed using Kaplan-Meier method and log-rank test, respectively. Thirty-four patients received concurrent chemoradiotherapy, whereas 21 patients received chemotherapy alone. The median survival time was 12 months for CCRT patients, compared to 11 months for chemotherapy alone patients (p=0.453). The median progression-free survival was 8 months for CCRT patients, compared to 5 months for chemotherapy alone patients (p=0.242). The overall response included 9 partial responses for CCRT and 1 partial response for chemotherapy alone. In total, 26% of patients from the CCRT group experienced grade 3{approx}4 bowel toxicity. In contract, no grade 3{approx}4 bowel toxicity was observed in the chemotherapy alone group. The significant prognostic factors of overall survival were lymph node status, high CA19-9, and tumor location. The response rate and progression-free survival were more favorable in the CCRT group, when compared with the chemotherapy alone group

  19. The Impact of Definitive Local Therapy for Lymph Node-Positive Prostate Cancer: A Population-Based Study

    Energy Technology Data Exchange (ETDEWEB)

    Rusthoven, Chad G., E-mail: chad.rusthoven@ucdenver.edu [Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado (United States); Carlson, Julie A.; Waxweiler, Timothy V.; Raben, David [Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado (United States); Dewitt, Peter E. [Department of Biostatistics, University of Colorado-Denver, Aurora, Colorado (United States); Crawford, E. David [Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado (United States); Department of Urology, University of Colorado-Denver, Aurora, Colorado (United States); Maroni, Paul D. [Department of Urology, University of Colorado-Denver, Aurora, Colorado (United States); Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado (United States)

    2014-04-01

    Purpose: To evaluate the survival outcomes for patients with lymph node-positive, nonmetastatic prostate cancer undergoing definitive local therapy (radical prostatectomy [RP], external beam radiation therapy [EBRT], or both) versus no local therapy (NLT) in the US population in the modern prostate specific antigen (PSA) era. Methods and Materials: The Surveillance, Epidemiology, and End Results database was queried for patients with T1-4N1M0 prostate cancer diagnosed from 1995 through 2005. To allow comparisons of equivalent datasets, patients were analyzed in separate clinical (cN+) and pathologically confirmed (pN+) lymph node-positive cohorts. Kaplan-Meier overall survival (OS) and prostate cancer-specific survival (PCSS) estimates were generated, with accompanying univariate log-rank and multivariate Cox proportional hazards comparisons. Results: A total of 796 cN+ and 2991 pN+ patients were evaluable. Among cN+ patients, 43% underwent EBRT and 57% had NLT. Outcomes for cN+ patients favored EBRT, with 10-year OS rates of 45% versus 29% (P<.001) and PCSS rates of 67% versus 53% (P<.001). Among pN+ patients, 78% underwent local therapy (RP 57%, EBRT 10%, or both 11%) and 22% had NLT. Outcomes for pN+ also favored local therapy, with 10-year OS rates of 65% versus 42% (P<.001) and PCSS rates of 78% versus 56% (P<.001). On multivariate analysis, local therapy in both the cN+ and pN+ cohorts remained independently associated with improved OS and PCSS (all P<.001). Local therapy was associated with favorable hazard ratios across subgroups, including patients aged ≥70 years and those with multiple positive lymph nodes. Among pN+ patients, no significant differences in survival were observed between RP versus EBRT and RP with or without adjuvant EBRT. Conclusions: In this large, population-based cohort, definitive local therapy was associated with significantly improved survival in patients with lymph node-positive prostate cancer.

  20. Thoughts about Actuarial Undergraduate Education and Teaching in Fujian Colleges%福建省高校精算本科教育与教学的思考

    Institute of Scientific and Technical Information of China (English)

    李玉水

    2014-01-01

    随着福建经济快速发展,对精算人才的需求越来越大,表现在福建省保险业的发展刺激保险精算人才的需求、福建省社会保障制度可持续健康的发展需要精算人才、金融机构风险管理技术的提升需要精算技术。为此,要提高对精算的宣传与认识,扩大精算本科招生规模、根据精算应用方向来设置课程、在教学上要从理论到实践,注重综合素质的培养、促进闽台两岸精算人才培养与合作,最终培养出适合市场需要精算复合型人才及促进福建省精算本科教育健康可持续发展。%With the rapid economic development in Fujian, the demand for actuarial talent is growing, showing in the development of the insurance industry in Fujian stimulating the actuarial talent needs, the sustainable and healthy development of the social security system in Fujian needing actuarial talent, the promotion of the financial institution risk management techniques requiring actuarial techniques. Therefore, improving actuarial propaganda and cognition, expanding the actuarial undergraduate enrollment, according to the actuarial application direction to set course plan, paying attention to the overall quality by training from theory to practice in teaching, promoting actuarial personnel training and cooperation between Fujian and Taiwan, eventually cultivating the compound actuarial talent in accordance with needs of the market, and promoting the actuarial undergraduate education’s healthy and sustainable development in Fujian.

  1. Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study.

    Science.gov (United States)

    Liu, Jian-Ye; Dai, Ying-Bo; Zhou, Fang-Jian; Long, Zhi; Li, Yong-Hong; Xie, Dan; Liu, Bin; Tang, Jin; Tan, Jing; Yao, Kun; He, Le-Ye

    2017-01-17

    Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1-4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1-4/N0-X UTUC. We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1-4/N0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox's proportional hazards model was used for univariate and multivariate analysis. The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46-3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54-1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616-3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81-3.17, P = 0.17). The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1-4/N0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.

  2. Salvage prostate HDR brachytherapy combined with interstitial hyperthermia for local recurrence after radiation therapy failure

    Energy Technology Data Exchange (ETDEWEB)

    Kukielka, A.M.; Hetnal, M.; Dabrowski, T.; Walasek, T.; Brandys, P.; Reinfuss, M. [Centre of Oncology, M. Sklodowska - Curie Institute, Krakow Branch, Department of Radiotherapy, Krakow (Poland); Nahajowski, D.; Kudzia, R.; Dybek, D. [Centre of Oncology, M. Sklodowska - Curie Institute, Krakow Branch, Department of Medical Physics, Department of Radiotherapy, Krakow (Poland)

    2014-02-15

    The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy. Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83 %). The aim of the hyperthermia treatment was to heat the prostate to 41-43 C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir + 2 ng/ml). The median age was 71 years (range 62-83 years), the median initial PSA level was 16.3 ng/ml (range 6.37-64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044-25.346 ng/ml). The median follow-up was 13 months (range 4-48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan-Meier estimate of biochemical control after salvage treatment was 74 %. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir < 0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients. IHT in combination

  3. Breast conserving treatment of locally advanced carcinoma T2 and T3 after neoadjuvant chemotherapy followed by quadrantectomy and high dose-rate brachytherapy, as a boost, complementary teletherapy and adjuvant chemotherapy; Tratamento conservador dos carcinomas de mama localmente avancados T2 e T3, apos quimioterapia neoadjuvante, com quadrantectomia e braquiterapia de alta taxa de dose como reforco de dose, teleterapia complementar e quimioterapia adjuvante

    Energy Technology Data Exchange (ETDEWEB)

    Fristachi, Carlos Elias [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Onco-Ginecologia e Mastologia]. E-mail: cefristachi@uol.com.br; Miziara Filho, Miguel Abrao; Soares, Celia Regina; Fogaroli, Ricardo Cesar; Pelosi, Edilson Lopes; Martins, Homero Lavieri Martins [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Radioterapia; Baracat, Fausto Farah [Hospital do Servidor Publico Estadual de Sao Paulo (HSPE), SP (Brazil). Servico de Ginecologia e Mastologia; Piato, Sebastiao [Irmandade da Santa Casa de Misericordia de Sao Paulo, SP (Brazil). Dept. de Obstetricia e Ginecologia (DOGI)

    2005-07-01

    Objective: to assess the treatment of breast cancer T2 and T3(T > = 4 cm), through neoadjuvant chemotherapy, quadrantectomy and high-dose-rate (HDR) brachytherapy as a boost, complementary radiotherapy and adjuvant chemotherapy, considering its method problems, its esthetics results, the aspect of local control, overall survival, and disease-free survival. Patients and method: this clinical prospective descriptive study was based on the evaluation of 26 patients ranging from 30 to 70 years old, with infiltrating ductal carcinoma, clinical stage IIB and IIIA, responsive to the neoadjuvant chemotherapy. Early and late radiotherapy complications were evaluated according to the criteria established by the RTOG/EORTC (Radiotherapy and Oncology Group /European Organization for Research and Treatment of Cancer) groups. Esthetics evaluation was done in accordance with the criteria set by a plastic surgeon. Local control was evaluated by clinical method, mammography and ultrasonography. Overall survival (OS) and the disease-free survival (DFS) were assessed according to Kaplan-Meier methodology. All the patients were treated at the Dr. Arnaldo Vieira de Carvalho Cancer Institute, from June/1995 to November/2001, and evaluated in March, 2002, with median follow-up of 28.7 months. Results: early complications were observed in 8 patients (30.6%). Two patients were classified as G3 and G4 (RTOG/EORTC). Six patients had late complications and three of them (11.5%) were classified as G3 and G4. One patient (3.8%) had local recurrence, 64 months after having local treatment. Esthetics results were considered good or regular in 16 patients (60.5%) out of 24 patients who were examined. Overall survival and disease-free survival in 24, 36 and 60 months were 100%, 92.3% and 83.1% respectively. Conclusion: early and late radiotherapy complications were considerate high when compared to literature, but esthetic results were considered acceptable. RL, OS and DFS were comparable to other

  4. LA ESCALA DE PORCENTAJES DE LA LEY 27/2011: UN ENFOQUE ACTUARIAL PARA UN NUEVO MODELO SOSTENIBLE

    Directory of Open Access Journals (Sweden)

    Pedro Javier Budia Aldana

    2014-05-01

    Full Text Available La Ley 27/2011, de 1 de agosto, sobre actualización, adecuación y modernización del sistema de seguridad social, ha variado la escala de porcentajes aplicables a la base reguladora en función del número de años cotizados. Los nuevos porcentajes afectan a los trabajadores que se vayan a jubilar con periodos de cotización entre 15 y 37 años y, especialmente, a aquellos trabajadores cuyas pensiones sean bajas y puedan ser beneficiarios de complemento a mínimos. Estas variaciones, que se han ido produciendo en la escala de porcentajes a través de sucesivos cambios legislativos, han llevado al actuario a estudiar cuáles serían los porcentajes de equilibrio financiero-actuarial según el número de años cotizados y la edad de inicio en el mercado laboral para cubrir todas las pensiones que pueda causar el trabajador. The Law 27/2011 of 1 August, about updating, improvement and modernization of the social security system has changed the scale of percentages applicable to the regulatory base depending on the number of years of contributions. The new rates affect workers who are to retire on contribution periods between 15 and 37 years, and especially to those workers whose pensions are low and can receive minimum supplements. These variations, that have they occurred in the percentage scale through successive legislative changes, have led to the actuary to study what percentage of financial and actuarial balance would be according to the number of years of contributions and the age of onset in the labor market to cover all pensions that may cause the worker.

  5. Actuarial calculation on time value of money%资金时间价值的精算

    Institute of Scientific and Technical Information of China (English)

    丁静之

    2001-01-01

    Interest is defined as compensation for money use,but the definition can not reflect its nature.In fact,interest is actual the compensation for time value of money.A class of actuarial calculation on time value of money is given from this point of view,which will do great help to understanding of actuarial science.%经济学中,利息被定义为在一定时间内使用他人或组织的资金而支付的报酬.这一定义没有反映利息的本质,没有说明支付上述报酬的原因及具体的计算方法.故认为:借方不仅要归还贷方的借贷资金,还要支付资金提早使用的时间价值,利息应该是资金的时间价值的折算,并且应有精算思想去讨论它的折算方法.

  6. Improved local control without elective nodal radiotherapy in patients with unresectable NSCLC treated by 3D-CRT

    Institute of Scientific and Technical Information of China (English)

    YANG Kunyu; CAO Fengjun; WANG Jianhua; LIU Li; ZHANG Tao; WU Gang

    2007-01-01

    To investigate the influence of prophylactic elective nodal irradiation on the therapeutic results of definitive radiotherapy for patients with stage IliA or stage IIIB unresectable non-small-cell lung cancer,55 patients with clinically inoperable advanced non-small-cell lung cancer were studied.After four cycles of induction chemotherapy,the patients were divided into two groups at random.In one group,the elective nodal irradiation was included in clinical tumor volume(CTV)of definitive radiotherapy(ENI group);and in the other group,elective nodal irradiation was not included in CTV(non-ENI group).For the patients in the ENI group,the mean prescription dose for gross tumor volumes was 58.4 Gy,while for the patients in the non-ENI group,it was 65.8 Gy(P<0.05).The responsive rates were 45.8% and 74.0%(P<0.05),and the rate of the elective nodal failure (ENF)was 4.2% and 11.1%,respectively.Kaplan-Meier analysis showed that the mean local-progression-free survival time was 11.0 and 15.0 months,and one-year local-failure rates were 51.9% and 24.5%(P<0.05).The median overall survival time was 13.0 and 15.0 months,respectively (P=0.084).The one-year survival rates were 55.7% and 72.5%,and two-year survival rates were 0% and 19.9%.There was no significant difference in the occurrences of radiation-associated complications between the two groups.Our results showed that omitting elective nodal irradiation did not result in a high incidence of elective nodal failure.On the contrary,it decreased local failure by increasing prescription doses to the primary diseases and lymphadenopaphy,and thereby it may further prolong the patients' survival.

  7. Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC).

    Science.gov (United States)

    Nkanga, Mireille Solange Nganga; Longo-Mbenza, Benjamin; Adeniyi, Oladele Vincent; Ngwidiwo, Jacques Bikaula; Katawandja, Antoine Lufimbo; Kazadi, Paul Roger Beia; Nzonzila, Alain Nganga

    2017-08-23

    The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4-4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2-12.1; P types included acute myeloid leukaemia (28.6% n = 18), multiple myeloma (22.2% n = 14), myelodysplastic syndromes (15.9% n = 10), chronic myeloid leukaemia (15.9% n = 10), chronic lymphoid leukaemia (9.5% n = 6), and acute lymphoid leukaemia (7.9% n = 5). After adjusting for confounders using Cox regression analysis, age ≥ 55 years, exposure to pollution, combined local dry season + La Nina and combined local dry season + El Nino were the most significant predictors of

  8. Local recurrence after surgery for non-small cell lung cancer: a recursive partitioning analysis of multi-institutional data.

    Science.gov (United States)

    Kelsey, Chris R; Higgins, Kristin A; Peterson, Bercedis L; Chino, Junzo P; Marks, Lawrence B; D'Amico, Thomas A; Varlotto, John M

    2013-10-01

    To define subgroups at high risk of local recurrence (LR) after surgery for non-small cell lung cancer using a recursive partitioning analysis (RPA). This Institutional Review Board-approved study included patients who underwent upfront surgery for I-IIIA non-small cell lung cancer at Duke Cancer Institute (primary set) or at other participating institutions (validation set). The 2 data sets were analyzed separately and identically. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered an LR. Recursive partitioning was used to build regression trees for the prediction of local recurrence-free survival (LRFS) from standard clinical and pathological factors. LRFS distributions were estimated with the Kaplan-Meier method. The 1411 patients in the primary set had a 5-year LRFS rate of 77% (95% confidence interval [CI], 0.74-0.81), and the 889 patients in the validation set had a 5-year LRFS rate of 76% (95% CI, 0.72-0.80). The RPA of the primary data set identified 3 terminal nodes based on stage and histology. These nodes and their 5-year LRFS rates were as follows: (1) stage I/adenocarcinoma, 87% (95% CI, 0.83-0.90); (2) stage I/squamous or large cell, 72% (95% CI, 0.65-0.79); and (3) stage II-IIIA, 62% (95% CI, 0.55-0.69). The validation RPA identified 3 terminal nodes based on lymphovascular invasion (LVI) and stage: (1) no LVI/stage IA, 82% (95% CI, 0.76-0.88); (2) no LVI/stage IB-IIIA, 73% (95% CI, 0.69-0.80); and (3) LVI, 58% (95% CI, 0.47-0.69). The risk of LR was similar in the primary and validation patient data sets. There was discordance between the 2 data sets regarding the clinical factors that best segregate patients into risk groups. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  9. Palliative radiotherapy in locally advanced head and neck cancer after failure of induction chemotherapy: Comparison of two fractionation schemes

    Directory of Open Access Journals (Sweden)

    Kailash Chandra Pandey

    2013-01-01

    Full Text Available Context: Among patients with locally advanced head and neck squamous cell cancers (LAHNSCC, the prognosis after nonresponse or progression despite induction chemotherapy (IC is dismal, and further treatment is often palliative in intent. Given that nonresponse to chemotherapy could indicate subsequent radioresistance, we intended to assess the outcomes with two different fractionation schemes. Aims: To compare the outcomes of two fractionation schemes- ′standard′ (consisting 3GyX5 daily fractions for 2 consecutive weeks versus ′hybrid′ (6GyX3 fractions on alternate days during the 1 st week, followed by 2GyX5 daily fractions in the 2 nd week. Settings and Design: Prospective randomized controlled two-arm unblinded trial. Materials and Methods: Patients with locally advanced oropharyngeal, laryngeal, and hypopharyngeal cancers treated with a minimum of two cycles of taxane, platinum, and fluorouracil-based IC were eligible if residual disease volume amounted >30 cm 3 . Kaplan-Meier survival curves were compared by the log-rank test. Response rates were compared using the unpaired t-test. Quality of life (QOL was measured via patient reported questionnaires. Results: Of the initially enrolled 51 patients, 45 patients (24 from standard arm, and 21 from the hybrid arm were eligible for analysis. Despite being underpowered to attain statistical significance, there still seemed to be a trend towards improvement in progression-free (Hazard ratio (HR for progression: 0.5966; 95% CI 0.3216-1.1066 and overall survival (HR for death: 0.6062; 95% CI 0.2676-1.3734 with the hybrid arm when compared to the standard arm. Benefits were also observed with regards to response rates and QOL. Rate of complications were similar in both arms. Conclusions: In comparison to the routinely used palliative fractionation scheme of 30 Gray (Gy in 10 fractions (Fr, the use of hybrid fractionation which integrates hypofractionation in the 1 st week, followed by

  10. Phenol-Soluble Modulins Contribute to Early Sepsis Dissemination Not Late Local USA300-Osteomyelitis Severity in Rabbits.

    Directory of Open Access Journals (Sweden)

    Benjamin Davido

    Full Text Available In bone and joint infections (BJIs, bacterial toxins are major virulence factors: Panton-Valentine leukocidin (PVL expression leads to severe local damage, including bone distortion and abscesses, while α-hemolysin (Hla production is associated with severe sepsis-related mortality. Recently, other toxins, namely phenol-soluble modulins (PSMs expressed by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA strain USA300 (LAC WT were shown to have ex vivo intracellular cytotoxic activity after S. aureus invasion of osteoblasts, but their in vivo contribution in a relatively PVL-sensitive osteomyelitis model remains poorly elucidated.We compared the outcomes of experimental rabbit osteomyelitises induced with pvl+hla+psms+ LAC WT and its isogenic Δpsm derivatives (LAC Δpsmα and LAC Δpsmαβhld using an inoculum of 3 × 108 CFUs. Mortality, hematogenous spread (blood culture, spleen and kidney, lung and bone involvements were assessed in two groups (non-survivors of severe sepsis and survivors sacrificed on day (D 14.Severe sepsis-related mortality tended to be lower for Δpsm derivatives (Kaplan-Meier curves, P = .06. Non-survivors' bone LAC-Δpsmα (6.9 log10 CFUs/g of bone, P = .04 or -Δpsmαβhld (6.86 log10 CFUs/g of bone, P = .014 densities were significantly higher than LAC WT (6.43 log10 CFUs/g of bone. Conversely, lung Δpsmαβhld CFUs were significantly lower than LAC WT (P = .04. LAC Δpsmα, Δpsmαβhld and WT induced similar bone damage in D14 survivors, with comparable bacterial densities (respectively: 5.89, 5.91, and 6.15 log10 CFUs/g of bone. Meanwhile, pulmonary histological scores of inflammation were significantly higher for LAC Δpsmα- and Δpsmαβhld-infected rabbits compared to LAC WT (P = .04 and .01, respectively but with comparable lung bacterial densities.Our experimental results showed that deactivating PSM peptides significantly limited bacterial dissemination from bone during the early

  11. Substance Abuse among High-Risk Sexual Offenders: Do Measures of Lifetime History of Substance Abuse Add to the Prediction of Recidivism over Actuarial Risk Assessment Instruments?

    Science.gov (United States)

    Looman, Jan; Abracen, Jeffrey

    2011-01-01

    There has been relatively little research on the degree to which measures of lifetime history of substance abuse add to the prediction of risk based on actuarial measures alone among sexual offenders. This issue is of relevance in that a history of substance abuse is related to relapse to substance using behavior. Furthermore, substance use has…

  12. Recursos tecnológicos y actividades no presenciales para un mejor aprendizaje de la Estadística Actuarial

    Directory of Open Access Journals (Sweden)

    Antonio Fernández Morales

    2010-12-01

    Full Text Available En este artículo se describe el diseño y los resultados obtenidos con una estrategia didáctica innovadora para el aprendizaje de la Estadística Actuarial en la licenciatura de Ciencias Actuariales y Financieras de la Universidad de Málaga. Mediante un uso intensivo de actividades no presenciales y elementos tecnológicos que favorecen el aprendizaje en movilidad se pretende potenciar el aprendizaje autónomo, colaborativo y contextualizado. Para ello se han diseñado, entre otras, actividades de identificación y asimilación de competencias, un laboratorio virtual de supervivencia basado en un simulador gráfico interactivo y un microportal para dispositivos iPhone y iPod touch de Apple.

  13. Properties of actuarially fair and pay-as-you-go health insurance schemes for the elderly. An OLG model approach.

    Science.gov (United States)

    Johansson, P O

    2000-07-01

    The aged dependency ratio or ADR is growing at a fast pace in many countries. This fact causes stress to the economy and might create conflicts of interest between young and old. In this paper the properties of different health insurance systems for the elderly are analysed within an overlapping generations (OLG) model. The properties of actuarial health insurance and different variations of pay-as-you-go (PAYG) health insurance are compared. It turns out that the welfare properties of these contracts are heavily dependent on the economy's dynamic properties. Of particular importance is the magnitude of the rate of population growth relative to the interest rate. In addition, it is shown that public health insurance is associated with an inherent externality resulting in a second-best solution.

  14. Clinical outcomes following 3D image-guided brachytherapy for vaginal recurrence of endometrial cancer.

    Science.gov (United States)

    Lee, Larissa J; Damato, Antonio L; Viswanathan, Akila N

    2013-12-01

    To evaluate clinical outcomes for women with recurrent endometrial cancer treated with 3D image-guided brachytherapy 44 women, of whom 13 had received prior RT, received salvage RT for vaginal recurrence from 9/03 to 8/11. HDR or LDR interstitial brachytherapy was performed under MR or CT guidance in 35 patients (80%); 9 (20%) had CT-guided HDR cylinder brachytherapy. The median cumulative dose in EQD2 was 75.5 Gy. Actuarial estimates of local failure (LF), disease-free (DFS) and overall survival (OS) were calculated by Kaplan-Meier. Histologic subtypes were endometrioid (EAC, 33), papillary serous/clear cell (UPSC/CC, 5) and carcinosarcoma (CS, 6). The 2-year DFS/OS rates were 75%/89% for EAC and 11%/24% for UPSC/CC/CS (both pradiotherapy. 3D image-guided brachytherapy results in excellent local control for women with recurrent endometrial cancer, particularly with cumulative EQD2 doses greater than 70 Gy. Successful salvage of vaginal recurrence is related to tumor grade and histologic subtype. © 2013.

  15. 国内外高校精算教育的比较研究%The Comparative Study on Actuarial Education and Foreign Universities

    Institute of Scientific and Technical Information of China (English)

    张薏; 李玮

    2011-01-01

    2010年12月14日,国际精算协会(IAA)接纳中国精算师协会(CAA)成为其第63位正式单位会员。2011年3月17日,中国精算师协会(CAA)与英国精算师协会(I&FA)签署了精算考试相互认可备忘录。这标志着中国精算师资格考试在通往国际化的道路上迈出了实质性的步伐,中国的精算教育正在逐步获得国际标准的认可。随着市场经济的发展,对精算教育的要求也会越来越高。高校教育只是精算教育的一个方面,只有与职业教育相配合,与业界共同努力,才能培养出优秀的精算专业人才。%In December 14,2010, International Actuarial Association (IAA) accepted China Association of Ac-tuaries(CAA) as its sixty- third formal members of units. In March 17,2011, CAA and the British Association of Actuaries (I&FA) signed a memorandum of mutual recognition of actuarial exams. This series of events undoubtedly marks the Chinese actuarial qualification examination has stepped materiality pace to the road of internationaliza- tion, and the Chinese actuarial education is gradually gaining the recognition of international standards. This paper compares the actuarial education development status m the domestic and foreign universities, analyzes some existing problems of the current college education in training plan, teaching practice, foreign exchange and other aspects in domestic, and puts forward some ideas to integration with the international actuarial education in the future.

  16. [Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study].

    Science.gov (United States)

    Martínez-Ramos, David; Fortea-Sanchis, Carlos; Escrig-Sos, Javier; Prats-de Puig, Miguel; Queralt-Martín, Raquel; Salvador-Sanchis, José Luís

    2014-01-01

    Antecedentes: la cirugía conservadora es un patrón de referencia del tratamiento de la mayor parte de los tumores mamarios en estadios iniciales. Sin embargo, una minoría de pacientes intervenidas con esta opción tendrá recurrencia local o locorregional. Por ello resulta de interés evaluar los posibles factores relacionados con esta recurrencia. Material y métodos: estudio retrospectivo, con base poblacional, efectuado con base en los datos del Registro de Tumores de Castellón (Comunidad Valenciana, España) de pacientes intervenidas de cáncer primario de mama no metastático de enero de 2000 a diciembre de 2008. Se utilizaron las curvas de Kaplan-Meier y la prueba de log-rank para estimar la recurrencia local a cinco años. Se definieron dos grupos de pacientes, uno con cirugía conservadora y otro con cirugía no conservadora de la mama. Se realizó un estudio multivariado de Cox. Resultados: se encontraron 410 pacientes con promedio de 6.8% de recurrencias locales. En el análisis univariado sólo el tamaño tumoral y la afectación ganglionar demostraron diferencias significativas. En el análisis multivariado los factores pronóstico independientes fueron: la cirugía conservadora (Hazard ratio [HR] 4.62; IC [intervalo de confianza] 95% 1.12-16.82), el número de ganglios linfáticos positivos (HR 1.07; IC 95% 1.01-1.17) y el tamaño del tumor en milímetros (HR 1.02; IC 95% 1.01-1.06). Conclusiones: la recurrencia local postcirugía conservadora de mama es mayor en tumores de más de 2 cm. Aunque el tamaño del tumor no debería ser una contraindicación para esta cirugía sí deben tomarse en cuenta como un factor de riesgo.

  17. ANÁLISIS ACTUARIAL DE LA INDEMNIZACIÓN POR NECESIDAD DE AYUDA DE TERCERA PERSONA ESTABLECIDA EN LA LEY 35/2015, DE 22 DE SEPTIEMBRE

    Directory of Open Access Journals (Sweden)

    Olga Gómez Pérez-Cacho

    2016-06-01

    Full Text Available La Ley 35/2015, de 22 de septiembre, establece un nuevo sistema para la valoración de los daños y perjuicios causados a las personas en accidentes de circulación, el cual incluye indemnizaciones cuya finalidad es compensar los perjuicios patrimoniales que sufren los perjudicados, ya se trate de lucro cesante o de daño emergente.Conforme a lo establecido en la propia Ley, las más relevantes de esas indemnizaciones requieren una valoración actuarial, siendo ese el caso de la indemnización por necesidad de ayuda de tercera persona. El presente trabajo tiene por objeto analizar la metodología de valoración actuarial que, para esta indemnización, se incluye en las “Bases Técnicas Actuariales del Baremo” y los resultados que se obtienen en el marco de los principios y criterios que la Ley 35/2015 establece con carácter general para el sistema y, en particular, para dicha indemnización. The Law 35/2015, September 22nd, establishes a new system for valuation of traffic accident victims damages which includes compensations of economic damages (loss of income/profit or emerging damage. According to the Law, the more relevant of these compensations require actuarial valuation. The compensation for victims requiring third party aid is one of them. In this paper, we analyze the actuarial valuation methodology that the “Bases Técnicas Actuariales del Baremo” (Scale Actuarial Technical Basis set to calculate this compensation, as well as the assumed biometric, economic and financial hypothesis and the obtained results. The framework for this is the set of principles and criteria which the Law 35/2015 establishes in general for the system and in particular for this compensation.

  18. Sobrevida e fatores prognósticos de pacientes com câncer de próstata clinicamente localizado Sobrevida y factores pronósticos de pacientes con cáncer de próstata clínicamente localizado Survival and prognostic factors of patients with clinically localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Arn Migowski

    2010-04-01

    -tratamiento fueron calculados hazard ratios (HR e intervalos con 95% de confianza, siguiéndose el modelo de riesgos proporcionales de Cox. El presupuesto de esos riesgos fue evaluado por el análisis de los residuos de Schoenfeld y la influencia de valores aberrantes por los residuos martingala y escore. RESULTADOS: De los 258 pacientes estudiados, 46 fueron a óbito durante el período de seguimiento. La sobrevida global fue de 88% en cinco años y de 71% en diez. La clasificación de Gleason mayor que 6, PSA mayor que 40ng/mL, estadio B2 y color de la piel blanca fueron marcadores independientes de peor pronóstico. CONCLUSIONES: La clasificación de Gleason, el toque rectal y el valor del PSA poseen gran poder predictivo y deben ser utilizados en la estratificación del riesgo pre-tratamiento de los pacientes con cáncer de próstata localizado.OBJECTIVE: To assess survival rates and clinical (pretreatment prognostic factors in patients with clinically localized adenocarcinoma of the prostate. METHODS: Hospital cohort including 258 patients registered in the National Cancer Institute, in the city of Rio de Janeiro, southeastern Brazil, from 1990 to 1999. Five- and ten-year survival functions were estimated using the Kaplan-Meier estimator from the histological diagnosis (initial time of follow-up to death due to prostate cancer (events. Prognostic factors were assessed using hazard ratios (HR with confidence intervals of 95%, following the Cox's proportional hazards model. The assumption of proportionality of risks was tested using Schoenfeld residuals and the impact of outliers in the model fitness was analyzed using martingale and score residuals. RESULTS: Of 258 patients studied, 46 died during follow-up. The overall five-year and ten-year survival rates were 88% and 71%, respectively. A Gleason score higher than 6, PSA levels higher than 40 ng/mL, B2 stage, and white skin color were independent markers of poor prognosis. CONCLUSIONS: Gleason score, digital rectal examination

  19. Risk Factors for Brain Metastases in Locally Advanced Non-Small Cell Lung Cancer With Definitive Chest Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Zhe; Bi, Nan; Wang, Jingbo; Hui, Zhouguang; Xiao, Zefen; Feng, Qinfu; Zhou, Zongmei; Chen, Dongfu; Lv, Jima; Liang, Jun; Fan, Chengcheng; Liu, Lipin; Wang, Luhua, E-mail: wlhwq@yahoo.com

    2014-06-01

    Purpose: We intended to identify risk factors that affect brain metastases (BM) in patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving definitive radiation therapy, which may guide the choice of selective prevention strategies. Methods and Materials: The characteristics of 346 patients with stage III NSCLC treated with thoracic radiation therapy from January 2008 to December 2010 in our institution were retrospectively reviewed. BM rates were analyzed by the Kaplan-Meier method. Multivariate Cox regression analysis was performed to determine independent risk factors for BM. Results: The median follow-up time was 48.3 months in surviving patients. A total of 74 patients (21.4%) experienced BM at the time of analysis, and for 40 (11.7%) of them, the brain was the first site of failure. The 1-year and 3-year brain metastasis rates were 15% and 28.1%, respectively. In univariate analysis, female sex, age ≤60 years, non-squamous cell carcinoma, T3-4, N3, >3 areas of lymph node metastasis, high lactate dehydrogenase and serum levels of tumor markers (CEA, NSE, CA125) before treatment were significantly associated with BM (P<.05). In multivariate analysis, age ≤60 years (P=.004, hazard ratio [HR] = 0.491), non-squamous cell carcinoma (P=.000, HR=3.726), NSE >18 ng/mL (P=.008, HR=1.968) and CA125 ≥ 35 U/mL (P=.002, HR=2.129) were independent risk factors for BM. For patients with 0, 1, 2, and 3 to 4 risk factors, the 3-year BM rates were 7.3%, 18.9%, 35.8%, and 70.3%, respectively (P<.001). Conclusions: Age ≤60 years, non-squamous cell carcinoma, serum NSE >18 ng/mL, and CA125 ≥ 35 U/mL were independent risk factors for brain metastasis. The possibilities of selectively using prophylactic cranial irradiation in higher-risk patients with LA-NSCLC should be further explored in the future.

  20. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience.

    Science.gov (United States)

    Patel, Uday B; Taylor, Fiona; Blomqvist, Lennart; George, Christopher; Evans, Hywel; Tekkis, Paris; Quirke, Philip; Sebag-Montefiore, David; Moran, Brendan; Heald, Richard; Guthrie, Ashley; Bees, Nicola; Swift, Ian; Pennert, Kjell; Brown, Gina

    2011-10-01

    To assess magnetic resonance imaging (MRI) and pathologic staging after neoadjuvant therapy for rectal cancer in a prospectively enrolled, multicenter study. In a prospective cohort study, 111 patients who had rectal cancer treated by neoadjuvant therapy were assessed for response by MRI and pathology staging by T, N and circumferential resection margin (CRM) status. Tumor regression grade (TRG) was also assessed by MRI. Overall survival (OS) was estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging of good and poor responders on MRI or pathology and survival outcomes after controlling for patient characteristics. On multivariate analysis, the MRI-assessed TRG (mrTRG) hazard ratios (HRs) were independently significant for survival (HR, 4.40; 95% CI, 1.65 to 11.7) and disease-free survival (DFS; HR, 3.28; 95% CI, 1.22 to 8.80). Five-year survival for poor mrTRG was 27% versus 72% (P = .001), and DFS for poor mrTRG was 31% versus 64% (P = .007). Preoperative MRI-predicted CRM independently predicted local recurrence (LR; HR, 4.25; 95% CI, 1.45 to 12.51). Five-year survival for poor post-treatment pathologic T stage (ypT) was 39% versus 76% (P = .001); DFS for the same was 38% versus 84% (P = .001); and LR for the same was 27% versus 6% (P = .018). The 5-year survival for involved pCRM was 30% versus 59% (P = .001); DFS, 28 versus 62% (P = .02); and LR, 56% versus 10% (P = .001). Pathology node status did not predict outcomes. MRI assessment of TRG and CRM are imaging markers that predict survival outcomes for good and poor responders and provide an opportunity for the multidisciplinary team to offer additional treatment options before planning definitive surgery. Postoperative histopathology assessment of ypT and CRM but not post-treatment N status were important postsurgical predictors of outcome.

  1. Benefits of intra-operative systemic chemotherapy during curative surgery in patients with locally advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-bin; YU Jian-chun; MA Zhi-qiang; KANG Wei-ming; ZHOU Li; YE Xin

    2013-01-01

    Background There is little information on the impact of intra-operative systemic chemotherapy on gastric cancer.The aim of this study was to identify prognostic factors in patients with locally advanced gastric cancer and undergoing curative resection,with a focus on evaluating survival benefits and tolerance of intra-operative systemic chemotherapy.Methods We retrospectively analyzed clinicopathological data for 264 consecutive patients who underwent curative resection for gastric cancer at Peking Union Medical College Hospital from January 2002 to January 2007.Survival curves were plotted using the Kaplan-Meier method and compared using log-rank tests.Univariate and multivariate analyses were performed with the Cox proportional hazard model.Results Patients who received intra-operative systemic chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P=0.019 and 0.010,respectively) than patients who did not receive intra-operative systemic chemotherapy.In the subgroup analysis,systemic intra-operative chemotherapy benefited the 5-year overall survival and disease-free survival rates for patients with cancer of stage pTNM ⅠB-ⅢB,but not stage pTNM ⅢC.Patients who received intra-operative systemic chemotherapy in combination with post-operative chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P=0.046 and 0.021,respectively) than patients who only received postoperative chemotherapy.However,the difference in these rates between patients who received only intra-operative systemic chemotherapy and patients who only received curative surgery was not statistically significant (P=0.150 and 0.170,respectively).Multivariate analyses showed that intra-operative systemic chemotherapy was a favorable prognostic factor for the overall survival and disease-free survival rates (P =0.048 and 0.023,respectively).No grade 4 toxicities related to intra-operative systemic chemotherapy were recorded within the

  2. Comparison of FDG PET metabolic tumour volume versus ADC histogram: prognostic value of tumour treatment response and survival in patients with locally advanced uterine cervical cancer.

    Science.gov (United States)

    Ueno, Yoshiko; Lisbona, Robert; Tamada, Tsutomu; Alaref, Amer; Sugimura, Kazuro; Reinhold, Caroline

    2017-07-01

    To evaluate the prognostic utility of volume-based parameters of fluorine-18 fludeoxyglucose positron emission tomography ((18)F-FDG PET) and apparent diffusion coefficient (ADC) histogram analysis for tumour response to therapy and event-free survival (EFS) in patients with uterine cervical cancer receiving chemoradiotherapy. The study included 21 patients diagnosed with locally advanced uterine cervical cancer who underwent pre-treatment MRI and (18)F-FDG PET and were treated with concurrent chemoradiotherapy. (18)F-FDG parameters: maximum and mean standardized uptake value; metabolic tumour volume (MTV); total lesion glycolysis (TLG); ADC parameters: maximum, mean and minimum values; percentile ADC values (10-90%); skewness and kurtosis of ADC were measured and compared between the responder and non-responder groups using a Wilcoxon rank-sum test. The Cox regression analysis and Kaplan-Meier survival curves were performed for EFS analysis. MTV and TLG of the primary tumour were significantly higher in the non-responder group than in the responder group (p = 0.04 and p = 0.01). Applying Cox regression multivariate analysis, MTV [hazard ratio (HR), 4.725; p = 0.036], TLG (HR, 4.725; p = 0.036) and 10-percentile ADC (HR, 5.207; p = 0.048) showed a statistically significant association with EFS. With the optimal cut-off value, the EFS rates above the cut-off value for MTV and TLG were significantly lower than that below the cut-off value (p = 0.002 and p = 0.002). Pre-treatment volume-based quantitative parameters of (18)F-FDG PET may have better potential than ADC histogram for predicting treatment response and EFS in patients with locally advanced cervical cancer. Advances in knowledge: In this study, pre-treatment volume-based quantitative parameters of (18)F-FDG PET had better potential than ADC histogram for predicting treatment response and survival in patients with locally advanced cervical cancer.

  3. Stereotactic Body Radiation Therapy for Re-irradiation of Persistent or Recurrent Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Minatel, Emilio; Durofil, Elena [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Polesel, Jerry [Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Avanzo, Michele [Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Baresic, Tania [Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Bearz, Alessandra [Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Del Conte, Alessandro [Department of Medical Oncology, Pordenone General Hospital, Aviano, Pordenone (Italy); Franchin, Giovanni; Gobitti, Carlo; Rumeileh, Imad Abu; Trovo, Mauro G. [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)

    2014-04-01

    Purpose: To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity. Methods and Materials: The analysis was conducted in 17 patients with “in-field” recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test. Results: The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05). Conclusions: Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.

  4. [Hypofractionation in locally advanced breast cancer: "flash" scheme].

    Science.gov (United States)

    Padilha, Marisa; Gonçalves, Sara; Fardilha, Carlos; Melo, Gilberto; Miranda, Cristina; Alves, Paula

    2013-01-01

    Introdução: O carcinoma da mama é uma das principais causas de morte no nosso país. No Serviço de Radioterapia do Instituto Português de Oncologia de Coimbra de Coimbra utilizamos, desde há mais de 30 anos, um esquema de hipofraccionamento de radioterapia, denominado “Flash”, como opção terapêutica em doentes idosos ou com baixo Performance Status, portadores de carcinoma da mama localmente avançado ou com estádios IIb ou IV, com intenção neoadjuvante ou paliativa. Objectivos: Avaliar a resposta ao tratamento, nomeadamente sobrevivência global aos três anos, resposta local e toxicidades aguda e crónica, no grupo de doentes seleccionados submetidos a esquema de hipofraccionamento, em estudo retrospectivo. Metodologia: Entre Janeiro de 2006 e Dezembro de 2008, um total de 83 doentes com diagnóstico de Carcinoma da Mama Localmente Avançado ou com estádios IIb ou IV, foi submetido a “Flash” mamário. A dose de radioterapia prescrita foi de 13Gy / 2Fr / 3 dias (em 23 doentes - 27,7%) e 26Gy / 4Fr / 2,5 semanas (em 60 doentes - 72,3%), com fotões de 4 MV, sobre a mama afectada. Foi avaliada sobrevivência global segundo o método de Kaplan-Meier. A análise estatística foi efectuada através da aplicação SPSS, versão 17.0 e os testes estatísticos foram avaliados ao nível de significância de 5%. Resultados: 80 doentes (96,4%) que efectuaram “Flash” mamário eram do género feminino, com idades compreendidas entre os 59 e os 93 anos (idade média 80,72 + 5,87 anos) e Performance Status (Karnosfsky: 0 - 100) entre 90 e 50%. Em 72 doentes (86,7%) o diagnóstico histológico foi Carcinoma Ductal Invasivo. A cirurgia após a realização do “Flash” Mamário foi realizada em 44 doentes (53%) após evidência de resposta local à radioterapia, sendo a Mastectomia Radical Modificada a técnica cirúrgica mais frequente. Efectuou-se o diagnóstico de metastização óssea em 10 doentes (12%), sendo que a taxa de sobrevivência global foi

  5. TU-CD-BRB-08: Radiomic Analysis of FDG-PET Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated with SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Y; Shirato, H [Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan); Song, J; Pollom, E; Chang, D; Koong, A [Stanford University, Palo Alto, CA (United States); Li, R [Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan); Stanford University, Palo Alto, CA (United States)

    2015-06-15

    Purpose: This study aims to identify novel prognostic imaging biomarkers in locally advanced pancreatic cancer (LAPC) using quantitative, high-throughput image analysis. Methods: 86 patients with LAPC receiving chemotherapy followed by SBRT were retrospectively studied. All patients had a baseline FDG-PET scan prior to SBRT. For each patient, we extracted 435 PET imaging features of five types: statistical, morphological, textural, histogram, and wavelet. These features went through redundancy checks, robustness analysis, as well as a prescreening process based on their concordance indices with respect to the relevant outcomes. We then performed principle component analysis on the remaining features (number ranged from 10 to 16), and fitted a Cox proportional hazard regression model using the first 3 principle components. Kaplan-Meier analysis was used to assess the ability to distinguish high versus low-risk patients separated by median predicted survival. To avoid overfitting, all evaluations were based on leave-one-out cross validation (LOOCV), in which each holdout patient was assigned to a risk group according to the model obtained from a separate training set. Results: For predicting overall survival (OS), the most dominant imaging features were wavelet coefficients. There was a statistically significant difference in OS between patients with predicted high and low-risk based on LOOCV (hazard ratio: 2.26, p<0.001). Similar imaging features were also strongly associated with local progression-free survival (LPFS) (hazard ratio: 1.53, p=0.026) on LOOCV. In comparison, neither SUVmax nor TLG was associated with LPFS (p=0.103, p=0.433) (Table 1). Results for progression-free survival and distant progression-free survival showed similar trends. Conclusion: Radiomic analysis identified novel imaging features that showed improved prognostic value over conventional methods. These features characterize the degree of intra-tumor heterogeneity reflected on FDG

  6. Association of loss of epithelial syndecan-1 with stage and local metastasis of colorectal adenocarcinomas: An immunohistochemical study of clinically annotated tumors

    Directory of Open Access Journals (Sweden)

    Skacel Marek

    2008-06-01

    Full Text Available Abstract Background Syndecan-1 is a transmembrane proteoglycan with important roles in cell-cell and cell-extracellular matrix adhesion and as a growth factor co-receptor. Syndecan-1 is highly expressed by normal epithelial cells and loss of expression has been associated with epithelial-mesenchymal transition and the transformed phenotype. Loss of epithelial syndecan-1 has been reported in human colorectal adenocarcinomas, but whether this has prognostic significance remains undecided. Here we have examined syndecan-1 expression and its potential prognostic value with reference to a clinically annotated tissue microarray for human colon adenocarcinomas. Methods Syndecan-1 expression was examined by immunohistochemistry of a tissue microarray containing cores from 158 colorectal adenocarcinomas and 15 adenomas linked to a Cleveland Clinic, IRB-approved database with a mean clinical follow-up of 38 months. The Kaplan-Meier method was used to analyze the relationship between syndecan-1 expression and patient survival. Potential correlations between syndecan-1 expression and the candidate prognostic biomarker fascin were examined. Results Syndecan-1 is expressed at the basolateral borders of normal colonic epithelial cells. On adenocarcinoma cells, syndecan-1 was present around cell membranes and in cytoplasm. In 87% of adenocarcinomas, syndecan-1 was decreased or absent; only 13% of patients had stained for syndecan-1 on more than 75% of tumor cells. Decreased syndecan-1 correlated with a higher TNM stage and lymph node metastasis and was more common in males (p = 0.042, but was not associated with age, tumor location or Ki67 index. Reduced tumor syndecan-1 staining also correlated with upregulation of stromal fascin (p = 0.016. Stromal syndecan-1 was observed in 16.6% of tumors. There was no difference in survival between patients with low or high levels of either tumor or stromal syndecan-1. Conclusion Syndecan-1 immunoreactivity was decreased

  7. Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients: An observational study of 10-year experience.

    Science.gov (United States)

    Lee, Jie; Lin, Jhen-Bin; Sun, Fang-Ju; Chen, Yu-Jen; Chang, Chih-Long; Jan, Ya-Ting; Wu, Meng-Hao

    2017-03-01

    Patients with locally advanced cervical cancer (LACC) are at risk of para-aortic lymph node (PALN) metastasis. Pelvic concurrent chemoradiotherapy, the current standard treatment for LACC, has a PALN failure rate of 9% according to the Radiation Therapy Oncology Group Trial 90-01, suggesting that it may not completely eliminate all microscopic tumors in the PALNs. To minimize the toxicities associated with conventional prophylactic extended-field radiotherapy, our institute use prophylactic semiextended field radiotherapy that includes only the PALNs below the level of the renal vessels. Use of intensity-modulated radiotherapy (IMRT) is another means of reducing the incidence of toxicity. This study evaluated the safety and efficacy of prophylactic semiextended field IMRT (SEF-IMRT) and concurrent cisplatin chemotherapy in patients with LACC.We retrospectively assessed survival and toxicity in 76 patients with stage IB2-IVA cervical cancer and negative PALNs who received prophylactic SEF-IMRT and concurrent weekly cisplatin (40 mg/m) between 2004 and 2013. The region targeted by SEF-IMRT included the PALNs below the level of the renal vessels, and the prescribed dose was 50.4 Gy in 28 fractions. Brachytherapy was administered at a dose of 30 Gy in 6 fractions. Survival outcomes were calculated by using the Kaplan-Meier method, and acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 3.0.All patients completed the planned SEF-IMRT, as well as brachytherapy. Acute grade ≥3 gastrointestinal, genitourinary, and hematologic toxicities were observed in 2, 0, and 41 patients, respectively. The median follow-up time after SEF-IMRT was 55 (range, 11-124) months. Eight patients developed out-field distant recurrences without PALN failure, and 1 patient experienced out-field PALN failure with simultaneous distant metastasis. No patients had late genitourinary toxicities, and 3 patients had late grade 3

  8. Modelo actuarial para estimar la tasa de interés justa/óptima de un financiamiento automotriz

    Directory of Open Access Journals (Sweden)

    Robert Hernández Martínez

    2014-01-01

    Full Text Available El presente modelo actuarial de tasa de interés justa, pondera de manera equilibrada el precio del dinero - tanto para un prestamista, como para el solicitante - en donde ninguna de las partes resulta más beneficiada en perjuicio de la otra. De este modo, sea cual sea la elección del enganche y plazo que el cliente decida, siempre obtendrá el precio óptimo del financiamiento solicitado. La función Z = f(x,y representa a la variable de tasa de interés justa, en donde ambas partes tendrían una relación del tipo “ganar - ganar”; es decir, que ambas partes resultan mutuamente beneficiadas de la operación crediticia y en la cual ninguna de ellas obtiene ventaja en perjuicio de su contraparte. El precio justo del crédito automotriz se encuentra sobre la superficie de una gráfica de tres dimensiones cuyos puntos óptimos convergen en el vector (x,y,z; que determina la tasa de interés i, para un crédito sano. El diseño de un modelo computacional permite que el usuario interactúe con las variables de enganche y plazo, para conocer cómo influyen en el comportamiento de su crédito; tanto en el pago mensual, como en los intereses, impuestos y seguros; ofreciéndole una corrida financiera a lo largo del plazo contratado. Así, el modelo actuarial es totalmente dinámico ya que se adapta a los escenarios que se propongan. Corolario de lo anterior, resulta que cualquier punto fuera de la superficie óptima de la gráfica implicaría una ventaja/desventaja para alguna de las partes; por lo que el presente modelo permite realizar análisis de sensibilidad para tomar decisiones ANTES de celebrar la operación, considerando diferentes escenarios para las variables (x,y; de este modo, el modelo representa una herramienta de PREVISIÓN e incluso de PREVENCIÓN para la toma de mejores decisiones financieras.

  9. 中国精算的早期历史:从“Actuary”到“精算师”%The Early History of Chinese Actuarial Profession: From the Term of Actuary to Jingsuanshi (Accurate Calculating Master)

    Institute of Scientific and Technical Information of China (English)

    谢志刚

    2016-01-01

    术语“Actuary”于1775年出现于英国,用于命名人寿保险公司中一种特殊而关键的职务,这种职务逐渐形成一种专门职业.鸦片战争后,上海开埠,英商“永福人寿(Standard Life Assurance Co.)”和“永年人寿(China Mutual Life Insurance Co.)”于1898年在沪上设立(分)公司,两家公司的负责人都是英国的Actuary.之后的1912年,我国民族资本设立的人寿保险公司从上海发端,开始有中国人从事Actuary工作,并在上世纪三十年代初被称为“精算师”.1936年6月,上海保险同业公会设立“寿险精算委员会”,是我国第一个精算师职业团体.本文以此脉络梳理我国保险业的发展,还原我国精算师职业的真实历史和应有国际地位.

  10. Calculo y comparacion de la prima de un reaseguro de salud usando el modelo de opciones de Black-Scholes y el modelo actuarial

    Directory of Open Access Journals (Sweden)

    Luis Eduardo Giron

    2015-12-01

    Full Text Available La presente investigación pretende calcular y comparar la prima de un reaseguro  usando el modelo de opciones de Black-Scholes y el modelo clásico actuarial tradicional. El período de análisis va desde enero de 2011 hasta diciembre de 2012. Los resultados obtenidos muestran que el modelo de Black-Scholes, que se utiliza normalmente para valorar opciones financieras, puede ser también usado para la estimación de primas de reaseguros de salud; y que la prima neta estimada a partir de este modelo se aproxima a las establecidas por el método actuarial, excepto cuando el deducible del reaseguro es muy alto (por encima de $200.000.000.

  11. The Development and Validation of an Actuarial Risk Assessment Tool for the Prediction of First-Time Offending.

    Science.gov (United States)

    Assink, Mark; van der Put, Claudia E; Stams, Geert Jan J M

    2016-05-01

    For prevention purposes, it is important that police officers can estimate the risk for delinquency among juveniles who were involved in a criminal offense, but not in the role of a suspect. In the present study, the Youth Actuarial Risk Assessment Tool for First-Time Offending (Y-ARAT-FO) was developed based solely on police records with the aim to enable Dutch police officers to predict the risk for first-time offending. For the construction of this initial screening instrument, an Exhaustive Chi-squared Automatic Interaction Detector (Exhaustive CHAID) analysis was performed on a data set that was retrieved from the Dutch police system. The Y-ARAT-FO was developed on a sample of 1,368 juveniles and validated on a different sample of 886 juveniles showing moderate predictive accuracy in the validation sample (area under the receiver operating characteristic curve [AUC] = .728). The predictive accuracy of the Y-ARAT-FO was considered sufficient to justify its use as an initial screening instrument by the Dutch police.

  12. An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost.

    Science.gov (United States)

    Pyenson, Bruce S; Sander, Marcia S; Jiang, Yiding; Kahn, Howard; Mulshine, James L

    2012-04-01

    Lung cancer screening is not established as a public health practice, yet the results of a recent large randomized controlled trial showed that screening with low-dose spiral computed tomography reduces lung cancer mortality. Using actuarial models, this study estimated the costs and benefits of annual lung cancer screening offered as a commercial insurance benefit in the high-risk US population ages 50-64. Assuming current commercial reimbursement rates for treatment, we found that screening would cost about $1 per insured member per month in 2012 dollars. The cost per life-year saved would be below $19,000, an amount that compares favorably with screening for cervical, breast, and colorectal cancers. Our results suggest that commercial insurers should consider lung cancer screening of high-risk individuals to be high-value coverage and provide it as a benefit to people who are at least fifty years old and have a smoking history of thirty pack-years or more. We also believe that payers and patients should demand screening from high-quality, low-cost providers, thus helping set an example of efficient system innovation.

  13. Treatment referral for sex offenders based on clinical judgment versus actuarial risk assessment: match and analysis of mismatch.

    Science.gov (United States)

    Smid, Wineke J; Kamphuis, Jan Henk; Wever, Edwin C; Van Beek, Daan

    2013-07-01

    The Risk Need Responsivity (RNR) principles (Andrews & Bonta, 2010) dictate that higher risk sex offenders should receive more intensive treatment. The present study investigates how clinically based treatment assignment relates to risk level in a sex offender sample from The Netherlands. Correlational analyses served to identify sources of mismatches: that is, variables differing significantly in their relation between treatment selection and risk level. Our study sample consisted of 194 convicted rapists and 214 convicted child molesters. All participants' criminal files were retrospectively coded in terms of the items of the STATIC-99R, PCL: SV, and SVR-20. A low to moderate correlation was observed between clinical treatment selection and actuarial risk levels. A substantial part of the sex offenders, especially child molesters, received overly intensive treatment and another substantial part, especially rapists, received treatment of lesser intensity than indicated by their risk levels. General violent and antisocial risk factors seemed to be underemphasized in the clinical evaluation of sex offenders, especially rapists. A negative attitude toward intervention was negatively associated with clinical treatment selection. It is concluded that clinical treatment selection leads to an insufficient match between risk level and treatment level and systematic use of validated structured risk assessment instruments is necessary to ensure optimal adherence to the risk principle.

  14. 保险精算课程内容设置的研究%The research about the teaching content setting of actuarial science course

    Institute of Scientific and Technical Information of China (English)

    闫达文; 宋立新; 朱安妮

    2013-01-01

    For the setting of the actuarial science course′s teaching content proposed the principle that some parts should be extended and the others should be contracted conversely,and designed the three main lines of the teaching based on the principle.Within the short class period,this course could reveal systematically the application of the actuarial methods in the risk management of the financial institutions including insurance.Made the students hold the clear purpose and strong interest throughout leaning the actuarial course,improved the teaching effect and quality.%针对保险精算课程教学内容的设置,提出有“收”、有“放”原则,并依此设计了三条授课主线。在有限的课时内,系统地揭示精算方法在保险公司等金融机构风险管理中的运用过程,保证学生的学习目标始终明确,保持强烈的学习兴趣,从而提高了教学效果和质量。

  15. Radiotherapy and chemotherapy in the treatment of head and neck cancer: results after five years of a randomized study

    Energy Technology Data Exchange (ETDEWEB)

    Santarelli, M.; Raffetto, N.; Torcia, P.; Vitturini, A.; Tombolini, V.; Maurizi Enrici, R. [Istituto di radiologia Universita Roma ' ' La Sapienza' ' , Rome (Italy)

    1999-11-01

    Purpose: this study was undertaken to evaluate the efficacy of two regimens of chemoradiotherapy in the treatment of locally advanced head and neck cancer. Methods: from 1992 to 1997, 127 patients with locally advanced head and neck cancer (stage III-IV) were randomized. Sixty-six patients (group a), 42 male and 24 female, with a median age of 48 years (range 40-72) received during radiotherapy two courses (1.-6. week) of chemotherapy with carbo-platin (300 mg/m{sup 2} day 1) and etoposide (60 mg/m{sup 2} days 1 to 3). Sixty-one patients (group b), 40 male and 21 female, with a median age of 51 years (range 42-69) received two cycles of chemotherapy with 5 FU (750 mg/m{sup 2} days 1 to 5) and MIT C ( 10 mg/m{sup 2} day 1). The median dose of radiotherapy was 60 Gy (range 55-66 Gy) 180 cGy /d 5w. Results: the actuarial five-year survival rate(Kaplan-Meier) was 38 % for group a (CBDCA+etoposide+RT) and 25 % for group b (5FU+MIT C+RT). The difference was statistically significant (p = 0.036). Toxicity group a: mucositis G III in 41 patients and G IV in 16; dysphagia G III in 46 patients and IV in 5; leukopenia in 24 patients; 28 patients required nutritional therapy. Toxicity group b: mucositis G III in 38 patients and G IV in 17; dysphagia G III in 48 patients and G IV in 3; leukopenia in 23 patients; 25 patients needed nutritional therapy. Conclusions: the data of the actuarial survival five-year rate suggest that concomitant chemotherapy in group a (CBDCA+etoposide+RT) is better than the concomitant chemotherapy in group b (5FU+MIT C+RT). (author)

  16. Fibroblast growth factor 2 is of prognostic value for patients with locally advanced squamous cell carcinoma of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Rades, D.; Seibold, N.D. [University of Luebeck, Department of Radiation Oncology, Luebeck (Germany); Gebhard, M.P.; Noack, F. [University of Luebeck, Institute of Pathology, Luebeck (Germany); Schild, S.E. [Mayo Clinic Scottsdale, Department of Radiation Oncology, Scottsdale (United States)

    2014-01-15

    Patients with locally advanced SCCHN have a poor prognosis. This study investigated the prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients treated with surgery followed by radiotherapy. The impact of FGF-2-expression and 11 additional potential prognostic factors on loco-regional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively evaluated in 146 patients. Additional factors included age, gender, performance status, pre-radiotherapy hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papilloma virus (HPV) status, extent of resection, and chemotherapy. Univariate analyses were performed with the Kaplan-Meier method and the log-rank test, multivariate analyses with the Cox proportional hazard model. On multivariate analysis, improved LRC was significantly associated with FGF-2-negativity [risk ratio (RR): 7.33; 95 %-confidence interval (CI): 2.88-19.05; p < 0.001], lower T-category (RR: 2.42; 95 %-CI: 1.47-4.33; p < 0.001), lower N-category (RR: 12.36; 95 %-CI: 3.48-78.91; p < 0.001), and pre-radiotherapy hemoglobin levels ≥12 g/dl (RR: 4.18; 95 %-CI: 1.73-10.53; p = 0.002). No factor was significantly associated with improved MFS. Lower T-category showed a trend (RR: 1.59; 95 %-CI: 0.97-2.82; p = 0.069). Better OS was significantly associated with FGF-2-negativity (RR: 5.10; 2.22-11.80; p < 0.001), lower T-category (RR: 2.17; 95 %-CI: 1.38-3.68; p < 0.001), lower N-category (RR: 3.86; 95 %-CI: 1.60-10.85; p = 0.002), and pre-radiotherapy hemoglobin levels ≥12 g/dl (RR: 3.20; 95 %-CI: 1.46-7.30; p = 0.004). HPV-positivity showed a trend (RR: 2.36; 95 %-CI: n.a.; p = 0.054). Tumor cell expression of FGF-2 proved to be an independent prognostic factor for LRC and OS. This factor can help personalize treatment and stratify patients in future trials. (orig.)

  17. Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy.

    Science.gov (United States)

    Russo, Andrea L; Arvold, Nils D; Niemierko, Andrzej; Wong, Nathan; Wong, Julia S; Bellon, Jennifer R; Punglia, Rinaa S; Golshan, Mehra; Troyan, Susan L; Brock, Jane E; Harris, Jay R

    2013-07-01

    We sought to assess whether a close surgical margin (>0 and <2 mm) after breast-conserving therapy (BCT) confers an increased risk of local recurrence (LR) compared with a widely negative margin (≥2 mm). We studied 906 women with early-stage invasive breast cancer treated with BCT between January 1998 and October 2006; 91 % received adjuvant systemic therapy. Margins were coded as: (1) widely negative (n = 729), (2) close (n = 85), or (3) close (n = 84)/positive (n = 8) but having no additional tissue to remove according to the surgeon. Cumulative incidence of LR and distant failure (DF) were calculated using the Kaplan-Meier method. Gray's competing-risk regression assessed the effect of margin status on LR and Cox proportional hazards regression assessed the effect on DF, controlling for biologic subtype, age, and number of positive lymph nodes (LNs). Three hundred seventy-seven patients (41.6 %) underwent surgical re-excision, of which 63.5 % had no residual disease. With a median follow-up of 87.5 months, the 5-year cumulative incidence of LR was 2.5 %. The 5-year cumulative incidence of LR by margin status was 2.3 % (95 % CI 1.4-3.8 %) for widely negative, 0 % for close, and 6.4 % (95 % CI 2.7-14.6 %) for no additional tissue, p = 0.3. On multivariate analysis, margin status was not associated with LR; however, triple-negative subtype (AHR 3.7; 95 % CI 1.6-8.8; p = 0.003) and increasing number of positive LNs (AHR 1.6; 95 % CI 1.1-2.3; p = 0.025) were associated. In an era of routine adjuvant systemic therapy, close surgical margins and maximally resected close/positive margins were not associated with an increased risk of LR compared to widely negative margins. Additional studies are needed to confirm this finding.

  18. Dose-Volume Analysis of Predictors for Gastrointestinal Toxicity After Concurrent Full-Dose Gemcitabine and Radiotherapy for Locally Advanced Pancreatic Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Huang Jiayi [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Robertson, John M., E-mail: jrobertson@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Ye Hong [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Margolis, Jeffrey; Nadeau, Laura [Division of Medical Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Yan Di [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2012-07-15

    Purpose: To identify dosimetric predictors for the development of gastrointestinal (GI) toxicity in patients with locally advanced pancreatic adenocarcinoma (LAPC) treated with concurrent full-dose gemcitabine and radiotherapy (GemRT). Methods and Materials: From June 2002 to June 2009, 46 LAPC patients treated with definitive GemRT were retrospectively analyzed. The stomach and duodenum were retrospectively contoured separately to determine their dose-volume histogram (DVH) parameters. GI toxicity was defined as Grade 3 or higher GI toxicity. The follow-up time was calculated from the start of RT to the date of death or last contact. Univariate analysis (UVA) and multivariate analysis (MVA) using Kaplan-Meier and Cox regression models were performed to identify risk factors associated with GI toxicity. The receiver operating characteristic curve and the area under the receiver operating characteristic curve (AUC) were used to determine the best DVH parameter to predict for GI toxicity. Results: Of the patients, 28 (61%) received concurrent gemcitabine alone, and 18 (39%) had concurrent gemcitabine with daily erlotinib. On UVA, only the V{sub 20Gy} to V{sub 35Gy} of duodenum were significantly associated with GI toxicity (all p {<=} 0.05). On MVA, the V{sub 25Gy} of duodenum and the use of erlotinib were independent risk factors for GI toxicity (p = 0.006 and 0.02, respectively). For the entire cohort, the V{sub 25Gy} of duodenum is the best predictor for GI toxicity (AUC = 0.717), and the 12-month GI toxicity rate was 8% vs. 48% for V{sub 25Gy} {<=} 45% and V{sub 25Gy} > 45%, respectively (p = 0.03). However, excluding the erlotinib group, the V{sub 35Gy} is the best predictor (AUC = 0.725), and the 12-month GI toxicity rate was 0% vs. 41% for V{sub 35Gy} {<=} 20% and V{sub 35Gy} > 20%, respectively (p = 0.04). Conclusions: DVH parameters of duodenum may predict Grade 3 GI toxicity after GemRT for LAPC. Concurrent use of erlotinib during GemRT may increase GI

  19. RTOG 0417: Efficacy of Bevacizumab in Combination With Definitive Radiation Therapy and Cisplatin Chemotherapy in Untreated Patients With Locally Advanced Cervical Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Schefter, Tracey, E-mail: tracey.schefter@ucdenver.edu [University of Colorado, Denver, Aurora, Colorado (United States); Winter, Kathryn [RTOG Statistical Center, Philadelphia, Pennsylvania (United States); Kwon, Janice S. [University of British Columbia and BC Cancer Agency, Vancouver, British Columbia (Canada); Stuhr, Kelly [University of Colorado, Denver, Aurora, Colorado (United States); Balaraj, Khalid [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia); Yaremko, Brian Patrick [Western University, London Regional Cancer Program, London, Ontario (Canada); Small, William [Loyola University Chicago Stritch School of Medicine, Chicago, Illinois (United States); Sause, William [Intermountain Medical Center, Murray, Utah (United States); Gaffney, David [University of Utah Health Sciences Center, Salt Lake City, Utah (United States)

    2014-01-01

    Purpose: Radiation Therapy Oncology Group 0417 was a phase II study that explored the safety and efficacy of the addition of bevacizumab to chemoradiation therapy. The safety results have been previously reported. Herein we report the secondary efficacy endpoints of overall survival (OS), locoregional failure (LRF), para-aortic nodal failure (PAF), distant failure (DF), and disease-free survival (DFS). Methods and Materials: Eligible patients with bulky Stage IB-IIIB disease were treated with once-weekly cisplatin (40 mg/m{sup 2}) chemotherapy and standard pelvic radiation therapy and brachytherapy. Bevacizumab was administered at 10 mg/kg intravenously every 2 weeks for 3 cycles during chemoradiation. For OS, failure was defined as death of any cause and was measured from study entry to date of death. LRF was defined as any failure in the pelvis. PAF was defined as any para-aortic nodal failure. DF was analyzed both including and excluding PAF. DFS was measured from study entry to date of first LRF. DF was measured with or without PAF or death. OS and DFS were estimated by the Kaplan-Meier method, and LRF and DF rates were estimated by the cumulative incidence method. Results: 49 eligible patients from 28 institutions were enrolled between 2006 and 2009. The median follow-up time was 3.8 years (range, 0.8-6.0 years). The surviving patients had a median follow-up time of 3.9 years (range, 2.1-6.0 years). Most patients had tumors of International Federation of Gynecology and Obstetrics Stage IIB (63%), and 80% were squamous. The 3-year OS, DFS, and LRF were 81.3% (95% confidence interval [CI], 67.2%-89.8%), 68.7% (95% CI, 53.5%-79.8%), and 23.2% (95% CI, 11%-35.4%), respectively. The PAF, DF without PAF, and DF with PAF at 3 years were 8.4% (95% CI, 0.4%-16.3%), 14.7% (95% CI, 4.5%-24.9%), and 23.1% (95% CI 11.0%-35.2%), respectively. Conclusion: In this study, bevacizumab in combination with standard pelvic chemoradiation therapy for locally advanced cervical

  20. Impact of Dose to the Bladder Trigone on Long-Term Urinary Function After High-Dose Intensity Modulated Radiation Therapy for Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ghadjar, Pirus; Zelefsky, Michael J.; Spratt, Daniel E. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Munck af Rosenschöld, Per; Oh, Jung Hun; Hunt, Margie [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Kollmeier, Marisa [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Happersett, Laura; Yorke, Ellen; Deasy, Joseph O. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Jackson, Andrew, E-mail: jacksona@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-02-01

    Purpose: To determine the potential association between genitourinary (GU) toxicity and planning dose–volume parameters for GU pelvic structures after high-dose intensity modulated radiation therapy in localized prostate cancer patients. Methods and Materials: A total of 268 patients who underwent intensity modulated radiation therapy to a prescribed dose of 86.4 Gy in 48 fractions during June 2004-December 2008 were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Dose–volume histograms of the whole bladder, bladder wall, urethra, and bladder trigone were analyzed. The primary endpoint for GU toxicity was an IPSS sum increase ≥10 points over baseline. Univariate and multivariate analyses were done by the Kaplan-Meier method and Cox proportional hazard models, respectively. Results: Median follow-up was 5 years (range, 3-7.7 years). Thirty-nine patients experienced an IPSS sum increase ≥10 during follow-up; 84% remained event free at 5 years. After univariate analysis, lower baseline IPSS sum (P=.006), the V90 of the trigone (P=.006), and the maximal dose to the trigone (P=.003) were significantly associated with an IPSS sum increase ≥10. After multivariate analysis, lower baseline IPSS sum (P=.009) and increased maximal dose to the trigone (P=.005) remained significantly associated. Seventy-two patients had both a lower baseline IPSS sum and a higher maximal dose to the trigone and were defined as high risk, and 68 patients had both a higher baseline IPSS sum and a lower maximal dose to the trigone and were defined as low risk for development of an IPSS sum increase ≥10. Twenty-one of 72 high-risk patients (29%) and 5 of 68 low-risk patients (7%) experienced an IPSS sum increase ≥10 (P=.001; odds ratio 5.19). Conclusions: The application of hot spots to the bladder trigone was significantly associated with relevant changes in IPSS during follow-up. Reduction of radiation dose to the lower bladder and specifically the

  1. Actuarial Assessment of Sex Offender Recidivism Risk: A Validation of the German version of the Static-991

    Directory of Open Access Journals (Sweden)

    Martin Rettenberger

    2006-12-01

    Full Text Available The Static-99 and the RRASOR are actuarial risk assessment tools for evaluating the risk of sexual and violent recidivism in sexual offenders. The Static-99 was developed in 1999 by Karl R. Hanson (Canada and David Thornton (Great Britain and is in the mean time regularly used for risk assessment in North America and some countries in Europe. The RRASOR can be described as a predecessor of the Static-99 and was published by Hanson in 1997. At first we translated the revised version of the Static-99 (Harris, Phenix, Hanson & Thornton, 2003 and adapted the instrument and the manual to the forensic context in Germany and Austria (Rettenberger & Eher, 2006. In this retrospective study, interrater reliability and concurrent validity of the RRASOR and of the German adaption of the Static-99 is presented. Furthermore we evaluated the predictive accuracy of the Static-99 and the RRASOR and compared their results. The instruments were validated from file information of Austrian sexuel offenders, who were convicted between 1968 and 2002. Both the Static-99 and the RRASOR had good interrater reliability and concurrent validity. The Static-99 showed good predictive validity for general (r = .41, AUC = .74, sexual (r = .35, AUC = .74 and violent (r = .41, AUC = .76 recidivism, whereas the predictive accuracy of the RRASOR was moderate for general (r = .29, AUC = .66, sexual (r = .30, AUC = .68 and violent (r = .28, AUC = .67 recidivism. The Static-99 exhibited a higher accuracy for the prediction of sexual offender recidivism. Although further validation studies on German-speaking populations of sex offenders are necessary, these results support the utility of the German version of the revised version of the Static-99 in improving risk assessment of sexual offenders.

  2. The 434(G>C) polymorphism in the eosinophil cationic protein gene and its association with tissue eosinophilia in oral squamous cell carcinomas

    DEFF Research Database (Denmark)

    Pereira, Michele C; Oliveira, Denise T; Olivieri, Eloísa H R

    2010-01-01

    variables. METHODS: The ECP genotypes of 165 healthy individuals and 157 OSCC patients were detected by PCR-RFLP analysis after cleavage of the amplified DNA sequence with enzyme PstI. TATE was obtained by morphometric analysis. Chi-square test or Fisher's exact test was used to analyze the association...... of ECP-gene polymorphism 434(G>C) with TATE, demographic, clinical, and microscopic variables in OSCC patients. Disease-free survival and overall survival were calculated by the Kaplan-Meier product-limit actuarial method and the comparison of the survival curves were performed using log rank test...

  3. From Meehl (1954) to fast and frugal heuristics (and back) : new insights into how to bridge the clinical-actuarial divide

    OpenAIRE

    Konstantinos V. Katsikopoulos; Pachur, Thorsten; Machery, Edouard; Wallin, Annika

    2008-01-01

    It is difficult to overestimate Paul Meehl’s influence on judgment and decision-making research. His ‘disturbing little book’ (Meehl, 1986, p. 370) Clinical versus Statistical Prediction: A Theoretical Analysis and a Review of the Evidence (1954) is known as an attack on human judgment and a call for replacing clinicians with actuarial methods. More than 40 years later, fast and frugal heuristics—proposed as models of human judgment—were formalized, tested, and found to be surprisingly accura...

  4. Análisis Actuarial de la indemnización por necesidad de ayuda de tercera persona prevista en la Ley 35/2015

    OpenAIRE

    Gómez Pérez-Cacho, Olga; Moreno Ruiz, Rafael; Trigo Martínez, Eduardo

    2016-01-01

    La Ley 35/2015, de 22 de septiembre, establece un nuevo sistema para la valoración de los daños y perjuicios causados a las personas en accidentes de circulación, el cual incluye indemnizaciones cuya finalidad es compensar los perjuicios patrimoniales que sufren los perjudicados, ya se trate de lucro cesante o de daño emergente. Conforme a lo establecido en la propia Ley, las más relevantes de esas indemnizaciones requieren una valoración actuarial, siendo ése el caso de la indemnización ...

  5. Offering Lung Cancer Screening to High-Risk Medicare Beneficiaries Saves Lives and Is Cost-Effective: An Actuarial Analysis

    Science.gov (United States)

    Pyenson, Bruce S.; Henschke, Claudia I.; Yankelevitz, David F.; Yip, Rowena; Dec, Ellynne

    2014-01-01

    Background By a wide margin, lung cancer is the most significant cause of cancer death in the United States and worldwide. The incidence of lung cancer increases with age, and Medicare beneficiaries are often at increased risk. Because of its demonstrated effectiveness in reducing mortality, lung cancer screening with low-dose computed tomography (LDCT) imaging will be covered without cost-sharing starting January 1, 2015, by nongrandfathered commercial plans. Medicare is considering coverage for lung cancer screening. Objective To estimate the cost and cost-effectiveness (ie, cost per life-year saved) of LDCT lung cancer screening of the Medicare population at high risk for lung cancer. Methods Medicare costs, enrollment, and demographics were used for this study; they were derived from the 2012 Centers for Medicare & Medicaid Services (CMS) beneficiary files and were forecast to 2014 based on CMS and US Census Bureau projections. Standard life and health actuarial techniques were used to calculate the cost and cost-effectiveness of lung cancer screening. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures. Results Approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately 3 years. Based on our analysis, the average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. LDCT screening for lung cancer in Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years is low cost, at approximately $1 per member per month. This assumes that 50% of these patients were screened. Such screening is also highly cost-effective, at <$19,000 per life

  6. Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Peter [Liverpool Hospital, Department of Nuclear Medicine and PET, Liverpool BC, NSW (Australia); University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Western Sydney University, Sydney, NSW (Australia); Min, Myo; Forstner, Dion [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Lee, Mark [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Holloway, Lois [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Western Sydney University, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Bray, Victoria; Fowler, Allan [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia)

    2017-05-15

    To evaluate the prognostic utility of nodal metabolic parameters derived from FDG PET/CT performed before radiotherapy (prePET) and during the third week of radiotherapy (iPET) in patients with mucosal primary head and neck squamous cell carcinoma (MPHNSCC). This analysis included 75 patients with newly diagnosed locally advanced node-positive MPHNSCC treated with radical radiotherapy and concurrent systemic therapy who underwent prePET and iPET: N1 11 patients, N2a 38, N2b 12, N2c 9, N3 5. The median follow-up was 28 months (9 - 70 months). The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of the index lymph node (node with the highest TLG) and the combined total lymph nodes, and their percentage reductions on iPET were determined, and the results were correlated with 3-year Kaplan-Meier locoregional, regional and distant metastatic failure-free survival (FFS), disease-free survival (DFS) and overall survival (OS). Optimal cut-off values were derived from receiver operating characteristic curves. Cox regression univariate and multivariate analyses with clinical covariates were performed. Based on assessment of residual nodal metabolic burden during treatment, the iPET index node SUVmean (optimal cut-off value 2.95 g/ml) and the total node SUVmean (optimal cut-off value 3.25) were the best independent predictors of outcome in the multivariate analysis: index node SUVmean for DFS and OS p = 0.033 and 0.003, respectively, and the total node SUVmean for locoregional FFS, DFS and OS p = 0.028, 0.025 and 0.014, respectively. Based on the assessment of response rates during treatment, a reduction of more than 50 % in the total node TLG was the best biomarker for locoregional and regional FFS, DFS and OS in the multivariate analysis (p = 0.001, 0.016, 0.001 and 0.004, respectively), and reduction in the total node MTV for locoregional FFS, DFS and OS (p = 0.026, 0.003 and 0

  7. Thoughts and some suggestions about actuarial science education in China colleges%对我国高校精算教育现状的思考与几点建议

    Institute of Scientific and Technical Information of China (English)

    朱江红; 王金花

    2011-01-01

    总结了我国高校精算教育在扣多年的发展历程中所取得的成绩,分析了我国高校精算教育发展的现状,并对存在的一些问题提出了一些建议。%This article summarized the results of the developing of the actuarial science education of China colleges and,universities during the 2 decades, discussed the current situation of our actuarial science education, and provided some suggestions according to the problems.

  8. Tablas de vida para cálculo actuarial de rentas vitalicias y retiro programado. Costa Rica circa 2000

    Directory of Open Access Journals (Sweden)

    Luis Rosero Bixby

    2004-01-01

    Full Text Available Se presentan las tablas completas de mortalidad de Costa Rica del periodo 1995- 2000 y se describe el procedimiento seguido en su estimación. Este procedimiento incluye una evaluación detallada de la información básica, especialmente de los errores censales de declaración de la edad entre los adultos mayores. Predominan los errores de exageración de la edad, los cuales inflan la población de edades avanzadas, especialmente de los 80 años en adelante. Por ejemplo, la población de 95 años y más de edad del censo está inflada en 22%. Las tablas de vida incluyen una extrapolación de la mortalidad para edades mayores de 100 años. Con una muestra de alrededor de 7 mil adultos mayores se determina que el patrón de mortalidad de los derecho-habientes de pensión es menor que el de la población general. La esperanza de vida al nacer de hombres y mujeres resultó de 74,6 y 79,4 años, respectivamente y a la edad 60 fue de 20,6 y 23,2 años, respectivamente, en toda la población de Costa Rica, y de 22,0 y 25,3 años entre los derecho-habientes de pensión. Para tomar en cuenta la disminución de la mortalidad que probablemente ocurrirá en el futuro en Costa Rica se recomienda usar la tabla de vida proyectada para 2020-25. Se seleccionó este periodo porque la esperanza de vida a la edad 65 es muy parecida a la estimada para la cohorte de nacidos en 1940, la cual se considera representativa de quienes se pensionarán en el corto y mediano plazo. Se presenta la tabla completa de 2020-25, corregida por la menor mortalidad de los derecho-habientes, para que sea utilizada en el cálculo actuarial de pensiones vitalicias y retiro programado en el periodo 2000-5. La esperanza de vida a la edad 60 en esta tabla resultó de 23,6 para los hombres y 26,8 para las mujeres, es decir, unos tres años más altas que las estimadas para la población de Costa Rica 1995-2000. Se recomienda actualizar estas estimaciones cada 5 años.

  9. Tablas de vida para cálculo actuarial de rentas vitalicias y retiro programado. Costa Rica circa 2000

    Directory of Open Access Journals (Sweden)

    Rosero-Bixby, Luis

    2004-01-01

    Full Text Available Se presentan las tablas completas de mortalidad de Costa Rica del periodo 1995-2000 y se describe el procedimiento seguido en su estimación. Este procedimiento incluye una evaluación detallada de la información básica, especialmente de los errores censales de declaración de la edad entre los adultos mayores. Predominan los errores de exageración de la edad, los cuales inflan la población de edades avanzadas, especialmente de los 80 años en adelante. Por ejemplo, la población de 95 años y más de edad del censo está inflada en 22%. Las tablas de vida incluyen una extrapolación de la mortalidad para edades mayores de 100 años. Con una muestra de alrededor de 7 mil adultos mayores se determina que el patrón de mortalidad de los derecho-habientes de pensión es menor que el de la población general. La esperanza de vida al nacer de hombres y mujeres resultó de 74,6 y 79,4 años, respectivamente y a la edad 60 fue de 20,6 y 23,2 años, respectivamente, en toda la población de Costa Rica, y de 22,0 y 25,3 años entre los derecho-habientes de pensión. Para tomar en cuenta la disminución de la mortalidad que probablemente ocurrirá en el futuro en Costa Rica se recomienda usar la tabla de vida proyectada para 2020-25. Se seleccionó este periodo porque la esperanza de vida a la edad 65 es muy parecida a la estimada para la cohorte de nacidos en 1940, la cual se considera representativa de quienes se pensionarán en el corto y mediano plazo. Se presenta la tabla completa de 2020-25, corregida por la menor mortalidad de los derecho-habientes, para que sea utilizada en el cálculo actuarial de pensiones vitalicias y retiro programado en el periodo 2000-5. La esperanza de vida a la edad 60 en esta tabla resultó de 23,6 para los hombres y 26,8 para las mujeres, es decir, unos tres años más altas que las estimadas para la población de Costa Rica 1995-2000. Se recomienda actualizar estas estimaciones cada 5 años.

  10. Research on Actuarial Models about Reform of Endowment Insurance about Institutional Organization in China%事业单位养老保险制度改革精算模型研究

    Institute of Scientific and Technical Information of China (English)

    任勇

    2015-01-01

    从中国事业单位养老保险改革实践出发,在西方寿险精算理论和精算模型基础上,分别建立事业单位养老保险制度改革过程中关于新人、中人和即将退休人员的养老保险精算模型。并分别给出关于新人、中人和即将退休人员的养老保险应由事业单位和政府财政需要补贴资金精算现值的计算公式。%Based on the practice of reform of endowment insurance about Institutional Organization in China , actuarial theory of life insurance and actuarial models in the West,actuarial models about the newcomer,men-in-service and retiring staff are set up respectively,and the actuarial present values of subsidy due to Institutional Or⁃ganization and Government fiscal revenue are given too,aiming at the purpose of providing the basis for the re-form.

  11. Duración del tratamiento con etanercept y razones de discontinuación en una cohorte de pacientes con patología reumática

    OpenAIRE

    2011-01-01

    [EN]: [Objective]: To evaluate the duration of etanercept (ETN) treatment and motives for discontinuation in our local cohort of patients with rheumatic pathology and compare them to the group with other biological treatments. [Patients and methods]: Prospective observational cohort study. Disease diagnosis, start and end date and motive for discontinuation were recorded. Survival estimation was explored using Kaplan-Meier analysis with remaining patients censored at 1-year, 2-years and 5-yea...

  12. Survival benefit of early androgen receptor inhibitor therapy in locally advanced prostate cancer

    DEFF Research Database (Denmark)

    Thomsen, Frederik B; Brasso, Klaus; Christensen, Ib J

    2015-01-01

    -metastatic PCa. Kaplan-Meier analysis was used to estimate overall survival (OS) and multivariate Cox proportional hazard model was performed to analyse time-to-event (death). FINDINGS: A total of 1218 patients were included into the Scandinavian Prostate Cancer Group (SPCG)-6 study of which 607 were randomised......BACKGROUND: The optimal timing of endocrine therapy in non-metastatic prostate cancer (PCa) is still an issue of debate. METHODS: A randomised, double-blind, parallel-group trial comparing bicalutamide 150mg once daily with placebo in addition to standard care in patients with hormone-naïve, non...... disease (HR=1.19 (95% CI: 1.00-1.43), p=0.056). However, a survival gain from bicalutamide therapy was present in patients with localised disease and a baseline PSA greater than 28ng/mL at randomisation. In multivariate Cox proportional hazard model, only including patients managed on watchful waiting...

  13. Dose-Painted Intensity-Modulated Radiation Therapy for Anal Cancer: A Multi-Institutional Report of Acute Toxicity and Response to Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kachnic, Lisa A., E-mail: lisa.kachnic@bmc.org [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Tsai, Henry K. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Coen, John J. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hartshorn, Kevan [Department of Medicine, Boston Medical Center, Boston, MA (United States); Kwak, Eunice L. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Willins, John D. [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hong, Theodore S. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

    2012-01-01

    Purpose: Chemoradiation for anal cancer yields effective tumor control, but is associated with significant acute toxicity. We report our multi-institutional experience using dose-painted IMRT (DP-IMRT). Patients and Methods: Between August 2005 and May 2009, 43 patients were treated with DP-IMRT and concurrent chemotherapy for biopsy-proven, squamous cell carcinoma of the anal canal at two academic medical centers. DP-IMRT was prescribed as follows: T2N0: 42 Gy, 1.5 Gy/fraction (fx) to elective nodal planning target volume (PTV) and 50.4 Gy, 1.8 Gy/fx to anal tumor PTV; T3-4N0-3: 45 Gy, 1.5 Gy/fx to elective nodal PTV, and 54 Gy, 1.8 Gy/fx to the anal tumor and metastatic nodal PTV >3 cm with 50.4 Gy, 1.68 Gy/fx to nodal PTVs {<=}3 cm in size. Acute and late toxicity was reported by the treating physician. Actuarial analysis was performed using the Kaplan-Meier method. Results: Median age was 58 years; 67% female; 16% Stage I, 37% II; 42% III; 5% IV. Fourteen patients were immunocompromised: 21% HIV-positive and 12% on chronic immunosuppression. Median follow-up was 24 months (range, 0.6-43.5 months). Sixty percent completed chemoradiation without treatment interruption; median duration of treatment interruption was 2 days (range, 2-24 days). Acute Grade 3+ toxicity included: hematologic 51%, dermatologic 10%, gastrointestinal 7%, and genitourinary 7%. Two-year local control, overall survival, colostomy-free survival, and metastasis-free survival were 95%, 94%, 90%, and 92%, respectively. Conclusions: Dose-painted IMRT appears effective and well-tolerated as part of a chemoradiation therapy regimen for the treatment of anal canal cancer.

  14. 基于期权定价视角的医疗保险精算原理与方法%The Principle and Method of Medical Insurance Actuarial and Its Application Based on Option Pricing Theory

    Institute of Scientific and Technical Information of China (English)

    郑红

    2011-01-01

    期权定价与精算定价还存在一定差异,如何克服这些差异并建立适合于医疗保险精算特点的期权定价模型是本文研究的出发点.将期权定价与精算技术整合于医疗保险精算领域,通过规范的经济分析将纯保费测算问题转化为期权定价问题,将医疗保险纯保费看成是一个特珠的欧式看涨期权价格.利用医疗保险精算的期权定价方法,从评估保险人的损失和相应概率入手确定医疗保险的纯保费,通过对模型的适当修正,实现考虑免赔额、共同保险和赔偿限额的纯保费期权定价,为医疗保险精算提供了一个新颖的分析工具,进一步拓展了医疗保险精算方法的研究.最后利用卫生部统计中心数据,基于历年人均医疗费用水平测算了我国居民需缴纳的门诊社区费率,为我国医疗改革和医疗保险实践提供理论参考和决策支持.%Option pricing and actuarial pricing also exist certain differences. The starting point of this paper is to explore how to overcome these differences to establish an option pricing modelsuitable to insurance actuarial characteristics. The option pricing and actuarial technique are integrated in medical insurance actuarial fields, by turning the pure premium actuarial problem into an option pricing issues , and health insurance pure premiums into a special European call option prices through the specification of economic analysis. Using the option pricing method of medical insurance actuarial, the paper determines pure health insurance premiums from payoff of the insurer and the corresponding probability to get the pure premium pricing eonsidering the deductibles, coinsurance and compensaion limits through appropriate amendments to the model, and to provide a new analysis tool for medical insurance actuarial, and further expansion of the medical insurance actuarial methods. Finally Community-based health Care fee are calculated using the statistics from the

  15. 巨灾期权的保险精算定价探析%Analysis of Actuarial Pricing for Catastrophe Insurance Options

    Institute of Scientific and Technical Information of China (English)

    谢世清; 梅云云

    2011-01-01

    巨灾期权定价理论的滞后是阻碍其市场发展的重要原因之一。利用保险精算原理为巨灾期权定价具有一定优势,并可以借鉴寿险精算中的生命表技术来编制巨灾指数分布表。本文首先从保险精算的角度推导出了巨灾期权的理论定价公式;其次利用巨灾指数分布表对巨灾期权进行了保险精算实证定价;最后比较分析了巨灾指数分布表和寿险生命表。%The lagging pricing models of catastrophe insurance options have hindered the market development. This paper argues that the actuarial pricing method has some advantages and proposes that the preparation of catastrophe index distribution table can learn f

  16. Actuarial Analysis of Social Security Pension Fund Balance%社会保障养老金平衡的精算研究

    Institute of Scientific and Technical Information of China (English)

    郭翠; 柳向东; 王蕙

    2011-01-01

    The social security pension balance problem is one of the popular topics. On the basis of part accumulation system , overall social planing and individual account, using the standard of China's current actual situation, survival theory and cash flow method , modifies the existing social security model and establishes a new social security pension balance actuarial model are studied. Furthermore, the social security pension balance and fund gap are discussed.%社会保障养老金的平衡问题是社会的一个热点问题之一.在部分积累制的基础上,分别对社会统筹账户和个人账户进行研究.以中国目前实际情况为标准,运用生存理论和现金流方法,对已有社会保障模型进行修改,建立一个新的社会保障养老金平衡的精算模型.并在该模型下,对社会保障养老金平衡和基金缺口进行了讨论.

  17. Sex offender treatment outcome, actuarial risk, and the aging sex offender in Canadian corrections: a long-term follow-up.

    Science.gov (United States)

    Olver, Mark E; Nicholaichuk, Terry P; Gu, Deqiang; Wong, Stephen C P

    2013-08-01

    The present study is an examination of sex offender treatment outcome in a large national cohort of Canadian Federally incarcerated sex offenders followed up an average of 11.7 years postrelease. A brief actuarial risk scale (BARS), which predicted sexual and violent recidivism, was created for the purposes of the present study to control for risk-related differences between treated and untreated offenders. In total, 732 offenders were identified as having completed (n = 625) or not attended (n = 107) a sex offender treatment program and for whom sufficient information was available to complete the scale. Controlling for risk and individual differences in follow-up time using Cox regression survival analyses and an 8-year fixed follow-up period, treated sex offenders demonstrated significantly lower rates of violent, but not sexual, recidivism. When the treated and untreated groups were stratified by risk level, significant differences were observed only among moderate or high risk offenders. Some significant group differences also emerged on indicators of recidivism severity, with treated offenders demonstrating slower times to sexual reoffense and lower scores on a quantified metric of sexual and violent recidivism severity after controlling for risk. Differences in recidivism base rates between treated and untreated offenders were also larger in magnitude for younger offenders (i.e., under age 50 at release), than for older offenders; however, interactions between age and treatment were not found. The findings are consistent with the risk principle and have possible implications regarding the dynamic nature of sexual violence risk.

  18. Propuesta de formulación financiero-actuarial de un seguro de dependencia y acercamiento a una aplicación práctica

    Directory of Open Access Journals (Sweden)

    Mª Manuela Segovia

    2005-01-01

    Full Text Available En los países industrializados, convergen dos fenómenos demográficos, la longevidad y la escasa natalidad, que provocan un envejecimiento de la población y con ello una serie de procesos sociales que son necesarios atender. Uno de ellos, es la cobertura de la dependencia de las personas mayores, entendiendo por dependencia, la necesidad de ayuda para realizar las tareas básicas de la vida diaria. España se encuentra en la actualidad en plena discusión parlamentaria para regular mediante ley la dependencia y cubrir el avance de este problema que en los próximos años se verá agravado por nuestra evolución demográfica y social. Esta ley pretende establecer las bases para su atención mediante un seguro de dependencia, bien de cobertura pública por parte del Estado o bien por aseguradoras privadas. El trabajo presentado en este congreso forma parte de un estudio amplio sobre la dependencia en España y abordará una aproximación a la formulación actuarial de un seguro de dependencia partiendo del uso de cadenas de Markov para un modelo de múltiples estados, y un acercamiento a la aplicación práctica mediante el análisis de datos sobre discapacidad de nuestro país.

  19. 机关事业单位基本养老保险的精算应计负债%Actuarial Accrued Liability of the Basic Old-age Insurance for Government and Public Institution Employees

    Institute of Scientific and Technical Information of China (English)

    杨再贵

    2016-01-01

    By establishing actuarial model through a parallelogram framework ,this paper measured the actuarial accrued liability of the basic old‐age insurance for government and public institution employees at the beginning of 2015 .Raising the re‐tirement age ,interest rate ,contribution rate and salary growth rate will decrease the actuarial accrued liability ,where the effect of the retirement age is very much strong and that of the interest rate is very strong .Raising the benefit yearly growth rate , work‐age salary growth rate and age‐linked‐benefit growth rate will increase the actuarial accrued liability ,where the effect of the benefit yearly growth rate is very strong ..To control the scale of actuarial accrued liability ,it is necessary to moderately postpone retirement ,to raise the yield rate of investment and salary grow th rate by innovations .With these measures ,the con‐tribution rate can be reduced .%通过养老金测算的平行四边形框架建立养老保险的精算模型应计负债,测算机关事业单位基本养老保险在2015年初的精算应计负债。提高退休年龄、利率、缴费率和工资增长率都会降低精算应计负债,退休年龄的影响非常强,利率的影响也很强。提高养老金增长率、工龄工资增长率和同年度养老金随年龄增长率都会增加精算应计负债,养老金增长率的影响很强。为控制机关事业单位基本养老保险精算应计负债,可适时适度提高退休年龄,创造条件提高投资收益率,通过全社会创新提高社会生产力来提高工资增长率,与此同时可降低缴费率。

  20. Prognostic role of metabolic parameters of {sup 18}F-FDG PET-CT scan performed during radiation therapy in locally advanced head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Min, Myo; Forstner, Dion [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); University of New South Wales, Sydney, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Lin, Peter; Shon, Ivan Ho; Lin, Michael [University of New South Wales, Sydney, NSW (Australia); Liverpool Hospital, Department of Nuclear Medicine and Positron Emission Tomography, Liverpool, NSW (Australia); University of Western Sydney, Sydney, NSW (Australia); Lee, Mark T. [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); University of New South Wales, Sydney, NSW (Australia); Bray, Victoria; Fowler, Allan [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Chicco, Andrew [Liverpool Hospital, Department of Nuclear Medicine and Positron Emission Tomography, Liverpool, NSW (Australia); Tieu, Minh Thi [Calvary Mater Newcastle, Department of Radiation Oncology, Newcastle, NSW (Australia); University of Newcastle, Newcastle, NSW (Australia)

    2015-12-15

    To evaluate the prognostic value of {sup 18}F-FDG PET-CT performed in the third week (iPET) of definitive radiation therapy (RT) in patients with newly diagnosed locally advanced mucosal primary head and neck squamous-cell-carcinoma (MPHNSCC). Seventy-two patients with MPHNSCC treated with radical RT underwent staging PET-CT and iPET. The maximum standardised uptake value (SUV{sub max}), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary tumour (PT) and index node (IN) [defined as lymph node(s) with highest TLG] were analysed, and results were correlated with loco-regional recurrence-free survival (LRFS), disease-free survival (DFS), metastatic failure-free survival(MFFS) and overall survival (OS), using Kaplan-Meier analysis. Optimal cutoffs (OC) were derived from receiver operating characteristic curves: SUV{sub max-PT} = 4.25 g/mL, MTV{sub PT} = 3.3 cm{sup 3}, TLG{sub PT} = 9.4 g, for PT, and SUV{sub max-IN} = 4.05 g/mL, MTV{sub IN} = 1.85 cm{sup 3} and TLG{sub IN} = 7.95 g for IN. Low metabolic values in iPET for PT below OC were associated with statistically significant better LRFS and DFS. TLG was the best predictor of outcome with 2-year LRFS of 92.7 % vs. 71.1 % [p = 0.005, compared with SUV{sub max} (p = 0.03) and MTV (p = 0.022)], DFS of 85.9 % vs. 60.8 % [p = 0.005, compared with SUV{sub max} (p = 0.025) and MTV (p = 0.018)], MFFS of 85.9 % vs. 83.7 % [p = 0.488, compared with SUV{sub max} (p = 0.52) and MTV (p = 0.436)], and OS of 81.1 % vs. 75.0 % [p = 0.279, compared with SUV{sub max} (p = 0.345) and MTV (p = 0.512)]. There were no significant associations between the percentage reduction of primary tumour metabolic parameters and outcomes. In patients with nodal disease, metabolic parameters below OC (for both PT and IN) were significantly associated with all oncological outcomes, while TLG was again the best predictor: LRFS of 84.0 % vs. 55.3 % (p = 0.017), DFS of 79.4 % vs. 38.6 % (p = 0.001), MFFS 86.4 % vs. 68.2 % (p = 0

  1. Intra-operative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal resection for rectal cancer

    DEFF Research Database (Denmark)

    Bülow, S; Christensen, I J; Iversen, L H

    2011-01-01

    on the Danish National Colorectal Cancer Database and included patients treated with abdominoperineal resection between 1 May 2001 and 31 December 2006. Follow up in the departments was supplemented with vital status in the Civil Registration System. The analysis included actuarial local and distant recurrence...... was reported in 108 (10%) patients. The cumulative 5-year local recurrence rate was 11% [95% confidence interval (CI), 7-13)], overall survival was 56% (95% CI, 53-60) and cancer-specific survival was 68% (95% CI, 65-71). Multivariate analysis showed that perforation, tumour stage and nonradical surgery were...

  2. Outcomes and Patterns of Failure for Grade 2 Meningioma Treated With Reduced-Margin Intensity Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Press, Robert H. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Prabhu, Roshan S., E-mail: roshansprabhu@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Appin, Christina L.; Brat, Daniel J. [Department of Pathology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Shu, Hui-Kuo G. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hadjipanayis, Constantinos; Olson, Jeffrey J.; Oyesiku, Nelson M. [Department of Neurosurgery, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Curran, Walter J.; Crocker, Ian [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2014-04-01

    Purpose: The purpose of this study was to evaluate intracranial control and patterns of local recurrence (LR) for grade 2 meningiomas treated with intensity modulated radiation therapy (IMRT) with limited total margin expansions of ≤1 cm. Methods and Materials: We reviewed records of patients with a neuropathological diagnosis of grade 2 meningioma who underwent IMRT at our institution between 2002 and 2012. Actuarial rates were determined by the Kaplan-Meier method from the end of RT. LR was defined as in-field if ≥90% of the recurrence was within the prescription isodose, out-of-field (marginal) if ≥90% was outside of the prescription isodose, and both if neither criterion was met. Results: Between 2002 and 2012, a total of 54 consecutive patients underwent IMRT for grade 2 meningioma. Eight of these patients had total initial margins >1 cm and were excluded, leaving 46 patients for analysis. The median imaging follow-up period was 26.2 months (range, 7-107 months). The median dose for fractionated IMRT was 59.4 Gy (range, 49.2-61.2 Gy). Median clinical target volume (CTV), planning target volume (PTV), and total margin expansion were 0.5 cm, 0.3 cm, and 0.8 cm, respectively. LR occurred in 8 patients (17%), with 2-year and 3-year actuarial local control (LC) of 92% and 74%, respectively. Six of 8 patients (85%) had a known pattern of failure. Five patients (83%) had in-field LR; no patients had marginal LR; and 1 patient (17%) had both. Conclusions: The use of IMRT to treat grade 2 meningiomas with total initial margins (CTV + PTV) ≤1 cm did not appear to compromise outcomes or increase marginal failures compared with other modern retrospective series. Of the 46 patients who had margins ≤1 cm, none experienced marginal failure only. These results demonstrate efficacy and low risk of marginal failure after IMRT treatment of grade 2 meningiomas with reduced margins, warranting study within a prospective clinical trial.

  3. Role of radiation therapy in the treatment of pediatric non-Hodgkin's lymphomas. [Complications of local irradiation and chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Carabell, S.C.; Cassady, J.R.; Weinstein, H.J.; Jaff, N.

    1978-11-01

    Between 1971 and 1976, 64 patients less than 18 years of age with non-Hodgkin's lymphoma were treated at Boston's Children's Hospital Medical Center-Joint Center for Radiation Therapy. A multimodality approach was used, consisting of radiation therapy (3500 to 4500 rad), surgery, and chemotherapy. Since 1973, all patients have received a regimen initially comprising Adriamycin, Prednisone, 6-Mercaptopurine, Vincristine, and L-Asparaginase. Methotrexate was substituted for Adriamycin following a cumulative total dose of 450 mg/m/sup 2/. The 5-year actuarial survival for all patients was 61%, while relapse-free survival was 54%. The actuarial and relapse-free survival for patients presenting with localized disease was 75% and 72%, respectively. Median follow-up was 40 months and all relapses occurred within 24 months of initial therapy. A multidisciplinary approach, such as the current regimen, offers a good prognosis for this disease.

  4. Locally advanced pancreatic adenocarcinoma. Chemoradiotherapy, reevaluation and secondary resection; Adenocarcinomes pancreatiques localement evolues. Chimioradiotherapie, reevaluation et resection secondaire?

    Energy Technology Data Exchange (ETDEWEB)

    Delpero, J.R.; Turrini, O. [Institut Paoli-Calmettes, Dept. de chirurgie, 13 - Marseille (France)

    2006-11-15

    Induction chemoradiotherapy (CRT) may down-stage locally advanced pancreatic tumors but secondary resections are unfrequent. However some responders' patients may benefit of a RO resection. Patients and methods. We report 18 resections among 29 locally advanced pancreatic cancers; 15 patients were treated with neo-adjuvant 5-FU-cisplatin based (13) or taxotere based (2 patients) chemoradiotherapy (45 Gy), and 3 patients without histologically proven adenocarcinoma were resected without any preoperative treatment. Results. The morbidity rate was 28% and the mortality rate was 7%; one patient died after resection (5.5%) and one died after exploration (9%). The RO resection rate was 50%. The median survival for the resected patients was not reached and the actuarial survival at 3 years was 59%. Two specimens showed no residual tumor and the two patients were alive at 15 and 46 months without recurrence; one specimen showed less than 10% viable tumoral cells and the patient was alive at 36 months without recurrence. A mesenteric infarction was the cause of a late death at 3 years in a disease free patient (radiation induced injury of the superior mesenteric artery). The median survival of the 11 non-resected patients was 21 months and the actuarial survival at 2 years was 0%. When the number of the resected patients (18) was reported to the entire cohort of the patients with locally advanced pancreatic cancer treated during the same period in our institution, the secondary resectability rate was 9%. Conclusion. Preoperative chemoradiotherapy identifies poor surgical candidates through observation and may enhance the margin status of patients undergoing secondary resection for locally advanced tumors. However it remains difficult to evaluate the results in the literature because of the variations in the definitions of resectability. The best therapeutic strategy remains to be defined, because the majority of patients ultimately succumb with distant metastatic

  5. Ablative dose proton beam therapy for stage I and recurrent non-small cell lung carcinomas. Ablative dose PBT for NSCLC

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Uk; Cho, Kwan Ho; Kim, Joo Young; Kim, Dae Yong; Kim, Tae Hyun; Suh, Yang-Gun; Kim, Yeon-Joo [Research Institute and Hospital, National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); Moon, Sung Ho [Research Institute and Hospital, National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); Research Institute and Hospital, National Cancer Center, Center for Lung Cancer, Goyang (Korea, Republic of); Research Institute and Hospital, National Cancer Center, Proton Therapy Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769 (Korea, Republic of); Pyo, Hong Ryull [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiation Oncology, Seoul (Korea, Republic of)

    2016-09-15

    To evaluate the efficacy and safety of ablative dose hypofractionated proton beam therapy (PBT) for patients with stage I and recurrent non-small cell lung carcinoma (NSCLC). A total of 55 patients with stage I (n = 42) and recurrent (n = 13) NSCLC underwent hypofractionated PBT and were retrospectively reviewed. A total dose of 50-72 CGE (cobalt gray equivalent) in 5-12 fractions was delivered. The median follow-up duration was 29 months (range 4-95 months). There were 24 deaths (43.6%) during the follow-up period: 11 died of disease progression and 13 from other causes. Kaplan-Meier overall survival rate (OS) at 3 years was 54.9% and the median OS was 48.6 months (range 4-95 months). Local progression was observed in 7 patients and the median time to local progression was 9.3 months (range 5-14 months). Cumulative actuarial local control rate (LCR), lymph node metastasis-free survival, and distant metastasis-free survival rates at 3 years were 85.4, 78.4, and 76.5%, respectively. Larger tumor diameter was significantly associated with poorer LCR (3-year: 94% for ≤3 cm vs. 65% for >3 cm, p = 0.006) on univariate analysis and also an independent prognostic factor for LCR (HR 6.9, 95% CI = 1.3-37.8, p = 0.026) on multivariate analysis. No grade 3 or 4 treatment-related toxicities developed. One grade 5 treatment-related adverse event occurred in a patient with symptomatic idiopathic pulmonary fibrosis. Ablative dose hypofractionated PBT was safe and promising for stage I and recurrent NSCLC. (orig.) [German] Beurteilung von Wirksamkeit und Sicherheit hypofraktionierter Protonentherapie (PBT) mit ablativen Dosen fuer nichtkleinzellige Lungenkarzinome (NSCLC) im Stadium I und rekurrierende NSCLC. Retrospektiv wurden insgesamt 55 NSCLC-Patienten (Stadium I: n = 42; rekurrierender Tumor: n = 13), analysiert. Sie waren mit einer Gesamtdosis von 50-72 CGE (''cobalt gray equivalent'') in 5-12 Fraktionen behandelt worden. Der Median der Follow

  6. Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas?

    Science.gov (United States)

    Barrientos-Ruiz, Irene; Ortiz-Cruz, Eduardo José; Serrano-Montilla, José; Bernabeu-Taboada, Daniel; Pozo-Kreilinger, Jose Juan

    2017-02-01

    the biopsy tract specimen; during the period in question, our routine practice was to excise the biopsy tract whenever possible at the time of the definitive resection. Using the logistic regression test and Mantel-Haenszel test, we compared open with percutaneous biopsies in terms of the proportion of those that were contaminated at our site and for outside referral biopsies separately, because we do not assume the level of expertise was the same (our site is a referral tumor center). We compared the local recurrence-free survival between patients with and without contamination and between open and percutaneous biopsies using the Kaplan Meier test, again separating those performed at our site from those referred for purposes of this analysis. Twenty-one of 180 biopsy tracts were contaminated (12%). Twenty of 62 (32%) of the open biopsies and one of 118 (0.8%) of the percutaneous core needle biopsies had cell seeding (odds ratio [OR], 56; 95% CI, 7-428; p biopsies performed in our center, and none of the 21 (0%) percutaneous biopsies performed in other centers had contaminated biopsy tracts (p = 0.047). Two of 15 (13%) open biopsies performed at our center and 18 of 41(38%) open biopsies performed at other centers had contaminated biopsy tracts (OR, 4; 95% CI, 1-7; p = 0.001). Four of 74 (5%) bone sarcomas and 18 of 106 (17%) soft tissue sarcomas had biopsy tract contamination (OR, 3; 95% CI, 1-10; p = 0.023). The local recurrence-free survival was longer for patients without contaminated tracts (mean, 107 months; 95% CI, 74-141 months) than for those with biopsy tract seeding (mean, 11 months; 95% CI, 1-20 months; p biopsies were associated with an increased risk of tumoral seeding of the biopsy site, and tumoral seeding was associated with an increased risk of local recurrence. However, it is possible that other factors, such as increased complexity of the tumor or a difficult location, influenced the decision to obtain an open biopsy. Even so, based on these

  7. 一种利率双随机条件下的有序状态寿险精算模型%One Actuarial Models of Orderly Life Insurance under the Condition of Dual Random Interest Rate

    Institute of Scientific and Technical Information of China (English)

    孙荣

    2012-01-01

    有序状态的联合寿险依赖于多个被保险人的死亡顺序,与一般的联合寿险相比具有一定的复杂性.本文研究联合生命保险中有序条件的复合状态寿险精算函数,对利率采用反射Brownian运动和Poisson过程的双随机模型及死亡均匀分布假设下的一种联合投保有序条件的复合状态建模,给出了生命年金、保险金、纯保费精算现值及保险金的二阶矩的表达式.运用这些表达式可以对联合投保有序状态的保险损失风险进行分析.%Joint life insurance of orderly compound status depends on the death order of the insured persons. As compared with the general insurances, it is of more complexity to a certain extent. This paper investigates the actuarial function of joint life insurance of orderly compound status. Both reflected standard Brownian motion and Possion process are used to model the stochastic interest rates and further it is employed to construct the actuarial model. The formulas of joint life insurance of compound status are proposed, including the life annuities, insurance, actuarial present value of net premiums and second moments of insurance. Based on the formulas so proposed, the loss risk of the joint life insurance of orderly compound status can reasonably be analyzed.

  8. 弹性退休制下退休年金的随机精算模型与模拟测算∗%The Stochastic Actuarial Models and Simulation about Retirement Annuity under Flexible Retirement System

    Institute of Scientific and Technical Information of China (English)

    孙荣

    2016-01-01

    弹性退休制是应对老龄化的社会养老保险制度改革未来选择之一,因此研究该制度下的退休年金精算问题具有重要的理论与现实意义。本文运用二项分布拟合退休年龄,带跳的非连续随机微分方程拟合利率,带跳Feller过程拟合死力强度,分析了弹性退休制下退休年金寿险精算函数,给出了生命年金、退休年金、退休年金二阶矩精算现值与均衡净保费的表达式,并利用模型对相关精算函数进行模拟测算。这些公式为弹性退休制下的保险金、均衡保险费等提供了精算分析的理论基础,从而为我国养老保险制度改革的制度设计、防控养老保险帐户风险提供了依据。%The flexible retirement system is one of the options of society endowment insurance system to deal with the aging. Therefore, the pension annuity under the system has important impact on theory and practice. This paper investigates the actuarial function of retirement annuity under the flexible retirement system. Under the hypothesis that the distribution of the retirement age is binomial distribution, the interest rate is decided by the discontinuous stochastic differential equations with jumps, and the death intensity is decided by Feller process with a jump. The formulas of the retirement annuity are proposed, including the life annuities, insurance, net premiums and insurance actuarial present value of second moment, and the sim-ulatived estimation for the relevant actuarial functions is derived. These formulas provide the basis of the actuarial analysis of insurance and balance insurance under the flexible retirement system, thus they can be applied for the old-age insurance system and control of risk pension account in China.

  9. The Determination of Pension Levels for Urban Residents in Zhejiang Province by Actuarial Model%精算模型对浙江省城镇居民社会养老保险水平的测定

    Institute of Scientific and Technical Information of China (English)

    应苗红

    2011-01-01

    The current situation of social old-age insurance level for urban residents of Zhejiang Province were expounded and actuarial model was used to analyze reasons of "low" social old-age insurance level, and suggestions for social old-age insurance level were put forward.%阐述了浙江省城镇居民社会养老保险水平现状及精算模型对社会养老保险水平“低度”原因分析,并提出提高社会养老保险水平的建议.

  10. Research on Actuarial Present Value of Inheritance Annuity under Different Dependent Structure%相依情形下继承年金精算现值的研究

    Institute of Scientific and Technical Information of China (English)

    张兵强; 陶菊春

    2012-01-01

    Based on dependent multi-life status,actuarial present value of the husband and wife joint inheritance annuity,the son to father's endowment type inheritance annuity and the father to the children raisin type inheritance annuity was studied.The effects of individual dependence to life was analysed by basis of comonotonicity,and the dependences of individual life was settled by using Copula function,finally the husband and wife joint heritance annuity was studied.The research result indicates that dependency degree of the individual life has important influence for inheritance annuity actuarial present value,the individual dependency degree more high,inheritance annuity actuarial present value is small,especially,in the individual life remaining independent of each other,inheritance annuity actuarial present value obtained maximal.%在多生命状态各个体剩余寿命相依的情形下,研究了夫妻联合型继承年金、子对父的养老型继承年金和父对子的抚养型继承年金的精算现值.本文主要利用同单调关系讨论了个体之间的相依关系对其寿命的影响,进而利用Copula函数处理了个体生命间的相依性,最后通过实例研究了夫妻联合型继承年金.研究结果表明:个体生命间的相依性程度对继承年金精算现值有着重要影响,个体间相依性程度越高,继承年金的精算现值越小,特别地,在个体剩余寿命相互独立时,继承年金的精算现值达到极大.

  11. Diseño, desarrollo, e implementación de una hoja electrónica para el análisis y cálculo actuarial

    OpenAIRE

    Falcones Collantes, Eduardo Xavier; Sandoya Sanchez, Fernando

    2009-01-01

    En el presente artículo se presenta a breves rasgos el diseño e implementación de una hoja electrónica actuarial para el análisis de modelos de seguros y rentas, a través de sus valores actuariales, así como para el cálculo de primas netas de inventario y comercial con sus reservas respectivas para distintos planes actuariales, desarrollado bajo el lenguaje de programación Visual Basic 6.0 incluidas las herramientas que este presenta para la creación de componentes de código Active X....

  12. Life insurance theory actuarial perspectives

    CERN Document Server

    Vylder, F Etienne

    1997-01-01

    This book is different from all other books on Life Insurance by at least one of the following characteristics 1-4. 1. The treatment of life insurances at three different levels: time-capital, present value and price level. We call time-capital any distribution of a capital over time: (*) is the time-capital with amounts Cl, ~, ... , C at moments Tl, T , ..• , T resp. N 2 N For instance, let (x) be a life at instant 0 with future lifetime X. Then the whole oO oO life insurance A is the time-capital (I,X). The whole life annuity ä is the x x time-capital (1,0) + (1,1) + (1,2) + ... + (I,'X), where 'X is the integer part ofX. The present value at 0 of time-capital (*) is the random variable T1 T TN Cl V + ~ v , + ... + CNV . (**) In particular, the present value ofA 00 and ä 00 is x x 0 0 2 A = ~ and ä = 1 + v + v + ... + v'X resp. x x The price (or premium) of a time-capital is the expectation of its present value. In particular, the price ofA 00 and äx 00 is x 2 A = E(~) and ä = E(I + v + v + ... + v'X...

  13. Actuarial considerations on genetic testing.

    Science.gov (United States)

    Le Grys, D J

    1997-08-29

    In the UK the majority of life insurers employ relatively liberal underwriting standards so that people can easily gain access to life assurance cover. Up to 95% of applicants are accepted at standard terms. If genetic testing becomes widespread then the buying habits of the public may change. Proportionately more people with a predisposition to major types of disease may take life assurance cover while people with no predisposition may take proportionately less. A model is used to show the possible effect. However, the time-scales are long and the mortality of assured people is steadily improving. The change in buying habits may result in the rate of improvement slowing down. In the whole population, the improvement in mortality is likely to continue and could improve faster if widespread genetic testing results in earlier diagnosis and treatment. Life insurers would not call for genetic tests and need not see the results of previous tests except for very large sums assured. In the UK, life insurers are unlikely to change their underwriting standards, and are extremely unlikely to bring in basic premium rating systems that give discounts on the premium or penalty points according to peoples genetic profile. The implications of widespread genetic testing on medical insurance and some health insurance covers may be more extreme.

  14. 大学生科研训练与保险精算类课程教学的实践%Practice of Scientific Training for Undergraduates and Teaching in Actuarial Curriculum

    Institute of Scientific and Technical Information of China (English)

    史敬涛; 陈建良

    2011-01-01

    本文结合大学生科研训练项目的开展,针对数学专业本科生的自身特点,对保险精算类课程的教学模式和方法进行了分析探讨。实践表明,数学专业本科生保险精算类课程体系的建设刚刚起步,是一项长期和艰巨的工作,迫切需要越来越多的既有扎实数学理论基础又熟悉金融保险实际业务的教师和从业人员的共同努力。%In this paper,combined with the development of scientific training project for undergraduates,we analyze and discuss the teaching patterns and methods of actuarial curriculum with respect to the characteristics of undergraduates majoring in mathematics.Practice shows that the construction of actuarial curriculum for undergraduates majoring in mathematics has just started and it is a longtime and hard work.Joint efforts of more and more teachers and practitioners who not only have strong basis of mathematical theory,but also know well the real practice of financial and insurance are imminently needed.

  15. Inmunoterapia local Local immunotherapy

    Directory of Open Access Journals (Sweden)

    E. Lasa

    2003-01-01

    Full Text Available La inmunoterapia específica, junto con la evitación del alergeno y el tratamiento sintomático, forma parte del tratamiento de la patología alérgica. La modalidad más antigua, más conocida y mejor estudiada es la inmunoterapia subcutánea (ITSC, cuya eficacia tanto a corto como a largo plazo, ha sido ampliamente demostrada en numerosos estudios. Sin embargo, a pesar de haberse demostrado segura, no está exenta de efectos adversos y precisa ser administrada bajo supervisión de personal médico. Esto ha animado a buscar nuevas vías de administración de eficacia similar, con un buen perfil de seguridad, y de buena cumplimentación por parte del paciente. De las distintas alternativas estudiadas la más relevante es la inmunoterapia sublingual (ITSL. En ésta, se administra el antígeno en forma de gotas debajo de la lengua. Existen diferentes pautas de administración en función del alergeno implicado. La dosis óptima de tratamiento está aún sin determinar, hallándose en este momento en un rango amplio de dosis respecto a la inmunoterapia subcutánea. Su mecanismo de acción es poco conocido aunque en diversos estudios se han observado cambios inmunológicos. La ITSL ha mostrado un buen perfil de seguridad con escasos efectos secundarios, habitualmente de carácter local. Asimismo se han realizado distintos ensayos clínicos en los que se ha demostrado su eficacia en el tratamiento de la alergia respiratoria tanto en niños como en adultos. Por ello, aunque aún existen datos sin resolver respecto a esta vía de administración de inmunoterapia, ha sido propuesta por la OMS como una alternativa válida a la ITSC.Specific immunotherapy, together with avoidance of the allergen and symptomatic treatment, forms part of the treatment of allergic pathology. The oldest, best known and most studied form is subcutaneous immunotherapy (SCIT, whose efficacy, both in the short and the long term, has been widely demonstrated in numerous studies

  16. Documenting localities

    CERN Document Server

    Cox, Richard J

    1996-01-01

    Now in paperback! Documenting Localities is the first effort to summarize the past decade of renewed discussion about archival appraisal theory and methodology and to provide a practical guide for the documentation of localities.This book discusses the continuing importance of the locality in American historical research and archival practice, traditional methods archivists have used to document localities, and case studies in documenting localities. These chapters draw on a wide range of writings from archivists, historians, material culture specialists, historic preservationists

  17. Intraoperative perforation is an important predictor of local recurrence and impaired survival after abdominoperineal excision for rectal cancer

    DEFF Research Database (Denmark)

    Bülow, S; Christensen, Ij; Iversen, Lh

    2010-01-01

    National Colorectal Cancer Database and included patients operated with APR from 1.5.2001-31.12.2006. A follow up in the departments was supplemented with vital status in the Civil Registration System. The analysis included actuarial local and distant recurrence and overall and cancer specific survival......%). The cumulative 5-year LR rate was 11% (95% CI 7-13), OS was 56% (95% CI 53-60), and CS was 68% (95% CI 65-71). Multivariate analysis showed that perforation, tumour stage and non-radical surgery were independent risk factors for LR; tumour fixation, perforation and tumour stage were independent risk factors...

  18. Spinal radiosurgery - efficacy and safety after prior conventional radiotherapy

    Directory of Open Access Journals (Sweden)

    Nikolajek Katharina

    2011-12-01

    Full Text Available Abstract Background Conventional external beam radiotherapy is a standard procedure for treatment of spinal metastases. In case of progression spinal cord tolerance limits further radiotherapy in pre-irradiated areas. Spinal stereotactic radiotherapy is a non-invasive option to re-treat pre-irradiated patients. Nevertheless, spinal radiosurgery results in relevant dose deposition within the myelon with potential toxicity. Aim of the study was to retrospectively analyse the efficacy and feasibility for salvage radiosurgery of spinal metastases. Methods During a period of 4 years (2005-2009 70 lesions in 54 patients were treated in 60 radiosurgery sessions and retrospectively analysed. Clinical (pain, sensory and motor deficit and radiological (CT/MRI follow-up data were collected prospectively after radiosurgery. Pain - as main symptom - was classified by the Visual Analogue Scale (VAS score. Every patient received single session radiosurgery after having been treated first-line with conventionally fractionated radiotherapy. Kaplan-Meier method and life tables were used to analyse freedom from local failure and overall survival. Results At a median follow-up of 14.5 months the actuarial rates of freedom from local failure at 6/12/18 months were 93%, 88% and 85%, respectively. The median radiosurgery dose was 1 × 18 Gy (range 10-28 Gy to the median 70% isodose. The VAS score of patients with pain (median 6 dropped significantly (median 4, p = 0.002. In 6 out of 7 patients worse sensory or motor deficit after SRS was caused by local or distant failures (diagnosed by CT/MRI. One patient with metastatic renal cell carcinoma developed a progressive complete paraparesis one year after the last treatment at lumbar level L3. Due to multiple surgery and radiosurgery treatments at the lumbar region and further local progression, the exact reason remained unclear. Apart from that, no CTC grade III or higher toxicity has been observed. Conclusions By

  19. Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Jin Li; Lu-Nan Yan; Jian Yang; Zhe-Yu Chen; Bo Li; Yong Zeng; Tian-Fu Wen; Ji-Chun Zhao; Wen-Tao Wang; Jia-Yin Yang; Ming-Qing Xu; Yu-Kui Ma

    2009-01-01

    AIM:To identify prognostic factors of patients with hepatocellular carcinoma (HCC), who were treated by orthotopic liver transplantation (OLT).METHODS: From January 2000 to October 2006,165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test.RESULTS: The median follow-up was 13.0 mo (2.8-69.5 mo). Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively.One-, 2-, 3- and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%,respectively. In univariate analysis, number of tumors,total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria (97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively)compared with that of patients who met the Milan or University of California, San Francisco (UCSF) criteria.CONCLUSION: Macrovascular invasion and total tumor diameter are the strongest prognostic factors.The proposed criteria do not adversely affect the

  20. Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008

    Directory of Open Access Journals (Sweden)

    Estela Azeka

    2009-02-01

    Full Text Available OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.

  1. 随机利率下的反向抵押贷款精算定价模型研究%Actuarial Pricing Models of Reverse Mortgage with the Stochastic Interest Rate

    Institute of Scientific and Technical Information of China (English)

    贾念念; 赵雪; 杨文荟

    2015-01-01

    反向抵押贷款是应对养老问题的一个创新模式。本文为改进传统反向抵押贷款定价模型必须建立在固定利率基础之上的缺点,利用Wiener过程和负二项分布对利息力积累函数进行联合建模,构建了随机利率下的反向抵押贷款精算定价模型及死亡均匀分布(UDD)假设下随机利率反向抵押贷款精算定价模型。最后,本文运用Matlab软件对随机利率下精算定价模型进行数值测算,比较了不同参数的变化对贷款额的影响程度,得到随机利率下的反向抵押贷款精算定价模型对借款人具有一定的吸引力、贷款利率较房产价值年均升值率和房产折旧率更敏感、递增年金模型受贷款利率变动影响较小等结论。上述结论为我国反向抵押贷款的政策制定与定价提供了一定的理论依据。%The reverse mortgage is a creative measure to support the aged people. for improving shortcomings that the traditional reverse mortgage loan pricing model must be established on the basis of fixed interest rate, this paper builds the united model of accumulation function of interest force by process and negative-binomial distribution, and constructs reverse mortgages actuarial pricing model under the stochastic interest rate and the stochastic interest rate reverse actuarial pricing model under UDD assumption. Finally, this paper uses the Matlab software to change different parameters of actuarial pricing model under stochastic interest rate influence on the degree of the loan, it is concluded that the conclusion of the model is in line with the actual situation, therefore, it has important practical significance to study stochastic interest rate reverse mortgage loan pricing model.

  2. Intraoperative Radiation Therapy in Early Breast Cancer Using a Linear Accelerator Outside of the Operative Suite: An “Image-Guided” Approach

    Energy Technology Data Exchange (ETDEWEB)

    Hanna, Samir Abdallah, E-mail: samir.hanna@hsl.org.br [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Simões Dornellas de Barros, Alfredo Carlos; Martins de Andrade, Felipe Eduardo; Barbosa Bevilacqua, Jose Luiz [Department of Mastology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Morales Piato, José Roberto [Department of Mastology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Department of Gynecology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo (Brazil); Lopes Pelosi, Edilson [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Martella, Eduardo [Department of Radiation Oncology, Hospital Perola Byington, Sao Paulo (Brazil); Fernandes da Silva, João Luis [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Andrade Carvalho, Heloisa de [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Department of Radiology and Oncology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo (Brazil)

    2014-08-01

    Purpose: To present local control, complications, and cosmetic outcomes of intraoperative radiation therapy (IORT) for early breast cancer, as well as technical aspects related to the use of a nondedicated linear accelerator. Methods and Materials: This prospective trial began in May of 2004. Eligibility criteria were biopsy-proven breast-infiltrating ductal carcinoma, age >40 years, tumor <3 cm, and cN0. Exclusion criteria were in situ or lobular types, multicentricity, skin invasion, any contraindication for surgery and/or radiation therapy, sentinel lymph node involvement, metastasis, or another malignancy. Patients underwent classic quadrantectomy with intraoperative sentinel lymph node and margins evaluation. If both free, the patient was transferred from operative suite to linear accelerator room, and IORT was delivered (21 Gy). Primary endpoint: local recurrence (LR); secondary endpoints: toxicities and aesthetics. Quality assurance involved using a customized shield for chest wall protection, applying procedures to minimize infection caused by patient transportation, and using portal films to check collimator-shield alignment. Results: A total of 152 patients were included, with at least 1 year follow-up. Median age (range) was 58.3 (40-85.4) years, and median follow-up time was 50.7 (12-110.5) months. The likelihood of 5-year local recurrence was 3.7%. There were 3 deaths, 2 of which were cancer related. The Kaplan-Meier 5-year actuarial estimates of overall, disease-free, and local recurrence-free survivals were 97.8%, 92.5%, and 96.3%, respectively. The overall incidences of acute and late toxicities were 12.5% and 29.6%, respectively. Excellent, good, fair, and bad cosmetic results were observed in 76.9%, 15.8%, 4.3%, and 2.8% of patients, respectively. Most treatments were performed with a 5-cm collimator, and in 39.8% of the patients the electron-beam energy used was ≥12 MeV. All patients underwent portal film evaluation, and the shielding was

  3. Local architecture

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Local architecture refers to structures built in the countryside,such as temples,memorial halls,residences, stores,pavilions, bridges,decorated archways, and wells. Because these structures were all built by focal craftsmen and villagers in the traditional local style, they are generally called local architecture.

  4. Conformal radiotherapy of locally advanced bile duct carcinoma; Radiotherapie conformationnelle des cholangiocarcinomes de la voie biliaire principale localement evolues

    Energy Technology Data Exchange (ETDEWEB)

    Bouras, N.; Caudry, M.; Bonnel, C.; Trouette, R.; Demeaux, H.; Maire, J.P. [Centre Hospitalier Universitaire, Hopital Saint-Andre, Service de Radiotherapie, 33 - Bordeaux (France); Saric, J.; Rullier, E. [Centre Hospitalier Universitaire, Hopital Saint-Andre, Service de Chirurgie Viscerale et de Transplantation Hepatique, 33 - Bordeaux (France)

    2002-02-01

    Purpose. - Retrospective study of 23 patients treated with conformal radiotherapy for a locally advanced bile duct carcinoma. Patients and methods. - Eight cases were irradiated after a radical resection (RO), because they were N+; seven after microscopically incomplete resection (R1) ; seven were not resected (R2). A dose of 45 of 50 Gy was delivered, followed by a boost up to 60 Gy in R1 and R2 groups. Concomitant chemotherapy was given in 15 cases. Results.-Late toxicity included a stenosis of the duodenum, and one of the biliary anastomosis. Two patients died from cholangitis, the mechanism of which remains unclear. Five patients are in complete remission, six had a local relapse, four developed a peritoneal carcinosis, and six distant metastases. Actuarial survival rate is 75%, 28% and 7% at 1, 3 and 5 years, respectively (median: 16.5 months). Seven patients are still alive with a 4 to 70 months follow-up. Survival is similar in the 3 small subgroups. The poor local control among RON+ cases might be related to the absence of a boost to the 'tumor bed'. In R1 patients, relapses were mainly distant metastases, where'as local and peritoneal recurrences predominated in R2. Conclusion. - Conformal radio-chemotherapy delivering 60 Gy represents a valuable palliative approach in locally advanced biliary carcinoma. (authors)

  5. Análisis actuarial del fondo de jubilación de los empleados civiles de la comisión de tránsito de la provincia del Guayas

    OpenAIRE

    Duran Vinueza, Walter; Perez, . Werhli

    2009-01-01

    El presente estudio tiene por objeto analizar la situación financiera actual del Fondo de Jubilación de los empleados civiles de la Comisión de Tránsito de la Provincia del Guayas. No sin antes, describir los sistemas de pensiones públicos y privados y la aplicación de los mismos, en diferentes países de América, incluyendo al Ecuador y los aspectos legales que sustentan la seguridad pública social en dicho país. Así mismo, se ofrece un marco teórico actuarial de los modelos de pensiones y se...

  6. 分数跳-扩散O-U过程下幂型期权定价%Actuarial approach to power option pricing under fractional jump-diffusion O-U process

    Institute of Scientific and Technical Information of China (English)

    符双; 薛红

    2014-01-01

    This paper assumed that stock price followed the fractional jump-diffusion O-U process, and the riskless interest rate and the volatility rate of stock were time function.The power option pricing model was presented by an actuarial approach.The call option and put option pricing formulae of power option were obtained.%假设股票价格遵循分数跳-扩散O-U过程,且无风险利率和股票波动率均为时间的确定性函数,利用保险精算的方法,建立了分数跳扩散O-U过程下的幂型期权定价模型,获得了幂型期权的看涨和看跌定价公式。

  7. Análisis actuarial del fondo de jubilación de los empleados civiles de la comisión de tránsito de la provincia del Guayas

    OpenAIRE

    Duran Vinueza, Walter; Perez, Werhli

    2009-01-01

    El presente estudio tiene por objeto analizar la situación financiera actual del Fondo de Jubilación de los empleados civiles de la Comisión de Tránsito de la Provincia del Guayas. No sin antes, describir los sistemas de pensiones públicos y privados y la aplicación de los mismos, en diferentes países de América, incluyendo al Ecuador y los aspectos legales que sustentan la seguridad pública social en dicho país. Así mismo, se ofrece un marco teórico actuarial de los modelos de pensiones y se...

  8. The significance of the Van Nuys prognostic index in the management of ductal carcinoma in situ

    Directory of Open Access Journals (Sweden)

    Davies Mary

    2008-06-01

    Full Text Available Abstract Background Debate regarding the benefit of radiotherapy after local excision of ductal carcinoma in situ (DCIS continues. The Van Nuys Prognostic Index (VNPI is thought to be a useful aid in deciding which patients are at increased risk of local recurrence and who may benefit from adjuvant radiotherapy (RT. Recently published interim data from the Sloane project has showed that the VNPI score did significantly affect the chances of getting planned radiotherapy in the UK, suggesting that British clinicians may already be using this scoring system to assist in decision making. This paper independently assesses the prognostic validity of the VNPI in a British population. Patients and methods A retrospective review was conducted of all patients (n = 215 who underwent breast conserving surgery for DCIS at a single institution between 1997 – 2006. No patients included in the study received additional radiotherapy or hormonal treatment. Kaplan Meier survival curves were calculated, to determine disease free survival, for the total sample and a series of univariate analyses were performed to examine the value of various prognostic factors including the VNPI. The log-rank test was used to determine statistical significance of differential survival rates. Multivariate Cox regression analysis was performed to analyze the significance of the individual components of the VNPI. All analyses were conducted using SPSS software, version 14.5. Results The mean follow-up period was 53 months (range 12–97, SD19.9. Ninety five tumours were high grade (44% and 84 tumours exhibited comedo necrosis (39%. The closest mean initial excision margin was 2.4 mm (range 0–22 mm, standard deviation 2.8 and a total of 72 tumours (33% underwent further re-excision. The observed and the actuarial 8 year disease-free survival rates in this study were 91% and 83% respectively. The VNPI score and the presence of comedo necrosis were the only statistically significant

  9. Cancer of the anal canal and local control.

    Science.gov (United States)

    Valentini, V; Mantello, G; Luzi, S; Macchia, G; Manfrida, S; Smaniotto, D

    1998-01-01

    Concomitant radiochemotherapy is the standard treatment of squamous cell carcinoma of the anal canal. It can afford a high local control rate though the same impact has not been observed on survival. A few reports have concerned the impact of local control on distant metastases and survival. From 1988 to 1998 at the "Divisione di Radioterapia" of the "Università Cattolica del S. Cuore" of Rome 30 patients with squamous cell carcinoma of the anal canal were treated for cure. Treatment consisted of two cycles of radiotherapy (23.4 Gy) with a 4-5 week split in each cycle. 5FU (100 mg/sqm/24 h) was administered in continuous infusion for the first 4 days of therapy; mitomycin C (10 mg/sqm bolus) was administered on day 1, 4-6 weeks after the end of cycle 2 of concomitant radiochemotherapy, patients received a boost of interstitial brachytherapy. Local control on T of all patients was 84% at 5 years. Six patients showed locoregional recurrence: 3 recurrences on T and 4 disease progressions in locoregional lymph nodes. 3 of 6 patients underwent salvage surgery. The initial extent of the disease, the patient's age and brachytherapy boost did not have a statistically significant influence on local control. Two of the 30 patients showed liver metastases, and at their appearance, one patient was free of local disease while the other showed locoregional progression after Miles' operation for salvage. The metastasis-free interval was not significantly influenced by local control, although at 5 years, 96% of patients with local control of T were free of metastases vs 75% of those with recurrence on T (p = 0.22). Overall actuarial survival at 5 years was 75%. The behavior of survival in our experience seemed to be significantly influenced by local control: in the group with local control, 5-year survival was 85% vs 40% of patients with local recurrence (p = 0.01).

  10. Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

    Science.gov (United States)

    Johansson, Silvia; Åström, Lennart; Sandin, Fredrik; Isacsson, Ulf; Montelius, Anders; Turesson, Ingela

    2012-01-01

    Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT) of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT). The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU) and gastrointestinal (GI) toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity. PMID:22848840

  11. Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Silvia Johansson

    2012-01-01

    Full Text Available Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT. The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU and gastrointestinal (GI toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity.

  12. Local Helioseismology

    Directory of Open Access Journals (Sweden)

    Gizon Laurent

    2005-11-01

    Full Text Available We review the current status of local helioseismology, covering both theoretical and observational results. After a brief introduction to solar oscillations and wave propagation through inhomogeneous media, we describe the main techniques of local helioseismology: Fourier-Hankel decomposition, ring-diagram analysis, time-distance helioseismology, helioseismic holography, and direct modeling. We discuss local helioseismology of large-scale flows, the solar-cycle dependence of these flows, perturbations associated with regions of magnetic activity, and solar supergranulation.

  13. 局部晚期鼻咽癌调强放疗联合同期化疗的比较%A Comparative Study of Intensity-Modulated Radiotherapy with Concurrent FP or TP Chemotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma

    Institute of Scientific and Technical Information of China (English)

    尹宏; 何志刚; 向舫; 李煜; 罗英

    2016-01-01

    Objective:To investigate the differents in patients with locally advanced nasopharyngeal carcinoma who received intensity-modulated radiotherapy( IMRT) with two kind of chemotherapies.Methods:A retrospective analysis was performed on the clinical data of 120 patients with stageⅢorⅣa nasopharyngeal carcinoma who were admitted to our hospital from May 2010 to October 2012.60 received IMRT with 5-fluorouracil plus nedaplatin ( FP) chemotherapy,and 60 received IMRT with taxol plus nedaplatin (TP) chemotherapy.The Kaplan-Meier method wasused to calculate the survival rates,and the log-rank test was used to analyze the survival difference;the chisquare test was used to compare the acute toxicities in the two groups.Results:The follow-up rate was 100.00%.The 1、2-yearssurvival rate in the IMRT/FP group were 100.00%and 95.0%respectively, versus 100%and 91.7%in the IMRT/TP group.No significant difference was found between the two groups (P>0.05).The incidence rates of leukopenia ( grade≥3 ) , thrombocytopenia ( grade≥3 ) in the IMRT/FP group were 28.3% and 15.0%respectively, versus 65.0%and 23.3%in the IMRT/TP group ( P<0.05) .Conclusion:Compares with IMRT with concurrent FP chemotherapy, IMRT with concurrent TP chemotherapy does not lead to significantly better in survival rate, but have more acute toxicities.%目的:比较局部晚期鼻咽癌行调强放疗( IMRT)同期FP、TP方案化疗的差异。方法:将我院2010年5月至2012年10月收治的120例Ⅲ期、Ⅳa期局部晚期鼻咽癌患者分为2组,观察组行IMRT同期FP化疗,对照组行IMRT同期TP化疗。比较2组的疗效和不良反应。结果:随访率100%,观察组1年生存率为100畅00%,2年生存率为95畅0%;对照组1年生存率为100畅00%,2年生存率为91畅7%,2组比较无显著性差异( P>0畅05)。≥3级白细胞减少、血小板减少发生率观察组分别为28畅3%和15畅0%,对照组分别为65畅0%和23畅3%,2

  14. Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study

    Directory of Open Access Journals (Sweden)

    Zhang Long

    2011-10-01

    Full Text Available Abstract Background Relapses of epithelial ovarian carcinoma (EOC have a poor prognosis and are almost always fatal. The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT in advanced and recurrent EOC. Methods Forty-five women with EOC were treated with IOERT. Twenty-five patients had primary disease (PD without distant metastasis at IOERT, and 20 patients had an isolated local recurrence (ILR after surgery. All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm surgery. The whole pelvic (WP radiotherapy was intraoperatively delivered using 12 Mev electron beam; 43 patients received 18-20 Gy and two patients received 10 Gy. Thirty-three patients received postoperateive intraperitoneal (IP chemotherapy, while seven patients received intravenous (IV chemotherapy. Five patients refused concurrent chemotherapy. Overall survival (OS rates were analyzed using the Kaplan-Meier method. Results Tumor recurrence and metastasis were observed in 16 patients (35.6%. Of those, 14 patients (31.1% relapsed and two patients (4.4% had distant metastasis alone. Eight of 25 (32% local failures were observed in the PD group, as compared to 6/20 (30% in the ILR group (P = 0.885. Actuarial local control at five year follow-up was 31/45 (68.9%. Seventeen of the total 45 (37.8% patients died. Nine of 25 (36% in the PD group died, as compared to 8 of 20 (40% in the ILR group. The 5-year OS and disease-free survival (DFS rates were 28/45 (62.2% and 25/45 (55.6%, respectively. In the PD group, the 5-year OS and DFS rates were 16/25 (64% and 14/25 (56% (P > 0.05, vs. the ILR group at 12/20 and 11/20, respectively. The OS and DFS in the IOERT plus IP group were 25/33 (75.8% and 23/33 (69.7%, respectively, which were superior to the rates achieved with IOERT plus IV chemotherapy (P Conclusions IOERT may be feasible and effective as a boosting technique for advanced and recurrent

  15. Local food:

    DEFF Research Database (Denmark)

    Sundbo, Donna Isabella Caroline

    2013-01-01

    Recently there has been more focus on food in general and local food in particular. But what is local food? And what are the perceptions of this concept according to theory and to providers and consumers of local food? This article first summarises and compares three different theoretical...... as expressed by a group of Danish providers and consumers is empirically investigated through interviews, observation and surveys. From this, qualitative and quantitative data are generated, the analysis of which shows how varied perceptions of local food are. The elements of which the perceptions consist...... are identified and then categorised according to whether they pertain to the food product itself or the production methods and facilities and whether they describe physical or social properties of local food. From this a model with four categories is developed. It is found that properties of the product are more...

  16. Long-term results of preoperative 5-fluorouracil-oxaliplatin chemoradiation therapy in locally advanced rectal cancer.

    Science.gov (United States)

    Fontana, Elisa; Pucci, Francesca; Camisa, Roberta; Bui, Simona; Galdy, Salvatore; Leonardi, Francesco; Negri, Francesca Virginia; Anselmi, Elisa; Losardo, Pier Luigi; Roncoroni, Luigi; Dell'abate, Paolo; Crafa, Pellegrino; Cascinu, Stefano; Ardizzoni, Andrea

    2013-02-01

    To evaluate the activity, safety and long-term survival of patients after preoperative oxaliplatin and 5-fluorouracil chemoradiation therapy in locally advanced rectal cancer (LARC). Patients with resectable, T3-4 and/or nodal involvement rectal adenocarcinoma were treated with oxaliplatin 60 mg/m(2) weekly and 5-fluorouracil 200 mg/m(2)/d infused continuously for five days, over a period of five weeks, and radiotherapy (45 Gy/25 fractions). The primary end-point was pathological complete response (ypCR). Safety, overall survival (OS) and relapse-free survival (RFS) were secondary end-points. Sixty-six patients were treated. Grade 1-2 diarrhea was the most common adverse event. The ypCR rate was 16.7% (95% confidence interval=7.7-25.7%). After a median follow-up of 73.5 months, 23 patients (34.8%) had experienced relapse. Five-year actuarial RFS and OS rates were 64% and 73%, respectively. Five-year actuarial RFS was 91.7% in the ypCR group versus 57.8% in non-ypCR cases. Long-term local control and survival after this very well-tolerated regimen appear encouraging.

  17. Experience of the Casablanca radiotherapy-oncology centre on radiotherapy in the treatment of the adult Hodgkin lymphoma; Experience du centre de radiotherapie-oncologie de Casablanca sur la radiotherapie dans le traitement du lymphome de Hodgkin de l'adulte

    Energy Technology Data Exchange (ETDEWEB)

    Bouchbika, Z.; Benchakroun, N.; Sellai, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Benider, A. [Service radiotherapie-oncologie, CHU Ibn-Rochd, Casablanca (Morocco)

    2011-10-15

    The authors report the assessment of the local control, global survival and survival without recurrence, and also late complications, based on retrospective study over 8 years of 169 cases Hodgkin lymphoma in patients older than 18 (average age of 34) and who had been submitted to radiotherapy. Survival has been computed according to the Kaplan-Meier method. The authors notice that the recurrence rate is slightly higher than in the literature. During the considered period, radiotherapy was two-dimensional with higher doses than those corresponding to current standards. The improvement of radiotherapy techniques and the decrease of doses within the standards should improve the therapeutic results. Short communication

  18. On estimation of survival function under random censoring model

    Institute of Scientific and Technical Information of China (English)

    JIANG; Jiancheng(蒋建成); CHENG; Bo(程博); WU; Xizhi(吴喜之)

    2002-01-01

    We study an estimator of the survival function under the random censoring model. Bahadur-type representation of the estimator is obtained and asymptotic expression for its mean squared errors is given, which leads to the consistency and asymptotic normality of the estimator. A data-driven local bandwidth selection rule for the estimator is proposed. It is worth noting that the estimator is consistent at left boundary points, which contrasts with the cases of density and hazard rate estimation. A Monte Carlo comparison of different estimators is made and it appears that the proposed data-driven estimators have certain advantages over the common Kaplan-Meier estmator.

  19. Net Locality

    DEFF Research Database (Denmark)

    de Souza e Silva, Adriana Araujo; Gordon, Eric

    Provides an introduction to the new theory of Net Locality and the profound effect on individuals and societies when everything is located or locatable. Describes net locality as an emerging form of location awareness central to all aspects of digital media, from mobile phones, to Google Maps, to...... of emerging technologies, from GeoCities to GPS, Wi-Fi, Wiki Me, and Google Android....

  20. Net Locality

    DEFF Research Database (Denmark)

    de Souza e Silva, Adriana Araujo; Gordon, Eric

    Provides an introduction to the new theory of Net Locality and the profound effect on individuals and societies when everything is located or locatable. Describes net locality as an emerging form of location awareness central to all aspects of digital media, from mobile phones, to Google Maps, to...... of emerging technologies, from GeoCities to GPS, Wi-Fi, Wiki Me, and Google Android....

  1. Local Contexts

    Directory of Open Access Journals (Sweden)

    Philippe Schlenker

    2009-07-01

    Full Text Available The dynamic approach posits that a presupposition must be satisfied in its local context. But how is a local context derived from the global one? Extant dynamic analyses must specify in the lexical entry of any operator what its 'Context Change Potential' is, and for this very reason they fail to be sufficiently explanatory. To circumvent the problem, we revise two assumptions of the dynamic approach: we take the update process to be derivative from a classical, non-dynamic semantics -- which obviates the need for dynamic lexical entries; and we deny that a local context encodes what the speech act participants 'take for granted.' Instead, we take the local context of an expression E in a sentence S to be the smallest domain that one may restrict attention to when assessing E without jeopardizing the truth conditions of S. To match the results of dynamic semantics, local contexts must be computed incrementally, using only information about the expressions that precede E. This version of the theory can be shown to be nearly equivalent to the dynamic theory of Heim 1983 -- but unlike the latter, it is entirely predictive. We also suggest that local contexts can, at some cost, be computed symmetrically, taking into account information about all of S (except E; this leads to gradient predictions, whose assessment is left for future research. doi:10.3765/sp.2.3 BibTeX info

  2. Skeletal Plasmacytoma: Progression of disease and impact of local treatment; an analysis of SEER database

    Directory of Open Access Journals (Sweden)

    Scully Sean P

    2009-09-01

    Full Text Available Abstract Background Previous reports suggest an as yet unidentifiable subset of patients with plasmacytoma will progress to myeloma. The current study sought to establish the risk of developing myeloma and determine the prognostic factors affecting the progression of disease. Methods Patients with plasmacytoma diagnosed between 1973 and 2005 were identified in the SEER database(1164 patients. Patient demographics and clinical characteristics, treatment(s, cause of death, and survival were extracted. Kaplan-Meier, log-rank, and Cox regression were used to analyze prognostic factors. Results The five year survival among patients initially diagnosed with plasmacytoma that later progressed to multiple myeloma and those initially diagnosed with multiple myeloma were almost identical (25% and 23%; respectively. Five year survival for patients with plasmacytoma that did not progress to multiple myeloma was significantly better (72%. Age > 60 years was the only factor that correlated with progression of disease (p = 0.027. Discussion Plasmacytoma consists of two cohorts of patients with different overall survival; those patients that do not progress to systemic disease and those that develop myeloma. Age > 60 years is associated with disease progression. Identifying patients with systemic disease early in the treatment will permit aggressive and novel treatment strategies to be implemented.

  3. Locals Collection

    Directory of Open Access Journals (Sweden)

    Stephen Hastings-King

    2010-03-01

    Full Text Available A locals collection is a set of parameters that are used to delimit data-mining operations. This piece uses a collection of locals from around Essex Massachusetts to shape and delimit an interrogation of post-reality in contemporary America. It explores the notion of crisis, the possibility of a crisis of empire that may or may not emerge in a media-space that does not allow crisis of empire to be mentioned and relations this maybe-crisis to the various levels of economic dysfunction that have become evident since late 2008. But mostly this piece explores ways in which particular stories about particular people do and do not link/link to these larger-scale narratives. This is the first of a potential series of locals collections that will mine the American post-real.

  4. Localized shocks

    CERN Document Server

    Roberts, Daniel A; Susskind, Leonard

    2014-01-01

    We study products of precursors of spatially local operators, $W_{x_{n}}(t_{n}) ... W_{x_1}(t_1)$, where $W_x(t) = e^{-iHt} W_x e^{iHt}$. Using chaotic spin-chain numerics and gauge/gravity duality, we show that a single precursor fills a spatial region that grows linearly in $t$. In a lattice system, products of such operators can be represented using tensor networks. In gauge/gravity duality, they are related to Einstein-Rosen bridges supported by localized shock waves. We find a geometrical correspondence between these two descriptions, generalizing earlier work in the spatially homogeneous case.

  5. Cuadro clínico patológico y factores pronósticos de sobrevida en adultos con sarcomas de partes blandas

    Directory of Open Access Journals (Sweden)

    Juan Díaz-Plasencia

    1997-10-01

    Full Text Available Objetivo: Identificar el cuadro clínico - patológico y algunos factores pronósticos que influyen en la sobrevida actuarial a 5 años. Material y métodos: Analizamos retrospectivamente información de 44 adultos portadores de sarcomas de partes blandas tratados en el Hospital Belén, Perú, desde 1967 a 1994. La estimación de la sobrevida fue hecha por el método de Kaplan - Meier y en el análisis univariado utilizamos el test de log - rank. Resultados: La edad promedio fue de 46 ± 19 años (límites, 16 a 85 años. Hubo 21 hombres y 23 mujeres (H:M, 0,9:1. Las molestias más frecuentes fueron tumor y dolor local. Las localizaciones más afectadas fueron las extremidades inferiores (52% y superiores (21%. De acuerdo a la clasificación UICC, 48% de los casos estuvieron en estadio II. 23 % en estadio III, 18 % en estadio IV y 11 % en estadio I. Los tipos histológicos predominantes fueron: Fibrosarcoma (34 %, liposarcoma (16 % y rabdomiosarcoma (14 %. Trece tumores (30 % fueron clasificados como grado 3, 24 (55% como grado 2 y 7 (16 % como grado 1. La sobrevida a 5 años fue de 54 % con cirugía sola (n=27, 11 % con cirugía más radioterapia y/o quimioterapia (n=13 y 0% con radioterapia y /o quimioterapia (n=4 (p< 0.01. La sobrevida a 5 años en la serie total fue 38 %. Fueron factores que influyeron en la sobrevida: Edad (p< 0.001, tiempo de enfermedad (p <0.001, estado ganglionar regional (p <0.001, grado histológico (p < 0.01, estadio clínico (p <0.001 y tipo de tratamiento (p <0.001. Conclusión: El tratamiento de elección para los sarcomas de partes blandas es la cirugía de amplio margen. (Rev Med Hered 1997; 8: 129-141.

  6. Computed tomography (CT)-guided interstitial permanent implantation of (125)I seeds for refractory chest wall metastasis or recurrence.

    Science.gov (United States)

    Jiang, Ping; Liu, Chen; Wang, Junjie; Yang, Ruijie; Jiang, Yuliang; Tian, Suqing

    2015-02-01

    To evaluate the efficacy and safety of 125I seeds implantation for refractory chest wall (CW) metastasis or recurrence under CT guidance. In addition we assessed initial data obtained on the therapeutic response for refractory CW metastasis or recurrence. Twenty consecutive patients underwent permanent implantation of 125I seeds (from Jul. 2004 to Jan. 2011) under computed tomography (CT) guidance. Postoperative dosimetry was routinely performed for all patients. The actuarial D90 of the implanted 125I seeds ranged from 100 Gy to 160 Gy (median: 130 Gy). The activity of 125I seeds ranged from 0.5 mCi to 0.78 mCi (median: 0.71 mCi). The total number of seeds implanted ranged from 8 to 269 (median: 53). The follow-up period ranged from 3 to 54 months (median: 11.5 months). The survival and local control probabilities were calculated by the Kaplan-Meier method. Among all the 20 patients, 3 patients had complete remission CR (15%), 12 patients had partial remission PR (60%), 5 patients had stable disease SD. The 1-, 2-, 3- and 4-year tumor control rates were all 88.7% respectively. The 1- and 2-, 3-, 4-year cancer specific survival rates were 56.5% and 47.1%, 47.1%, 47.1% respectively. The 1- and 2-, 3-, 4-year overall survival rates were 53.3% and 35.6%, 35.6%, 35.6% respectively, with a median survival of 15 months (95% CI, 7.0-22.9). Mild brachial plexus injury was seen in one patient; grade 1 or 2 skin reactions were seen in 6 patients (30%) who had received external beam radiation therapy (EBRT) before. No grade 3 and 4 skin side effects were found. Rib fracture, ulceration, pneumothorax or hemopneumothorax were not seen. Interstitial permanent implantation of 125I seeds under CT guidance is feasible, efficacious and safe for refractory CW metastasis or recurrence.

  7. Local language

    NARCIS (Netherlands)

    Monique Turkenburg

    2002-01-01

    Original title: Taal lokaal. Children of immigrants living in the Netherlands have for years had the opportunity to receive lessons in their mother tongue at primary school. Since 1998 this has been referred to as minority language teaching (OALT in Dutch), and has been the responsibility of local

  8. 基于随机利率和多生命体相依的联合保险精算模型%Combined InsuranceActuarial Model under Stochastic Interest Rate and Dependent Lifetime

    Institute of Scientific and Technical Information of China (English)

    赵丽霞

    2014-01-01

    By simulating mortality rate through Common Shock model and describing the term struc-ture of interest rate with Wiener process,an actuarial model for family combined insurance under stochastic interest rate and dependent life time is designed.Then,the theoretical formulas of the balanced premium are obtained,on the condition that the death happens uniformly in tail age,the approximate methods are given which are feasible in insurance practices.Finally,influences of stochastic interest rate and death rate to insurance pricing are analyzed.%采用 Common Shock 模型模拟死亡率,并用 Wiener 过程刻画利率期限结构,构建了基于随机利率和生命体相依的联合保险的纯保费精算模型。在此基础上,导出均衡年保费的理论计算公式,并在尾部年龄服从均匀分布的假设下,给出保险实务操作中可行的近似计算方法。最后,通过数值模拟分析了随机利率、死亡率对保险定价的影响。

  9. Local Linearizability

    OpenAIRE

    Haas, Andreas; Henzinger, Thomas A.; Holzer, Andreas; Kirsch, Christoph M.; Lippautz, Michael; Payer, Hannes; Sezgin, Ali; Sokolova, Ana; Veith, Helmut

    2015-01-01

    The semantics of concurrent data structures is usually given by a sequential specification and a consistency condition. Linearizability is the most popular consistency condition due to its simplicity and general applicability. Nevertheless, for applications that do not require all guarantees offered by linearizability, recent research has focused on improving performance and scalability of concurrent data structures by relaxing their semantics. In this paper, we present local linearizability,...

  10. ANÁLISIS Y CONTEXTUALIZACIÓN DE LOS ASPECTOS DE ÍNDOLE ACTUARIAL Y DE SEGURIDAD SOCIAL DE LA LEY 35/2015 DE REFORMA DEL SISTEMA PARA LA VALORACIÓN DE LOS DAÑOS Y PERJUICIOS CAUSADOS A LAS PERSONAS EN ACCIDENTES DE CIRCULACIÓN

    Directory of Open Access Journals (Sweden)

    Luis María Sáez de Jáuregui Sanz

    2016-06-01

    Full Text Available En este trabajo se analizan y se contextualizan los aspectos de índole actuarial y de seguridad social recogidos en la Ley 35/2015 de reforma del sistema para la valoración de los daños y perjuicios causados a las personas en accidentes de circulación. Los preliminares de la Ley 35/2015 comienzan en 2011 con la creación de una Comisión de Expertos. A partir de ahí, se inicia un proceso que culmina, en primer lugar, en 2014 en Junta Consultiva de Seguros y Fondos de Pensiones con la entrega de un Texto articulado, unas Tablas de indemnización y unas Bases técnicas actuariales que configuran un nuevo y novedoso sistema de valoración y que termina de finalizar –tras su trámite parlamentario con prácticamente nulas modificaciones en lo fundamental– con la entrada en vigor el 1 de enero de 2016 de la Ley 35/2015, recogiéndose por primera vez en el ordenamiento jurídico español un modelo actuarial para indemnizar el lucro cesante y el daño emergente. This paper analyzes and contextualizes the actuarial and social security features of the brand new Law 35/2015 of reform for assessing the damage caused to people in road accidents. Preliminaries of the Law 35/2015 began in 2011 with the creation of a Committee of Experts. From there, a process, culminated first in 2014, in the Advisory Board of Insurance and Pension Funds with the delivery of an articulated text, tables compensation and the actuarial technical bases that form a new and novel assessment system, and ended -after the end of its parliamentary process with virtually no changes in fundamentally- with the entry into force, on January 1st of 2016, of the Law 35/2015, introducing for the first time in the Spanish legal system an actuarial model to compensate people for loss of profits and its consequential damages.

  11. Local Professionals for Local Market

    Institute of Scientific and Technical Information of China (English)

    Wen Xiaojie

    2010-01-01

    @@ In the past three decades,the Chinese hotel industry has developed at a rapid pace,with the number of hotels-especially high star hotelsgrowing fast.In Beijing alone,there arc nearly 60 five-star hotels.With the development of the hotel industry.China has also begun to see the number of local hotel professionals,including senior managers,increase.Wen Xiaojie,Deputy General Manager and Owner's Representative of Sofitel Wanda Beijing,is among the most outstanding senior hotel managers.

  12. 新型农村社会养老保险替代率精算分析%Actuarial Analysis of the Replacement Rate of New Rural Social Endowment Insurance

    Institute of Scientific and Technical Information of China (English)

    黄锦英; 罗倩倩

    2011-01-01

    Based on the analysis of existing research literatures and the policy document about new rural endowment insurance which was put forward in September 2009,this paper tries to construct an actuarial model of endowment insurance replacement rate in order to make an empirical analysis of the replacement rate of new rural social endowment insurance.The result appears that the relationship between the payment years,payment level and the replacement rate level presents positive correlation.This paper also explores the reasons for the low level of replacement rate and the inefficiency of protection and finally puts forward some corresponding countermeasures in government subsidy,investment operations for individual account,payment methods,etc.%在分析已有研究文献的基础上,基于2009年9月出台的新型农村社会养老保险政策文件,依据相关规定和数据构建养老保险替代率精算模型,对新型农村社会养老保险替代率进行实证分析,测算出新制度下养老金缴费年限和缴费档次与替代率水平之间具有正向相关关系,探索新制度下养老金的替代率水平低及其预期保障力不足的深层次原因,并在政府补贴力度、个人账户投资运营以及缴费方式上提出相应的建议。

  13. Multiple Attenuation Model and Actuarial Present Value of Pension Scheme Based on CIR Interest Rate%基于CIR利率的养老金计划多元衰减模型与精算现值

    Institute of Scientific and Technical Information of China (English)

    李浩; 侯为波; 张增林

    2016-01-01

    随着我国人口老年化问题的日趋加剧,养老金计划对于老年人口的生活保障愈显得重要。寿险精算理论在科学合理制定保险产品价格方面至关重要。利率是影响价格的最重要因素之一。从长期来看,利率随时间的变化而波动,具有很强的随机波动性。文章考虑利用具有随机波动特性的CIR利率模型,建立养老金多元衰减模型,进而获得延期年金的精算现值解析式。%With the problem of astogeny getting worse,pension schemes are even more vital to the liv⁃ing security of the old. The theory of life contingencies plays an important role in setting the scientif⁃ic and reasonable prices of insurance products. The rate of interest is one of the key factors that af⁃fect prices. In the long run, the rate of interest fluctuates with time going by, enjoying strong and random volatility. To establish the multiple attenuation pattern of pension, the authors consider using the pattern of the rate of interest characterized by random and fluctuant CIR,and then gain the formu⁃la of actuarial present value of deferred annuity.

  14. Nestin expression associates with poor prognosis and triple negative phenotype in locally advanced (T4 breast cancer

    Directory of Open Access Journals (Sweden)

    F. Piras

    2011-11-01

    Full Text Available Nestin, an intermediate filament protein, has traditionally been noted for its importance as a neural stem cell marker. However, in recent years, expression of nestin has shown to be associated with general proliferation of progenitor cell populations within neoplasms. There is no reported study addressing nestin expression in T4 breast cancer patients. Thus, the aim of the present study was to investigate, through immunohistochemistry, the expression and distribution of nestin in T4 breast cancer, in order to determine its association with clinical and pathological parameters as well as with patients’ outcome. Nestin was detectable in tumoral cells and in endothelial cells of blood microvessels, and it is significantly expressed in triple-negative and in inflammatory breast cancer (IBC subgroups of T4 breast tumours. The Kaplan-Meier analysis showed that the presence of nestin in tumoral cells significantly predicted poor prognosis at 5-years survival (P=0.02 and with borderline significance at 10-years of survival (P=0.05 in T4 breast cancer patients. On the basis of these observations, we speculate that nestin expression may characterize tumours with an aggressive clinical behavior, suggesting that the presence of nestin in tumoral cells and vessels may be considered an important factor that leads to a poor prognosis. Further studies are awaited to define the biological role of nestin in the etiology of these subgroups of breast cancers.

  15. Preoperative Plasma Fibrinogen Level as a Significant Prognostic Factor in Patients With Localized Renal Cell Carcinoma After Surgical Treatment.

    Science.gov (United States)

    Lee, Hakmin; Lee, Sang Eun; Byun, Seok-Soo; Kim, Hyeon Hoe; Kwak, Cheol; Hong, Sung Kyu

    2016-01-01

    We sought to investigate the association of preoperative fibrinogen levels with clinicopathologic outcomes after surgical treatment of nonmetastatic renal cell carcinoma. We reviewed the records of 1511 patients who had their fibrinogen levels measured preceding surgery. The associations between preoperative fibrinogen level and risk of adverse clinicopathologic outcomes were tested using the multivariate logistic regression and multiple Cox-proportional hazards model, respectively. Based on plasma fibrinogen levels, we stratified the patients into 2 groups with a cut-off value of 328  mg/dL. Kaplan-Meier analysis showed significantly inferior survival outcomes in progression-free (P fibrinogen level (≥328  mg/dL) was significantly related to a higher Fuhrman grade (hazard ratio [HR] 1.374, P = 0.006) and a larger tumor size (≥7  cm) (HR 2.364, P fibrinogen level is a significant predictor for poor disease progression (HR 1.857, P fibrinogen levels were significantly associated with poor pathological features and worse survival outcomes in patients with nonmetastatic renal cell carcinoma after surgical treatment. Further evaluations such as prospective randomized trials are needed to understand the underlying mechanism for these associations.

  16. Local Warming

    CERN Document Server

    Vanderbei, Robert J

    2012-01-01

    Using 55 years of daily average temperatures from a local weather station, I made a least-absolute-deviations (LAD) regression model that accounts for three effects: seasonal variations, the 11-year solar cycle, and a linear trend. The model was formulated as a linear programming problem and solved using widely available optimization software. The solution indicates that temperatures have gone up by about 2 degrees Fahrenheit over the 55 years covered by the data. It also correctly identifies the known phase of the solar cycle; i.e., the date of the last solar minimum. It turns out that the maximum slope of the solar cycle sinusoid in the regression model is about the same size as the slope produced by the linear trend. The fact that the solar cycle was correctly extracted by the model is a strong indicator that effects of this size, in particular the slope of the linear trend, can be accurately determined from the 55 years of data analyzed. The main purpose for doing this analysis is to demonstrate that it i...

  17. Rehydrate locally.

    Science.gov (United States)

    Djokoto, E

    1997-11-01

    In 1991, in the northern region of Ghana, during the cholera epidemic, 10 rural health centers replied to a questionnaire regarding cholera case referrals. The results were as follows: 6 centers referred serious cases to hospitals, 2 did not receive patients because of fear of infection, and 2 received all patients. Although no patients admitted to the rural health centers died, many of the referred patients did. Of 14 cases referred to a hospital, 3 died in transit, 4 died at the hospital, and 7 survived. Deaths might be prevented if patients were treated promptly and locally with oral rehydration solutions based on cereals and rice; these are easy to prepare, superior to, and more available than standard oral rehydration salts (ORS). One mother walked 5 miles to a rural health post with her sick baby on her back, only to find that the dehydrated child had died on the way. During the 1991 cholera epidemic in Ghana, the author treated several patients in their homes; all recovered. Prompt and frequent rehydration in the home is the best treatment for diarrhea and cholera.

  18. Outcomes for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresction%局部复发直肠癌超常规大分割同步放化疗疗效分析

    Institute of Scientific and Technical Information of China (English)

    姚波; 王雅棣; 路娜; 刘清智; 陈点点

    2015-01-01

    Objective To analyze the response rate and prognostic factors for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresection.Methods Totally 52 patients with locally recurrent rectal cancer received hypofractionated irradiation and concurrent chemotherapy from January 2006 to January 2013 were enrolled.All patients received intensity-modulated radiotherapy (IMRT).The median dose was 63.4 Gy (61.6-64.4 Gy) at 2.2-2.3 Gy/f,5 f/week.Thirteen patients underwent prophylactic irradiation at lymph nodes region,the total dose of 45-50.4 Gy with conventional fraction and a simultaneous integrated boost was used.All patients received concurrent chemotherapy,capecitabine at 1 650 mg·m-2 ·d-1,divided into 2 times,5 d/week.The variables were compared by the chi-square test or Fisher's exact test.Local control (LC) and overall survival (OS) were calculated with using the Kaplan-Meier method.Results For all patients,the clinical complete response (CR),partial response (PR),stable disease (SD) and progressive disease (PD) was 23.1%,38.5%,32.7% and 5.8%,respectively.The response rate (CR + PR) for patients with previous irradiation to pelvis and without were 37.1% and 71.1%,respectively (x2 =5.40,P < 0.05);for patients with 1 and 2 or more recurrent subsites were 81.8% and 46.7%,respectively (x2 =6.63,P < 0.05).Acute grade 3 skin and hematologic toxicities occurred in 19 patients (36.5%) and 1 patient (1.9%),respectively.None occurred grade 4 toxicity and none occurred grade 3 or more gastrointestinal and urologic toxicities.Four patients showed severe late toxicity of anastomotic stricture and performed a stoma at transverse colon.No other severe late toxicities were observed.The LC at 5 years was 49.1% and the OS was 23.1%.Conclusions For patients with locally recurrent rectal cancer,hypofractionated chemoradiotherapy without resection is an acceptable and effective regimen,the response rate and

  19. Quantum Locality?

    Energy Technology Data Exchange (ETDEWEB)

    Stapp, Henry

    2011-11-10

    vagaries that he cites do not upset the proof in question. It is show here in detail why the precise statement of this theorem justifies the specified application of CQT. It is also shown, in response to his challenge, why a putative proof of locality that he has proposed is not valid.

  20. Factors affecting commencement and cessation of smoking behaviour in Malaysian adults

    Directory of Open Access Journals (Sweden)

    Ghani Wan

    2012-03-01

    Full Text Available Abstract Background Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as bidi and rokok daun are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs. Methods Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios. Results Males had a much higher prevalence of the habit (61.7% as compared to females (5.8%. Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p Conclusions Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.

  1. Factors affecting commencement and cessation of smoking behaviour in Malaysian adults.

    Science.gov (United States)

    Ghani, Wan Maria Nabillah; Razak, Ishak Abdul; Yang, Yi Hsin; Talib, Norain Abu; Ikeda, Noriaki; Axell, Tony; Gupta, Prakash C; Handa, Yujiro; Abdullah, Norlida; Zain, Rosnah Binti

    2012-03-19

    Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as bidi and rokok daun are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs. Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios. Males had a much higher prevalence of the habit (61.7%) as compared to females (5.8%). Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.

  2. High serum uric acid concentration predicts poor survival in patients with breast cancer.

    Science.gov (United States)

    Yue, Cai-Feng; Feng, Pin-Ning; Yao, Zhen-Rong; Yu, Xue-Gao; Lin, Wen-Bin; Qian, Yuan-Min; Guo, Yun-Miao; Li, Lai-Sheng; Liu, Min

    2017-08-26

    Uric acid is a product of purine metabolism. Recently, uric acid has gained much attraction in cancer. In this study, we aim to investigate the clinicopathological and prognostic significance of serum uric acid concentration in breast cancer patients. A total of 443 female patients with histopathologically diagnosed breast cancer were included. After a mean follow-up time of 56months, survival was analysed using the Kaplan-Meier method. To further evaluate the prognostic significance of uric acid concentrations, univariate and multivariate Cox regression analyses were applied. Of the clinicopathological parameters, uric acid concentration was associated with age, body mass index, ER status and PR status. Univariate analysis identified that patients with increased uric acid concentration had a significantly inferior overall survival (HR 2.13, 95% CI 1.15-3.94, p=0.016). In multivariate analysis, we found that high uric acid concentration is an independent prognostic factor predicting death, but insufficient to predict local relapse or distant metastasis. Kaplan-Meier analysis indicated that high uric acid concentration is related to the poor overall survival (p=0.013). High uric acid concentration predicts poor survival in patients with breast cancer, and might serve as a potential marker for appropriate management of breast cancer patients. Copyright © 2017. Published by Elsevier B.V.

  3. Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy

    Directory of Open Access Journals (Sweden)

    Keck Bastian

    2013-02-01

    Full Text Available Abstract Background Since the definition of different histologic subtypes of urothelial carcinomas by the World Health Organization (WHO 2004 classification, description of molecular features and clinical behavior of these variants has gained more attention. Methods We reviewed 205 tumor samples of patients with locally advanced bladder cancer mainly treated within the randomized AUO-AB05/95 trial with radical cystectomy and adjuvant cisplatin-based chemotherapy for histologic subtypes. 178 UC, 18 plasmacytoid (PUC and 9 micropapillary (MPC carcinomas of the bladder were identified. Kaplan Meier analysis and backward multivariate Cox’s proportional hazards regression analysis were performed to compare overall survival between the three histologic subtypes. Results Patients suffering from PUC have the worst clinical outcome regarding overall survival compared to conventional UC and MPC of the bladder that in turn seem have to best clinical outcome (27.4 months, 62.6 months, and 64.2 months, respectively; p=0.013 by Kaplan Meier analysis. Backward multivariate Cox´s proportional hazards regression analysis (adjusted to relevant clinicopathological parameters showed a hazard ratio of 3.2 (p=0.045 for PUC in contrast to patients suffering from MPC. Conclusions Histopathological diagnosis of rare variants of urothelial carcinoma can identify patients with poor prognosis.

  4. 任意支撑上5阶凸随机序的极值分布及其在保险精算中的应用%Extremal distributions for 5-convex stochastic orderings with arbitrary discrete support and applications in actuarial sciences

    Institute of Scientific and Technical Information of China (English)

    田有功; 刘转玲

    2014-01-01

    在离散的5阶凸随机序意义下,研究了在R+上的任意离散子集上取值的随机变量的极值分布①。在保险精算应用中,估计了Lunberg调整系数的界。%In the sense of discrete 5-convex stochastic ordering, the extremal distribution for random variables valued in an arbitrary discrete subset of the half-positive real line R+was considered.The bounds of Lundberg’s adjustment coef-ficient in actuarial sciences were estimated.

  5. Actuarial Evaluation of the Financial Operation Situation of China's Basic Medical Insurance System%中国基本医疗保险制度财务运行状况的精算评估

    Institute of Scientific and Technical Information of China (English)

    曾益; 任超然; 李媛媛

    2012-01-01

    人口老龄化的加剧可能会恶化我国城镇职工医疗保险制度的财务状况。文章在相关参数假设的基础上通过精算模型评估发现,虽然城镇职工医疗保险个人账户累计余额逐年增加,但是在2025年统筹基金将会收不抵支,收支差为-102.11亿元,这一差值还会逐年扩大,至2033年累计结余会使用完毕。针对以上状况,文章在评估了几种改善统筹基金财务状况的政策方案后发现,个人账户与统筹基金合并能将收不抵支和出现赤字的年份推迟到2034年和2046年,这一方案优于其他方案。%The increasing population aging may worsen the financial sit uation of China's urban resident basic medical insurance system. Based on the hypothesis of related parameters and the actuarial evaluation models, this paper finds that the accumulated amount of the urban resident medical sav ings accounts increases year by year, but the income of the pooling fund will not balance the expense in 2025; the gap between income and expenditure is -10. 211 billion yuan and as the gap will gradually widen, the accumulated amount of the pooling fund will be used up in 2033. After evaluating some policy options of improving the financial status of the pooling fund, this pa per shows that the integration of individual medical savings accounts and pooling fund can postpone the time of income over expenditure until 2034 and the time of deficit until 2046, so it is better than other policy options.

  6. Life Insurance Actuarial Model with Returnable Premium

    Institute of Scientific and Technical Information of China (English)

    YanhuaiLang

    2004-01-01

    Insurance is the important aspect of finance. It has been fully developed in the western developed countries. With the fast development of market economy in our country,it is necessary to introduce the alien modern theories and techniques, and at the same time,adapt them to our concrete situation. The model of general life insurance product is to be established in this paper, including deferred life annuities, increasing whole life insurance and returnable premiums. Then through the regulation of various parameters, we can obtain various insurance products.

  7. Restricted Coherent Risk Measures and Actuarial Solvency

    Directory of Open Access Journals (Sweden)

    Christos E. Kountzakis

    2012-01-01

    Full Text Available We prove a general dual representation form for restricted coherent risk measures, and we apply it to a minimization problem of the required solvency capital for an insurance company.

  8. A Quasi Actuarial Prospect for Individual Assessment.

    Science.gov (United States)

    Owens, William A.

    A conceptual model of individual assessment through the use of biodata responses with minimal input information is outlined. The process is considered especially applicable to industrial psychology. A scored autobiographical data form, which measures the individual's past behavior and experiences, provides for assignment to a specific subgroup…

  9. Actuarial risk measures for financial derivative pricing

    NARCIS (Netherlands)

    M.J. Goovaerts; R.J.A. Laeven

    2008-01-01

    We present an axiomatic characterization of price measures that are superadditive and comonotonic additive for normally distributed random variables. The price representation derived involves a probability measure transform that is closely related to the Esscher transform, and we call it the Esscher

  10. The fiscal stress arising from state and local retiree health obligations.

    Science.gov (United States)

    Lutz, Byron; Sheiner, Louise

    2014-12-01

    A major factor weighing down the long-term finances of state and local governments is the obligation to fund retiree benefits. While state and local government pension obligations have been analyzed in great detail, much less attention has been paid to the costs of the other major retiree benefit provided by these governments: retiree health insurance. The first portion of the paper uses the information contained in the annual actuarial reports for public retiree health plans to reverse engineer the cash flows underlying the liabilities given in the report. Obtaining the cash flows allows us to construct liability estimates which are consistent across governments in terms of the discount rate, actuarial method and assumptions concerning medical cost inflation and mortality. We find that the total unfunded accrued liability of state and local governments for the provision of retiree health care exceeds $1 trillion, or about ⅓ of total state and local government revenue. Relative to pension obligations discounted at the same rate, we find that unfunded retiree health care liabilities are ½ the size of unfunded pension obligations. We also find that using assumptions concerning the growth in health care costs that are arguably more realistic than those employed by most states actually reduces the size of the liability in most cases. Pushing in the opposite direction, we find that using plausibly more realistic mortality assumptions increases the size of liability. The second portion of the paper places retiree health care obligations into context by examining the budget pressures associated with retiree health on a continuing, largely pay-as-you go basis. We find that much of the projected increase in retiree health obligations as a share of revenue is the result of health care cost growth. On average, states could put their retiree health obligations into long-run fiscal balance by contributing an additional ¾ percent of total revenue toward the benefit each year

  11. Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Schreiber, David; Weiss, Jeffrey P.; Safdieh, Joseph; Weiner, Joseph; Rotman, Marvin; Schwartz, David [Veterans Affairs, New York Harbor Healthcare System, Brooklyn (United States); Rineer, Justin [University of Florida Health Cancer Center at Orlando Health, Orlando (United States)

    2015-03-15

    We analyzed outcomes of patients with prostate cancer undergoing either radical retropubic prostatectomy (RRP) +/- salvage radiation or definitive radiation therapy (RT) +/- androgen deprivation. From 2003-2010 there were 251 patients who underwent RRP and 469 patients who received RT (> or =7,560 cGy) for prostate cancer. Kaplan-Meier analysis was performed with the log-rank test to compare biochemical control (bCR), distant metastatic-free survival (DMPFS), and prostate cancer-specific survival (PCSS) between the two groups. The median follow-up was 70 months and 61.3% of the men were African American. For low risk disease the 6-year bCR were 90.3% for RT and 85.6% for RRP (p = 0.23) and the 6-year post-salvage bCR were 90.3% vs. 90.9%, respectively (p = 0.84). For intermediate risk disease the 6-year bCR were 82.6% for RT and 59.7% for RRP (p < 0.001) and 82.6% vs. 74.0%, respectively, after including those salvaged with RT (p = 0.06). For high risk disease, the 6-year bCR were 67.4% for RT and 41.3% for RRP (p < 0.001) and after including those salvaged with RT was 67.4% vs. 43.1%, respectively (p < 0.001). However, there were no significant differences between the two groups in regards to DMPFS or PCSS. Treatment approaches utilizing RRP +/- salvage radiation or RT +/- androgen deprivation yielded equivalent DMPFS and PCSS outcomes. Biochemical control rates, using their respective definitions, appeared equivalent or better in those who received treatment with RT.

  12. Postmastectomy Radiotherapy for Locally Advanced Breast Cancer Receiving Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Icro Meattini

    2014-01-01

    Full Text Available Neoadjuvant chemotherapy (NAC is widely used in locally advanced breast cancer (BC treatment. The role of postmastectomy radiotherapy (PMRT after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6% underwent PMRT and 72 cases (42.4% did not receive radiation. At a median follow-up period of 7.7 years (range 2–16 for the whole cohort, median time to locoregional recurrence (LRR was 3.3 years (range 0.7–12.4. The 5-year and 10-year actuarial LRR rate were 14.5% and 15.9%, respectively. At the multivariate analysis the factors that significantly correlated with survival outcome were ≥4 positive nodes (HR 5.0, 1.51–16.52; P=0.035, extracapsular extension (HR 2.18, 1.37–3.46; P=0.009, and estrogen receptor positive disease (HR 0.57, 0.36–0.90; P=0.003. Concerning LRR according to use of radiation, PMRT reduced LRR for patient with clinical T3 staged disease (P=0.015. Our experience confirmed the impact of pathological nodal involvement on survival outcome. PMRT was found to improve local control in patients presenting with clinical T3 tumors, regardless of the response to chemotherapy.

  13. Comorbidity, Use of Common Medications, and Risk of Early Death in Patients with Localized or Locally Advanced Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Carsten Nieder

    2011-01-01

    Full Text Available In this paper, we analyze predictive factors for early death from comorbidity (defined as death within 3 years from diagnosis and unrelated to prostate cancer in patients with localized or locally advanced prostate cancer. Such information may guide individually tailored treatment or observation strategies, and help to avoid overtreatment. We retrospectively analyzed baseline parameters including information on comorbidity and medication use among 177 patients (median age at diagnosis 70 years. Actuarial survival analyses were performed. During the first 3 years, two patients (1.1% died from progressive prostate cancer after they had developed distant metastases. The risk of dying from other causes (3.4% was numerically higher, although not to a statistically significant degree. Six patients who died from other causes had age-adjusted Charlson comorbidity index (CCI scores ≥5 (CCI is a sum score where each comorbid condition is assigned with a score depending on the risk of dying associated with this condition. The main comorbidity was cardiovascular disease. The two statistically significant predictive factors were medication use and age-adjusted CCI score ≥5 (univariate analysis. However, medication use was not an independent factor as all patients with age-adjusted CCI score ≥5 also used at least one class of medication. Median survival was 30 months in patients with age-adjusted CCI score ≥5. Prediction of non-prostate cancer death may be important to prevent overtreatment in patients who are more threatened by comorbidity. Our data suggest that simple parameters such as use of medications vs. none, or presence of serious cardiac disease vs. none, are not sufficient, and that age-adjusted CCI scores outperform the other factors included in our analysis.

  14. Local Duality for 2-Dimensional Local Ring

    Indian Academy of Sciences (India)

    Belgacem Draouil

    2008-11-01

    We prove a local duality for some schemes associated to a 2-dimensional complete local ring whose residue field is an -dimensional local field in the sense of Kato–Parshin. Our results generalize the Saito works in the case =0 and are applied to study the Bloch–Ogus complex for such rings in various cases.

  15. Early diffusion weighted magnetic resonance imaging can predict survival in women with locally advanced cancer of the cervix treated with combined chemo-radiation

    Energy Technology Data Exchange (ETDEWEB)

    Somoye, Gbolahan; Parkin, David [Ward 42, Aberdeen Royal Infirmary, Aberdeen (United Kingdom); Harry, Vanessa [Royal Marsden NHS Foundation Trust, London (United Kingdom); Semple, Scott [Queen' s Medical Research Institute, Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh (United Kingdom); Plataniotis, George [Musgrove Park Hospital, Taunton and Somerset NHS Foundation, Taunton (United Kingdom); Scott, Neil [University of Aberdeen, Section of Population Health, Aberdeen (United Kingdom); Gilbert, Fiona J. [University of Cambridge, Radiology Department, Box 218, Cambridge (United Kingdom)

    2012-11-15

    To assess the predictive value of diffusion weighted imaging (DWI) for survival in women treated for advanced cancer of the cervix with concurrent chemo-radiotherapy. Twenty women treated for advanced cancer of the cervix were recruited and followed up for a median of 26 (range <1 to 43) months. They each had DWI performed before treatment, 2 weeks after beginning therapy (midtreatment) and at the end of treatment. Apparent diffusion coefficient (ADC) values were calculated from regions of interest (ROI). All participants were reviewed for follow-up data. ADC values were compared with mortality status (Mann-Whitney test). Time to progression and overall survival were assessed (Kaplan-Meier survival graphs). There were 14 survivors. The median midtreatment ADC was statistically significantly higher in those alive compared to the non-survivors, 1.55 and 1.36 (x 10{sup -3}/mm{sup 2}/s), respectively, P = 0.02. The median change in ADC 14 days after treatment commencement was significantly higher in the alive group compared to non-survivors, 0.28 and 0.14 (x 10{sup -3}/mm{sup 2}/s), respectively, P = 0.02. There was no evidence of a difference between survivors and non-survivors for pretreatment baseline or post-therapy ADC values. Functional DWI early in the treatment of advanced cancer of the cervix may provide useful information in predicting survival. (orig.)

  16. Idade de aparecimento e desaparecimento das pontas rolândicas em 160 crianças acompanhadas ambulatorialmente: estudo atuarial Age of appearance and disappearance of rolandic spikes of 160 children: an actuarial study

    Directory of Open Access Journals (Sweden)

    MOACIR A. BORGES

    1999-09-01

    Full Text Available PROPOSTA: Determinar a idade em que surgem e desaparecem as pontas rolândicas (PR em traçados eletrencefalográficos de rotina. MÉTODO: Estudo prospectivo hospitalar, baseado em 412 eletrencefalogramas de 160 crianças que frequentaram o ambulatório de neuropediatria entre as idades de 1 e 16 anos, no período de março de 1989, a março de 1998. Usou-se o sistema 10/20 para colocação dos eletrodos. As crianças foram dividas, por idade, em quatro grupos (1 a 4; 5 a 8; 9 a 16; 1 a 16 e usou-se o método de curva atuarial, considerando-se como evento, o desaparecimento da PR. RESULTADOS: PR teve distribuição entre meninos e meninas na razão de 64/36. A idade média em que surgiu a PR foi 7 anos (7,2 para homens e 6,6 para mulheres e, num pequeno grupo de crianças que tinha EEG normal anterior ao surgimento da PR, a idade média foi 6,8 anos. Após 7 anos de seguimento, a percentagem de pacientes livres de PRs era 60% para o grupo de 1 a 4 anos na admissão, 84% para os grupos de 5 a 8 anos e 9 a 16 anos. Para o grupo total (1 a 16 anos a percentagem de livres de PR, após 7 anos de seguimento, foi 78%. CONCLUSÃO: O estudo mostra que as PR surgiram, em média, aos 7 anos e têm probabilidade de desaparecimento até 7 anos de seguimento, independetemente da faixa etária de aparecimento.This study aims to determine the age at which the rolandic spikes (RS appear and disappear in routine EEGs. METHOD: It has been carried out a hospital based prospective study of 412 EEGs records of 160 children who had been assisted at the neuropediatric out-patient department during the period between March, 1989 and March,1998. Recordings were made on 8-channel instruments and 10/20 system has been to place the electrodes. The children have been divided into 4 groups, according to their age (1 to 4; 5 to 8; 9 to 16; 1 to 16, and the actuarial curve method has been used to show the disappearance of the rolandic spikes. RESULTS: RS distribution between

  17. 手术联合高剂量放疗治疗局部晚期嗅神经母细胞瘤的临床效果%Effect of surgery combined with high-dose radiotherapy in treating locally advanced esthesioneuroblastoma

    Institute of Scientific and Technical Information of China (English)

    高军茂; 许卫东; 陈点点; 张富利; 王雅棣

    2016-01-01

    Objective To explore the effect of surgery combined with high-dose irradiation in treatment of locally advanced esthesioneuroblastoma (ENB).Methods Eleven patients pathologically confirmed as ENB from March 2005 to December 2014 were retrospectively analyzed.All patients were treated with simultaneous-boost intensity modulated radiation therapy before or after surgery combined with or not with chemotherapy.After radiotherapy,Kaplan Meier method was used to calculate the cumulative survival rates and disease-free survival (DFS) rate for 5 years.Results Surgery was performed in 10 patients,among them,9 cases received surgery + postoperative radiotherapy and 1 cases received preoperative radiotherapy + surgery,6 cases received complete tumor excision and 4 cases received partial tumor resection.One case who received preoperative radiotherapy refused surgery and underwent radical cure of radiotherapy.Three patients received adjuvant chemotherapy during the first treatment.The median follow-up period was 52 months (5-86 months).The cumulative survival rate and DFS rate for 5 years were 45.0% and 42.6%;the median overall survival time and DFS time were 60 months and 55 months.Local recurrence occurred in 1 patient,lymphatic metastasis occurred in 2 cases,distant metastasis occurred in 4 cases.No cervical nodal failure occurred in 9 patients receiving elective prophylactic irradiation of nodal.Conclusion Surgery combined with high-dose irradiation provides a high local control rate in treating ENB of Kadish stage B and C;elective prophylactic irradiation of nodal might prevent regional failure in locally advanced ENB.%目的 探讨手术联合高剂量放疗治疗局部晚期嗅神经母细胞瘤的临床效果.方法 回顾性选择2005年3月至2014年12月于北京军区总医院就诊的经病理证实为Kadish B、C期嗅神经母细胞瘤的患者11例,所有患者均术前或术后接受同期整合补量调强放射治疗和/或化疗治疗.放疗结

  18. VT Certified Local Governments

    Data.gov (United States)

    Vermont Center for Geographic Information — Vermont established its Certified Local Government (CLG) program in 1985 to better help local governments integrate historic preservation concerns with planning and...

  19. Limits to local government

    NARCIS (Netherlands)

    Rob Gilsing

    2005-01-01

    Original title: Bestuur aan banden. A great deal is expected of local authority youth policy: the idea is that the local authority is in a better position than central government to develop policy that is tailored to the local situation. Moreover, it is felt that it is easier for local authorities

  20. 非手术综合治疗保留中晚期喉癌患者喉器官的效果分析%Effective analysis of non-surgical combined treatments for laryngeal organ preservation in locally advanced laryngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    颜芳; 张欣欣; 马林; 刘明波; 陈南翔; 王嘉陵; 武文明; 黄德亮

    2016-01-01

    Objective To evaluate the therapeutic effects,larynx preservation and adverse events of non-surgical combined treatments for laryngeal organ preservation in locally advanced laryngeal squamous cell carcinomas(SCCs).Methods Forty-six patients with locally advanced laryngeal carcinoma (T2-4,N0-N3) were treated individually with non-surgical combined treatments for larynx preservation (LP).These treatments included concurrent chemoradiotherapy (CCRT) (± epidermal growth factor receptor (EGFR)inhibitor),induction chemotherapy (ICT) followed by CCRT (± EGFR inhibitor),or concurrent radiotherapy and EGFR inhibitor.Radiation therapy was given to a total dose of 60-70 Gy.The KaplanMeier method was used to determine the overall survival.Side-effects were evaluated with the established Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria.Results The average follow-up time was 31.8 months (range 6-95 months).All patients completed the planned radiotherapywithout treatment breaks,and 45(97.8%) of 46 patients completed the planned chemotherapy.The 3-year and 5-year overall survival rates were 87.3% and 67.2%,respectively.The 5-year larynx preservation rate was 100.0%.The 3-year and 5-year progression free survival rates were 95.1% and 87.7%,respectively.The most common acute side effect in grade 3 was oropharyngeal mucositis.After treatment,tracheotomy was still required in 2 patients with glottis cancer for laryngeal edema or stenosis.No patient depended on a percutaneous gastrostomy and experienced speech impairment.Conclusion Patients with locally advanced laryngeal cancer can be offered non-surgical combined treatments for laryngeal preservation and the high quality of life,showing a higher laryngeal preservation survival rate with minimal toxicities.%目的 评估应用非手术综合治疗方法治疗中晚期喉癌患者的治疗效果.方法 回顾性分析2007年11月至2015年4月,解放军总医院耳鼻咽喉头颈外科46例应

  1. Local real analysis in locally homogeneous spaces

    CERN Document Server

    Bramanti, Marco

    2011-01-01

    We introduce the concept of locally homogeneous space, and prove in this context L^p and Holder estimates for singular and fractional integrals, as well as L^p estimates on the commutator of a singular or fractional integral with a BMO or VMO function. These results are motivated by local a-priori estimates for subelliptic equations.

  2. Local food and tourism

    DEFF Research Database (Denmark)

    Boesen, Morten; Sundbo, Donna; Sundbo, Jon

    2017-01-01

    This article investigates the question: Why local food networks succeed or fail in collaborating with local tourism actors to create more tourism based on local food? The article focuses on entrepreneurial local food networks and their collaboration with local tourism actors. Emphasis...... is on the actions and attitude logics of local food networks and tourism actors, and whether their respective logics fit as a factor to explain why or why not development of local food concepts lead to increased local tourism. Six local food networks and their collaboration with local tourism actors are studied...... by using observation supplemented with other qualitative methods. Analysis of these networks reveals that successful collaboration is characterised by the food networks and tourism actors having at least one logic in common. The fitting logics that lead to success are primarily celebrity and civic logics...

  3. Defining local food

    DEFF Research Database (Denmark)

    Eriksen, Safania Normann

    2013-01-01

    Despite evolving local food research, there is no consistent definition of “local food.” Various understandings are utilized, which have resulted in a diverse landscape of meaning. The main purpose of this paper is to examine how researchers within the local food systems literature define local...... food, and how these definitions can be used as a starting point to identify a new taxonomy of local food based on three domains of proximity....

  4. Homogeneous Beliefs and Mispricing of Black-Scholes Model Option Pricing Model Based on Actuarial Method%同质信念与 Black-Scholes 公式定价偏差--基于期权定价的保险精算方法∗

    Institute of Scientific and Technical Information of China (English)

    柯政; 秦梦

    2015-01-01

    本文分析了包括 BS 的鞅方法在内的四种期权定价方法.Mogens Bldt 和郑红给出的保险精算定价方法是非套利定价,缺少足够的理论基础.另外,存在同质信念的市场上 BS 定价并非完全无套利,如果对不同股票进行分散化投资,只要基础资产种类足够多,也可套取利益.不同投资者的漂移率取同一常数μ体现了他们的同质信念,与弱有效的现实市场情况相符.进一步分析得出结论,即使存在同质信念,如果μt 是一个可料过程而非常数,会使得精算定价难以计算确定期望,从而无效.根据 SAS 软件的模拟结果,在同质信念下,精算套利定价显著高于 BS 鞅方法定价.通过恒生股指期权的实证检验,说明同质信念下的漂移率更适合取同一常数而不是可料过程,实证检验发现精算套利理论价格与实际价格差距很小,说明此方法比较有效.%This paper analyzed the four option pricing methods including the martingale method.Mogens Bldt and Hong Zheng gave actuarial pricing methods for options respectively,however,both of the methods are not non-arbitrage lack ade-quate theoretical basis.In addition,BS pricing method is not completely non-arbitrage,for diversified investment at different stock,as long as a sufficient number,may make profit.Moreover,the same drift of stock for different investors embodies homogeneous beliefs,which complies with weak efficient market assumption in real market.Further analysis concludes that,e-ven if homogeneous beliefs exist,the drift of stock could be a previsible process,which results in difficulty to calculate and de-termine the expectations in actuarial pricing and thus invalids the pricing in actuarial method.According to the simulation run by SAS,with homogeneous assumption,actuarial non-arbitrage pricing gives significantly higher price for options than BS. Through empirical test of the Hang Seng index options,the authors

  5. Localized therapy for male breast cancer: functional advantages with comparable outcomes using breast conservation.

    Science.gov (United States)

    Fogh, Shannon; Kachnic, Lisa A; Goldberg, Saveli I; Taghian, Alphonse G; Powell, Simon N; Hirsch, Ariel E

    2013-10-01

    Male breast cancer (MBC) accounts for approximately 1% of all breast cancers. Given the rarity of this disease, treatment of MBC generally follows the same principles as treatment of female breast cancer. However, the traditional surgical approach for MBC is modified radical mastectomy (MRM) or total simple mastectomy (TSM) instead of breast conservation surgery (BCS). The purpose of this study was to examine the feasibility of BCS as an alternative to mastectomy for MBC with respect to musculoskeletal functionality and treatment outcome. A retrospective analysis was undertaken of all male patients with breast cancer who presented to Massachusetts General Hospital or Boston Medical Center for localized therapy from 1990 to 2003. Musculoskeletal functionality (tissue fibrosis, arm edema, and range of motion) and treatment outcome (local-regional control, disease-free survival, and overall survival) were evaluated. Functional/cosmetic outcomes were assessed by multidisciplinary review of patient follow-up visits and were scored as either "good-excellent" or "fair-poor" to account for subjectivity between different clinicians. Forty-two patients in total were identified to undergo localized treatment. Thirty patients (71%) received MRM, 4 (10%) had TSM, and 8 (19%) underwent BCS. Actuarial overall 1-year fair-poor documented tissue fibrosis, arm edema, and decreased range of motion rates were 13%, 23%, and 27% for patients receiving MRM; 25%, 0%, and 50% for patients who underwent TSM; and 13%, 0%, and 0% for those undergoing BCS, respectively. Overall survival and disease-free survival were not statistically different between the groups. These data suggest that breast conservation therapy may be considered a reasonable local treatment option for male patients presenting with breast cancer because it may offer functional advantages over mastectomy with comparable rates of local control and disease-free survival and overall survival. Copyright © 2013 Elsevier Inc. All

  6. Local perturbations perturb—exponentially–locally

    Energy Technology Data Exchange (ETDEWEB)

    De Roeck, W., E-mail: wojciech.deroeck@fys.kuleuven.be; Schütz, M., E-mail: marius.schutz@fys.kuleuven.be [Instituut voor Theoretische Fysica, K. U. Leuven, Celestijnenlaan 200D, B-3001 Heverlee (Belgium)

    2015-06-15

    We elaborate on the principle that for gapped quantum spin systems with local interaction, “local perturbations [in the Hamiltonian] perturb locally [the groundstate].” This principle was established by Bachmann et al. [Commun. Math. Phys. 309, 835–871 (2012)], relying on the “spectral flow technique” or “quasi-adiabatic continuation” [M. B. Hastings, Phys. Rev. B 69, 104431 (2004)] to obtain locality estimates with sub-exponential decay in the distance to the spatial support of the perturbation. We use ideas of Hamza et al. [J. Math. Phys. 50, 095213 (2009)] to obtain similarly a transformation between gapped eigenvectors and their perturbations that is local with exponential decay. This allows to improve locality bounds on the effect of perturbations on the low lying states in certain gapped models with a unique “bulk ground state” or “topological quantum order.” We also give some estimate on the exponential decay of correlations in models with impurities where some relevant correlations decay faster than one would naively infer from the global gap of the system, as one also expects in disordered systems with a localized groundstate.

  7. The clinical observation of three-dimensional conformal radiotherapy combined with FOLFOX chemotherapy for rectal cancer of postoperative local recurrence

    Institute of Scientific and Technical Information of China (English)

    Yeqin Zhou; Mi Liu; Daiyuan Ma; Tao Ren; Xiaojie Ma; Xianfu Li; Bangxian Tan

    2012-01-01

    Objective: The aim of this study was to explore the three-dimensional conformal radiotherapy combined with FOLFOX scheme chemotherapy in the treatment of postoperative recurrence of rectal cancer. Methods: Sixty-eight cases of recurrent rectal cancer were divided randomly into two groups: 34 cases of conformal radiotherapy plus FOLFOX chemotherapy group (experiment group) and 34 cases of conformal radiotherapy (control group). After 6 MvX line with three-dimensional conformal radiotherapy technologies for recurrent lesions and pelvic cavity around subclinical lymphatic drainage radiotherapy after radiotherapy to DT 40 Gy to reposit was made use of between both groups, experiment group was made the new treatment plan to continue to irradiate to 50 Gy, and then Shrinkage GTV was pushed quantity in the field 66 Gy. Researchers took chemotherapy in the first week and the fourth week after radiotherapy, with 5-fluorouracil 500 mg/m2, calcium leucovorin 200 mg, d1-5 with intravenous drip, Oxaliplatin 130 mg/m2 and d1 with intravenous drip 2 h, 21 days was one cycle. Kaplan-Meier method was used for survival analysis. Results: The survival rates for 1, 2 and 3 years for experiment group and control group were 88.2%, 64.7%, 47.1% and 66.7%, 38.2%, 29.4% (P = 0.03), the 2-year rate of distant metastases was 32.4% and 58.8% (P = 0.032) respectively. The median survival time was 33 and 20 months respectively. There were some side effects between the groups, but there was no statistical difference. Conclusion: Three-dimensional conformal radiotherapy plus FOLFOX chemotherapy can be considered as a safe and effective approach to treat rectal cancer patients of postoperative recurrence, and can improve the survival rates of patients and reduce distant metastasis rate obviously and make the acute adverse reaction rate insignificantly.

  8. Localization of telomerase hTERT protein in frozen sections of basal cell carcinomas (BCC) and tumor margin tissues.

    Science.gov (United States)

    Fabricius, Eva-Maria; Kruse-Boitschenko, Ute; Khoury, Reem; Wildner, Gustav-Paul; Raguse, Jan-Dirk; Klein, Martin; Hoffmeister, Bodo

    2009-12-01

    In previous studies we demonstrated telomerase activity in frozen tissues from BCC and their tumor-free margins by the PCR ELISA. In this study we examined in the same frozen sections immunohistochemical presence of hTERT in the nucleus. After fixation in acetone and methanol followed by steaming we used for visualization the antigen-antibody reactions by APAAP. This was the best method of preparation of the frozen sections in our preliminary hTERT-study with squamous cell carcinomas. This study was supplemented with antibodies against Ki-67, nucleolin, common leucocyte antigen CD45 and mutated p53. The immunoreactive scores were determined and included the comparison with telomerase activity. The investigation of hTERT expression was performed in the tissues of 41 patients with BCC and control tissues of 14 patients without tumor. Eleven commercial antibodies were used for a nuclear staining of hTERT expression. With the anti-hTERT antibodies we looked for both satisfactory distribution and intensity of immunohistochemical labeling in the carcinomas and in the squamous epithelia of the tumor centers, of the tumor-free margins and of the control tissues. The hTERT expression in the BCC was distributed heterogeneously. The score values established by the anti-hTERT antibodies used were variably or significantly increased. In the stroma they tended to be negative, so we disregarded stroma hTERT. Proof of hTERT did not differ uniformly from telomerase activity. We compared the high with the lower median hTERT values in the Kaplan-Meier curve. Patients with lower hTERT scores in the center or tumor margin as shown by some of the antibodies suffered relapse earlier. Finally, we compared the hTERT expression in BCC tissues with the hTERT scores in HNSCC tissues from our previous study. Only one anti-hTERT antibody (our Ab 7) yielded significantly higher scores in BCC than in HNSCC.

  9. Preliminary Experience in Treatment of Papillary and Macular Retinoblastoma: Evaluation of Local Control and Local Complications After Treatment With Linear Accelerator-Based Stereotactic Radiotherapy With Micromultileaf Collimator as Second-Line or Salvage Treatment After Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Pica, Alessia, E-mail: Alessia.Pica@chuv.ch [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Moeckli, Raphael [University Institute for Radiation Physics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Balmer, Aubin [Department of Radiation Oncology, Jules Gonin Eye Hospital, Lausanne (Switzerland); Beck-Popovic, Maja [Unit of Pediatric Oncology, University of Lausanne, Lausanne (Switzerland); Chollet-Rivier, Madeleine [Department of Anesthesiology, University of Lausanne, Lausanne (Switzerland); Do, Huu-Phuoc [University Institute for Radiation Physics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Weber, Damien C. [Department of Radiation Oncology, Geneva University Hospital, University of Geneva, Geneva (Switzerland); Munier, Francis L. [Department of Radiation Oncology, Jules Gonin Eye Hospital, Lausanne (Switzerland)

    2011-12-01

    Purpose: To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator. Methods and Materials: Between 2004 and 2008, 11 children (15 eyes) with macular and/or papillary retinoblastoma were treated with SRT. The mean age was 19 months (range, 2-111). Of the 15 eyes, 7, 6, and 2 were classified as International Classification of Intraocular Retinoblastoma Group B, C, and E, respectively. The delivered dose of SRT was 50.4 Gy in 28 fractions using a dedicated micromultileaf collimator linear accelerator. Results: The median follow-up was 20 months (range, 13-39). Local control was achieved in 13 eyes (87%). The actuarial 1- and 2-year local control rates were both 82%. SRT was well tolerated. Late adverse events were reported in 4 patients. Of the 4 patients, 2 had developed focal microangiopathy 20 months after SRT; 1 had developed a transient recurrence of retinal detachment; and 1 had developed bilateral cataracts. No optic neuropathy was observed. Conclusions: Linear accelerator-based SRT for papillary and/or macular retinoblastoma in children resulted in excellent tumor control rates with acceptable toxicity. Additional research regarding SRT and its intrinsic organ-at-risk sparing capability is justified in the framework of prospective trials.

  10. Stereotactic body radiotherapy for centrally located stage I NSCLC. A multicenter analysis

    Energy Technology Data Exchange (ETDEWEB)

    Schanne, Daniel H.; Nestle, Ursula; Grosu, Anca L. [Universitaetsklinik Freiburg, Klinik fuer Strahlenheilkunde, Freiburg (Germany); Allgaeuer, Michael [Barmherzige Brueder, Klinik fuer Strahlentherapie, Regensburg (Germany); Andratschke, Nicolaus; Molls, Michael [TU Muenchen, Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie, Muenchen (Germany); Appold, Steffen [Universitaetsklinikum Dresden, Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie, Dresden (Germany); Dieckmann, Ute [Allgemeines Krankenhaus Wien, Univ. Klinik fuer Strahlentherapie, Wien (Austria); Ernst, Iris [Universitaetsklinikum Muenster, Klinik fuer Strahlentherapie, Muenster (Germany); Ganswindt, Ute [LMU Muenchen, Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie, Muenchen (Germany); Holy, Richard [Universitaetsklinikum Aachen, Klinik fuer Strahlentherapie, Aachen (Germany); Nevinny-Stickel, Meinhard [Medizinischen Universitaet Innsbruck, Univ. Klinik fuer Strahlentherapie und Radioonkologie, Innsbruck (Austria); Semrau, Sabine [Universitaetsklinikum Erlangen, Strahlenklinik Erlangen, Erlangen (Germany); Sterzing, Florian [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Wittig, Andrea [Philipps-Universitaet Marburg, Klinik fuer Strahlentherapie und Radioonkologie, Marburg (Germany); Guckenberger, Matthias [Universitaet Wuerzburg, Klinik und Poliklinik fuer Strahlentherapie, Wuerzburg (Germany)

    2014-08-27

    The purpose of this work is to analyze patterns of care and outcome after stereotactic body radiotherapy (SBRT) for centrally located, early-stage, non-small cell lung cancer (NSCLC) and to address the question of potential risk for increased toxicity in this entity. A total of 90 patients with centrally located NSCLC were identified among 613 cases in a database of 13 German and Austrian academic radiotherapy centers. The outcome of centrally located NSCLC was compared to that of cases with peripheral tumor location from the same database. Patients with central tumors most commonly presented with UICC stage IB (50 %), while the majority of peripheral lesions were stage IA (56 %). Average tumor diameters were 3.3 cm (central) and 2.8 cm (peripheral). Staging PET/CT was available for 73 and 74 % of peripheral and central tumors, respectively. Biopsy was performed in 84 % (peripheral) and 88 % (central) of cases. Doses varied significantly between central and peripheral lesions with a median BED{sub 10} of 72 Gy and 84 Gy, respectively (p < 0.001). Fractionation differed as well with medians of 5 (central) and 3 (peripheral) fractions (p < 0.001). In the Kaplan-Meier analysis, 3-year actuarial overall survival was 29 % (central) and 51 % (peripheral; p = 0.004) and freedom from local progression was 52 % (central) and 84 % (peripheral; p < 0.001). Toxicity after treatment of central tumors was low with no grade III/IV and one grade V event. Mortality rates were 0 and 1 % after 30 and 60 days, respectively. Local tumor control in patients treated with SBRT for centrally located, early-stage NSCLC was favorable, provided ablative radiation doses were prescribed. This was, however, not the case in the majority of patients, possibly due to concerns about treatment-related toxicity. Reported toxicity was low, but prospective trials are needed to resolve the existing uncertainties and to establish safe high-dose regimens for this cohort of patients. (orig.) [German] Ziel

  11. Prediction of Neck Dissection Requirement After Definitive Radiotherapy for Head-and-Neck Squamous Cell Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Thariat, Juliette [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Department of Radiation Oncology/IBDC CNRS UMR, Cancer Center Antoine-Lacassagne, University Nice Sophia-Antipolis, Nice, Cedex 2 (France); Ang, K. Kian; Allen, Pamela K. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Ahamad, Anesa [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); University of the West Indies, St. Augustine (Trinidad and Tobago); Williams, Michelle D. [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Myers, Jeffrey N. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Department of Cancer Biology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); El-Naggar, Adel K. [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Ginsberg, Lawrence E. [Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Rosenthal, David I. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Glisson, Bonnie S. [Department of Thoracic/Head and Neck Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Morrison, William H. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Weber, Randal S. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S., E-mail: agarden@mdanderson.org [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

    2012-03-01

    Background: This analysis was undertaken to assess the need for planned neck dissection in patients with a complete response (CR) of involved nodes after irradiation and to determine the benefit of a neck dissection in those with less than CR by tumor site. Methods: Our cohort included 880 patients with T1-4, N1-3M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received treatment between 1994 and 2004. Survival curves were calculated by the Kaplan-Meier Method, comparisons of rates with the log-rank test and prognostic factors by Cox's proportional hazard model. Results: Nodal CR occurred in 377 (43%) patients, of whom 365 patients did not undergo nodal dissection. The 5-year actuarial regional control rate of patients with CR was 92%. Two hundred sixty-eight of the remaining patients (53%) underwent neck dissections. The 5-year actuarial regional control rate for patients without a CR was 84%. Those who had a neck dissection fared better with 5-year actuarial regional control rates of 90% and 76% for those operated and those not operated (p < 0.001). Variables associated with poorer regional control rates included higher T and N stage, non-oropharynx cancers, non-CR, both clinical and pathological. Conclusions: With 92% 5-year neck control rate without neck dissection after CR, there is little justification for systematic neck dissection. The addition of a neck dissection resulted in higher neck control after partial response though patients with viable tumor on pathology specimens had poorer outcomes. The identification of that subgroup that benefits from additional treatment remains a challenge.

  12. Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Safdieh, Joseph; Schwartz, David; Weiner, Joseph; Weiss, Jeffrey P.; Madeb, Isaac; Rotman, Marvin; Schreiber, David [Dept.of Veteran Affairs, New York Harbor Healthcare System, Brooklyn (United States); Rineer, Justin [University of Florida Health Cancer Center, Orlando (United States)

    2014-09-15

    To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.

  13. Aging in Sweden: local variation, local control.

    Science.gov (United States)

    Davey, Adam; Malmberg, Bo; Sundström, Gerdt

    2014-08-01

    Aging in Sweden has been uniquely shaped by its history-most notably the long tradition of locally controlled services for older adults. We considered how local variations and local control shape the experience of aging in Sweden and organized the paper into 3 sections. First, we examine aging in Sweden along demography, economy, and housing. Next, we trace the origins and development of the Swedish welfare state to consider formal supports (service provision) and informal supports (caregiving and receipt of care). Finally, we direct researchers to additional data resources for understanding aging in Sweden in greater depth. Sweden was one of the first countries to experience rapid population aging. Quality of life for a majority of older Swedes is high. Local control permits a flexible and adaptive set of services and programs, where emphasis is placed on improving the quality and targeting of services that have already reached a plateau as a function of population and expenditures.

  14. Locally localized gravity and geometric transitions

    Energy Technology Data Exchange (ETDEWEB)

    Bazeia, Dionisio [Departamento de Fisica, Universidade Federal da Paraiba, Caixa Postal 5008, 58051-970 Joao Pessoa, Paraiba (Brazil)]. E-mail: bazeia@fisica.ufpb.br; Brito, Francisco A. [Departamento de Fisica, Universidade Federal de Campina Grande, 58109-970 Campina Grande, Paraiba (Brazil); Gomes, Adalto Rodrigues [Departamento de Fisica, Universidade Federal da Paraiba, Caixa Postal 5008, 58051-970 Joao Pessoa, Paraiba (Brazil); Departamento de Ciencias Exatas, Centro Federal de Educacao Tecnologica do Maranhao, 65025-001 Sao Luis, Maranhao (Brazil)

    2004-11-01

    In this paper we analyze the local localization of gravity in AdS{sub 4} thick brane embedded in AdS{sub 5} space. The 3-brane is modelled by domain wall solution of a theory with a bulk scalar field coupled to five-dimensional gravity. In addition to small four-dimensional cosmological constant, the vacuum expectation value (vev) of the scalar field controls the emergence of a localized four-dimensional quasi-zero mode. We introduce high temperature effects, and we show that gravity localization on a thick 3-brane is favored below a critical temperature T{sub c}. These investigations suggest the appearance of another critical temperature T*, where the thick 3-brane engenders the geometric (author)

  15. Local Debt Scare

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    China steps up a clampdown on the financing vehicles of local governments control over local governments’ financing vehicles will be tightened to fend off what some economists warn could turn into a mountain

  16. Temporal Non-locality

    Science.gov (United States)

    Filk, Thomas

    2013-04-01

    In this article I investigate several possibilities to define the concept of "temporal non-locality" within the standard framework of quantum theory. In particular, I analyze the notions of "temporally non-local states", "temporally non-local events" and "temporally non-local observables". The idea of temporally non-local events is already inherent in the standard formalism of quantum mechanics, and Basil Hiley recently defined an operator in order to measure the degree of such a temporal non-locality. The concept of temporally non-local states enters as soon as "clock-representing states" are introduced in the context of special and general relativity. It is discussed in which way temporally non-local measurements may find an interesting application for experiments which test temporal versions of Bell inequalities.

  17. Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extraperitoneal rectal cancer.

    Science.gov (United States)

    Coco, Claudio; Valentini, Vincenzo; Manno, Alberto; Mattana, Claudio; Verbo, Alessandro; Cellini, Numa; Gambacorta, Maria Antonietta; Covino, Marcello; Mantini, Giovanna; Miccichè, Francesco; Pedretti, Giorgio; Petito, Luigi; Rizzo, Gianluca; Cosimelli, Maurizio; Impiombato, Fabrizio Ambesi; Picciocchi, Aurelio

    2006-03-01

    This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal cancer treated by preoperative radiochemotherapy. Eighty-three consecutive patients who developed locally advanced resectable extraperitoneal rectal cancer underwent preoperative concomitant radiochemotherapy followed by surgery, including total mesorectal excision. Median follow-up was 108 (range, 10-169) months. The living patients underwent complete follow-up of, at least, nine years. Fourteen patients developed local recurrence. The time to detection was longer than two years in eight cases and longer than five years in four. Twenty-one patients developed metastases, 19 within the first five years from surgery. At the univariate analysis, clinical stage at presentation, lymph node involvement at clinical restaging after neoadjuvant therapy, and pT and pN stage were found positively correlated to the incidence of metastases. At the multivariate analysis, the only factors which confirmed a positive correlation were pT stage and pN stage. The actuarial overall survival at five, seven, and ten years was 75.5, 67.8, and 60.4 percent, respectively. The same figures for cancer-related survival were 77.9, 70, and 65.8 percent. At the univariate analysis, factors directly correlated with worse survival were: TNM stage at clinical restaging after neoadjuvant therapy (in particular lymph node involvement) pTNM, pT, and pN. At the multivariate analysis the only factors that confirmed a correlation with worse survival were pTNM, pT, and pN. Long- term follow-up allows to individuate 28 percent of all local relapses after the first five years from surgery. Postoperative stage is highly predictive of prognosis.

  18. A Local Supervisor

    Science.gov (United States)

    Mutchler, James

    1974-01-01

    Direct supervision of teachers for agricultural programs in Ohio is moving from the State to the local level. The primary function of the local supervisor is to improve the instruction in programs for high school and adult students in the Vocational Education Planning District. Other duties vary according to local policies. (AG)

  19. Locally minimal topological groups

    OpenAIRE

    Außenhofer, Lydia; Chasco, María Jesús; Dikranjan, Dikran; Domínguez, Xabier

    2009-01-01

    A Hausdorff topological group $(G,\\tau)$ is called locally minimal if there exists a neighborhood $U$ of 0 in $\\tau$ such that $U$ fails to be a neighborhood of zero in any Hausdorff group topology on $G$ which is strictly coarser than $\\tau.$ Examples of locally minimal groups are all subgroups of Banach-Lie groups, all locally compact groups and all minimal groups. Motivated by the fact that locally compact NSS groups are Lie groups, we study the connection between local minimality and the ...

  20. PTEN protein loss is associated with an increased risk of recurrence in Chinese patients after prostatectomy for clinically localized prostate cancer%PTEN蛋白缺失与中国前列腺癌患者根治术后生化复发风险关系的研究

    Institute of Scientific and Technical Information of China (English)

    王涛; 杨晓群; 孙娟娟; 甘华磊; 王朝夫

    2015-01-01

    前列腺癌患者的管理及指导进一步治疗。%Background and purpose:Loss of the tumor suppressor phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is one of the most common somatic genetic aberrations in prostate cancer in Western countries and is frequently associated with tumor progression and poor prognosis. This study aimed to investigate the frequency of PTEN protein loss in Chinese prostate cancer patients and to determine its association with the biochemical recurrence of prostate cancer.Methods:The data from 225 diagnosed localized prostate cancer patients with radical prostatectomy from 2006 to 2011 were collected retrospectively, including patient’s age at diagnosis, prostate-speciifc antigen (PSA) level at diagnosis, Gleason score, clinical stage, surgical margin, and time to biochemical recurrence or not. This study performed PTEN protein immunohistochemistry on tissue microarrays, which were made from 225 Chinese prostate cancer patients mentioned above, treated by radical prostatectomy with one case including 2 cancer spots and 2 adjacent normal gland spots. Correlations of PTEN loss with clinicopathological features were analyzed usingχ2 test. Kaplan-Meier survival model and Cox proportional hazards regression model were used to evaluate the predictive role of PTEN protein expression and patient characteristics for biochemical recurrence. Results:PTEN protein loss was observed in 15% of the patients and was associated with increased preoperative PSA levels (P=0.03) and old age (P=0.009). In univariate Kaplan–Meier analysis, the factors associated with the biochemical recurrence of prostate cancer included PSA levels (P=0.000 4), Gleason sum (P=0.019 8), and PTEN status (P=0.013 1). In multivariable Cox regression analysis, PTEN expression (HR=0.536, P=0.044), PSA levels (HR=1.879, P=0.001), and Gleason score (HR=1.361,P=0.03) were signiifcant in predicting biochemical recurrence of prostate cancer.Conclusion:PTEN protein

  1. Resultado do tratamento cirúrgico das neoplasias do seio piriforme

    Directory of Open Access Journals (Sweden)

    Costa Claudiney C.

    2003-01-01

    Full Text Available Os tumores da laringe e hipofaringe apresentam alta incidência no Brasil, sendo o sexto sítio mais comum entre os tumores malignos no sexo masculino. O diagnóstico inicial geralmente é realizado com lesões em estadio clínicos avançados diminuindo o sucesso do tratamento instituído. OBJETIVOS: Avaliar a evolução de 60 pacientes com carcinoma epidermóide de seio piriforme, considerando tratamento instituído, complicações e sobrevida estimada em 5 anos. FORMA DE ESTUDO: Estudo retrospectivo. MÉTODO: Os testes estatístico utilizados foram o método de Kaplan-Meier e o teste exato de Fisher. RESULTADOS: Dos 60 pacientes, 43 foram submetidos a tratamento cirúrgico seguido de radioterapia. Atualmente 27,9% estão vivos sem doença, 11,6% vivos com doença, 9,4% mortos sem doença, 34,8% mortos com doença e perda de seguimento de 16,3%. A complicação pós-operatória mais freqüente foi a fístula cutânea. A recidiva local ocorreu em 5 pacientes, regional em 6, loco-regional em 3 e metástase à distância em 6. Não houve correlação entre margem cirúrgica comprometida e sobrevida em 20 pacientes com recidiva tumoral (Teste de Fisher. Aplicando a curva de sobrevida atuarial pelo método Kaplan-Meier, obtivemos média de sobrevida em 5 anos de 23,2 meses. CONCLUSÃO: A principal complicação pós-operatória foi a fístula cutânea, sendo tratada clinicamente. A margem cirúrgica comprometida não alterou o prognóstico, apesar de ser sempre um dos princípios da cirurgia oncológica. A principal falha no tratamento foi a recidiva locorregional. A curva de sobrevida atuarial (Kaplan-Meier em cinco anos apresentou média de 23,2 meses.

  2. Local Failure in Parameningeal Rhabdomyosarcoma Correlates With Poor Response to Induction Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ladra, Matthew M. [Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Mandeville, Henry C. [The Royal Marsden Hospital, London (United Kingdom); Niemierko, Andrzej; Padera, Timothy P.; Friedmann, Alison M.; MacDonald, Shannon M.; Ebb, David; Chen, Yen-Lin; Tarbell, Nancy J. [Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Yock, Torunn I., E-mail: tyock@partners.org [Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2015-06-01

    Background: Local control remains a challenge in pediatric parameningeal rhabdomyosarcoma (PM-RMS), and survival after local failure (LF) is poor. Identifying patients with a high risk of LF is of great interest to clinicians. In this study, we examined whether tumor response to induction chemotherapy (CT) could predict LF in embryonal PM-RMS. Methods: We identified 24 patients with embryonal PM-RMS, age 2 to 18 years, with complete magnetic resonance imaging and gross residual disease after surgical resection. All patients received proton radiation therapy (RT), median dose 50.4 Gy{sub RBE} (50.4-55.8 Gy{sub RBE}). Tumor size was measured before initial CT and before RT. Results: With a median follow-up time of 4.1 years for survivors, LF was seen in 9 patients (37.5%). The median time from the initiation of CT to the start of RT was 4.8 weeks. Patients with LF had a similar initial (pre-CT) tumor volume compared with patients with local controlled (LC) (54 cm{sup 3} vs 43 cm{sup 3}, P=.9) but a greater median volume before RT (pre-RT) (40 cm{sup 3} vs 7 cm{sup 3}, P=.009) and a smaller median relative percent volume reduction (RPVR) in tumor size (0.4% vs 78%, P<.001). Older age (P=.05), larger pre-RT tumor volume (P=.03), and smaller RPVR (P=.003) were significantly associated with actuarial LF on univariate Cox analysis. Conclusions: Poor response to induction CT appears to be associated with an increased risk of LF in pediatric embryonal PM-RMS.

  3. Local Exhaust Ventilation

    DEFF Research Database (Denmark)

    Madsen, Ulla; Breum, N. O.; Nielsen, Peter V.

    Capture efficiency of a local exhaust system, e.g. a kitchen hood, should include only contaminants being direct captured. In this study basic concepts of local exhaust capture efficiency are given, based on the idea of a control box. A validated numerical model is used for estimation of the capt......Capture efficiency of a local exhaust system, e.g. a kitchen hood, should include only contaminants being direct captured. In this study basic concepts of local exhaust capture efficiency are given, based on the idea of a control box. A validated numerical model is used for estimation...

  4. Local Social Networks

    DEFF Research Database (Denmark)

    Sapuppo, Antonio; Sørensen, Lene Tolstrup

    2011-01-01

    Online social networks have become essential for many users in their daily communication. Through a combination of the online social networks with opportunistic networks, a new concept arises: Local Social Networks. The target of local social networks is to promote social networking benefits...... in physical environment in order to leverage personal affinities in the users' surroundings. The purpose of this paper is to present and discuss the concept of local social networks as a new social communication system. Particularly, the preliminary architecture and the prototype of local social networks...

  5. Modeling Local Control After Hypofractionated Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Report From the Elekta Collaborative Lung Research Group

    Energy Technology Data Exchange (ETDEWEB)

    Ohri, Nitin, E-mail: ohri.nitin@gmail.com [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Werner-Wasik, Maria [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Grills, Inga S. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Belderbos, Jose [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Hope, Andrew [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Yan Di; Kestin, Larry L. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Guckenberger, Matthias [Department of Radiation Oncology, University of Wuerzburg, Wuerzburg (Germany); Sonke, Jan-Jakob [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Bissonnette, Jean-Pierre [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Xiao, Ying [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States)

    2012-11-01

    Purpose: Hypofractionated stereotactic body radiation therapy (SBRT) has emerged as an effective treatment option for early-stage non-small cell lung cancer (NSCLC). Using data collected by the Elekta Lung Research Group, we generated a tumor control probability (TCP) model that predicts 2-year local control after SBRT as a function of biologically effective dose (BED) and tumor size. Methods and Materials: We formulated our TCP model as follows: TCP = e{sup [BED10-c Asterisk-Operator L-TCD50]/k} Division-Sign (1 + e{sup [BED10-c Asterisk-Operator L-TCD50]/k}), where BED10 is the biologically effective SBRT dose, c is a constant, L is the maximal tumor diameter, and TCD50 and k are parameters that define the shape of the TCP curve. Least-squares optimization with a bootstrap resampling approach was used to identify the values of c, TCD50, and k that provided the best fit with observed actuarial 2-year local control rates. Results: Data from 504 NSCLC tumors treated with a variety of SBRT schedules were available. The mean follow-up time was 18.4 months, and 26 local recurrences were observed. The optimal values for c, TCD50, and k were 10 Gy/cm, 0 Gy, and 31 Gy, respectively. Thus, size-adjusted BED (sBED) may be defined as BED minus 10 times the tumor diameter (in centimeters). Our TCP model indicates that sBED values of 44 Gy, 69 Gy, and 93 Gy provide 80%, 90%, and 95% chances of tumor control at 2 years, respectively. When patients were grouped by sBED, the model accurately characterized the relationship between sBED and actuarial 2-year local control (r=0.847, P=.008). Conclusion: We have developed a TCP model that predicts 2-year local control rate after hypofractionated SBRT for early-stage NSCLC as a function of biologically effective dose and tumor diameter. Further testing of this model with additional datasets is warranted.

  6. Risk factors for brain metastases after definitive chemoradiation for locally advanced non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Petrović Marina

    2009-01-01

    Full Text Available Background/Aim. As therapy for locally advanced nonsmall cell lung carcinoma (NSCLC improves, brain metastases (BM still remain a great problem. The aim of the study was to analyze risk factors for BM in patients with locally advanced NSCLC after chemoradiation therapy. Methods. Records for 150 patients with non-resectable stage IIIA/IIIB NSCLC treated with combined chemoradiation therapy were analyzed. All of them had negative brain metastases imaging result before the treatment. Incidence of BM was examined in relation to age, sex, histological type, stage, performance status scale of wellbeing of cancer patients, weight loss, chemotherapy regimen and chemotherapy timing. Results. One- and 2-year incidence rates of BM were 19 and 31%, respectively. Among pretreatment parameters, stage IIIB was associated with a higher risk of BM (p < 0.004 vs stage IIIA. Histologically, the patients with nonsquamous tumors had an exceptionally high 2-year BM risk rate of 32% (p < 0.02. Examining treatment-related parameters, 1-year and 2-year actuarial risk of BM were 27 and 39%, respectively, in the patients receiving chemotherapy before radiotherapy and 15 and 20%, respectively, when radiotherapy was not delayed (p < 0.03. On multivariate analysis, timing of chemotherapy (p < 0.05 and stage IIIA vs IIIB (p < 0.01 remained statistically significant. Conclusion. Patients with IIIB stage, nonsquamous NSCLC, particularly those receiving sequential chemotherapy, had significantly high BM rates.

  7. Hypofractionated radiotherapy for localized prostate cancer using three-dimensional conformal radiotherapy technique: 3 years toxicity analysis

    Directory of Open Access Journals (Sweden)

    R White

    2015-01-01

    Full Text Available BACKGROUND: Hypofractionated radiotherapy in the radical treatment of localized prostate cancer has potential biological advantages relative to conventional fractionation. We report prospectively collected toxicity data from a cohort of patients treated with a 3D conformal technique (3DCRT. MATERIALS AND METHODS: 90 patients receiving curative intent hypofractionated radiotherapy with 57Gy in 19 daily fractions over 3.8 weeks were evaluated prospectively for the development of radiation related toxicity over a 3 year period. RESULTS: All patients completed treatment. Maximal acute toxicity experienced was 58.6, 10 and 1.1% for grade 1, 2 and 3 genitourinary (GU toxicity respectively and 75.6, 9 and 0% for gastrointestinal (GI toxicity. For late toxicity the three year actuarial rates of grade 1, 2 and 3 GU and GI toxicity respectively were 47.3, 2.4 and 0%; and 40, 9.3 and 4.7%. There were no grade 4 or worse acute or late toxicities. 97.6% of evaluable patients remained free of biochemical failure 36 months post radiotherapy. CONCLUSIONS: A 57Gy in 19 daily fraction radiotherapy schedule using 3D conformal radiotherapy for the definitive treatment of localized prostate cancer has acceptable early and late toxicity.

  8. Management of primary germ cell tumors of the mediastinum.

    Science.gov (United States)

    Economou, J S; Trump, D L; Holmes, E C; Eggleston, J E

    1982-05-01

    Twenty-eight patients with primary malignant germ cell tumors (GCT) of the mediastinum were treated at the University of California at Los Angeles and The Johns Hopkins Hospital in the past 30 years. Of 11 patients with pure seminomas, nine (82%) are free of disease from 6 months to 15 years following therapy. The primary treatment modality in these patients was mediastinal radiation; one patient with metastatic disease had a complete remission and prolonged survival following combination chemotherapy. Seventeen patients had GCT with nonseminomatous elements. Only three (18%) are alive and free of disease. One patient treated only surgically is alive at 15 years and two patients treated with combination chemotherapy and operation are alive and free of disease at 6 months and 3 years. When analyzed by a Kaplan-Meier actuarial survival estimate, patients with nonseminomatous GCT who were treated with cisplatin-bleomycin-based chemotherapy had a median survival of 14.0 months whereas those treated with chemotherapy regimens not employing these agents had a median survival of 4.0 months (generalized Wilcoxon test, p = 0.0495). Patients with pure seminomas are effectively treated with radiation therapy. Patients with nonseminomatous tumors have a much poorer prognosis and deserve aggressive multimodality therapy with cisplatin-bleomycin-based chemotherapy.

  9. Renal tolerance to nonhomogenous irradiation: Comparison of observed effects to predictions of normal tissue complication probability from different biophysical models

    Energy Technology Data Exchange (ETDEWEB)

    Flentje, M.; Hensley, F.; Gademann, G.; Wannenmacher, M. (Univ. of Heidelberg (Germany)); Menke, M. (German Cancer Research Center, Heidelberg (Germany))

    1993-09-01

    A patient series was analyzed retrospectively as an example of whole organ kidney irradiation with an inhomogenous dose distribution to test the validity of biophysical models predicting normal tissue tolerance to radiotherapy. From 1969 to 1984, 142 patients with seminoma were irradiated to the paraaortic region using predominantly rotational techniques which led to variable but partly substantial exposure of the kidneys. Median follow up was 8.2 (2.1-21) years and actuarial 10-year survival (Kaplan-Meier estimate) 82.8%. For all patients 3-dimensional dose distributions were reconstructed and normal tissue complication probabilities for the kidneys were generated from the individual dose volume histograms. To this respect different published biophysical algorithms were introduced in a 3-dimensional-treatment planning system. In seven patients clinically manifest renal impairment was observed (interval 10-84 months). An excellent agreement between predicted and observed effects was seen for two volume-oriented models, whereas complications were overestimated by an algorithm based on critical element assumptions. Should these observations be confirmed and extended to different types of organs corresponding algorithms could easily be integrated into 3-dimensional-treatment planning programs and be used for comparing and judging different plans on a more biologically oriented basis.

  10. Impact of Pancreatic Leaks on Survival Following Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Fabio Ausania

    2010-05-01

    Full Text Available Context Pancreatic leak following pancreaticoduodenectomy has a major impact on postoperative mortality. However, it is not clear whether pancreatic leaks affect long term survival in patients with pancreatic ductal adenocarcinoma. Objective The aim of this study is to compare the long term outcome in patients who underwent pancreaticoduodenectomy, with and without postoperative pancreatic leak. Patients All 133 patients who underwent a pancreaticoduodenectomy at the HepatoPancreatoBiliary Unit, Addenbrooke’s Hospital, Cambridge, between June 2002 and June 2007 were identified from a prospectively held database. The study was restricted to 47 patients who had a confirmed diagnosis of pancreatic ductal adenocarcinoma. Setting Pancreatic leak was defined as drain fluid amylase more than three times the serum level for more than 3 days post operatively. Main outcome measure Long term survival of patients with and without leaks were compared using Kaplan-Meier curves and significance was measured using the log-rank test. Results Median follow-up was 30.8 months. The median actuarial survival of all ductal adenocarcinoma patients was 19 months. Pancreatic leaks occurred in 9 patients (19.1%. There were no significant differences in the overall survival or presence of recurrence between the two groups. Conclusions Pancreatic leak following pancreaticoduodenectomy does not appear to impact on long-term outcome of patients with pancreatic ductal adenocarcinoma.

  11. Impact of immunosuppression treatment on the improvement in graft survival after deceased donor renal transplantation: a long-term cohort study.

    Science.gov (United States)

    González-Molina, Miguel; Burgos, Dolores; Cabello, Mercedes; Ruiz-Esteban, Pedro; Rodríguez, Manuel A; Gutiérrez, Cristina; López, Verónica; Baena, Víctor; Hernández, Domingo

    2014-01-01

    We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 (P<0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was significantly less pronounced in 1996-2001, indicating better preservation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel reactive antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Modern immunosuppression could have contributed to the improved kidney transplant outcome.

  12. Adjuvant radiotherapy for gallbladder cancer: A dosimetric comparison of conformal radiotherapy and intensity-modulated radiotherapy

    Institute of Scientific and Technical Information of China (English)

    Xiao-Nan Sun; Qi Wang; Ben-Xing Gu; Yan-Hong Zhu; Jian-Bin Hu; Guo-Zhi Shi; Shu Zheng

    2011-01-01

    AIM: To assess the efficacy and toxicity of conformal radiotherapy (CRT) and compare with intensity-modulated radiotherapy (IMRT) in the treatment of gallbladder cancer.METHODS: Between November 2003 and January 2010, 20 patients with gallbladder cancer were treated with CRT with or without chemotherapy after surgical resection. Preliminary survival data were collected and examined using both Kaplan-Meier and actuarial analysis. Demographic and treatment parameters were collected. All patients were planned to receive 46-56 Gy in 1.8 or 2.0 Gy per fraction. CRT planning was compared with IMRT.RESULTS: The most common reported acute toxicities requiring medication (Radiation Therapy Oncology Group, Radiation Therapy Oncology Group Grade2) were nausea (10/20 patients) and diarrhea (3/20).There were no treatment-related deaths. Compared with CRT planning, IMRT significantly reduced the volume of right kidney receiving > 20 Gy and the volume of liver receiving > 30 Gy. IMRT has a negligible impact on the volume of left kidney receiving > 20 Gy. The 95% of prescribed dose for a planning tumor volume using either 3D CRT or IMRT planning were 84.0% ±6.7%, 82.9% ± 6.1%, respectively (P > 0.05).CONCLUSION: IMRT achieves similar excellent target coverage as compared with CRT planning, while reducingthe mean liver dose and volume above threshold dose. IMRT offers better sparing of the right kidney compared with CRT planning, with a significantly lower mean dose and volume above threshold dose.

  13. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Keeling, Aoife N.; Khalidi, Karim; Leong, Sum [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Wang, Tim T. [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Ayyoub, Alaa S.; McGrath, Frank P. [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Athanasiou, Thanos [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Lee, Michael J., E-mail: mlee@rcsi.ie [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland)

    2011-03-15

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  14. Below knee angioplasty in elderly patients: predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2012-02-01

    AIM: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). MATERIALS AND METHODS: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. RESULTS: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). CONCLUSION: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  15. Dose response explorer: an integrated open-source tool for exploring and modelling radiotherapy dose-volume outcome relationships

    Energy Technology Data Exchange (ETDEWEB)

    Naqa, I El [Washington University, Saint Louis, MO (United States); Suneja, G [Brown Medical School, Providence, RI (United States); Lindsay, P E [Washington University, St. Louis, MO (United States); Hope, A J [Washington University, Saint Louis, MO (United States); Alaly, J R [Washington University, Saint Louis, MO (United States); Vicic, M [Washington University, Saint Louis, MO (United States); Bradley, J D [Washington University, Saint Louis, MO (United States); Apte, A [Washington University, Saint Louis, MO (United States); Deasy, J O [Washington University, Saint Louis, MO (United States)

    2006-11-21

    Radiotherapy treatment outcome models are a complicated function of treatment, clinical and biological factors. Our objective is to provide clinicians and scientists with an accurate, flexible and user-friendly software tool to explore radiotherapy outcomes data and build statistical tumour control or normal tissue complications models. The software tool, called the dose response explorer system (DREES), is based on Matlab, and uses a named-field structure array data type. DREES/Matlab in combination with another open-source tool (CERR) provides an environment for analysing treatment outcomes. DREES provides many radiotherapy outcome modelling features, including (1) fitting of analytical normal tissue complication probability (NTCP) and tumour control probability (TCP) models, (2) combined modelling of multiple dose-volume variables (e.g., mean dose, max dose, etc) and clinical factors (age, gender, stage, etc) using multi-term regression modelling, (3) manual or automated selection of logistic or actuarial model variables using bootstrap statistical resampling, (4) estimation of uncertainty in model parameters, (5) performance assessment of univariate and multivariate analyses using Spearman's rank correlation and chi-square statistics, boxplots, nomograms, Kaplan-Meier survival plots, and receiver operating characteristics curves, and (6) graphical capabilities to visualize NTCP or TCP prediction versus selected variable models using various plots. DREES provides clinical researchers with a tool customized for radiotherapy outcome modelling. DREES is freely distributed. We expect to continue developing DREES based on user feedback.

  16. Dose response explorer: an integrated open-source tool for exploring and modelling radiotherapy dose volume outcome relationships

    Science.gov (United States)

    El Naqa, I.; Suneja, G.; Lindsay, P. E.; Hope, A. J.; Alaly, J. R.; Vicic, M.; Bradley, J. D.; Apte, A.; Deasy, J. O.

    2006-11-01

    Radiotherapy treatment outcome models are a complicated function of treatment, clinical and biological factors. Our objective is to provide clinicians and scientists with an accurate, flexible and user-friendly software tool to explore radiotherapy outcomes data and build statistical tumour control or normal tissue complications models. The software tool, called the dose response explorer system (DREES), is based on Matlab, and uses a named-field structure array data type. DREES/Matlab in combination with another open-source tool (CERR) provides an environment for analysing treatment outcomes. DREES provides many radiotherapy outcome modelling features, including (1) fitting of analytical normal tissue complication probability (NTCP) and tumour control probability (TCP) models, (2) combined modelling of multiple dose-volume variables (e.g., mean dose, max dose, etc) and clinical factors (age, gender, stage, etc) using multi-term regression modelling, (3) manual or automated selection of logistic or actuarial model variables using bootstrap statistical resampling, (4) estimation of uncertainty in model parameters, (5) performance assessment of univariate and multivariate analyses using Spearman's rank correlation and chi-square statistics, boxplots, nomograms, Kaplan-Meier survival plots, and receiver operating characteristics curves, and (6) graphical capabilities to visualize NTCP or TCP prediction versus selected variable models using various plots. DREES provides clinical researchers with a tool customized for radiotherapy outcome modelling. DREES is freely distributed. We expect to continue developing DREES based on user feedback.

  17. Hypopharynx and larynx defect repair after resection for pyriform fossa cancer with a platysma skin flap.

    Science.gov (United States)

    Cai, Qian; Liang, Faya; Huang, Xiaoming; Han, Ping; Pan, Yong; Zheng, Yiqing

    2015-02-01

    We used a platysma skin flap to repair larynx and hypopharynx defects to improve postoperative laryngeal function in patients with pyriform fossa cancer. Larynx-sparing surgery and postoperative radiotherapy were used in 10 patients with pyriform fossa cancer. The surgical approaches of lymph node dissection of the neck, vertical partial laryngectomy, and pyriform fossa resection were adopted, and a platysma skin flap was used to repair the resulting defects. In this group, the overall 3-year survival rate was 75% according to the Kaplan-Meier analysis, and the local control rate was 90%. Additionally, all patients were able to speak fluently with mild-to-moderate hoarseness. The tracheal tube was removed in all cases. Laryngeal fistulas were observed in 1 patient during radiotherapy. In conclusion, a platysma skin flap can be used to rebuild the larynx and hypopharynx in larynx-sparing resection for pyriform fossa cancer. These patients can obtain good postoperative function in swallowing, breathing, and pronunciation.

  18. Breast-conserving treatment of early breast cancer; Results in a common trial

    Energy Technology Data Exchange (ETDEWEB)

    Pirtoli, L. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Bellezza, A. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Pepi, F. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Tucci, E. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Crociani, M. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Crastolla, A.M. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Farzad, M. (Siena Univ. (Italy). Unita Operativa di Radioterapia); Bindi, M. (Siena Univ. (Italy). Unita Operativa di Radioterapia)

    1993-01-01

    Results of large prospective trials, often based on selected series and optimal treatment techniques, indicate that breast conserving therapy is appropriate for most patients with early breast cancer. Questions remain regarding the therapeutic outcome in common practice. We report on a series of 206 consecutive, unselected patients treated with current radiotherapy procedures. The Kaplan-Meier evaluation showed 5- and 8-year survival rates (93%, 91%), distant disease-free survival rates (87%, 85%) and local relapse-free survival rates (90%, 88%) that were comparable to those of the conservative arms in reported randomised trials and to the data from retrospective studies reported by authoritative institutions. However, subanalysis according to prognostic factors such as menopausal status, age and axillary nodal status was of limited value, due to the small number of cases. (orig.).

  19. First Danish single-institution experience with radical prostatectomy

    DEFF Research Database (Denmark)

    Vrang, Marie-Louise; Røder, Martin Andreas; Vainer, Ben

    2012-01-01

    OBJECTIVE: This study aimed to investigate the impact of positive surgical margins (PSMs), stratified by location and extension, on biochemical outcome after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: The study included data from 605 consecutive patients treated with RRP...... for localized prostate cancer. Patients with node-positive disease were excluded. Biochemical recurrence-free survival was calculated using the Kaplan-Meier method. Univariate and multivariate analysis was used to assess risk factors. RESULTS: The overall PSM rate was 35.4%. Eighty-three per cent (82.......7%) of these had a single PSM, whereas 17.3% of patients had two or more PSMs. Apical PSMs were present in 42.5% and non-apical in 57.5%. The presence of any PSM had a significant impact on the risk of biochemical recurrence (BR) [hazard ratio (HR) = 3.3, p

  20. Locally Localized Gravity: The Inside Story

    CERN Document Server

    Kaloper, Nemanja; Kaloper, Nemanja; Sorbo, Lorenzo

    2005-01-01

    We derive the exact gravitational field of a relativistic particle localized on an $AdS$ 3-brane, with curvature radius $\\ell$, in $AdS_5$ bulk with radius $L$. The solution is a gravitational shock wave. We use it to explore the dynamics of locally localized tensor gravitons over a wide range of scales. At distances below $L$ the shock wave looks exactly like the $5D$ $GR$ solution. Beyond $L$ the solution approximates very closely the shock wave in 4D $AdS$ space all the way out to distances $\\ell^3/L^2$ along the brane. At distances between $L$ and $\\ell$, the effective 4D graviton is a composite built of the ultralight mode and heavier gravitons, whereas between $\\ell$ and $\\ell^3/L^2$ it is just the ultralight mode. Finally beyond $\\ell^3/L^2$ the shock reveals a glimpse of the fifth dimension, since the ultralight mode wave function decays to zero at the rate inherited from the full $5D$ geometry. We obtain the precise bulk-side formula for the 4D Planck mass, defined as the coupling of the ultralight m...

  1. Locally minimal topological groups

    CERN Document Server

    enhofer, Lydia Au\\ss; Dikranjan, Dikran; Domínguez, Xabier

    2009-01-01

    A Hausdorff topological group $(G,\\tau)$ is called locally minimal if there exists a neighborhood $U$ of 0 in $\\tau$ such that $U$ fails to be a neighborhood of zero in any Hausdorff group topology on $G$ which is strictly coarser than $\\tau.$ Examples of locally minimal groups are all subgroups of Banach-Lie groups, all locally compact groups and all minimal groups. Motivated by the fact that locally compact NSS groups are Lie groups, we study the connection between local minimality and the NSS property, establishing that under certain conditions, locally minimal NSS groups are metrizable. A symmetric subset of an abelian group containing zero is said to be a GTG set if it generates a group topology in an analogous way as convex and symmetric subsets are unit balls for pseudonorms on a vector space. We consider topological groups which have a neighborhood basis at zero consisting of GTG sets. Examples of these locally GTG groups are: locally pseudo--convex spaces, groups uniformly free from small subgroups (...

  2. Local anesthesia: a review.

    Science.gov (United States)

    Malamed, S F; Sykes, P; Kubota, Y; Matsuura, H; Lipp, M

    1992-01-01

    Local anesthetics are the most widely administered drugs in dentistry. Significant advances have been made in past decades that have greatly increased both the safety and the efficacy of these important drugs. This paper reviews the history of local anesthesia, pharmacokinetics and clinical implications, techniques, complications, and future directions in the quest for more effective pain control in dentistry.

  3. Locally Orderless Registration Code

    DEFF Research Database (Denmark)

    2012-01-01

    This is code for the TPAMI paper "Locally Orderless Registration". The code requires intel threadding building blocks installed and is provided for 64 bit on mac, linux and windows.......This is code for the TPAMI paper "Locally Orderless Registration". The code requires intel threadding building blocks installed and is provided for 64 bit on mac, linux and windows....

  4. Local solid shape

    NARCIS (Netherlands)

    Koenderink, Jan|info:eu-repo/dai/nl/070864543; van Doorn, A.J.; Wagemans, Johan

    2015-01-01

    Local solid shape applies to the surface curvature of small surface patches-essentially regions of approximately constant curvatures-of volumetric objects that are smooth volumetric regions in Euclidean 3-space. This should be distinguished from local shape in pictorial space. The difference is cate

  5. Fast Local Computation Algorithms

    CERN Document Server

    Rubinfeld, Ronitt; Vardi, Shai; Xie, Ning

    2011-01-01

    For input $x$, let $F(x)$ denote the set of outputs that are the "legal" answers for a computational problem $F$. Suppose $x$ and members of $F(x)$ are so large that there is not time to read them in their entirety. We propose a model of {\\em local computation algorithms} which for a given input $x$, support queries by a user to values of specified locations $y_i$ in a legal output $y \\in F(x)$. When more than one legal output $y$ exists for a given $x$, the local computation algorithm should output in a way that is consistent with at least one such $y$. Local computation algorithms are intended to distill the common features of several concepts that have appeared in various algorithmic subfields, including local distributed computation, local algorithms, locally decodable codes, and local reconstruction. We develop a technique, based on known constructions of small sample spaces of $k$-wise independent random variables and Beck's analysis in his algorithmic approach to the Lov{\\'{a}}sz Local Lemma, which und...

  6. Locally orderless registration code

    DEFF Research Database (Denmark)

    2012-01-01

    This is code for the TPAMI paper "Locally Orderless Registration". The code requires intel threadding building blocks installed and is provided for 64 bit on mac, linux and windows.......This is code for the TPAMI paper "Locally Orderless Registration". The code requires intel threadding building blocks installed and is provided for 64 bit on mac, linux and windows....

  7. Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study.

    Science.gov (United States)

    Kirchheiner, Kathrin; Nout, Remi A; Tanderup, Kari; Lindegaard, Jacob C; Westerveld, Henrike; Haie-Meder, Christine; Petrič, Primož; Mahantshetty, Umesh; Dörr, Wolfgang; Pötter, Richard

    2014-05-01

    Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study (www.embracestudy.dk) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity is still pronounced with currently applied IGABT, and it needs further attention

  8. $Local^{3}$ Index Theorem

    CERN Document Server

    Teleman, Nicolae

    2011-01-01

    $Local^{3}$ Index Theorem means $Local(Local(Local \\;Index \\; Theorem)))$. $Local \\; Index \\; Theorem$ is the Connes-Moscovici local index theorem \\cite{Connes-Moscovici1}, \\cite{Connes-Moscovici2}. The second "Local" refers to the cyclic homology localised to a certain separable subring of the ground algebra, while the last one refers to Alexander-Spanier type cyclic homology. The Connes-Moscovici work is based on the operator $R(A) = \\mathbf{P} - \\mathbf{e}$ associated to the elliptic pseudo-differential operator $A$ on the smooth manifold $M$, where $\\mathbf{P}$, $\\mathbf{e}$ are idempotents, see \\cite{Connes-Moscovici1}, Pg. 353. The operator $R(A)$ has two main merits: it is a smoothing operator and its distributional kernel is situated in an arbitrarily small neighbourhood of the diagonal in $M \\times M$. The operator $R(A)$ has also two setbacks: -i) it is not an idempotent (and therefore it does not have a genuine Connes-Chern character); -ii) even if it were an idempotent, its Connes-Chern character ...

  9. Local Solid Shape

    Directory of Open Access Journals (Sweden)

    Jan Koenderink

    2015-10-01

    Full Text Available Local solid shape applies to the surface curvature of small surface patches—essentially regions of approximately constant curvatures—of volumetric objects that are smooth volumetric regions in Euclidean 3-space. This should be distinguished from local shape in pictorial space. The difference is categorical. Although local solid shape has naturally been explored in haptics, results in vision are not forthcoming. We describe a simple experiment in which observers judge shape quality and magnitude of cinematographic presentations. Without prior training, observers readily use continuous shape index and Casorati curvature scales with reasonable resolution.

  10. Genetic variants in microRNAs and microRNA target sites predict biochemical recurrence after radical prostatectomy in localized prostate cancer.

    Science.gov (United States)

    Huang, Shu-Pin; Lévesque, Eric; Guillemette, Chantal; Yu, Chia-Cheng; Huang, Chao-Yuan; Lin, Victor C; Chung, I-Che; Chen, Lih-Chyang; Laverdière, Isabelle; Lacombe, Louis; Fradet, Yves; Chang, Ta-Yuan; Lee, Hong-Zin; Juang, Shin-Hun; Bao, Bo-Ying

    2014-12-01

    Recent evidence indicates that microRNAs might participate in prostate cancer initiation, progression and treatment response. Germline variations in microRNAs might alter target gene expression and modify the efficacy of prostate cancer therapy. To determine whether genetic variants in microRNAs and microRNA target sites are associated with the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). We retrospectively studied two independent cohorts composed of 320 Asian and 526 Caucasian men with pathologically organ-confined prostate cancer who had a median follow-up of 54.7 and 88.8 months after RP, respectively. Patients were systematically genotyped for 64 single-nucleotide polymorphisms (SNPs) in microRNAs and microRNA target sites, and their prognostic significance on BCR was assessed by Kaplan-Meier analysis and Cox regression model. After adjusting for known clinicopathologic risk factors, two SNPs (MIR605 rs2043556 and CDON rs3737336) remained associated with BCR. The numbers of risk alleles showed a cumulative effect on BCR [perallele hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.16-2.21, p for trend = 0.005] in Asian cohort, and the risk was replicated in Caucasian cohort (HR 1.55, 95% CI 1.15-2.08, p for trend = 0.004) and in combined analysis (HR 1.57, 95% CI 1.26-1.96, p for trend microRNAs and microRNA target sites can be predictive biomarkers for BCR after RP.

  11. Local Debt Scare

    Institute of Scientific and Technical Information of China (English)

    HU YUE

    2010-01-01

    @@ Control over local governments' financing vehicles will be tightened to fend off what some economistswarn could turn into a mountain of hidden debts,the State Council vowed at an executive meeting on May 26.

  12. Local Democracy in Myanmar

    DEFF Research Database (Denmark)

    Kyed, Helene Maria; Harrisson, Annika Pohl; McCarthy, Gerard

    2016-01-01

    Myanmar is undergoing a comprehensive political transition. In April this year the first democratically elected government in six decades came into power under the leadership of NLD, the pro-democracy party headed by Aung San Suu Kyi. The largest peace conference in the country’s history was held....... However, often overlooked in this larger picture of transition is the state of local democracy, including village level governance and everyday state-citizen engagements. Political changes at this level are equally crucial for the wider democratization process. This roundtable summary discusses the 2016...... local elections of village tract and urban ward administrators and reflects on the future of local democracy and decentralization in Myanmar. Local administrators are the primary point of contact between the state and citizens. How they are elected and how they govern in the everyday are essential...

  13. rural y conocimiento local

    Directory of Open Access Journals (Sweden)

    Teresa Acampora

    2007-01-01

    Full Text Available En el contexto de la crisis de los modelos alimentarios en el siglo XXI, las producciones agroalimentarias están en un período de redescubrimiento. Las autoras analizan las principales estrategias que tienen los actores locales para perseguir la valorización de los recursos locales con identidad territorial; para luego ahondar en las políticas de diferenciación de los productos con marcas colectivas certifi-cadas. Finalmente, se ponen en evidencia las relaciones entre productos típicos, conservación de la agrobiodiversidad y conocimientos locales. Aquí se articula el debate sobre valorización de los productos típicos con el debate internacional sobre el conocimiento tradicional y el folclor, que se ha generado a partir de la preocupación internacional sobre la erosión de la biodiversidad y los conocimientos locales.

  14. The Local Turn

    NARCIS (Netherlands)

    Warren, Carol; Visser, Leontine

    2016-01-01

    The local turn in good governance theory and practice responded to critiques of the ineffectiveness of state management and the inequity of privatization alternatives in natural resource management. Confounding expectations of greater effectiveness from decentralised governance, including communi

  15. Locally orderless registration

    DEFF Research Database (Denmark)

    Darkner, Sune; Sporring, Jon

    2013-01-01

    This paper presents a unifying approach for calculating a wide range of popular, but seemingly very different, similarity measures. Our domain is the registration of n-dimensional images sampled on a regular grid, and our approach is well suited for gradient-based optimization algorithms. Our...... approach is based on local intensity histograms and built upon the technique of Locally Orderless Images. Histograms by Locally Orderless Images are well posed and offer explicit control over the 3 inherent and unavoidable scales: the spatial resolution, intensity levels, and spatial extent of local......, and we compare these variations both theoretically, and empirically. Finally, using our algorithm, we explain the empirically observed differences between two popular joint density estimation techniques used in registration: Parzen Windows and Generalized Partial Volume....

  16. Time to Go Local!

    Science.gov (United States)

    ... Consumer Health Information, NLM On MedlinePlus.gov health topic pages, you will find "Go Local" links that take ... you visit one of the over 700 health topic pages on MedlinePlus.gov , you will see a box ...

  17. Interface localization near criticality

    CERN Document Server

    Delfino, Gesualdo

    2016-01-01

    The theory of interface localization in near-critical planar systems at phase coexistence is formulated from first principles. We show that mutual delocalization of two interfaces, amounting to interfacial wetting, occurs when the bulk correlation length critical exponent $\

  18. RNA Localization in Astrocytes

    DEFF Research Database (Denmark)

    Thomsen, Rune

    2012-01-01

    Messenger RNA (mRNA) localization is a mechanism by which polarized cells can regulate protein synthesis to specific subcellular compartments in a spatial and temporal manner, and plays a pivotal role in multiple physiological processes from embryonic development to cell differentiation......, regulation of the blood brain barrier and glial scar tissue formation. Despite the involvement in various CNS functions only a limited number of studies have addressed mRNA localization in astrocytes. This PhD project was initially focused on developing and implementing methods that could be used to asses mRNA...... localization in astrocyte protrusions, and following look into the subcellular localization pattern of specific mRNA species of both primary astrocytes isolated from cortical hemispheres of newborn mice, and the mouse astrocyte cell line, C8S. The Boyden chamber cell fractionation assay was optimized, in a way...

  19. nuevo gobierno local

    Directory of Open Access Journals (Sweden)

    José Vargas Hernández

    2005-01-01

    Full Text Available Este trabajo tiene como objetivo analizar las funciones y estructura de ingeniería social del nuevo gobierno local para dar respuesta a las demandas sociales, promover el desarrollo y regular los nuevos servicios públicos. A partir de una delimitación de los conceptos de soberanía y autonomía del nuevo gobierno local, se reconfigura una nueva estructura de gobernabilidad de los gobiernos locales que implica una mayor participación ciudadana en los procesos de toma de decisiones y la formulación de las políticas públicas, mediante la facilitación de procesos de descentralización de funciones y mecanismos coordinadores de servicios públicos. Finalmente se analizan las implicaciones en la gobernabilidad de la ingeniería social del nuevo gobierno local.

  20. Sources of localized waves

    OpenAIRE

    Chatzipetros, Argyrios Alexandros

    1994-01-01

    The synthesis of two types of Localized Wave (L W) pulses is considered; these are the 'Focus Wave Model (FWM) pulse and the X Wave pulse. First, we introduce the modified bidirectional representation where one can select new basis functions resulting in different representations for a solution to the scalar wave equation. Through this new representation, we find a new class of focused X Waves which can be extremely localized. The modified bidirectional decomposition is applied...

  1. Cosmology and Local Physics

    CERN Document Server

    Ellis, G F R

    2002-01-01

    This article is dedicated to the memory of Dennis Sciama. It revisits a series of issues to which he devoted much time and effort, regarding the relationship between local physics and the large scale structure of the universe - in particular, Olber's paradox, Mach's principle, and the various arrows of time. Thus the focus is various ways in which local physics is influenced by the universe itself.

  2. Bornological Locally Convex Cones

    Directory of Open Access Journals (Sweden)

    Davood Ayaseh

    2014-10-01

    Full Text Available In this paper we define bornological and b-bornological cones and investigate their properties. We give some characterization for these cones. In the special case of locally convex topological vector space both these concepts reduce to the known concept  of bornological spaces. We introduce and investigate the  convex quasiuniform   structures U_{tau}, U_{sigma}(P,P* and \\U_{beta}(P,P* on locally convex cone (P,U.

  3. Localization under Adversary Misdirection

    Science.gov (United States)

    2014-10-01

    locations using manifold learning algorithms. Source Localization A number of methods exist for estimating location including angle of arrival (AOA), time...improvement of the least-squares estimator. IEEE Transactions on Signal Processing, 56(5):1788–1800, 2008. [12] M. Fazel, H. Hindi , and S.P. Boyd. Log-det...and applications, pages 20–29. ACM, 2003. [54] N. Patwari and A.O. Hero III. Manifold learning algorithms for localization in wireless sensor networks

  4. Localization of plastic deformation

    Energy Technology Data Exchange (ETDEWEB)

    Rice, J R

    1976-04-01

    The localization of plastic deformation into a shear band is discussed as an instability of plastic flow and a precursor to rupture. Experimental observations are reviewed, a general theoretical framework is presented, and specific calculations of critical conditions are carried out for a variety of material models. The interplay between features of inelastic constitutive description, especially deviations from normality and vertex-like yielding, and the onset of localization is emphasized.

  5. Acute local radiation injuries

    Energy Technology Data Exchange (ETDEWEB)

    Gongora, R. (Institut Curie, 75 - Paris (France)); Jammet, H. (Commissariat a l' Energie Atomique, ISPN, 92 - Fontenay-aux-Roses (France))

    1983-01-01

    Local acute radiation injuries do not occur very often. Their origin is generally accidental. They show specific anatomo-clinical features. The clinical evolution and therapeutic behaviour are dependent on the dose level and topographical distribution. The dosimetric assessment requires physical methods and paraclinical investigations. From a study of 60 cases followed by the International Center of Radiopathology, the clinical symptomatology is described and the problems raised to the radiopathologist physician by local acute radiation injuries are stated.

  6. Desempleo y justicia local

    Directory of Open Access Journals (Sweden)

    Elster, Jon

    2003-04-01

    Full Text Available In this paper Jon Elster presents a set of criteria of local justice that regulate dismissals. In situations where work is limited and companies adopt means of employment redundancy, the decision of dismissing certain workers —when this one tries not to be arbitrary— can be based on local criteria of fairness like merit, efficiency, age or other analysed in this work. So, after defining the concept of local justice and presenting some examples, the paper focuses on the importance of the work to organize and structure the life of people. Unemployment has serious consequences for the persons who suffer it and the author advises that it is necessary to subordinate dismissals to criteria of local justice.

    En este artículo se presentan una serie de criterios de justicia local para regular los despidos. En situaciones en las que el trabajo es escaso y las empresas adoptan medidas de regulación de empleo, la decisión de despedir a unos trabajadores o a otros se puede basar, cuando se intenta que no sea arbitraria, en criterios locales de equidad como el mérito, la eficacia, la edad u otros que se analizan en este trabajo. Así, tras definir el concepto de justicia local y presentar algunos ejemplos, el artículo se centra en la importancia del trabajo para organizar y estructurar la vida de la gente. Las graves consecuencias que tiene, por ello, el desempleo para quien lo sufre, aconseja que los despidos se sometan a criterios de justicia local.

  7. Transcatheter arterial chemoembolization and radiation therapy for treatment-naive patients with locally advanced hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won [Dept. of Radiation Oncology, Yeungnam University Medical Center, Daegu (Korea, Republic of); Oh, Dong Ryul; Park, Hee Chul; Lim, Do Hoon; Shin, Sung Wook; Cho, Sung Ki; Gwak, Geum Youn; Choi, Moon Seok; Paik, Yong Han; Paik, Seung Woon [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) followed by radiotherapy (RT) in treatment-naive patients with locally advanced hepatocellular carcinoma (HCC). Eligibility criteria were as follows: newly diagnosed with HCC, the Barcelona Clinic Liver Cancer stage C, Child-Pugh class A or B, and no prior treatment for HCC. Patients with extrahepatic spread were excluded. A total of 59 patients were retrospectively enrolled. All patients were treated with TACE followed by RT. The time interval between TACE and RT was 2 weeks as per protocol. A median RT dose was 47.25 Gy10 as the biologically effective dose using the α/β = 10 (range, 39 to 65.25 Gy10). At 1 month, complete response was obtained in 3 patients (5%), partial response in 27 patients (46%), stable disease in 13 patients (22%), and progressive disease in 16 patients (27%). The actuarial one- and two-year OS rates were 60.1% and 47.2%, respectively. The median OS was 17 months (95% confidence interval, 5.6 to 28.4 months). The median time to progression was 4 months (range, 1 to 35 months). Grade 3 or greater liver enzyme elevation occurred in only two patients (3%) after RT. Grade 3 gastroduodenal toxicity developed in two patients (3%). The combination treatment of TACE followed by RT with two-week interval was safe and it showed favorable outcomes in treatment-naive patients with locally advanced HCC. A prospective randomized trial is needed to validate these results.

  8. TOURISM AND LOCAL DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    BORMA AFRODITA

    2015-04-01

    Full Text Available The paper presents a theoretical approach of the relation between tourism and local development. The research method used is based on documenting and summarizing aspects related to the importance of tourism on local development. According to data provided by the World Tourism Organization (WTO, 2014, compared to 2010, a 91% increase of the number of international tourist arrivals is forecasted in 2030, from 948 million arrivals (2010 to 1,810 million arrivals (2030. Therefore, it is no surprise that tourism is viewed as a development strategy in many national economies. Tourism literature captures a series of arguments that emphasize the contribution of tourism to local development by: creating new jobs, revitalizing cultural traditions, improving infrastructure, environmental protection, etc. For Romania, as well, it may be noted that tourism strategies included in the 2013-2016 Government Programme are oriented towards local tourism by: decentralizing the authorization and approval activity, developing an integrated tourism by capitalizing all the local resources (cultural, agricultural, handicraft, etc., connecting Romanian tourism to international trends, etc. In order to achieve the aforementioned objectives, the 2013-2016 Government Program provides the clarification on the issue of decentralization, since the current government believes that a balanced development of Romania can only be achieved through transfer of authority to the local, county and regional levels.

  9. Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, Andrew J.; Tao, Randa [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rebueno, Neal C. [Department of Radiation Dosimetry, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Christensen, Eva N.; Allen, Pamela K. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wang, Xin A. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Amini, Behrang [Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tannir, Nizar M. [Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tatsui, Claudio E.; Rhines, Laurence D. [Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Li, Jing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California (United States); Brown, Paul D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ghia, Amol J., E-mail: ajghia@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2015-08-01

    Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy. Methods and Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months). Endpoints were overall survival and local control (LC); recurrences were classified as either in-field or marginal. Results: The 1-year actuarial LC and overall survival rates were 88% and 64%, respectively. Patients with local relapses had poorer dosimetric coverage of the gross tumor volume (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin ≥33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared with patients with a lower GTV BED Dmin; this factor was the only significant variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 0.29, 95% confidence interval 0.14-0.60) and also was the only variable significant in a separate competing risk multivariate model (P=.001, hazard ratio 0.30, 95% confidence interval 0.15-0.62). Conclusions: Stereotactic body radiation therapy offers durable control for spinal metastases, but there is a subset of patients that recur locally. Patients with local relapse had significantly poorer tumor coverage, which was likely attributable to treatment planning directives that prioritized the

  10. Adjuvant Ab Interno Tumor Treatment After Proton Beam Irradiation.

    Science.gov (United States)

    Seibel, Ira; Riechardt, Aline I; Heufelder, Jens; Cordini, Dino; Joussen, Antonia M

    2017-06-01

    This study was performed to show long-term outcomes concerning globe preservation in uveal melanoma patients after proton beam therapy with the main focus on outcomes according to different adjuvant ab interno surgical procedures. Retrospective cohort study. All patients treated with primary proton beam therapy for choroidal or ciliary body melanoma between June 1998 and June 2015 were included. A total of 2499 patients underwent primary proton beam therapy, with local tumor control and globe preservation rates of 95.9% and 94.8% after 5 years, respectively. A total of 110 (4.4%) patients required secondary enucleation. Unresponsive neovascular glaucoma was the leading cause of secondary enucleation in 78 of the 2499 patients (3.1%). The 5-year enucleation-free survival rate was 94.8% in the endoresection group, 94.3% in the endodrainage group, and 93.5% in the comparator group. The log-rank test showed P = .014 (comparator group vs endoresection group) and P = .06 (comparator group vs endodrainage-vitrectomy group). Patients treated with endoresection or endodrainage-vitrectomy developed less radiation retinopathy (30.5% and 37.4% after 5 years, P = .001 and P = .048 [Kaplan-Meier], respectively) and less neovascular glaucoma (11.6% and 21.3% after 5 years, P = .001 and P = .01 [Kaplan-Meier], respectively) compared with the comparator group (52.3% radiation retinopathy and 57.8% neovascular glaucoma after 5 years). This study suggests that in larger tumors the enucleation and neovascular glaucoma rates might be reduced by adjuvant surgical procedures. Although endoresection is the most promising adjuvant treatment option, the endodrainage-vitrectomy is recommended in patients who are ineligible for endoresection. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

    Science.gov (United States)

    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.

    2012-01-01

    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  12. CD56-positive lymphocyte infiltration in relation to human papillomavirus association and prognostic significance in oropharyngeal squamous cell carcinoma.

    Science.gov (United States)

    Wagner, Steffen; Wittekindt, Claus; Reuschenbach, Miriam; Hennig, Ben; Thevarajah, Mauran; Würdemann, Nora; Prigge, Elena-Sophie; von Knebel Doeberitz, Magnus; Dreyer, Thomas; Gattenlöhner, Stefan; Klussmann, Jens Peter

    2016-05-01

    Human papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx (OSCC) are clinical and biological distinct from their HPV-unrelated counterparts. Patients with HPV-related OSCC display improved prognosis and therefore we investigated possible immune cell infiltrations associated with this tumor phenotype. We retrospectively analyzed a randomly selected cohort of 140 OSCC for presence of immune cells and HPV by immunohistochemistry and PCR followed by bead-based hybridization (Luminex technology). HPV prevalence was 24.3% as determined by positive staining of p16INK4a and detection of high risk HPV-DNA. We found significantly higher numbers of CD56 positive (CD56+) cells in tumor and surrounding microenvironment in HPV-associated compared to HPV-negative OSCC (t-test: p = 0.004 and p = 0.002). For the entire cohort presence of CD56+ cells was associated with increased overall survival independent from HPV (Kaplan-Meier: p = 0.002; Cox regression: p = 0.042). Presence of CD56+ cells also correlated with a better outcome in HPV-negative and especially in HPV-negative OSCC with alcohol consumption ≤ 2 standard drinks per day (Kaplan-Meier: p = 0.05 and p = 0.003). Immunofluorescence localization of granular Granzyme B (GZMB) within CD56+ cells and coexpression of CD16 and CD56 suggests that detected CD56+ cells mainly represent cytotoxic Natural Killer (NK) cells. The fraction of potentially cytotoxic NK cells was significantly higher in HPV-associated compared to HPV-negative OSCC (Mann-Whitney-U-Test: p = 0.011). The elevated abundance and activity of cytotoxic NK cells in OSCC with HPV driven carcinogenesis might contribute to favorable outcome in HPV-related OSCC.

  13. Three- to nine-year survival estimates and fracture mechanisms of zirconia- and alumina-based restorations using standardized criteria to distinguish the severity of ceramic fractures.

    Science.gov (United States)

    Moráguez, Osvaldo D; Wiskott, H W Anselm; Scherrer, Susanne S

    2015-12-01

    The aims of this study were set as follows: 1. To provide verifiable criteria to categorize the ceramic fractures into non-critical (i.e., amenable to polishing) or critical (i.e., in need of replacement) 2. To establish the corresponding survival rates for alumina and zirconia restorations 3. To establish the mechanism of fracture using fractography Fifty-eight patients restored with 115 alumina-/zirconia-based crowns and 26 zirconia-based fixed dental prostheses (FDPs) were included. Ceramic fractures were classified into four types and further subclassified into "critical" or "non-critical." Kaplan-Meier survival estimates were calculated for "critical fractures only" and "all fractures." Intra-oral replicas were taken for fractographic analyses. Kaplan-Meier survival estimates for "critical fractures only" and "all fractures" were respectively: Alumina single crowns: 90.9 and 68.3 % after 9.5 years (mean 5.71 ± 2.6 years). Zirconia single crowns: 89.4 and 80.9 % after 6.3 years (mean 3.88 ± 1.2 years). Zirconia FDPs: 68.6 % (critical fractures) and 24.6 % (all fractures) after 7.2 and 4.6 years respectively (FDP mean observation time 3.02 ± 1.4 years). No core/framework fractures were detected. Survival estimates varied significantly depending on whether "all" fractures were considered as failures or only those deemed as "critical". For all restorations, fractographic analyses of failed veneering ceramics systematically demonstrated heavy occlusal wear at the failure origin. Therefore, the relief of local contact pressures on unsupported ceramic is recommended. Occlusal contacts on mesial or distal ridges should systematically be eliminated. A classification standard for ceramic fractures into four categories with subtypes "critical" and "non-critical" provides a differentiated view of the survival of ceramic restorations.

  14. Phase II Trial of Cetuximab and Conformal Radiotherapy Only in Locally Advanced Pancreatic Cancer with Concurrent Tissue Sampling Feasibility Study.

    Science.gov (United States)

    Rembielak, Agata I; Jain, Pooja; Jackson, Andrew S; Green, Melanie M; Santorelli, Gillian R; Whitfield, Gillian A; Crellin, Adrian; Garcia-Alonso, Angel; Radhakrishna, Ganesh; Cullen, James; Taylor, M Ben; Swindell, Ric; West, Catharine M; Valle, Juan; Saleem, Azeem; Price, Patricia M

    2014-02-01

    Preclinical data have indicated the anti-epidermal growth factor receptor (EGFR) agent cetuximab (Erbitux) as a radiosensitizer in pancreatic cancer, but this has not been specifically addressed in a clinical study. We report the results of an original study initiated in 2007, where cetuximab was tested with radiotherapy (RT) alone in locally advanced pancreatic cancer in a phase II trial (PACER). Patients (n = 21) received cetuximab loading dose (400 mg/m(2)) and weekly dose (250 mg/m(2)) during RT (50.4 Gy in 28 fractions). Toxicity and disease response end point data were prospectively assessed. A feasibility study of on-trial patient blood and skin sampling was incorporated. Treatment was well tolerated, and toxicity was low; most patients (71%) experienced acute toxicities of grade 2 or less. Six months posttreatment, stable local disease was achieved in 90% of evaluable patients, but only 33% were free from metastatic progression. Median overall survival was 7.5 months, and actuarial survival was 33% at 1 year and 11% at 3 years, reflecting swift metastatic progression in some patients but good long-term control of localized disease in others. High-grade acneiform rash (P = .0027), posttreatment stable disease (P = .0059), and pretreatment cancer antigen 19.9 (CA19.9) level (P = .0042) associated with extended survival. Patient skin and blood samples yielded sufficient RNA and good quality protein, respectively. The results indicate that cetuximab inhibits EGFR-mediated radioresistance to achieve excellent local control with minimal toxicity but does not sufficiently control metastatic progression in all patients. Translational studies of patient tissue samples may yield molecular information that may enable individual treatment response prediction.

  15. Monaural Sound Localization Revisited

    Science.gov (United States)

    Wightman, Frederic L.; Kistler, Doris J.

    1997-01-01

    Research reported during the past few decades has revealed the importance for human sound localization of the so-called 'monaural spectral cues.' These cues are the result of the direction-dependent filtering of incoming sound waves accomplished by the pinnae. One point of view about how these cues are extracted places great emphasis on the spectrum of the received sound at each ear individually. This leads to the suggestion that an effective way of studying the influence of these cues is to measure the ability of listeners to localize sounds when one of their ears is plugged. Numerous studies have appeared using this monaural localization paradigm. Three experiments are described here which are intended to clarify the results of the previous monaural localization studies and provide new data on how monaural spectral cues might be processed. Virtual sound sources are used in the experiments in order to manipulate and control the stimuli independently at the two ears. Two of the experiments deal with the consequences of the incomplete monauralization that may have contaminated previous work. The results suggest that even very low sound levels in the occluded ear provide access to interaural localization cues. The presence of these cues complicates the interpretation of the results of nominally monaural localization studies. The third experiment concerns the role of prior knowledge of the source spectrum, which is required if monaural cues are to be useful. The results of this last experiment demonstrate that extraction of monaural spectral cues can be severely disrupted by trial-to-trial fluctuations in the source spectrum. The general conclusion of the experiments is that, while monaural spectral cues are important, the monaural localization paradigm may not be the most appropriate way to study their role.

  16. Representing properties locally.

    Science.gov (United States)

    Solomon, K O; Barsalou, L W

    2001-09-01

    Theories of knowledge such as feature lists, semantic networks, and localist neural nets typically use a single global symbol to represent a property that occurs in multiple concepts. Thus, a global symbol represents mane across HORSE, PONY, and LION. Alternatively, perceptual theories of knowledge, as well as distributed representational systems, assume that properties take different local forms in different concepts. Thus, different local forms of mane exist for HORSE, PONY, and LION, each capturing the specific form that mane takes in its respective concept. Three experiments used the property verification task to assess whether properties are represented globally or locally (e.g., Does a PONY have mane?). If a single global form represents a property, then verifying it in any concept should increase its accessibility and speed its verification later in any other concept. Verifying mane for PONY should benefit as much from having verified mane for LION earlier as from verifying mane for HORSE. If properties are represented locally, however, verifying a property should only benefit from verifying a similar form earlier. Verifying mane for PONY should only benefit from verifying mane for HORSE, not from verifying mane for LION. Findings from three experiments strongly supported local property representation and ruled out the interpretation that object similarity was responsible (e.g., the greater overall similarity between HORSE and PONY than between LION and PONY). The findings further suggest that property representation and verification are complicated phenomena, grounded in sensory-motor simulations.

  17. Development of Local Chicken Production Based on Local Feed Ingredients

    Directory of Open Access Journals (Sweden)

    Cecep Hidayat

    2012-06-01

    Full Text Available Development of local chicken production based on local feed ingredient is in line with the vision of Indonesian goverment to fulfill meat and egg national requirement based on local resources. There are two big problem which become stumblingblock in developing local chicken production. The first problem is the difficulty to get day old chick of local chicken. This problem can be solved by integrating breeder institutions belong to goverment with research institution and with local chicken producer association. The second problem is the low performance of local chicken. To improve local chicken performance, it can be done by improving the breed, feed and management. Several research results show that good performance of local chicken were obtained by inclusion of local feed ingredients in the ration. Therefore, development of local chicken production based an local feed resources can be applied.

  18. Localization on Hopf surfaces

    CERN Document Server

    Assel, Benjamin; Martelli, Dario

    2014-01-01

    We discuss localization of the path integral for supersymmetric gauge theories with an R-symmetry on Hermitian four-manifolds. After presenting the localization locus equations for the general case, we focus on backgrounds with S^1 x S^3 topology, admitting two supercharges of opposite R-charge. These are Hopf surfaces, with two complex structure moduli p,q. We compute the localized partition function on such Hopf surfaces, allowing for a very large class of Hermitian metrics, and prove that this is proportional to the supersymmetric index with fugacities p,q. Using zeta function regularisation, we determine the exact proportionality factor, finding that it depends only on p,q, and on the anomaly coefficients a, c of the field theory. This may be interpreted as a supersymmetric Casimir energy, and provides the leading order contribution to the partition function in a large N expansion.

  19. Tackling Health Inequalities Locally

    DEFF Research Database (Denmark)

    Diderichsen, Finn; Scheele, Christian Elling; Little, Ingvild Gundersen

    of this study. It is based on three sources: 1. Interviews with policymakers (administrators and politicians) within healthcare administrations, childhood/education, and labour market administrations from September 2014 to March 2015*. 2. Textual analysis of available policy documents from regions...... of translating small inequalities in wealth into small inequalities in health. Denmark, Norway and Sweden all have legislation that indifferent ways offers local governments key roles in public health. This is partly due to local governments’ responsibility for many policy areas of great relevance to health...... state model, including its health policy, as an area of Nordic collaboration (104). However, realising the principle of health (equity) in all policiesis no simple matter. The national authorities and local government federations in Denmark, Norway and Sweden have therefore initiated various activities...

  20. Local homotopy theory

    CERN Document Server

    Jardine, John F

    2015-01-01

    This monograph on the homotopy theory of topologized diagrams of spaces and spectra gives an expert account of a subject at the foundation of motivic homotopy theory and the theory of topological modular forms in stable homotopy theory. Beginning with an introduction to the homotopy theory of simplicial sets and topos theory, the book covers core topics such as the unstable homotopy theory of simplicial presheaves and sheaves, localized theories, cocycles, descent theory, non-abelian cohomology, stacks, and local stable homotopy theory. A detailed treatment of the formalism of the subject is interwoven with explanations of the motivation, development, and nuances of ideas and results. The coherence of the abstract theory is elucidated through the use of widely applicable tools, such as Barr's theorem on Boolean localization, model structures on the category of simplicial presheaves on a site, and cocycle categories. A wealth of concrete examples convey the vitality and importance of the subject in topology, n...

  1. Locality and causality revisited

    CERN Document Server

    Kent, A

    2002-01-01

    Bell gave the now standard definition of a local hidden variable theory and showed that such theories cannot reproduce the predictions of quantum mechanics without violating his ``free will'' criterion: experimenters' measurement choices can be assumed to be uncorrelated with properties of the measured system prior to measurement. An alternative is considered here: a probabilistic theory of hidden variables underlying quantum mechanics could be statistically local, in the sense that it supplies global configuration probabilities which are defined by expressions involving only local terms. This allows Bell correlations without relying on {\\it either} a conspiracy theory in which prior common causes correlate the system state with experimenters' choices {\\it or} a reverse causation principle in which experimenters' choices affect the earlier system states. In particular, there is no violation of the free will criterion. It gives a different perspective on Bell correlations, in which the puzzle is not that appar...

  2. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer.

    Science.gov (United States)

    Fodor, J; Major, T; Polgár, C; Orosz, Z; Sulyok, Z; Kásler, M

    2008-06-01

    Between 1983 and 1987, 1309 women with stage I or II breast cancer underwent mastectomy (n=894) or conservative surgery (CS, n=415). Of these patients, 124 developed an isolated local recurrence (ILR): chest wall, 56 and in-breast, 68. The 10-year actuarial rate of cause-specific survival after treatment for ILR was 52%. On multivariate analysis three independent prognostic factors for the risk of death after ILR were identified: operability of recurrence (operable vs. inoperable, relative risk [RR]: 5.9), age at initial diagnosis (>40 vs. 24 vs. mastectomy) and recurrent tumor grade (1-2 vs. 3) were not independent predictors of survival. In the mastectomy group, single surgical scar recurrence with initial node negative stage predicted good prognosis, and the 10-year survival was 85%. In the CS group, the 10-year survival rate was 88% with new primary tumor and 54% with true recurrence (p=0.01), and the type of salvage surgery (mastectomy vs. repeat complete excision) had no significant impact on survival (p=0.2). The majority (n=44) of CS patients developed mastectomy (n=16). The identified unfavorable prognostic factors are pointers of the forthcoming systemic progression. Patients with < or = 2 cm in-breast recurrence might receive a second CS.

  3. Conditional Survival Analysis of Patients With Locally Advanced Laryngeal Cancer: Construction of a Dynamic Risk Model and Clinical Nomogram

    Science.gov (United States)

    Sheu, Tommy; Vock, David M.; Mohamed, Abdallah S. R.; Gross, Neil; Mulcahy, Collin; Zafereo, Mark; Gunn, G. Brandon; Garden, Adam S.; Sevak, Parag; Phan, Jack; Lewin, Jan S.; Frank, Steven J.; Beadle, Beth M.; Morrison, William H.; Lai, Stephen Y.; Hutcheson, Katherine; Marai, G. Elisabeta; Canahuate, Guadalupe M.; Kies, Merrill; El-Naggar, Adel; Weber, Randal S.; Rosenthal, David I.; Fuller, Clifton D.

    2017-01-01

    Conditional survival (CS), the survival beyond a pre-defined time interval, can identify periods of higher mortality risk for patients with locally advanced laryngeal cancer who face treatment-related toxicity and comorbidities related to alcohol and smoking in the survivorship setting. Using Weibull regression modeling, we analyzed retrospectively abstracted data from 638 records of patients who received radiation to identify prognostic factors for overall survival (OS) and recurrence free survival (RFS) for the first 3 years of survival and for OS conditional upon 3 years of survival. The CS was iteratively calculated, stratifying on variables that were statistically significant on multivariate regression. Predictive nomograms were generated. The median total follow up time was 175 months. The 3- and 6- year actuarial overall survival (OS) was 68% (95% confidence interval [CI] 65–72%) and 49% (CI 45–53%). The 3-year conditional overall survival (COS) at 3 years was 72% (CI 65–74%). Black patients had worse COS over time. Nodal disease was significantly associated with recurrence, but after 3 years, the 3-year conditional RFS converged for all nodal groups. In conclusion, the CS analysis in this patient cohort identified subgroups and time intervals that may represent opportunities for intervention. PMID:28276466

  4. Split-Course, High-Dose Palliative Pelvic Radiotherapy for Locally Progressive Hormone-Refractory Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gogna, Nirdosh Kumar, E-mail: kumar_gogna@health.qld.gov.au [Radiation Oncology Services, Mater Centre, Brisbane, Queensland (Australia); Baxi, Siddhartha; Hickey, Brigid; Baumann, Kathryn [Radiation Oncology Services, Mater Centre, Brisbane, Queensland (Australia); Burmeister, Elizabeth [Princess Alexandra Hospital, Brisbane, Queensland (Australia); Holt, Tanya [Radiation Oncology Services, Mater Centre, Brisbane, Queensland (Australia)

    2012-06-01

    Purpose: Local progression, in patients with hormone-refractory prostate cancer, often causes significant morbidity. Pelvic radiotherapy (RT) provides effective palliation in this setting, with most published studies supporting the use of high-dose regimens. The aim of the present study was to examine the role of split-course hypofractionated RT used at our institution in treating this group of patients. Methods and Materials: A total of 34 men with locoregionally progressive hormone-refractory prostate cancer, treated with a split course of pelvic RT (45-60 Gy in 18-24 fractions) between 2000 and 2008 were analyzed. The primary endpoints were the response rate and actuarial locoregional progression-free survival. Secondary endpoints included overall survival, compliance, and acute and late toxicity. Results: The median age was 71 years (range, 53-88). Treatment resulted in an overall initial response rate of 91%, a median locoregional progression-free survival of 43 months, and median overall survival of 28 months. Compliance was excellent and no significant late toxicity was reported. Conclusions: The split course pelvic RT described has an acceptable toxicity profile, is effective, and compares well with other high-dose palliative regimens that have been previously reported.

  5. Single High Intensity Focused Ultrasound Session as a Whole Gland Primary Treatment for Clinically Localized Prostate Cancer: 10-Year Outcomes

    Directory of Open Access Journals (Sweden)

    Ksenija Limani

    2014-01-01

    Full Text Available Objectives. To assess the treatment outcomes of a single session of whole gland high intensity focused ultrasound (HIFU for patients with localized prostate cancer (PCa. Methods. Response rates were defined using the Stuttgart and Phoenix criteria. Complications were graded according to the Clavien score. Results. At a median follow-up of 94months, 48 (44.4% and 50 (46.3% patients experienced biochemical recurrence for Phoenix and Stuttgart definition, respectively. The 5- and 10-year actuarial biochemical recurrence free survival rates were 57% and 40%, respectively. The 10-year overall survival rate, cancer specific survival rate, and metastasis free survival rate were 72%, 90%, and 70%, respectively. Preoperative high risk category, Gleason score, preoperative PSA, and postoperative nadir PSA were independent predictors of oncological failure. 24.5% of patients had self-resolving LUTS, 18.2% had urinary tract infection, and 18.2% had acute urinary retention. A grade 3b complication occurred in 27 patients. Pad-free continence rate was 87.9% and the erectile dysfunction rate was 30.8%. Conclusion. Single session HIFU can be alternative therapy for patients with low risk PCa. Patients with intermediate risk should be informed about the need of multiple sessions of HIFU and/or adjuvant treatments and HIFU performed very poorly in high risk patients.

  6. Low-dose rate prostate brachytherapy is well tolerated in patients with a history of inflammatory bowel disease.

    Science.gov (United States)

    Peters, Christopher A; Cesaretti, Jamie A; Stone, Nelson N; Stock, Richard G

    2006-10-01

    We report on the follow-up of 24 patients with a prior history of inflammatory bowel disease (IBD) treated with brachytherapy for early-stage prostate cancer. Twenty-four patients with a history of inflammatory bowel disease (17 with ulcerative colitis (UC), 7 with Crohn's disease [CD]) underwent prostate brachytherapy between 1992 and 2004. Fifteen patients were treated with I-125 implantation and 6 patients were treated with Pd-103 alone or in combination with 45 Gy external beam radiation. Charts were reviewed for all patients, and all living patients were contacted by phone. National Cancer Institute common toxicity scores for proctitis were assigned to all patients. Actuarial risk of late toxicity was calculated by the Kaplan-Meier method. Statistical analysis was performed using SPSS software. Follow-up ranged from 3 to 126 months (median, 48.5 months; mean, 56.8 months). None of the patients experienced Grade 3 or 4 rectal toxicity. Four patients experienced Grade 2 late rectal toxicity. The 5-year actuarial freedom from developing late Grade 2 rectal toxicity was 81%. At a median follow-up of 48.5 months, 23 patients were alive and had no evidence of disease with a median prostate-specific antigen for the sample of 0.1 ng/mL (range, <0.05-0.88 ng/mL). One patient died of other causes unrelated to his prostate cancer. Prostate brachytherapy is well tolerated in patients with a history of controlled IBD. Therefore, brachytherapy should be considered a viable therapeutic option in this patient population.

  7. Dosimetric and Late Radiation Toxicity Comparison Between Iodine-125 Brachytherapy and Stereotactic Radiation Therapy for Juxtapapillary Choroidal Melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Krema, Hatem, E-mail: htmkrm19@yahoo.com [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Heydarian, Mostafa [Department of Radiation Medicine, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Beiki-Ardakani, Akbar [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Weisbrod, Daniel [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Xu, Wei [Department of Biostatistics, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Laperriere, Normand J.; Sahgal, Arjun [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)

    2013-07-01

    Purpose: To compare the dose distributions and late radiation toxicities for {sup 125}I brachytherapy (IBT) and stereotactic radiation therapy (SRT) in the treatment of juxtapapillary choroidal melanoma. Methods: Ninety-four consecutive patients with juxtapapillary melanoma were reviewed: 30 have been treated with IBT and 64 with SRT. Iodine-125 brachytherapy cases were modeled with plaque simulator software for dosimetric analysis. The SRT dosimetric data were obtained from the Radionics XKnife RT3 software. Mean doses at predetermined intraocular points were calculated. Kaplan-Meier estimates determined the actuarial rates of late toxicities, and the log–rank test compared the estimates. Results: The median follow-up was 46 months in both cohorts. The 2 cohorts were balanced with respect to pretreatment clinical and tumor characteristics. Comparisons of radiation toxicity rates between the IBT and SRT cohorts yielded actuarial rates at 50 months for cataracts of 62% and 75% (P=.1), for neovascular glaucoma 8% and 47% (P=.002), for radiation retinopathy 59% and 89% (P=.0001), and for radiation papillopathy 39% and 74% (P=.003), respectively. Dosimetric comparisons between the IBT and SRT cohorts yielded mean doses of 12.8 and 14.1 Gy (P=.56) for the lens center, 17.6 and 19.7 Gy (P=.44) for the lens posterior pole, 13.9 and 10.8 Gy (P=.30) for the ciliary body, 61.9 and 69.7 Gy (P=.03) for optic disc center, and 48.9 and 60.1 Gy (P<.0001) for retina at 5-mm distance from tumor margin, respectively. Conclusions: Late radiation-induced toxicities were greater with SRT, which is secondary to the high-dose exposure inherent to the technique as compared with IBT. When technically feasible, IBT is preferred to treat juxtapapillary choroidal melanoma.

  8. Calming Local Debt Fears

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Local governments in China, barred from directly selling bonds and taking out bank loans, have set up thousands of financing vehicles to raise money to fund infrastructure projects. A first-ever audit found that these local government financing vehicles have accumulated a record breaking debt of 10.7 trillion yuan ($1.7 trillion).But there’s no need to panic over this debt, said Xu Lin, Director of the Department of Fiscal and Financial Affairs of the National Development and Reform Commission (NDRC), in a question-andanswer statement posted on the NDRC’s website on August 29.Edited excerpts follow:

  9. Calming Local Debt Fears

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Local governments in China,barred from directly selling bonds and taking out bank loans,have set up thousands of financing vehicles to raise money to fund infrastructure projects.A first-ever audit found that these local government financing vehicles have accumulated a record breaking debt of 10.7 trillion yuan ($1.7 trillion).But there's no need to panic over this debt,said Xu Lin,Director of the Department of Fiscal and Financial Affairs of the National Development and Reform Commission (NDRC),in a question-and-answer statement posted on the NDRC's website on August 29.

  10. Multidimensional Localized Solitons

    CERN Document Server

    Boiti, M; Martina, L; Boiti, Marco

    1993-01-01

    Abstract: Recently it has been discovered that some nonlinear evolution equations in 2+1 dimensions, which are integrable by the use of the Spectral Transform, admit localized (in the space) soliton solutions. This article briefly reviews some of the main results obtained in the last five years thanks to the renewed interest in soliton theory due to this discovery. The theoretical tools needed to understand the unexpected richness of behaviour of multidimensional localized solitons during their mutual scattering are furnished. Analogies and especially discrepancies with the unidimensional case are stressed.

  11. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2011-11-15

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  12. Local Area Networks.

    Science.gov (United States)

    Marks, Kenneth E.; Nielsen, Steven

    1991-01-01

    Discusses cabling that is needed in local area networks (LANs). Types of cables that may be selected are described, including twisted pair, coaxial cables (or ethernet), and fiber optics; network topologies, the manner in which the cables are laid out, are considered; and cable installation issues are discussed. (LRW)

  13. Beyond local climate

    DEFF Research Database (Denmark)

    D'haen, Sarah Ann Lise; Nielsen, Jonas Østergaard; Lambin, Eric F.

    2014-01-01

    At the household level, nonfarm activities are thought to help rural poor households buffer against agricultural risks related to local climate variability by providing them with cash to buy food in the case of harvest shortfalls. Over the recent decades, households in rural Sub-Sahara have been...

  14. Local control room

    CERN Multimedia

    CERN PhotoLab

    1972-01-01

    Local control room in the ejection building : all electronics pertaining to proton distribution and concomitants such as beam gymnastics and diagnostics at high energies will eventually be gathered here. Shown is the first of two rows of fast ejection electronic racks. It includes only what is necessary for operation.

  15. 'Think globally, act locally'

    DEFF Research Database (Denmark)

    Hoff, Jens Villiam

    2015-01-01

    and international levels. For local governments, the task of initiating or facilitating citizen action concerning climate change mitigation has generated the development of new policy instruments that increasingly target people’s everyday lives, homes and workplaces. Examples of the use of these new policy...

  16. Local youth policy

    NARCIS (Netherlands)

    R. Gilsing

    1999-01-01

    Original title: Lokaal jeugdbeleid. Local authorities have been given an important role in youth policy in the Netherlands. They are expected to develop preventive youth policy to increase the opportunities of young people and prevent them dropping out from society. At the request of the Ministry o

  17. Statistics of Local Extremes

    DEFF Research Database (Denmark)

    Larsen, Gunner Chr.; Bierbooms, W.; Hansen, Kurt Schaldemose

    2003-01-01

    . A theoretical expression for the probability density function associated with local extremes of a stochasticprocess is presented. The expression is basically based on the lower four statistical moments and a bandwidth parameter. The theoretical expression is subsequently verified by comparison with simulated...

  18. Local Color Correction

    Directory of Open Access Journals (Sweden)

    Juan Gabriel Gomila Salas

    2011-09-01

    Full Text Available In this paper we present a local algorithm for contrast enhancement developed by N. Moroney at Hewlett-Packard Laboratories and presented at the IS&T/SID Eight Color Imaging Conference, in 2000. The algorithm uses a non-linear masking, is fast and does not require any manual parameter adjustments.

  19. Local anaesthetic toxicity

    African Journals Online (AJOL)

    The aim of this review is to follow the history of the search for less toxic local anaesthetic drugs, to highlight ..... Lignocaine is an anti-arrhythmic drug as it causes a fast blockade, ... ion trafficking.32 In terms of their physiological effect, the heart.

  20. Teaching Local History.

    Science.gov (United States)

    Singer, Alan, Ed.

    2003-01-01

    This Social Science Docket theme issue focuses on teaching local history and included theme and non-themed articles, lesson plans, learning activities, and book, movie, and museum reviews designed for K-12 social studies teachers. Articles and materials in this issue are: "Editing Is Not Censorship" (Alan Singer); "Teachers Respond…

  1. Local spline approximants

    OpenAIRE

    Norton, Andrew H.

    1991-01-01

    Local spline approximants offer a means for constructing finite difference formulae for numerical solution of PDEs. These formulae seem particularly well suited to situations in which the use of conventional formulae leads to non-linear computational instability of the time integration. This is explained in terms of frequency responses of the FDF.

  2. Swedes’ Internationalization and Localization

    Institute of Scientific and Technical Information of China (English)

    张砚; 许妍

    2015-01-01

    The 1960s of Sweden saw a highlighted trend—being international,which ideologically had a profound impact on Swedes.everyday life.Nevertheless,the more heterogeneous and multi-cultural Sweden promptly became,the more eagerness Swedes show that uniqueness and localization were supposed to be called back,as in the case of the flag waving described in

  3. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  4. Progress in Local Helioseismology

    Science.gov (United States)

    Duvall, T. L., Jr.

    1997-05-01

    Much has been learned about the solar interior in the last two decades with the techniques of global helioseismology. By comparison, the efforts in local helioseismology, defined as the study of subsurface nonaxisymmetric phenomena, have been relatively modest. Part of the difficulty has been conceptual - it was not obvious how to attack the problem. The first attempts at local helioseismology were really scaled-down versions of the global techniques, in which mode measurements were made over a restricted area. These included the ring diagrams of Hill et al. and the Hankel function decompositions of Braun et al. Braun's methods have been extended to include other properties of standard scattering theory, including phase shift and S-matrix measurements. Both of these approaches are important components of our still rather limited arsenal of local helioseismic techniques. Recently more radical approaches to local helioseismology have been initiated, including the time-distance method of Duvall et al. and the knife-edge approach of Lindsey et al. In the time-distance method, the time for waves to travel along subsurface ray paths is determined from the temporal crosscorrelation of signals at two separated surface points. By measuring the times for many pairs of points from our dopplergrams covering the visible hemisphere, a tremendous quantity of information about the state of the solar interior is derived. The correct interpretation of all this information is considerably challenging. These methods show promise as a way of developing 3-d tomography of the solar interior. The current state of the different methods of local helioseismology will be reviewed.

  5. On the Application of Actuarial Techniques in the Teaching of Social Security Fund Management--A Case Study of Pension Fund%精算技术在社会保险基金管理课程教学中的应用--以养老保险为例

    Institute of Scientific and Technical Information of China (English)

    李锐; 杨雷; 刘倩

    2014-01-01

    Social security fund management is a core curriculum of public management major, is the foundation of the labor and social security curriculum system, is also the skill that students are supposed to master. Case study is on the top of the list. However because of shortage of tools, the course has always been taught by delivering concept. The paper introduces actuarial technique into the course teaching of social security fund management, and improves the curriculum system by combining with the related teaching cases, which can be a good combination of theory and practice.%社会保险基金管理是公共管理核心基础课程之一,是整个劳动与社会保障课程体系的基础,并且是公共管理专业学生必须掌握的专业技能。如何更好地开展该课程的案例教学,是该课程的首要任务,因为缺乏必要的分析工具,一直以来使得该课程以传授基本概念为主。本文将精算技术引入社会保险基金管理课程教学中,并结合养老保险条例开发了相关教学案例,从内容上丰富了该课程体系,并将理论与实务紧密地结合了起来。

  6. Skin-sparing mastectomy and immediate autologous breast reconstruction in locally advanced breast cancer patients: a UBC perspective.

    Science.gov (United States)

    Ho, Adelyn L; Tyldesley, Scott; Macadam, Sheina A; Lennox, Peter A

    2012-03-01

    To describe the clinical outcomes of patients with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy and preoperative radiotherapy, followed by skin-sparing mastectomy (SSM) and immediate autologous breast reconstruction (IABR). A retrospective review of 30 LABC patients who underwent SSM and IABR between 1997 to 2007 was performed. Data were drawn from patient records and the University of British Columbia (UBC) Breast Reconstruction and British Columbia Cancer Agency databases. All 30 patients received neoadjuvant chemotherapy, preoperative radiotherapy, SSM, and IABR. Fifteen patients (50%) had stage IIIA disease, 13 (43%) stage IIIB, and 2 (6.7%) stage IIIC. Reconstruction types included the pedicled transverse rectus myocutaneous flap (n = 24), the latissimus dorsi flap (n = 5), and a combination of transverse rectus myocutaneous and latissimus dorsi flap (n = 1). The median follow-up was 3.51 years (range 1-9.4 years). Local complications included mastectomy flap necrosis (n = 3), partial flap necrosis (n = 1), fat necrosis (n = 1), seroma (n = 3), infection (n = 2), and flap fibrosis (n = 1). The incidence of donor site complications was 20%. Overall 5-year actuarial locoregional relapse-free, distant relapse-free, and disease-specific survival rates were 80, 65, and 68%, respectively. Excellent or good physician-rated aesthetic results were achieved in 66% of patients. The UBC protocol avoids irradiation of the autologous breast reconstruction. Outcomes compare with findings from similar studies with respect to local recurrence, distant relapse, overall survival, and surgical complication rates. Neoadjuvant chemotherapy and preoperative radiotherapy in LABC patients desiring autologous breast reconstruction can be considered a safe option.

  7. Thermodynamics "beyond" local equilibrium

    Science.gov (United States)

    Vilar, Jose; Rubi, Miguel

    2002-03-01

    Nonequilibrium thermodynamics has shown its applicability in a wide variety of different situations pertaining to fields such as physics, chemistry, biology, and engineering. As successful as it is, however, its current formulation considers only systems close to equilibrium, those satisfying the so-called local equilibrium hypothesis. Here we show that diffusion processes that occur far away from equilibrium can be viewed as at local equilibrium in a space that includes all the relevant variables in addition to the spatial coordinate. In this way, nonequilibrium thermodynamics can be used and the difficulties and ambiguities associated with the lack of a thermodynamic description disappear. We analyze explicitly the inertial effects in diffusion and outline how the main ideas can be applied to other situations. [J.M.G. Vilar and J.M. Rubi, Proc. Natl. Acad. Sci. USA 98, 11081-11084 (2001)].

  8. Stable local oscillator module.

    Energy Technology Data Exchange (ETDEWEB)

    Brocato, Robert Wesley

    2007-11-01

    This report gives a description of the development of a Stable Local Oscillator (StaLO) multi-chip module (MCM). It is a follow-on report to SAND2006-6414, Stable Local Oscillator Microcircuit. The StaLO accepts a 100MHz input signal and produces output signals at 1.2, 3.3, and 3.6 GHz. The circuit is built as a multi-chip module (MCM), since it makes use of integrated circuit technologies in silicon and lithium niobate as well as discrete passive components. This report describes the development of an MCM-based version of the complete StaLO, fabricated on an alumina thick film hybrid substrate.

  9. The Local Interstellar Medium

    CERN Document Server

    Redfield, S

    2006-01-01

    The Local Interstellar Medium (LISM) is a unique environment that presents an opportunity to study general interstellar phenomena in great detail and in three dimensions. In particular, high resolution optical and ultraviolet spectroscopy have proven to be powerful tools for addressing fundamental questions concerning the physical conditions and three-dimensional (3D) morphology of this local material. After reviewing our current understanding of the structure of gas in the solar neighborhood, I will discuss the influence that the LISM can have on stellar and planetary systems, including LISM dust deposition onto planetary atmospheres and the modulation of galactic cosmic rays through the astrosphere - the balancing interface between the outward pressure of the magnetized stellar wind and the inward pressure of the surrounding interstellar medium. On Earth, galactic cosmic rays may play a role as contributors to ozone layer chemistry, planetary electrical discharge frequency, biological mutation rates, and cl...

  10. Local Governance and Corruption

    Directory of Open Access Journals (Sweden)

    Marius PROFIROIU

    2006-06-01

    Full Text Available This paper attempts to examine, from the Romanian perspective, the degree to which decentralization process and improvement of local governance contributes to the reduction of corruption in the short and medium term. Through the methodology that is used the paper is consistent with the international trend that endeavors to analyze the impact of corruption on economic and social processes at the local level. In addition, recent research on corruption issues has focused upon the measurement of the level of corruption level and on its impact on the growing rate of the GDP (Mauro [1995]1, Abed and Davoodi2, Krueger [1974]3, on the impact upon some of the national economical sectors (Tanzi [1998]4, Shang-Jin Wei [2001]5, or on the decentralization processes (Shah [2006]6.

  11. Local versus national

    DEFF Research Database (Denmark)

    Milan, Christian; Nielsen, Mads Pagh; Bojesen, Carsten

    2014-01-01

    The building sector has obtained increased awareness throughout the last decades due to its notable contribution to global greenhouse gas (GHG) emissions. One approach to decrease these emissions is the concept of net zero energy buildings (Net ZEB), which produce as much energy out of renewable...... sources as they consume through public grid connections on an annual balance. A global design solution for these buildings does not exist, since the energy resource availability is different everywhere. In earlier publications a methodology was presented which allows for the cost optimal design...... of individual energy supply systems based on on-site weather and building conditions, as well as considering the expected energy consumption profile. However, local planning processes are problematic if they do not take regional or national impacts into account. Given the grid connection, the local building...

  12. Localized and systemic scleroderma.

    Science.gov (United States)

    Hawk, A; English, J C

    2001-03-01

    Scleroderma is a broad term encompassing both localized and systemic sclerosis. Localized scleroderma is a cutaneous limited fibrosis that manifests as plaque morphea, generalized morphea, linear scleroderma, and deep morphea. Systemic scleroderma (sclerosis) can manifest as either limited or diffuse disease. Limited systemic sclerosis is typically preceded by Raynaud's phenomenon, involves cutaneous sclerosis distal to the elbows, with gastrointestinal and pulmonary fibrosis, and anticentromere antibody positivity. Diffuse systemic scleroderma is characterized by simultaneous Raynaud's phenomenon, cutaneous skin involvement proximal to the elbow with gastrointestinal, pulmonary, renal and cardiac fibrosis, and positive serology for antitopoisomerase and anti-RNAP III antibodies. This article discusses the classification, epidemiology, pathogenesis, clinical manifestations, treatment, and prognosis of the scleroderma.

  13. Local versus national

    DEFF Research Database (Denmark)

    Milan, Christian; Nielsen, Mads Pagh; Bojesen, Carsten

    2014-01-01

    The building sector has obtained increased awareness throughout the last decades due to its notable contribution to global greenhouse gas (GHG) emissions. One approach to decrease these emissions is the concept of net zero energy buildings (Net ZEB), which produce as much energy out of renewable...... sources as they consume through public grid connections on an annual balance. A global design solution for these buildings does not exist, since the energy resource availability is different everywhere. In earlier publications a methodology was presented which allows for the cost optimal design...... of individual energy supply systems based on on-site weather and building conditions, as well as considering the expected energy consumption profile. However, local planning processes are problematic if they do not take regional or national impacts into account. Given the grid connection, the local building...

  14. Local Quantum Gravity

    CERN Document Server

    Christiansen, Nicolai; Meibohm, Jan; Pawlowski, Jan M; Reichert, Manuel

    2015-01-01

    We investigate the ultraviolet behaviour of quantum gravity within a functional renormalisation group approach. The present setup includes the full ghost and graviton propagators and, for the first time, the dynamical graviton three-point function. The latter gives access to the coupling of dynamical gravitons and makes the system minimally self-consistent. The resulting phase diagram confirms the asymptotic safety scenario in quantum gravity with a non-trivial UV fixed point. A well-defined Wilsonian block spinning requires locality of the flow in momentum space. This property is discussed in the context of functional renormalisation group flows. We show that momentum locality of graviton correlation functions is non-trivially linked to diffeomorphism invariance, and is realised in the present setup.

  15. Temporal Bone Localized Chondroblastoma.

    Science.gov (United States)

    Demirhan, Hasan; Acioğlu, Engin; Durna, Yusuf Muhammed; Yiğit, Özgür; Bozkurt, Erol Rüştü; Karagöz, Yeşim

    2015-11-01

    Chondroblastoma is a highly destructive tumor originating from immature cartilage cells. Although chondroblastoma is defined as a benign tumor, it may exhibit malign tumor behaviors such as invasion or metastasis on neighboring structures. Magnetic resonance (MR) image is a solid mass lesion, which included heterogeneous hypointense in T2A and heterogeneous minimal hyperintense in T1A with destructive expansile characteristics and millimetric calcifications. Temporal bone chondroblastomas may complicate the diagnosis because of their different histologic characteristics. Microscopically, chondroblastic cell nests and calcification of locally "chicken wire" type around the cells are observed. These tumors secrete s-100 and vimentin and are used for differential diagnosis. In this study, a temporal bone localized chondroblastoma case is presented.

  16. Broadband local dielectric spectroscopy

    Science.gov (United States)

    Labardi, M.; Lucchesi, M.; Prevosto, D.; Capaccioli, S.

    2016-05-01

    A route to extend the measurement bandwidth of local dielectric spectroscopy up to the MHz range has been devised. The method is based on a slow amplitude modulation at a frequency Ω of the excitation field oscillating at a frequency ω and the coherent detection of the modulated average electric force or force gradient at Ω. The cantilever mechanical response does not affect the measurement if Ω is well below its resonant frequency; therefore, limitations on the excitation field frequency are strongly reduced. Demonstration on a thin poly(vinyl acetate) film is provided, showing its structural relaxation spectrum on the local scale up to 45 °C higher than glass temperature, and nanoscale resolution dielectric relaxation imaging near conductive nanowires embedded in the polymer matrix was obtained up to 5 MHz frequency, with no physical reason to hinder further bandwidth extension.

  17. Global-local interactions

    DEFF Research Database (Denmark)

    Larsen, Jytte Agergaard; Fold, Niels; Gough, Katherine

    2009-01-01

    Due to their dependence on a single crop, agricultural frontiers are often considered to be formed through phases of 'boom and bust'. These phases are closely related to fluctuations in world market prices of the commodity that constitutes the frontier's economic basis. This paper demonstrates how...... although migration patterns and economic growth are conditioned by world market dynamics, local socioeconomic outcomes within frontier regions are diverse. Frontier formation is far from a homogenous process that slowly incorporates all localities and communities in the same way. Dak Lak Province...... by the state's changing economic, social and political motives. Spontaneous immigration has dominated since the early 1990s when the coffee sector took off and regulations on population mobility were relaxed. This paper shows how household livelihoods differ substantially between four communes in Dak Lak...

  18. Local Control, Toxicity, and Cosmesis in Women >70 Years Enrolled in the American Society of Breast Surgeons Accelerated Partial Breast Irradiation Registry Trial

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Atif J., E-mail: atif_khan@rwjuh.edu [Robert Wood Johnson University Hospital, Cancer Institute of New Jersey, New Brunswick, NJ (United States); Vicini, Frank A.; Beitsch, Peter [American Society of Breast Surgeons, Columbia, MD (United States); Goyal, Sharad [Robert Wood Johnson University Hospital, Cancer Institute of New Jersey, New Brunswick, NJ (United States); Kuerer, Henry M.; Keisch, Martin; Quiet, Coral; Zannis, Victor; Keleher, Angela; Snyder, Howard; Gittleman, Mark; Whitworth, Pat; Fine, Richard [American Society of Breast Surgeons, Columbia, MD (United States); Lyden, Maureen [BioStat International, Inc., Tampa, FL (United States); Haffty, Bruce G. [Robert Wood Johnson University Hospital, Cancer Institute of New Jersey, New Brunswick, NJ (United States); American Society of Breast Surgeons, Columbia, MD (United States)

    2012-10-01

    Purpose: The American Society of Breast Surgeons enrolled women in a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System breast brachytherapy device. The present report examined the outcomes in women aged >70 years enrolled in the trial. Methods and Materials: A total of 1,449 primary early stage breast cancers were treated in 1,440 women. Of these, 537 occurred in women >70 years old. Fisher's exact test was performed to correlate age ({<=}70 vs. >70 years) with toxicity and with cosmesis. The association of age with local recurrence (LR) failure times was investigated by fitting a parametric model. Results: Older women were less likely to develop telangiectasias than younger women (7.9% vs. 12.4%, p = 0.0083). The incidence of other toxicities was similar. Cosmesis was good or excellent in 92% of the women >70 years old. No significant difference was found in LR as a function of age. The 5-year actuarial LR rate with invasive disease for the older vs. younger population was 2.79% and 2.92%, respectively (p = 0.5780). In women >70 years with hormone-sensitive tumors {<=}2 cm who received hormonal therapy (n = 195), the 5-year actuarial rate of LR, overall survival, disease-free survival, and cause-specific survival was 2.06%, 89.3%, 87%, and 97.5%, respectively. These outcomes were similar in women who did not receive hormonal therapy. Women with small, estrogen receptor-negative disease had worse LR, overall survival, and disease-free survival compared with receptor-positive patients. Conclusions: Accelerated partial breast irradiation with the MammoSite radiation therapy system resulted in low toxicity and produced similar cosmesis and local control at 5 years in women >70 years compared with younger women. This treatment should be considered as an alternative to omitting adjuvant radiotherapy for older women with small-volume, early-stage breast cancer.

  19. Local Rotational Symmetries.

    Science.gov (United States)

    1985-08-01

    way to choose among them. Spirals can occur in natural figures, e.g. a spiralled tail or a coil of rope or vine tendril, and in line drawings. Since...generated and removes it and all regions similar to it from the list of regions. The end result is a pruned list of distinct optimal regions. 4.7...that, at least to a first approximation, the potential symmetry regions pruned by the locality restriction are not perceptually salient. For example

  20. Global and Local Hollywood

    Directory of Open Access Journals (Sweden)

    Ben Goldsmith

    2012-03-01

    Full Text Available The term ‘Global Hollywood’ describes the international reach of the major Hollywood studios, and the internationalisation of financing, production, distribution and exhibition of films made by the majors, or by their subsidiaries and partners. In this article we describe how one place, the Gold Coast in the Australian state of Queensland, became a ‘Local Hollywood’ or a regular location for such international film and television production.

  1. Localized solar collectors

    Energy Technology Data Exchange (ETDEWEB)

    Ghasemi, Hadi; Marconnet, Amy Marie; Chen, Gang; Ni, George Wei

    2016-10-04

    A localized heating structure, and method of forming same, for use in solar systems includes a thermally insulating layer having interconnected pores, a density of less than about 3000 kg/m.sup.3, and a hydrophilic surface, and an expanded carbon structure adjacent to the thermally insulating layer. The expanded carbon structure has a porosity of greater than about 80% and a hydrophilic surface.

  2. The local mass density

    Science.gov (United States)

    Veeder, G. J.

    1974-01-01

    An improved mass-luminosity relation for faint main-sequence stars derived from recently revised masses for some faint double stars is presented. The total local mass density is increased to nearly 0.2 solar masses per cu pc. This estimate is as large as the mass density required by Oort's (1965) dynamical analysis of stellar motions perpendicular to the galactic plane if the mass is concentrated in a narrow layer.

  3. Top Local Cohomology Modules

    Institute of Scientific and Technical Information of China (English)

    Mohammad T. Dibaei; Siamak Yassemi

    2007-01-01

    For a finitely generated module M over a commutative Noetherian local ring (R, m), it is shown that there exist only a finite number of non-isomorphic top localeohomology modules Hdim(M) (M) for all ideals a of RIt is also shown that for a giveninteger r ≥ 0, if Hra(R/p) is zero for all p in Supp(M), then Hia(M)=0 for all I ≥ r.

  4. Long-term results of intraoperative electron beam radiation therapy for nonmetastatic locally advanced pancreatic cancer

    Science.gov (United States)

    Chen, Yingtai; Che, Xu; Zhang, Jianwei; Huang, Huang; Zhao, Dongbing; Tian, Yantao; Li, Yexiong; Feng, Qinfu; Zhang, Zhihui; Jiang, Qinglong; Zhang, Shuisheng; Tang, Xiaolong; Huang, Xianghui; Chu, Yunmian; Zhang, Jianghu; Sun, Yuemin; Zhang, Yawei; Wang, Chengfeng

    2016-01-01

    Abstract To assess prognostic benefits of intraoperative electron beam radiation therapy (IOERT) in patients with nonmetastatic locally advanced pancreatic cancer (LAPC) and evaluate optimal adjuvant treatment after IOERT. A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Two hundred forty-seven consecutive patients with nonmetastatic LAPC who underwent IOERT between January 2008 and May 2015 were identified and included in the study. Overall survival (OS) was calculated from the day of IOERT. Prognostic factors were examined using Cox proportional hazards models. The 1-, 2-, and 3-year actuarial survival rates were 40%, 14%, and 7.2%, respectively, with a median OS of 9.0 months. On multivariate analysis, an IOERT applicator diameter < 6 cm (hazards ratio [HR], 0.67; 95% confidence interval [CI], 0.47–0.97), no intraoperative interstitial sustained-release 5-fluorouracil chemotherapy (HR, 0.46; 95% CI, 0.32–0.66), and receipt of postoperative chemoradiotherapy followed by chemotherapy (HR, 0.11; 95% CI, 0.04–0.25) were significantly associated with improved OS. Pain relief after IOERT was achieved in 111 of the 117 patients, with complete remission in 74 and partial remission in 37. Postoperative complications rate and mortality were 14.0% and 0.4%, respectively. Nonmetastatic LAPC patients with smaller size tumors could achieve positive long-term survival outcomes with a treatment strategy incorporating IOERT and postoperative adjuvant treatment. Chemoradiotherapy followed by chemotherapy might be a recommended adjuvant treatment strategy for well-selected cases. Intraoperative interstitial sustained-release 5-fluorouracil chemotherapy should not be recommended for patients with nonmetastatic LAPC. PMID:27661028

  5. Rectal dose-volume constraints in high-dose radiotherapy of localized prostate cancer.

    Science.gov (United States)

    Fiorino, Claudio; Sanguineti, Giuseppe; Cozzarini, Cesare; Fellin, Gianni; Foppiano, Franca; Menegotti, Loris; Piazzolla, Anna; Vavassori, Vittorio; Valdagni, Riccardo

    2003-11-15

    To investigate the relationship between rectal bleeding and dosimetric-clinical parameters in patients receiving three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer. In a retrospective national study (AIROPROS01-01, AIRO: Associazione Italiana Radioterapia Oncologica), planning/clinical data for 245 consecutive patients with stage T1-4N0-x prostate carcinoma who underwent 3D-CRT to 70-78 Gy (ICRU point) were pooled from four Italian institutions. The correlation between late rectal bleeding and rectal dose-volume data (the percentage of rectum receiving more than 50, 55, 60, 65, 70, and 75 Gy [V(50-70)]) and other dosimetric and clinical parameters were investigated in univariate (log-rank) and multivariate (Cox regression model) analyses. Median follow-up was 2 years. Twenty-three patients were scored as late bleeders according to a modified RTOG definition (Grade 2: 16; Grade 3: 7); the actuarial 2-year rate was 9.2%. Excepting V75, all median and third quartile V(50-70) values were found to be significantly correlated with late bleeding at univariate analysis. The smallest p value was seen for V(50) below/above the third quartile value (66%). The V70 (cut-off value: 30%) was found to be also predictive for late bleeding. In the high-dose subgroup (74-78 Gy), Grade 3 bleeding was highly correlated with this constraint. The predictive value of both V(50) and V(70) was confirmed by multivariate analyses. The present article provides evidence for correlation between rectal DVH parameters and late rectal bleeding in patients treated with curative intent with 3D-CRT. To keep the rate of moderate/severe rectal bleeding below 5-10%, it seems advisable to limit V(50) to 60-65%, V(60) to 45-50%, and V70 to 25-30%.

  6. Non-Invasive Ventilation in HIV Positive patients with Sepsis and ...

    African Journals Online (AJOL)

    46987.2

    review of 385 folders, every 5thfile was selected as comparator group. .... Depending on patient responses, the oxygen flow rates were adjusted from between ... Kaplan-Meier plots using log rank test for between-group comparison. RESULTS.

  7. Electron localization functions and local measures of the covariance

    Indian Academy of Sciences (India)

    Paul W Ayers

    2005-09-01

    The electron localization measure proposed by Becke and Edgecombe is shown to be related to the covariance of the electron pair distribution. Just as with the electron localization function, the local covariance does not seem to be, in and of itself, a useful quantity for elucidating shell structure. A function of the local covariance, however, is useful for this purpose. A different function, based on the hyperbolic tangent, is proposed to elucidate the shell structure encapsulated by the local covariance; this function also seems to work better for the electron localization measure of Becke and Edgecombe. In addition, we propose a different measure for the electron localization that incorporates both the electron localization measure of Becke and Edgecombe and the Laplacian of the electron density; preliminary indications are that this measure is especially good at elucidating the shell structure in valence regions. Methods for evaluating electron localization functions directly from the electron density, without recourse to the Kohn-Sham orbitals, are discussed.

  8. Localized Acoustic Surface Modes

    KAUST Repository

    Farhat, Mohamed

    2015-08-04

    We introduce the concept of localized acoustic surface modes (ASMs). We demonstrate that they are induced on a two-dimensional cylindrical rigid surface with subwavelength corrugations under excitation by an incident acoustic plane wave. Our results show that the corrugated rigid surface is acoustically equivalent to a cylindrical scatterer with uniform mass density that can be represented using a Drude-like model. This, indeed, suggests that plasmonic-like acoustic materials can be engineered with potential applications in various areas including sensing, imaging, and cloaking.

  9. Spatially localized magnetoconvection

    Energy Technology Data Exchange (ETDEWEB)

    Lo Jacono, D; Bergeon, A [Universite de Toulouse (France); INPT, UPS, Institut de Mecanique des Fluides de Toulouse (IMFT), Allee Camille Soula, F-31400 Toulouse (France); Knobloch, E, E-mail: lojacono@imft.fr, E-mail: bergeon@imft.fr, E-mail: knobloch@berkeley.edu [Department of Physics, University of California, Berkeley, CA 94720 (United States)

    2012-06-01

    Numerical continuation is used to compute branches of time-independent, spatially localized convectons in an imposed vertical magnetic field focusing on values of the Chandrasekhar number Q in the range 10 < Q < 10{sup 3}. The calculations reveal that convectons initially grow by nucleating additional cells on either side, but with the build-up of field outside owing to flux expulsion, the convectons are able to transport more heat only by expanding the constituent cells. Thus, at large Q and large Rayleigh numbers, convectons consist of a small number of broad cells. (paper)

  10. Local, Regional or Global?

    DEFF Research Database (Denmark)

    Geisler Asmussen, Christian

    This paper proposes a multidimensional index of regional and global orientation which can be used in confirmatory studies with econometric methodologies. Unlike extant measures, the index is objectively scaled and controls for home country orientation and market size differences. The index is shown...... in fact reflects strong home country biases.Keywords: globalization; regional integration; global strategy; regional strategy; local strategy; triad; liability of foreignness...... to be consistent with models of internationalization that incorporate different assumptions about strategic choice and global competition. Preliminary results show that large multinationals follow home region oriented internationalization paths, although much of the regional effect reported by previous studies...

  11. Local analytic geometry

    CERN Document Server

    Abhyankar, Shreeram Shankar

    1964-01-01

    This book provides, for use in a graduate course or for self-study by graduate students, a well-motivated treatment of several topics, especially the following: (1) algebraic treatment of several complex variables; (2) geometric approach to algebraic geometry via analytic sets; (3) survey of local algebra; (4) survey of sheaf theory. The book has been written in the spirit of Weierstrass. Power series play the dominant role. The treatment, being algebraic, is not restricted to complex numbers, but remains valid over any complete-valued field. This makes it applicable to situations arising from

  12. 'Think globally, act locally'

    DEFF Research Database (Denmark)

    Hoff, Jens Villiam

    2015-01-01

    and international levels. For local governments, the task of initiating or facilitating citizen action concerning climate change mitigation has generated the development of new policy instruments that increasingly target people’s everyday lives, homes and workplaces. Examples of the use of these new policy......This chapter argues that citizen participation in environmental and climate policies has moved through four phases from the early 1960s until today. The most recent phase is characterised by a ‘reorientation towards the local’, a move which is increasingly supported by actors at both national...

  13. Localization of CANDU technology

    Energy Technology Data Exchange (ETDEWEB)

    Alizadeh, Ala

    2010-09-15

    The CANDU pressurized heavy water reactor's principal design features suit it particularly well for technology transfer and localization. When the first commercial CANDU reactors of 540 MWe entered service in 1971, Canada's population of less than 24 million supported a 'medium' level of industrial development, lacking the heavy industrial capabilities of larger countries like the USA, Japan and Europe. A key motivation for Canada in developing the CANDU design was to ensure that Canada would have the autonomous capacity to build and operate nuclear power reactors without depending on foreign sources for key components or enriched fuel.

  14. The Epidemiology of Bartonellosis in Peru

    Science.gov (United States)

    2000-12-19

    CHAPTER 3. Figure 1. Kaplan-Meier Survival Plot of hematic-phase bartonellosis 102 patients developing verrucous lesions Figure 2. TIme-line showing...onset of verrucous lesions in patients with 103 Hematic bartonellosis following treatment Figure 3. Kaplan-Meier Survival Pfot of ~nset of verrucous ...of bartonellosis in endemic areas, reports of aggressive verrucous bartonellosis from the western coastal desert region of Ecuador, emergence of the

  15. A digital local studies collection

    Directory of Open Access Journals (Sweden)

    Simona Resman

    2005-01-01

    Full Text Available Local studies and local studies departments reflect the entire spectrum of knowledge within the local community. Transition to the new digital environment means just continuing the basic functions of local studies collections: acquisition, cataloguing and preservation of materials in different formats on different media. The background of each digital library is the technical architecture of system that enables interaction between the user and the library, saving digital material and building a platform for searching and indexing digital objects. Using advanced ICT requests from librarians, designers of digital local studies collections a reflection about traditional roles. A digital local studies collection with new technology enlarges local boarders, local contents become more and more interesting for a wider sphere of people. In collecting of local materials a collaboration with archives and museums, with academic community, with community groups and with individuals comes in forefront. Digital local studies collections with their contents support local diversity, lifelong learning and social inclusion. The crucial elements of a digital local studies collection are attractive local contents with fast and simple access from one place – a portal. In the digital age public libraries become managers of knowledge also by establishing digital local studies collections.

  16. internacionales vs redes locales

    Directory of Open Access Journals (Sweden)

    Tania Elena González Alvarado

    2007-01-01

    Full Text Available El objetivo de este artículo es demostrar que las redes de cooperación empresarial internacionales, a pesar de que se articulan con las redes locales, son fenómenos con marcadas diferencias y, por tanto, se esperaría que al estudiar las primeras se consideraran sus particularidades sin perder, ni menoscabar, la importancia que tienen las segundas. Para demostrarlo se analiza el funcionamiento lógico de las redes de cooperación empresarial internacionales. Dicho análisis se deriva de la revisión de diversos trabajos empíricos y teóricos relacionados con la cooperación empresarial y la formación de redes, así como por el seguimiento de 86 empresas del sector agroindustrial mexicano que participaron en el encuentro Al-Partenariat 2003, Ciudad de México. El estudio de las redes internacionales es importante, no sólo porque éstas se consideran un medio para internacionalizar a la pequeña y mediana empresa (PYME sino también porque prolongan el proceso de desarrollo endógeno provocado por las redes locales.

  17. LOCALITY AND REALITY

    Energy Technology Data Exchange (ETDEWEB)

    Stapp, Henry P.

    1980-02-01

    Einstein's principle that no signal travels faster than suggests that observations in one spacetime region should not depend on whether or not a radioactive decay is detected in a spacelike separated region. This locality property is incompatible with the predictions of quantum theory, and this incompatibility holds independently of the questions of realism, objective reality, and hidden variables. It holds both in the pragmatic quantum theory of Bohr and in realistic frameworks. It is shown here to hold in a completed realistic quantum theory that reconciles Einstein's demand for a description of reality itself with Bohr's contention that quantum theory is complete. This completed realistic quantum theory has no hidden variables, and no objective reality in which observable attributes can become definite independently of observers. The, theory is described in some detail, with particular attention to those aspects related to the question of locality. This completed realistic quantum theory is in principle more comprehensive than Bohr.' s pragmatic quantum theory because it is not limited in principle by the requirement that the observed system be physically separated from the observing one. Applications are discussed.

  18. Draining the Local Void

    CERN Document Server

    Rizzi, Luca; Shaya, Edward J; Kourkchi, Ehsan; Karachentsev, Igor D

    2016-01-01

    Two galaxies that lie deep within the Local Void provide a test of the expectation that voids expand. The modest (M_B~-14) HI bearing dwarf galaxies ALFAZOAJ1952+1428 and KK246 have been imaged with Hubble Space Telescope in order to study the stellar populations and determine distances from the luminosities of stars at the tip of the red giant branch. The mixed age systems have respective distances of 8.39 Mpc and 6.95 Mpc and inferred line-of-sight peculiar velocities of -114 km/s and -66 km/s toward us and away from the void center. These motions compound on the Milky Way motion of ~230 km/s away from the void. The orbits of the two galaxies are reasonably constrained by a numerical action model encompassing an extensive region that embraces the Local Void. It is unambiguously confirmed that these two void galaxies are moving away from the void center at several hundred km/s.

  19. Locality and reality

    Energy Technology Data Exchange (ETDEWEB)

    Stapp, Henry P.

    1980-10-01

    Einstein's principle that no signal travels faster than suggests that observations in one spacetime region should not depend on whether or not a radioactive decay is detected in a spacelike separated region. This locality property is incompatible with the predictions of quantum theory, and this incompatibility holds independently of the questions of realism, objective reality, and hidden variables. It holds both in the pragmatic quantum theory of Bohr and in realistic frameworks. It is shown here to hold in a completed realistic quantum theory that reconciles Einstein's demand for a description of reality itself with Bohr's contention that quantum theory is complete. This completed realistic quantum theory has no hidden variables, and no objective reality in which observable attributes can become definite independently of observers. The, theory is described in some detail, with particular attention to those aspects related to the question of locality. This completed realistic quantum theory is in principle more comprehensive than Bohr.' s pragmatic quantum theory because it is not limited in principle by the requirement that the observed system be physically separated from the observing one. Applications are discussed.

  20. Localization & Exact Holography

    CERN Document Server

    Dabholkar, Atish; Murthy, Sameer

    2011-01-01

    We consider the AdS_2/CFT_1 holographic correspondence near the horizon of big four-dimensional black holes preserving four supersymmetries in toroidally compactified Type-II string theory. The boundary partition function of CFT_1 is given by the known quantum degeneracies of these black holes. The bulk partition function is given by a functional integral over string fields in AdS_2. Using recent results on localization we reduce the infinite-dimensional functional integral to a finite number of ordinary integrals over a space of localizing instantons. Under reasonable assumptions about the relevant terms in the effective action, these integrals can be evaluated exactly to obtain a bulk partition function. It precisely reproduces all terms in the exact Rademacher expansion of the boundary partition function as nontrivial functions of charges except for the Kloosterman sum which can in principle follow from an analysis of phases in the background of orbifolded instantons. Our results can be regarded as a step ...