Small cell carcinomas of the ovary (SCCO) are rare and aggressive malignant neoplasms carrying a poor prognosis. Although multi-modality treatment including chemotherapy leads to a high initial ...response rate, the majority of these patients relapse quickly and die within 2 years of diagnosis. Because these tumours are rare, there is no consensus to support any particular approach to management. We present 2 cases and review the relevant literature to make a number of recommendations. The treatment of these unusual cases should to be individually discussed in a multi-disciplinary team and multi-modality treatment including surgery, chemotherapy and radiotherapy should be considered for patients with limited disease. Conservative, fertility-preserving surgery may be considered in younger women with early-stage disease. Induction chemotherapy with weekly dose-dense and dose-intense carboplatin and taxane is useful. Prophylactic cranial irradiation (PCI) may be considered in patients in remission after primary treatment with chemotherapy or surgery.
A case of solitary bone metastasis from breast cancer, where MRI assessment of treatment response was inaccurate and whole-body fluorodeoxyglucose (18FDG) positron emission tomography with computed ...tomography (PET-CT) proved more reliable and objective, is presented.
Prediction of survivability in a patient for tumor progression is useful to estimate the effectiveness of a treatment protocol. In our work, we present a model to take into account the heterogeneous ...nature of a tumor to predict survival. The tumor heterogeneity is measured in terms of its mass by combining information regarding the radiodensity obtained in images with the gross tumor volume (GTV). We propose a novel feature called Tumor Mass within a GTV (TMG), that improves the prediction of survivability, compared to existing models which use GTV. Weekly variation in TMG of a patient is computed from the image data and also estimated from a cell survivability model. The parameters obtained from the cell survivability model are indicatives of changes in TMG over the treatment period. We use these parameters along with other patient metadata to perform survival analysis and regression. Cox's Proportional Hazard survival regression was performed using these data. Significant improvement in the average concordance index from 0.47 to 0.64 was observed when TMG is used in the model instead of GTV. The experiments show that there is a difference in the treatment response in responsive and non-responsive patients and that the proposed method can be used to predict patient survivability.
We report a model to predict patient's radiological response to curative radiation therapy (RT) for non-small-cell lung cancer (NSCLC). Cone-Beam Computed Tomography images acquired weekly during the ...six-week course of RT were contoured with the Gross Tumor Volume (GTV) by senior radiation oncologists for 53 patients (7 images per patient). Deformable registration of the images yielded six deformation fields for each pair of consecutive images per patient. Jacobian of a field provides a measure of local expansion/contraction and is used in our model. Delineations were compared post-registration to compute unchanged (\(U\)), newly grown (\(G\)), and reduced (\(R\)) regions within GTV. The mean Jacobian of these regions \(\mu_U\), \(\mu_G\) and \(\mu_R\) are statistically compared and a response assessment model is proposed. A good response is hypothesized if \(\mu_R < 1.0\), \(\mu_R < \mu_U\), and \(\mu_G < \mu_U\). For early prediction of post-treatment response, first, three weeks' images are used. Our model predicted clinical response with a precision of \(74\%\). Using reduction in CT numbers (CTN) and percentage GTV reduction as features in logistic regression, yielded an area-under-curve of 0.65 with p=0.005. Combining logistic regression model with the proposed hypothesis yielded an odds ratio of 20.0 (p=0.0).
Deformable registration of spatiotemporal Cone-Beam Computed Tomography (CBCT) images taken sequentially during the radiation treatment course yields a deformation field for a pair of images. The ...Jacobian of this field at any voxel provides a measure of the expansion or contraction of a unit volume. We analyze the Jacobian at different sections of the tumor volumes obtained from delineation done by radiation oncologists for lung cancer patients. The delineations across the temporal sequence are compared post registration to compute tumor areas namely, unchanged (U), newly grown (G), and reduced (R) that have undergone changes. These three regions of the tumor are considered for statistical analysis. In addition, statistics of non-tumor (N) regions are taken into consideration. Sequential CBCT images of 29 patients were used in studying the distribution of Jacobian in these four different regions, along with a test set of 16 patients. Statistical tests performed over the dataset consisting of first three weeks of treatment suggest that, means of the Jacobian in the regions follow a particular order. Although, this observation is apparent when applied to the distribution over the whole population, it is found that the ordering deviates for many individual cases. We propose a hypothesis to classify patients who have had partial response (PR). Early prediction of the response was studied using only three weeks of data. The early prediction of response of treatment was supported by a Fisher's test with odds ratio of 5.13 and a p-value of 0.043.
India′s ambitious goals for renewable energy raise many questions regarding the nature of investment required. We conduct financial modeling of actual renewable projects in India; and derive the ...following insights. First, the high cost of debt is the most pressing problem: higher cost and inferior terms of debt in India may raise the cost of renewable energy by 24–32% compared to the U.S. Second, even if cost of debt goes down, loan terms – including short tenors and variable interest rates – will become significant impediments, given that they add 13–14% to the cost of renewable energy in India compared to the U.S. Finally, due to the high cost of debt, policy lessons from the U.S. and Europe; which focus on finer instruments such as duration of revenue-support, revenue-certainty, investor-risk-perception, and completion/cost-certainty; are not likely to be as effective, with potential impacts on the cost of renewable energy in the 3–11% range. In fact, we find that an interest-rate subsidy, which reduces the cost of debt, reduces the overall subsidy burden by 13–16%. This suggests that Indian policymakers need to prioritize the provision of low-cost, long-term debt and take a closer look at the successful efforts by China and Brazil.
•We examine impact of policy on financing costs of renewables in India.•The high cost of debt – the most pressing problem – adds about 24–32% to the cost.•An interest rate subsidy can actually reduce the overall subsidy burden by 13–16%.•Loan terms – debt tenor and variable rate debt – add about 13–14% to the cost.•Finer policy instruments are not as effective, given that they add 3–11% to the cost.
This study aims to examine the spatio-temporal urban expansion pattern and its impacts on green space variation as well as thermal behavior in Doon valley over the last two decades during 2000 and ...2019. Landsat 5 and Landsat 8 images of February and May month of two study years 2000 and 2019 were used for the analysis. The land use change analysis revealed notable outgrowth of urbanization with 184% increase in Doon valley during 2000–2019. To examine the effects of locational factors on urban growth, relative Shannon entropy analysis was carried out based on two factors, i.e., distances from city center and roads. It was seen that all the roads and city center have witnessed consistent and higher urban spread in its surroundings with high relative entropy value more than 0.9. Further analysis shows that there was considerable loss of agriculture crop lands and fallow lands along the major roads and around city center. Forest area was mostly affected along the road towards Mussorie hill station (road 2) because of its hilly surroundings whereas in Subhash Nagar area (road 4), fallow land and cultivated land were mainly replaced by the development activities. Analysis was also carried out to assess the spatial-temporal distribution of land surface temperature (LST) and its changing dynamics with land covers. It revealed that LST has increased in all the land use types with overall increase of 1.86 °C and 8.62 °C in the months February and May, respectively, during the study period. It is also found that normalized difference vegetation index (NDVI) and LST are negatively correlated with
R
2
0.46 and 0.28 for the months February and May, respectively. However, the correlation between NDVI and LST was found highly significant with
P
value less than 0.01. Therefore, spatial and temporal changes of different land use types especially rapid urbanization at the cost of green spaces with rampant anthropogenic activities is one of the main factor for LST increase in the study area. Moreover, this temperature rise with ever-increasing anthropogenic activities is not a healthy indication for the hilly region like Doon Valley which may adversely affect the ecosystem stability and its resources as well. The study may be used as reference for future ecological and urban management studies and policies.
Business information is a crucial asset for the management in a retail organization which cooperates in decision making, operational executions, and technological advancement etc. The Information is ...required to be processed through database so the selection and identification of right Information System are required as per the nature of the retail organization. There are various types of Information System (IS) as Customer Relationship Management System, Management Information System, Enterprises Resource Planning, Decision Support Systems, corporate website etc. It is studied in this report that which type of IS fits in a large sized organization in the retail sector. The analysis of each IS explored representing the significance, applications, and implication into the selected criteria. It is observed that each IS has some specialty which meets the exact requirements of business in different segments. Moreover, the justified identification of IS understood through research study and analysis. The identification of right IS selection is well processed under a proper research design which concludes effective outcomes for the research objectives.
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