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The objective of this study was to systematically evaluate the data regarding the use of neoadjuvant, perioperative, surgical, and adjuvant treatment options in localized gastric cancer patients and to develop Appropriate Use Criteria recommended by a panel of experts convened by the American Radium Society.Preferred reporting items for systematic reviews and meta-analyses methodology was used to develop an extensive analysis of peer-reviewed phase 2/2R/3 trials, as well as meta-analyses found within the Ovid Medline database between 2010 and 2020. The expert panel then rated the appropriateness of various treatments in 5 representative clinical scenarios through a well-established consensus methodology (modified Delphi).For patients with medically operable locally advanced gastric cancer, the strongest recommendation was for perioperative chemotherapy based on high-quality data. Acceptable alternatives included surgery followed by either chemotherapy or concurrent chemoradiotherapy (CRT). For patients with upfront resection of stages I to III gastric cancer (no neoadjuvant therapy), the group strongly recommended adjuvant therapy with either chemotherapy alone or CRT, based on high-quality data. For patients with locally advanced disease who received preoperative chemotherapy without tumor regression, the group strongly recommended postoperative chemotherapy or postoperative CRT. Finally, for medically inoperable gastric cancer patients, there was moderate consensus recommending definitive concurrent CRT.The addition of chemotherapy and/or radiation, either in the neoadjuvant, adjuvant, or perioperative setting, results in improved survival rates for patients compared with surgery alone. For inoperable patients, definitive CRT is a reasonable treatment option, though largely palliative.

Purpose Limited guidance exists regarding the relative effectiveness of treatment options for nonmetastatic, operable patients with adenocarcinoma of the esophagus or gastroesophageal junction (GEJ). In this systematic review, the American Radium Society (ARS) gastrointestinal expert panel convened to develop Appropriate Use Criteria (AUC) evaluating how neoadjuvant and/or adjuvant treatment regimens compared with each other, surgery alone, or definitive chemoradiation in terms of response to therapy, quality of life, and oncologic outcomes. Methods and Materials Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology was used to develop an extensive analysis of peer-reviewed phase 2R and phase 3 randomized controlled trials as well as meta-analyses found within the Ovid Medline, Cochrane Central, and Embase databases between 2009 to 2019. These studies were used to inform the expert panel, which then rated the appropriateness of various treatments in 4 broadly representative clinical scenarios through a well-established consensus methodology (modified Delphi). Results For a medically operable nonmetastatic patient with a cT3 and/or cN+ adenocarcinoma of the esophagus or GEJ (Siewert I-II), the panel most strongly recommends neoadjuvant chemoradiation. For a cT2N0M0 patient with high-risk features, the panel recommends neoadjuvant chemoradiation as usually appropriate. For patients found to have pathologically involved nodes (pN+) who did not receive any neoadjuvant therapy, the panel recommends adjuvant chemoradiation as usually appropriate. These guidelines assess the appropriateness of various dose-fractionating schemes and target volumes. Conclusions Chemotherapy and/or radiation regimens for esophageal cancer are still evolving with many areas of active investigation. These guidelines are intended for the use of practitioners and patients who desire information about the management of operable esophageal adenocarcinoma.

Purpose The American Radium Society Appropriate Use Criteria (ARS AUC) presented in this manuscript are evidence-based guidelines for curative- intent treatment of non-metastatic anal squamous cell cancer that are developed by a multidisciplinary expert panel. Methods Guideline development and systematic review using PRISMA methodology include an extensive analysis of current medical literature from peer-reviewed journals and application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is not definitive, expert opinion may be used to recommend imaging or treatment. Results Evidence-based guidelines are presented about the evaluation and treatment of anal cancer in various clinical scenarios that are derived from supporting literature and multidisciplinary consensus. Conclusions These guidelines are intended for the use of all practitioners and patients who desire information about the management of anal cancer covered in these guidelines.

Introduction:This research quantifies and compares the effect of hip prostheses on dose distributions calculated using collapsed cone convolution superposition and Monte Carlo (with and without correcting for the density of the implant and surrounding tissues). The use of full volumetric modulated arc therapy arcs versus volumetric modulated arc therapy arcs avoiding the hip implants (skip arcs) was also studied.Materials and Methods:Six prostate patients with hip prostheses were included in this study. The hip prostheses and the streaking artifacts on the computed tomography images were contoured by a single physician, and full volumetric modulated arc therapy arcs were created in the Pinnacle3 TPS. Copies of each plan were made, and the doses were recalculated with the densities of the prostheses and surrounding tissues overridden. The plans were then exported to Monaco and recalculated using a Monte Carlo dose calculation algorithm, with and without densities of the prosthesis and surrounding tissues overridden.Results:With density overrides, Pinnacle3 had a 4.4% error for ion chamber measurements. Monaco was within 0.2% of ion chamber measurement when density overrides were used. On average, when density overrides were used in Pinnacle3 for patient dose calculations, the planning target volume D95 value dropped from 99.3% to 82.7%. Monaco also showed decreased planning target volume coverage when plans were recalculated with correct density information. Full arc plans (with density overrides) for the patient with a bilateral prosthesis provided significant bladder sparing and some rectal sparing compared to skip arc plans.Conclusion:When planning for prostate patients with hip prostheses, correct density information for implants and surrounding tissues should be used to optimize the plan and ensure optimal accuracy. If available, a Monte Carlo algorithm should be used as a second check. Full arcs could be used to spare dose to organs at risk, while maintaining adequate planning target volume coverage, when using a Monte Carlo dose calculation algorithm.

The goal of treatment for early stage rectal cancer is to optimize oncologic outcome while minimizing effect of treatment on quality of life. The standard of care treatment for most early rectal cancers is radical surgery alone. Given the morbidity associated with radical surgery, local excision for early rectal cancers has been explored as an alternative approach associated with lower rates of morbidity. The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines for the use of local excision in early stage rectal cancer that include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) used by a multidisciplinary expert panel to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. These guidelines are intended for the use of all practitioners and patients who desire information regarding the use of local excision in rectal cancer.

Graphical abstract, Highlights • We aimed at quantifying inter-observer Pancoast tumors delineation variability. • Experts’ delineations were used to define ground truth. • Other observers’ delineations were compared against ground truth. • High degree of variability was noted for most target volumes except GTV_P. • This unveils potentials for protocol modification for future IMRT studies., Introduction Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee’s multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.

Purpose: The aim of this study is to ascertain the subsequent radiobiological impact of using a consensus guideline target volume delineation atlas.Materials and methods: Using a representative case and target volume delineation instructions derived from a proposed IMRT rectal cancer clinical trial, gross tumor volume (GTV) and clinical/planning target volumes (CTV/PTV) were contoured by 13 physician observers (Phase 1). The observers were then randomly assigned to follow (atlas) or not-follow (control) a consensus guideline/atlas for anorectal cancers, and instructed to re-contour the same case (Phase 2).Results: The atlas group was found to have increased tumor control probability (TCP) after the atlas intervention for both the CTV (p < 0.0001) and PTV1 (p = 0.0011) with decreasing normal tissue complication probability (NTCP) for small intestine, while the control group did not. Additionally, the atlas group had reduced variance in TCP for all target volumes and reduced variance in NTCP for the bowel. In Phase 2, the atlas group had increased TCP relative to the control for CTV (p = 0.03).Conclusions: Visual atlas and consensus treatment guideline usage in the development of rectal cancer IMRT treatment plans reduced the inter-observer radiobiological variation, with clinically relevant TCP alteration for CTV and PTV volumes. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

A number of studies have previously assessed the role of teaching interventions to improve organ-at-risk (OAR) delineation. We present a preliminary study demonstrating the benefit of a combined atlas and real time software-based feedback intervention to aid in contouring of OARs in the head and neck.The study consisted of a baseline evaluation, a real-time feedback intervention, atlas presentation, and a follow-up evaluation. At baseline evaluation, 8 resident observers contoured 26 OARs on a computed tomography scan without intervention or aid. They then received feedback comparing their contours both statistically and graphically to a set of atlas-based expert contours. Additionally, they received access to an atlas to contour these structures. The resident observers were then asked to contour the same 26 OARs on a separate computed tomography scan with atlas access. In addition, 6 experts (5 radiation oncologists specializing in the head and neck, and 1 neuroradiologist) contoured the 26 OARs on both scans. A simultaneous truth and performance level estimation (STAPLE) composite of the expert contours was used as a gold-standard set for analysis of OAR contouring.Of the 8 resident observers who initially participated in the study, 7 completed both phases of the study. Dice similarity coefficients were calculated for each user-drawn structure relative to the expert STAPLE composite for each structure. Mean dice similarity coefficients across all structures increased between phase 1 and phase 2 for each resident observer, demonstrating a statistically significant improvement in overall OAR-contouring ability (P.01). Additionally, intervention improved contouring in 16/26 delineated organs-at-risk across resident observers at a statistically significant level (P ≤ .05) including all otic structures and suprahyoid lymph node levels of the head and neck.Our data suggest that a combined atlas and real-time feedback-based educational intervention detectably improves contouring of OARs in the head and neck.

Personal Information Management (PIM) refers to the practice and the study of the activities a person performs in order to acquire or create, store, organize, maintain, retrieve, use, and distribute information in each of its many forms (paper and digital, in e-mails, files, Web pages, text messages, tweets, posts, etc.) as needed to meet life's many goals (everyday and long-term, work-related and not) and to fulfill life's many roles and responsibilities (as parent, spouse, friend, employee, member of community, etc.). PIM activities are an effort to establish, use, and maintain a mapping between information and need. Activities of finding (and re-finding) move from a current need toward information while activities of keeping move from encountered information toward anticipated need. Meta-level activities such as maintaining, organizing, and managing the flow of information focus on the mapping itself. Tools and techniques of PIM can promote information integration with benefits for each kind of PIM activity and across the life cycle of personal information. Understanding how best to accomplish this integration without inadvertently creating problems along the way is a key challenge of PIM.

Management of resectable pancreatic adenocarcinoma continues to present a challenge due to a paucity of high-quality randomized studies. Administration of adjuvant chemotherapy is widely accepted due to the high risk of systemic spread associated with pancreatic adenocarcinoma, but the role of radiation therapy is less clear. This paper reviews literature associated with resectable pancreatic cancer to include prognostic factors to aid in the selection of patients appropriate for adjuvant therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel reviewed the pertinent literature and voted on five variants to establish appropriate recommended treatment of borderline and unresectable pancreatic cancer. The guidelines reviewed the use of radiation, chemotherapy, and surgery. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.

Discussion of a need for and potential of a study of human-information interaction is decades old. However, this discussion gains added impetus as computing technology and advances in HCI improve the transparency of access to information and "liberate" this information from dependency on a specific device for its persistence. But personal information is bound in other ways, most notably to a supporting application or service and in ways that resist liberation. This paper argues for a let-it-lie approach where a new class of applications might be "applied" to the information in situ through an API supported by its hosting application or service. The approach is illustrated through review of an itemMirror platform for the development of JavaScript web applications.

People are amassing large personal information stores. These stores present rich opportunities for analysis and use in matters of wealth, health, living and legacy. But these stores also bring with them new challenges for managing information across long periods of time. Hence personal information management (PIM) research increasingly must address the long term. For the seventh PIM workshop in a successful series started in 2005, we propose taking a look at personal information with exactly this longitudinal perspective. We expect the workshop to attract a range of people doing research related to PIM, HCI, personal digital archiving, aging, and the design of informational spaces for later life. Attendees will discuss issues related to storing information for the long run, how stored information can benefit a person throughout their lifetime (and into old age), and the legacy of a person's personal information.

SUMMARY The role of radiation therapy in the treatment of resectable rectal cancer is better defined than at any point in history; however, as technology improves, increasing treatment options can lead to better patient care when used appropriately with adequate training. Understanding the risk factors for local recurrence can assist in delivering individualized treatment options. Technological improvements such as intensity-modulated radiation therapy have the potential to decrease toxicity, but without adequate training, highly conformal treatment can result in undertreating or missing critical areas. This review will provide an overview of treatment and standard treatment options for resectable rectal cancer, as well as an update on the state of radiation therapy as it relates to rectal cancer and the use of intensity-modulated radiation therapy.

Phellodendron amurense bark extract (Nexrutine®) has shown a favorable effect on prostate cancer in vivo and in vitro. We evaluated its tolerance in patients undergoing surgery or radiation for prostate cancer. Patients received Nexrutine® orally (500 mg tid) either 1 to 2 months preoperatively or 1 to 2 months prior to and with radiation therapy. Common Terminology Criteria for Adverse Events were used to measure tolerance. In total, 21 patients (9 surgery and 12 radiation) underwent treatment. During the Nexrutine® alone component, there were two transient grade 3 toxicities (hypokalemia and urinary incontinence). There was no grade 4 toxicity. For the combined Nexrutine® and radiation component, no additional patients suffered a grade 3 toxicity. All the toxicities were transient. By the end of the neoadjuvant treatment, 81% of the patients had a decline in prostate-specific antigen. This is the first report of patients with prostate cancer being treated with P. amurense bark extract, and it was very well tolerated. Toxicities were minimal and self-limited. This compound can be safely used in further evaluation of a treatment effect on cancer. Copyright © 2014 John Wiley & Sons, Ltd.

The purpose of this study was the prospective comparison of objective and subjective effects of target volume region of interest (ROI) delineation using mouse-keyboard and pen-tablet user input devices (UIDs). The study was designed as a prospective test/retest sequence, with Wilcoxon signed rank test for matched-pair comparison. Twenty-one physician-observers contoured target volume ROIs on four standardized cases (representative of brain, prostate, lung, and head and neck malignancies) twice: once using QWERTY keyboard/scroll-wheel mouse UID and once with pen-tablet UID (DTX2100, Wacom Technology Corporation, Vancouver, WA, USA). Active task time, ROI manipulation task data, and subjective survey data were collected. One hundred twenty-nine target volume ROI sets were collected, with 62 paired pen-tablet/mouse-keyboard sessions. Active contouring time was reduced using the pen-tablet UID, with mean +/- SD active contouring time of 26 +/- 23 min, compared with 32 +/- 25 with the mouse (p a parts per thousand currency signaEuro parts per thousand 0.01). Subjective estimation of time spent was also reduced from 31 +/- 26 with mouse to 27 +/- 22 min with the pen (p = 0.02). Task analysis showed ROI correction task reduction (p = 0.045) and decreased panning and scrolling tasks (p < 0.01) with the pen-tablet; drawing, window/level changes, and zoom commands were unchanged (p = n.s.) Volumetric analysis demonstrated no detectable differences in ROI volume nor intra- or inter-observer volumetric coverage. Fifty-two of 62 (84%) users preferred the tablet for each contouring task; 5 of 62 (8%) denoted no preference, and 5 of 62 (8%) chose the mouse interface. The pen-tablet UID reduced active contouring time and reduced correction of ROIs, without substantially altering ROI volume/coverage.

Purpose: Cancer patients are at risk of cognitive impairment and depression. We sought to ascertain the prevalence of executive, visuospatial, memory, and general cognitive performance deficits before radiotherapy in a radiation oncology clinic referral population and correlate the neurocognitive measures with the depression symptom burden. Methods and Materials: A total of 122 sequential patients referred for radiotherapy evaluation were administered a test battery composed of the Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX1 and CLOX2), Mini Mental State Examination (MMSE), Memory Impairment Screen (MIS), and Geriatric Depression Scale (GDS). The mean age {+-} standard deviation was 58 {+-} 17 years. Of 122 patients, 24 (20%) had been referred for breast cancer, 21 (17%) for gastrointestinal cancer, 17 (14%) for genitourinary disease, and 8 (7%) for brain lesions; the rest were a variety of tumor sites. The cognitive performance among the tumor cohorts was compared using Bonferroni-corrected analysis of variance and Tukey-Kramer tests. Pearson correlation coefficients were determined between each cognitive instrument and the GDS. Results: Of the 122 patients, 52 (43%) exhibited a detectable executive cognition decrement on one or more test measures. Five percent had poor memory performance (MIS), 18% had poor visuospatial performance (CLOX2), and 13% hadmore » poor global cognition (MMSE). Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005). Conclusions: The results of this study have shown that patients referred for radiotherapy exhibit cognitive impairment profiles comparable to those observed in acutely ill medical inpatients. Executive control impairment appears more prevalent than global cognitive deficits, visuospatial impairment, or depression.« less

People can organize information items by placing them into folders or by tagging them with labels. Over the years there has been considerable discussion on the relative merits of folders vs. labels. But there is relatively little empirical data directly comparing people's experiences with each model of organization on comparable sets of information. We compared participants' experiences organizing information with both folders and labels over time. Results indicate that each model has its strengths and weaknesses when assessed with respect to basic activities of personal information management (PIM) such as keeping, organizing and re-finding. Results afford a deeper, more detailed understanding of each model in practice. This understanding is achieved by engaging participants in an active, “hands-on” comparison of models over a period of time. Study results point to syntheses in tool support for organizing information that might combine strengths of folders and labels while avoiding the inadvertent introduction of weaknesses from these models.

In this paper, we present initial findings from a six-month study involving qualitative interviews on the topic of project-related personal information management. Specifically, we report on the emergent theme of information management strategy abandonment - that is, what factors in particular might cause people to give up on their systems for managing documents, calendars, email, and other sorts of project information. In exploring the recurrence of this theme throughout the interview data, five factors emerged as particularly compelling and frequently-cited reasons for system abandonment: (1) visibility, (2) integration, (3) co-adoption, (4) scalability, and (5) return on investment. We describe each of these factors in turn, using examples from the interviews for illustration. These findings, though preliminary in nature, provide a starting point for understanding why systems fail and how future systems might be designed to improve their success rate.

The vast growth in digital content generated by individuals marks a new social trend known as “Generation C” (www.trendwatching.com/trends/GENERATION_C.htm). Personal content ranges from informal to formal, and includes scholarly papers, blogs, genealogical records, personal webpages, photo albums, family videos, music collections, power point presentations, bookmarks, personal correspondence, articles, computer programs, audio recordings (e.g. research interviews), spaces in collaborative systems, and personal digital libraries. Digital storage available for personal use continues to increase dramatically in capacity while declining in cost. Panelists will address challenges in the design of personal digital collections such as gathering, organizing, preserving, segmenting, accessing, and using digital content. Panelists are leaders in their field, representing an array of perspectives.

Low anterior resection or abdominoperineal resection are considered standard treatments for early rectal cancer but may be associated with morbidity in selected patients who are candidates for early distal lesions amenable to local excision (LE). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel recognizes the importance of accurate staging to identify patients who may be candidates for a LE approach. Patients who may be candidates for LE alone include those with small, low-lying T1 tumors, without adverse pathologic features. Several surgical approaches can be utilized for LE however none include lymph node evaluation. Adjuvant radiation±chemotherapy may be warranted depending on the risk of nodal metastases. Patients with high-risk T1 tumors, T2 tumors not amenable to radical surgery may also benefit from adjuvant treatment; however, patients with positive margins or T3 lesions should be offered abdominoperineal resection or low anterior resection. Neoadjuvant radiation±chemotherapy followed by LE in higher risk patients results in excellent local control, but it is not clear if this approach reduces recurrence rates over surgery alone.

For resectable gastric cancer, perioperative chemotherapy or adjuvant chemoradiation with chemotherapy are standards of care. The decision making for adjuvant therapeutic management can depend on the stage of the cancer, lymph node positivity, and extent of surgical resection. After gastric cancer resection, postoperative chemotherapy combined with chemoradiation should be incorporated in cases of D0 lymph node dissection, positive regional lymph nodes, poor clinical response to induction chemotherapy, or positive margins. In the setting of a D2 lymph node dissection, especially those with negative regional lymph nodes, adjuvant chemotherapy alone could be considered. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

We collected 19 bands of ocean colour data (spanning 391–904 nm) at 1 m2 spatial resolution from Mahone Bay on the south coast of Nova Scotia during July 2001 with an airborne hyperspectral sensor (CASI). The data were classified using 16 different protocols in an effort to accurately map benthic communities over 7 km2 of seabed to 6 m water depth. The primary objective was to depict the spatial pattern of invasion of the rocky subtidal zone by an introduced macroalga: Codium fragile. The best classification results were obtained using the first three axes of a principal component analysis of all 19 spectral channels and the maximum likelihood classification of four classes of benthic community (i.e., those dominated by Codium meadow, kelp bed, Codium–kelp mix, and sand) at three depth strata using an added bathymetry channel and no correction for water-column attenuation. The overall accuracy obtained for the entire visible seabed of the bay was 83.30% (Kappa statistic = 0.82). User's and producer's accu...

Users need ways to unify, simplify, and consolidate information too often fragmented by location, device, and software application.

This study (Keeping Found Things Found -KFTF) investigated the methods that people use in their workplace to re-access web information. People were observed using many different methods to keep web information for later use including the use of Bookmarks (or Favorites), self-addressed email, hand-written notes, and paper print-outs. Each keeping method provided a range of functions but none of the observed methods allowed for all desired functions. Participants in the KFTF study were also tested for their ability to return to a web site and several re-finding methods were observed and identified. When prompted with web site descriptions they had generated three to six months earlier, participants had a 95% or better success rate in returning to the cued-for web sites. Moreover, two thirds of these re-finding methods required no explicit keeping behavior. Common re-finding methods included the use of: 1.) A search service. 2.) Partial completion of a site's web address and acceptance of a suggested completion to this address (the auto-complete function). 3.) Hyperlinks from another web site. Results underline the importance of a reminding function. This paper also reports the data collected from a web survey conducted after the keeping and re-finding observations. 214 participants completed the survey. The data from the survey validated and elaborated the various methods that people use to keep web information for later re-use that were identified in earlier observational studies.

Two pilot-scale, GeoSiphon systems have been installed and tested for the treatment of contaminated groundwater at the Savannah River Site. These systems consisted of an in-situ treatment cell located in an area of higher hydraulic head and a siphon connecting the cell to a surface stream at a lower hydraulic head. The siphon induced contaminated groundwater flow through a permeable treatment media in the cells and transported the treated water to the discharge points in a surface stream. The hydraulic head available to drive the systems is divided between the head losses associated with the aquifer-treatment cell and siphon. Six different treatment cell configurations and seven different siphon configurations have been hydraulically evaluated in association with the two pilot-scale systems and are described herein. These pilot-scale systems demonstrated that GeoSiphon systems can treat any contaminant for which an appropriate permeable treatment media is available and can be applied to shallow groundwater contaminant plumes (no deeper than 7.6 m [25 ft]), where at least a few feet of head differential can be exploited. The systems could typically be applied in flood plains.

This observational study investigates the methods people use in their workplace to organize web information for re-use. In addition to the bookmarking and history list tools provided by web browsers, people observed in our study used a variety of other methods and associated tools. For example, several participants emailed web addresses (URLs) along with comments to themselves and to others. Other methods observed included printing out web pages, saving web pages to the hard drive, pasting the address for a web page into a document and pasting the address into a personal web site. Differences emerged between people according to their workplace role and their relationship to the information they were gathering. Managers, for example, depended heavily on email to gather and disseminate information and did relatively little direct exploration of the Web. A functional analysis helps to explain differences in “keeping” behavior between people and to explain the overall diversity of methods observed. People differ in the functions they require according to their workplace role and the tasks they must perform; methods vary widely in the functions they provide. The functional analysis can also help to assess the likely success of various tools, current and proposed.

Purpose: To create an IMRT treatment plan quantitative score using QUANTEC dose/volume parameters to assess plan quality. Methods: 132 IMRT patient plans of various treatment sites were evaluated. The optimized plan's dose volume histogram (DVH) was exported to Velocity for evaluation. The proposed scoring was based on calculating the shortest distance from the QUANTEC objective to the DVH line of each organ. Each plan was normalized against the “perfect” plan where the organs at risk (OAR) received no dose and hence the distance between the QUANTEC objective and the DVH line was maximized. The normalized scores allowed comparing the quality of plans across the treatment sites, dosimetrists, and physicians. The scores were plotted and statistically analyzed to serve as basis for future plans. Results: The score for each site was evaluated and the average percentage score resulted in the abdomen having an average percent score of 1.68 ± 1.49, 34.61 ± 35.19, 11.00 ± 15.39, 28.44 ± 25.13, 1.99 ± 5.83 for abdomen, brain, chest, head/neck, and pelvis. Differences in scores between the treatment sites are largely attributed to OAR segmentation and proximity of the OAR to the PTV. Small score differences between dosimetrist were attributed to the number of plans they have completed per site. A larger sample of treatment plans is being evaluated to investigate the effect of dosimetrist's experience on plan quality. Conclusion: This approach allows comparison of patient treatments which will help improve patient care and treatment outcomes with a quantitative score. A larger number of patient plans is being evaluated for improved statistics.

The management of rectal cancer in patients with metastatic disease at presentation is highly variable. There are no phase III trials addressing therapeutic approaches, and the optimal sequencing of chemotherapy, radiation therapy, and surgery remains unresolved. Although chemoradiation is standard for patients with stage II/III rectal cancer, its role in the metastatic setting is controversial. Omitting chemoradiation may not be appropriate in all stage IV patients, particularly those with symptomatic primary tumors. Moreover, outcomes in this setting are vastly different, as some treatments carry the potential for cure in selected patients, while others are purely palliative. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application, by the panel, of a well-established consensus methodology (Modified Delphi) to rate the appropriateness of imaging and treatment procedures. In instances in which evidence is lacking or not definitive, expert opinion may be used as the basis for recommending imaging or treatment.

Phellodendron amurense bark extract (Nexrutine®) has shown a favorable effect on prostate cancer in vivo and in vitro. We evaluated its tolerance in patients undergoing surgery or radiation for prostate cancer. Patients received Nexrutine® orally (500 mg tid) either 1 to 2 months preoperatively or 1 to 2 months prior to and with radiation therapy. Common Terminology Criteria for Adverse Events were used to measure tolerance. In total, 21 patients (9 surgery and 12 radiation) underwent treatment. During the Nexrutine® alone component, there were two transient grade 3 toxicities (hypokalemia and urinary incontinence). There was no grade 4 toxicity. For the combined Nexrutine® and radiation component, no additional patients suffered a grade 3 toxicity. All the toxicities were transient. By the end of the neoadjuvant treatment, 81% of the patients had a decline in prostate-specific antigen. This is the first report of patients with prostate cancer being treated with P. amurense bark extract, and it was very well tolerated. Toxicities were minimal and self-limited. This compound can be safely used in further evaluation of a treatment effect on cancer.

The Web or, more generally, the Internet, is the conduit for an increasingly large proportion of the information we use in order to make sense of and effect change in the world around us. Consider these examples: • A college student stays up through the night playing a MUDD (multi-user dungeons & dragons) game with other gamers from around the world. • A teenager leaves the family dinner table to spend the rest of the evening away from family and on the computer surfing the web and other (ostensible) teen's pages on MySpace while simultaneously involved in six different IM conversations. • The middle-aged man borrows time throughout his work day to work on several different blogs - making additions to his own and comments to others. He gets recognition and affirmation through these interactions that he does not get through interactions in his physical world.